Set #3

Mental disorders have had a long history in every culture and how it is interpreted and treated varies within each one. 17th and 18th century Europe sought religion and sorcery to try and explain these disorders. Schizophrenics heard “voices from God” and afflicted people were seen as taken over by a devil. Even in current day India, the explanation that one is “taken over by the Devil” is a culturally accepted explanation for mental illness. The American construction of mental illness has seen a steady change from religious forces and has planted itself firmly in the biomedical field. This can be read as our own culture’s move away from unexplainable forces to science as our answer.

Brain Disease Vs. Mental Illness

NPR. org: What's a Mental Disorder?

The above NPR clip discusses the ongoing conflict occurring in the psychiatric field regarding definitions and diagnoses of mental disorders. The American Psychiatric Association’s Diagnostic and Statistic Manual (DSM) is the ultimate and widely accepted manual used by healthcare professionals for mental illness diagnosing. The publication of new mental disorders such as Asperger’s can create a sudden boom in diagnosis of the disorders, which some attribute to a new answer to old symptoms. This can lead to over diagnosing and also overtreatment. The second article from the Baltimore Sun by Richard Vatz addresses the issue of over diagnosing. The author expresses the issue he has with the diagnostic techniques used that consists primarily of general population surveys and not what he calls “medical diagnosing” which I will assume to be Positron Emission Topography (PET), Magnetic Resonance Imaging (MRI) scans and other similar tests. The fact that the author is so upset with the statistic that 55 percent of the American population was suffering from mental illness at one time seemed bothersome to me. What was it about that fact that he found so unbelievable?

Allan Young’s article “Description of How Ideology Shapes Knowledge of a Mental Disorder (Posttraumatic Stress Disorder)” is a thoughtful analysis of how the production of knowledge, in terms of PTSD, is constructed through ideology, in this case The Institute observed. The Institute creates a “highly structured social environment in which correct behavior is a precondition for continued treatment” (Young 112) and Young brings up the idea that efficacy in treatment is not in part because of the treatment program itself, but due to the rigid structure that is placed on both patients and therapists. The construction of knowledge as an actual “product” that is manufactured by all of the “workers”, positions ideology as “a medium that ensures the Institute’s knowledge producers are integrated into the detail division of labor” (Young 116) that allows patients to begin to gain a tangible grasp on their disorder. This seems to be the crucial aspect in the treatment of a disorder that is “undiagnosible without evidence of the etiological trauma…[and]… that the content of the etiological events is embedded in the disorders symptoms” (Young 109). PTSD is still largely stigmatized in our culture, especially currently with the national unrest regarding the still recent wars and even those in the past. Soldiers return to a nation that held them in contempt for what they did, pushing them into the margins without any tools to begin to deconstruct their experiences. This stigma felt towards mental disorders is how I read Vatz’s disbelief that so many Americans suffer from mental disorders. Perhaps it is because we as a culture place much more emphasis on internalizing an “internal disease” that citizens aren’t given the tools to begin working their issues like the PTSD patients. There seems to be a feedback loop from patient to therapist in terms of interpretation that is structured around The Institute’s ideology. Not only are patients held responsible for their end of the loop, therapists are also held accountable for how they reciprocate information given to them. This relationship could be applied to patient and the world they live in, both must reciprocate what the other is voicing.

In shifting from ideology, Simon Cohn’s “Picturing the Brain Inside, Revealing the Illness Outside: A Comparison of the Different Meanings Attributed to Brain Scans by Scientists and Patients” focuses on a more technologically focused way of understanding mental disorder. Cohn describes illness as having “a precarious status for many patients, not in terms of the on-going distress and suffering caused by in terms of their existence-as a thing, or entity” (Cohn 65). The article articulates the opposing views biomedicine and mental disorder sufferers interpret body and brain. The example of the two researchers joking that they could give research volunteers a generic picture of the brain and pass it of as the volunteer is a great demonstration of the impersonal view most workers have been trained to have. That the researchers “only in terms of work in the lab” (Cohn 67) is deceptively simplistic as Cohn argues that the objectification of patients in deeper and “the role of technology is crucial to mask the very human processes involved” (Cohn 67). Can the shift towards a more biomedical diagnosing of mental illnesses place diagnosing illnesses through symptoms into a more “non-medical” field? Such as what Vatz describes to be the cause of overdiagnosing, will technology rob some mental illness sufferers of their disease because an MRI shows no visible signs of illness? The patients who volunteered for the study almost all asked for a copy of their brain scan and in the article are described as having deeply personal attachments to their brain scans, going so far as to manipulate them.

Art Therapy

The act of placing their brain scans on t-shirt reminded me of art therapy, which has become popular in mental health treatment. The video above voices similar themes that I found in Cohn and Young’s articles in that it is a way for patients to begin materializing and constructing their disorder. Technology has still not seen advancement in true understanding of the brain, there is no prototypical “normal brain” that one can compare all other brains to and so sometimes it feels as if we’re ultimately repeating history and attributing the disease to an unknown being/source. This does little in helping patients, who as has been shown, greatly value and benefit from some construction of their illness. To materialize a sometimes still-unexplainable occurrence, regardless of how it is diagnosed in science, is advantageous to those who need it.

Works Cited

Cohn, Simon. 2010. “Picturing the Brain Inside, Revealing the Illness Outside: A Comparison of the Different Meaning Attributed to Brain Scans by Scientists and Patients.” Pp. 65-84. IN Technologized Images Technologized Bodies. Edited by Jeanette Edwards, Penny Harvey and Peter Wade. New York: Berghahn Books.

Vatz, Richard. "Brain Disease vs. Mental Illness”. The Baltimore Sun January 27, 2011

“What’s a Mental Disorder? Even Experts Can’t Agree”. All Things Considered. National Public Radio. December 29, 2010. Radio

Young, Allan. 1993. “A Description of How Ideology Shapes Knowledge of a Mental Disorder (Posttraumatic Stress Disorder).” Pp. 108-128. IN Knowledge, Power and Practice: The Anthropology of Medicine and Everyday Life. Edited by Shirley Lindenbaum and Margaret Lock. Berkeley: University of California Press.

Set #2: Mediating

As I was going through this week's reading, a thought kept popping up, "What is it that makes America so obsessed with TV shows chronicling doctors' lives?" I included images from four such television shows that I thought of in five minutes, all revolving around medical doctors and their personal lives. Why are these shows so popular? Why aren’t there more shows about the personal lives of scientists, dentists, or even nurses? I feel that this manifested fantasy of the American doctor is a result of how the common person views and interacts with doctors in their lives and also how doctors themselves are generated.
Byron J. Good and Mary-Jo DelVecchio Good’s piece “Learning Medicine: The Construction of Medical Knowledge at Harvard Medical School” offers personal insight into the medical school institution through student interviews and direct observation. Access that is not generally granted to any other group outside of the medical realm, an act of exclusion that already establishes biomedicine as something guarded and private. “Lay man/men” as I’ll refer to anyone not in the medical field are firstly shut off from this realm by its creation of a new language, the language of science. Good and Good detail that three key points of medical education

1. “Science is the point of entry into medicine” (89)
2. “Medical education begins by entry into the body” (90)
3. “Medicine is learned from the perspective of individual cases

The science learned at the level of medical school is not like any type of science anyone even majoring in Biology or Chemistry can attempt. This feature selectively puts medical students into binary opposition with their lay men in terms of knowledge, creating the “knowing” and “un-knowing”. I felt that this entrance into an entirely newly world was also being further perpetuated in the example Good and Good bring up during one student’s interview. The student describes a potential applicant’s visit into their anatomy lab and saw her as “an intruder” (95) in their space. That this lay man, without the proper knowledge was granted access is seen as a violation of some unwritten code. But who writes this code? The workings of medical school ultimately seem aimed at disconnecting doctors more and more from their patients and their own bodies and body experiences as supported by one student’s changed views “I don’t feel like another person’s body is so foreign to me now…You just do the routine” (101).

An overarching theme I found in the readings was the debate of competency and caring. Medical schools, currently, are structured primarily around competency. What is expected of medical students, information wise, is what is most important and the caring aspect is seen as humanly innate. The caring aspect may be what draws students in but competency will ensure their survival. This competency-focused system has in turn created doctors who are generally impersonal workers. Maximizing efficiency and quickly diagnosing patients, leaves these patients feeling misunderstood about their body experiences and unheard. Doctors are then viewed as “doctor machines” (an interesting point to note as doctors also see patients’ as machines) that examine you for five minutes, ask a few questions, and leave in a hurry. In dealing with such an intimate topic that is one’s body and illness, such as cold experience is stunning. Most doctors are competent and sometimes caring. From this one-sided conversation patients have with their doctor stems the obsession with their inner workings. All four TV shows mentioned don’t focus on the technical side of doctors, they all show doctors in a human and very personal way. Story lines involve love triangles, break-ups, make-ups, and most often the struggle these doctors have in balancing their personal and professional lives. In an attempt to relate more to those who watch over our bodies, we seek ways to make them seem “more like us”, complicated and emotional. Below I have included a clip of a sketch comedy poking fun at all of these doctor television shows and I think it highlights the main themes seen in all four series. These television shows downplay competency and highlight the caring side of doctors.



In contrasting Good and Good’s real life observations and the television representations, which one is ultimately better? I don’t think that either are and Harvard Medical School seems to be moving away from such a stringent education system towards one that aims more at nurturing a doctors caring skills. Its hard to say if this is an earnest effort or one made only half heartedly but I don’t think it is right to judge the system currently as wrong. The medical school institution is still young, relatively, and has much room to grow.

Set #1: Birthing

Growing up a female in a very male oriented society, I am constantly reminded “it’s a man’s world” and the signs have only become more apparent as I immerse myself deeper into our society. I have spent a lot of my personal time dealing with sexual health and women’s reproductive rights, collaborating with organizations and lobbying. I chose the two images above because of the loaded messages they convey and how that is greatly influenced both by science and culture.

The neutral standpoint of biomedicine as “indifferent to the good and the bad-to human values and morality in general…Instead of judging, medicine diagnoses…” (Gordon 28) that Deborah Gordon chronicles in “Tenacious Assumptions in Western Medicine” has been revealed as being much more influenced by culture than previously presented. Where man meddles, such as in research, grand rounds, and cadaver autopsies judgment and cultural biases inevitably come into the mix. As Laurence Kirmayer’s “Mind and body as metaphors: hidden values in biomedicine” describes, illness has been placed as the irresponsibility of the individual and “the patient is seen as choosing to be sick, rejecting the physician’s help and, with it, the legitimate sick-role” (Kirmayer 64). The individual and its parts have been “removed from their context…’decontextualized’” (26) and this breakdown of the body removes power from the owner itself. By separating each organ into a separate unit instead of the powerful and connected entity it is, biomedicine removes man’s autonomy and possession over it. The concept of the sick role is also an important one to note because it is a great example of the view biomedicine puts on individual as only acting in naturalistic accepted ways such as an approved sick role. The sick role specifies how the individual must act as “sick”, what they must do to “cure” themselves, and the appropriate time they are allowed to inhabit this role. Any deviation from this role is not only unacceptable but looked down upon in both biomedicine and our society.

The creation of life is one of the most fundamentally pure and awe-inspiring acts of nature man has been able to understand. On a very basic level, union of a sperm and egg is the catalyst to a chain of events of cell division and formation of a human being. However, Emily Martin’s analysis of the incredibly loaded imagery of reproduction in her article “The Egg and the Sperm: How science has constructed a romance based on stereotypical male-female roles” goes into detail of the great difference between each genders reproductive organs and processes. Man and his sperm are represented as produced, viral units that are driven for egg fertilization. Woman and the egg, on the other hand, are represented as “unproductive” (Martin 488) and passive. In most visual representations of sexual reproduction, sperm are shown as vibrant movers flailing under the microscope while the egg is seen as a much more ethereal creature floating around in universe “awaiting her mate’s magic kiss, which instills the spirit that brings her to life” (Martin 490). The imagery that is firmly planted in our culture and biomedicine perpetuates gender roles of women as the “gentler sex” and places women’s reproductive organs “as biologically interdependent, while male organs are viewed as autonomous, operating independently, and in isolation” (Martin 490). The biomedical and culture approved role for woman is that of mother and Martin notes how pervasive this role plays by noting the disproportionate knowledge on the physiology of sperm in comparison to female counterparts and that it is not accident which places “the burden of birth control to be placed on women” (Martin 493). Therefore the image representing reproductive rights, is nice in theory but as has been demonstrated entirely unrealistic in terms of our culture and politics.

Advancements in technology with ultrasounds and procedures such as amniocentesis have allowed biomedicine to shine a bigger lens on women and their reproductive rights and health. The new discoveries made by science regarding sexual union is still stuck in the old imagery of the past and does not aim at furthering woman’s role in choice and autonomy. These procedures shift the power even less from women onto the fetuses they carry. The role we have placed on females as life bearer strictly limits women from any deviation.

As a woman, equality is something we must always strive and work for. The structures are in place to oppress woman in many aspects and biomedicine clearly plays a huge role in this. It is through open discussion and the work of anthropologists and biomedicine to mediate a catalyst for change in the ways we see our bodies.

Works Cited

Gordon, Deborah. "Tenacious Assumptions in Western Medicine." Biomedicine Examined. Ed. Maragaret Lock and Deborah Gordon. Dordrecht: Kluwer Academic, 1988.21-55

Kirmayer, Laurence. "Mind and Body as metaphors: hidden values in biomedicine." Biomedicine Examined. Ed. Maragaret Lock and Deborah Gordon. Dordrecht: Kluwer Academic, 1988.57-93

Martin, Emily. "The Egg and the Sperm: how science has constructed a romance based on stereotypical make-female roles." Signs. 16.3 (1991): 485-501.