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Chronic Conditions, Fluid States

Chronic Conditions, Fluid States: Chronicity and the Anthropology of Illness

Copyright Date: 2010
Published by: Rutgers University Press
Pages: 336
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  • Book Info
    Chronic Conditions, Fluid States
    Book Description:

    Chronic Conditions, Fluid Statesexplores the uneven impact of chronic illness and disability on individuals, families, and communities in diverse local and global settings. To date, much of the social as well as biomedical research has treated the experience of illness and the challenges of disease control and management as segmented and episodic. Breaking new ground in medical anthropology by challenging the chronic/acute divide in illness and disease, the editors, along with a group of rising scholars and some of the most influential minds in the field, address the concept of chronicity, an idea used to explain individual and local life-worlds, question public health discourse, and consider the relationship between health and the globalizing forces that shape it.

    eISBN: 978-0-8135-4973-6
    Subjects: Health Sciences, Anthropology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
    (pp. vii-xii)
    Lenore Manderson and Carolyn Smith-Morris
  4. Introduction: Chronicity and the Experience of Illness
    (pp. 1-18)

    In the past century, the world has witnessed dramatic epidemiological change. For reasons that we explore in this volume, the relative weight of infectious disease and injury on mortality and morbidity has declined, and instead, in the poorest and the wealthiest of nations, extended, often lifelong medical conditions predominate. These conditions neither develop nor continue in a vacuum, but are profoundly shaped by persistent injustice, inequality, poverty, and physical expressions of structural violence. These are all chronic problems; they interact with, contribute to, and shape the experiences of living with chronic health problems. These health problems include both infectious and...

  5. PART ONE The Idea of Chronicity

    • 1 The Chronicity of Life, the Acuteness of Diagnosis
      (pp. 21-37)

      The biotechnological marketplace shapes much of the discourse on the chronic–acute dichotomy, and ultimately has a significant effect on the foci of medical anthropologists. By distinguishing a condition that is curable and therefore acute (as in broken bones and many bacterial infections) from disease that is incurable and therefore chronic (as in heart disease and diabetes), we leave in place biomedicine’s self-referential system of disease classification (Taussig 1980). Any unquestioned use of this system has the potential of colonizing the lifeworlds of our informants and ignoring (or missing) the lifelong balance of health that they maintain. If, as I...

    • 2 Globalizing the Chronicities of Modernity: Diabetes and the Metabolic Syndrome
      (pp. 38-53)

      For most of human history as hunters, gatherers, and agriculturalists, humans maintained an active physical lifestyle that varied with seasonal resources and promoted cardiovascular and metabolic fitness. But for the past five hundred years, since early European imperialism, there have been major changes in everyday life and, in consequence, in health. Early industrialization and globalization diffused commodities and labor-saving technologies for work and home throughout the world. In recent decades, this process has gained extraordinary momentum: With modernity, large numbers of people now live a life of low physical activity, consistent energy intake from foods, and chronic levels of psychosocial...

    • 3 Is “Chronicity” Inevitable for Psychotic Illness?: Studying Heterogeneity in the Course of Schizophrenia in Yogyakarta, Indonesia
      (pp. 54-74)

      Schizophrenia has long been viewed as an almost inevitablychronicanddegenerativeform of mental illness. This chapter examines the course of schizophrenia-spectrum mental illness in Yogyakarta in central Java, based on a seven-year longitudinal study that follows a small series of cases of individuals with mental illness and their families. It examines questions about the role of culture in shaping the trajectory of illness over time, as well as the effects of inadequate mental health services on the course of mental illness.

      The association of the powerful and stigmatizing terms—chronicanddegenerative—with schizophrenia is rooted in the...

  6. PART TWO Gender and the Experience of Illness

    • 4 Male Infertility, Chronicity, and the Plight of Palestinian Men in Israel and Lebanon
      (pp. 77-95)

      Male infertility is a neglected reproductive health problem, yet it contributes to at least half of all cases of subfertility worldwide (P. Chan 2007; Kim 2001). Male infertility is often idiopathic, or of unknown cause; hence, it is recalcitrant to prevention and is among the most difficult forms of infertility to treat (Carrell et al. 2006; Devroey et al. 1998; Irvine 1998; Kamischke and Nieschlag 1998). So-called male factors in infertility include low sperm count (oligospermia), poor sperm motility (asthenospermia), defects of sperm morphology (teratozoospermia), and total absence of sperm in the ejaculate (azoospermia), the latter sometimes due to infection-induced...

    • 5 “Half a Woman”: Embodied Disruptions and Ideas of Gender among Australian Women
      (pp. 96-112)

      Scholarly attention and public health priorities related to women’s health have typically focused on pregnancy, childbirth, and other aspects of women’s reproductive health, and by extension, risks to the lives of women and their children. The chronic conditions that affect women uniquely or primarily—conditions that are not fatal, infectious, or exotic, nor with significant population impact—conventionally hover in the peripheral vision of most researchers; they rarely appear in government health policies or national audits of women’s health. Yet globally, women are affected routinely by common and persistent gynecological conditions that do not require urgent medical attention, are often...

    • 6 Ecuadorian Womenʹs Narratives of Lupus, Suffering, and Vulnerability
      (pp. 113-130)

      An unhappy consequence of growing urbanization and increased life expectancy in the developing world is the appearance of more “first world” health problems, especially “chronic disease” (Yach et al. 2004). In Latin America in particular, chronic illness, once associated with the wealthy and privileged, is increasingly found among a wide cross section of the population (Pan American Health Organization 2007). According to the Pan American Health Organization, chronic illnesses tax public and private resources in very different ways than more acute conditions, and many healthcare systems are ill prepared to meet the needs of the growing ranks of those with...

    • 7 Why Women Donʹt Die in Childbirth: Maternal Survivorship in Badakhshan, Tajikistan
      (pp. 131-154)

      The conventional way to explain maternal mortality is to link maternal health with women’s access to lifesaving obstetric care. When maternal complications arise there is little doubt that obstetric medicine including caesarean sections, vacuum and forceps-assisted deliveries, save women’s lives. This line of thinking governs the assumption that comprehensive emergency obstetric care (EOC) is responsible for low maternal mortality in wealthy countries, where less than 1 percent of the global distribution maternal deaths occur (AbouZahr 2003; Miller et al. 2003; Paxson 2005; Thaddeus and Maine 1994; Paxton et al. 2003, United Nations Children’s Fund 2002).¹ Meanwhile, many global health professionals...

  7. PART THREE The Clinical Interface

    • 8 Chronic Illness and the Assemblages of Time in Multisited Encounters
      (pp. 157-174)

      Time and timing are significant features of illness and medicine. Traditional Chinese Medicine (TCM) recognizes the importance of the circadian rhythms of illness. Body organs, the human body itself, and its life systems are treated with therapy that is organized into time periods known aschronotherapy(Samuels 2000). In the fourth century BC in Alexandria, Herophilos the anatomist measured pulse rates with a water clock in order to understand bodily rhythms and rates. Ayurvedic therapy is determined according to the seasons and their cycles. For biomedicine, time and timing are equally important in understanding illness and for therapy. Measurements of...

    • 9 Chronicity and AIDS in Three South African Communities
      (pp. 175-194)

      In their history of HIV, Elizabeth Fee and Daniel Fox describe the international AIDS meeting in Montreal, Quebec, in 1989, and how Samuel Broder, then head of the National Cancer Institute, declared that AIDS was a “chronic disease and cancer the appropriate model of therapy” (Fee and Fox 1992). The speech was an intentional effort to normalize AIDS and to demonstrate the potential cascade of benefits from treatment. With treatment, the implication was that stigma, resistance to testing and disclosure, and resistance to open discussion of HIV would be greatly reduced.

      At the time of the statement, the termhighly...

    • 10 Disability and Dysappearance: Negotiating Physical and Social Risk with Cystic Fibrosis
      (pp. 195-211)

      Notions of progress are embedded in culture, where ideas of activity, achievement, and future orientation inform a view of life seen as a trajectory, a narrative where the individual has the responsibility for creating continuity and permanence. Of course there is a great deal of slippage with this trajectory since the unpredictability of actual lives serves as an ongoing counterpoint to the archetypal social narrative focused on the linear, orderly unfolding of life. One of the enduring risks to this narrative is the body’s health—indeed, a cardinal element of embodiment is its indeterminacy. A common interruption to this narrative...

    • 11 Caring for Children with Special Healthcare Needs: “Once We Got There, It Was Fine”
      (pp. 212-229)

      With no stable map and no single point of entry, how do the parents or guardians of children newly living with chronic or disabling conditions gain access to and navigate through the various components of the healthcare system? How do they master what is generally, for them, a strange new world?

      In asking and seeking to answer these questions, my focus has been on the experiences of U.S. parents of very young children (aged up to five years) who have disabilities and health conditions that, although sometimes profound, are nonetheless not life threatening in the near term.¹ This chapter is...

    • 12 Chronic Conditions, Health, and Well-Being in Global Contexts: Occupational Therapy in Conversation with Critical Medical Anthropology
      (pp. 230-246)

      Medical anthropologists know that our perspectives on chronic disease and illness provide much-needed critiques of the hegemony of biomedicine and insights into clinical applications. But can we make our voices heard and influence action in places where it makes a difference? For several decades a crisis in academic jobs for social scientists has meant that interdisciplinary and interprofessional initiatives may define some of the most important opportunities in medical anthropology for years to come (Inhorn 2007c). Despite its phenomenal growth and success relative to anthropology overall, the subfield of medical anthropology has not been immune from these challenging conditions. Medical...

  8. Afterword: Chronicity–Time, Space, and Culture
    (pp. 247-252)

    A key health issue facing humanity today is the increasing burden of chronic conditions. The year 2000 was the first in history in which people over sixty worldwide outnumbered children under five. The future is one in which chronic illnesses and end-of-life conditions faced by aging populations will play an ever-greater role in health care. Chronic illness is embedded in the local flow of moral experience, in the struggles of individuals to craft a moral life, and in the aspiration for ethical values that extend beyond a local world and that speak to questions of fairness, justice, doing good in...

    (pp. 253-308)
    (pp. 309-314)
  11. INDEX
    (pp. 315-320)