Category Archives: medecine

autoethnography, community, medecine

on communities within communities

Leave a comment

For some reason, my anthropological imagination, these past months, has circled around renewed wonder about that reality indexed by words like “community” (polity, unum, cohort, congregation, plenum, etc.). This was first triggered as I tried to distance myself temporarily from what was bringing me to the neurological intensive care unit of a Large Urban Teaching Hospital. I knew enough to wonder what host of human beings were needed to keep my wife alive hooked to multiple machines in constant need of re-adjustment by this, but not necessarily by that, human being–with instructions by some to others to NOT do this or that.

So, I stood by the door, looking out. What struck me were the huddles of intense interaction and the spaces and silences between these. There had been the huddle who had greeted me with concerned stances, explained stuff I could barely register, asked me to sign various documents I did not read. They had introduced themselves as those who would operate on my wife—though I only found out later that their leader, the one with the ultimate authority (and responsibility) was not there. That huddle, I never saw again. But by the 2nd or 3rd day, I could identify recurring huddles. There was one I labeled “physicians” (students/residents/interns—clearly a divided community, even if they huddled together on the floor). There was one or more huddle made up of those I labeled “the nursing staff” (I discovered later that they too were divided into multiple units). There was a small one made by the police who were guarding one of the rooms. There was the janitorial staff. They were all in view of each other, often quite close physically. And yet they remained distinct. I could sense differences in the tenor of the speech each used (I was amused listening to flirting among the young cops…). But always they maintained boundaries which, I know from every research on the matter, require ongoing work to NOT acknowledge one another’s presence in the performance of their parallel duties—even when these duties required asking the other to move their bodies as happened regularly when floors had to be cleaned, or examinations done.

Continue reading on communities within communities →

apprenticeships, autoethnography, community, disability, learning/teaching, medecine, of processes, of the body

What is there to learn now, here, under maximum stress? (a problem for learning theory?)

Leave a comment

Learning with others is, necessarily, a political matter. Thus my insistence on writing about “polities” of practice. Still, it remains that “learning” post participation risks being taken as a somewhat automatic process in the movement towards “fuller” (political) participation. Through participation one may move from apprentice to master but focusing, as we must, on movement does not tell us much about the everyday activities of the one who moves (or of the activities of those who encourage the movement—or put blocks on the way), and particularly about the activity of sorting out what to learn (what to prioritize, what to ignore, etc.).

I thought about this in the interstices of other activities I was not  able to escape these past weeks. I found myself, much against my will, and my hopes, in the position of apprentice to “next of kin” practices, first in in the neurological intensive care unit of New York/Presbyterian Hospital, and then in the regular neurological unit, and then in a rehabilitation center. At 70, it is the case that I have never been in that position, legitimately or otherwise, and that I have had much to learn even as I worried about much more than learning.

Continue reading What is there to learn now, here, under maximum stress? (a problem for learning theory?) →

Actor-Network, applying anthropology, autoethnography, health, medecine, of the body

An actor-network of consequential consociates: applying anthropology to one’s personal case

Leave a comment

In this post, I am doing something somewhat different from the usual.  I am maintaining the order I think I have established (at least as I look at it, retrospectively): this is an experiment in anthropological theorizing and teaching.  But I am delving further into parts of my life that I have not brought out.

So here it goes: applied medical anthropology

A few years ago, my wife, Susan, was diagnosed with a form of cancer known as “myelofibrosis” (who may not know it under that name might be a topic for another post as the exact name can be consequential—see below).  The “official” diagnosis was made, not surprisingly by an oncologist, the acknowledged, state approved, expert who can transform speech (this is myelofibrosis) into not simply an act, but a sequence of new moves a particular set of others, from the patient, to her family, to insurance companies, must now make. [This would be easy to model as a special case of entry into a particular kind of polity of practice.]

The oncologist told us, as I remember it four years later, something like: “People live with this for 15 years or more … You are likely to die of something else … It will change your everyday life as you will now have to schedule regular medical visits.”  I remember she was altogether good at telling us something that we knew, and much that we did not know: we had certainly never heard of this cancer or of its treatment.  Of course we went to the Internet and learned what we could, talked to her further, and settled into what I am experimenting in calling, for various theoretical reasons, a “new normal.”  Actually, what we learned was not extremely bad news for people entering in their 70s.  The oncologist then (and I will keep emphasizing conversational and interactional temporality) tried a drug that would alleviate the symptoms of a cancer that affects the production by the bone marrow of red blood cells: profound anemia and the attendants limits on mobility.

Susan’s body, in its thinginess and peculiarities, was leading us to various particular disabilities that can be mitigated or expanded depending (de Wolfe 2014).

So, this was actually a good time for us to adopt the car culture of suburbia.  The long walks in Manhattan to which we were accustomed would not have been possible anymore.  We escaped one disability.

Continue reading An actor-network of consequential consociates: applying anthropology to one’s personal case →

apprenticeships, conversing, medecine, movement through social structures

Instruction, uncertainty, and meta-pragmatic repairing in medical education

Leave a comment

When I teach Lave and Wenger’s (1991) altogether brief introduction to “legitimate peripheral participation,” I do not teach it as a theory of learning but as a model for social structuring in Lévi-Strauss’s sense (1962 [1952]).  But Lévi-Strauss was seeking to model a moment in the organization of a people while Lave, in a major development, seeks to model movement through social structurings when everyone and everything involved in the movement constitute this structuring as it will be available for the future.  By an implication that remains to be developed, Lave also opened the way for a modeling of culture change.

In brief, for those who do not know the background to this approach, Lave asks us to move from imagining participation in any position as dependent on earlier learning to imagining this participation itself as producing some personal learning.  Thereby she argues that a personal movement into a position is dependent on mechanisms other than learning (or socialization/enculturation).  These are the mechanisms that make the initial positioning “legitimate” and authorize the acknowledgment of movement.  Wondering about legitimacy and authorization leads to searches for the interactional, political forces that establish legitimate participation, authorize certain forms of leaning, and thus of course, refuse participation, does not acknowledge learning, etc.

Continue reading Instruction, uncertainty, and meta-pragmatic repairing in medical education →

consciousness and knowledge, identity, medecine, on anthropological theorizing

Wondering about authoring one’s self

Leave a comment

While preparing a discussion of Holland on identity, figured worlds, agency, practice, I read a wonderful account of a doctor’s experience in pronouncing a patient dead:

One recent night I was asked to declare the death of a woman I had never met.

    “Ms. L. passed,” the nurse said. “Could you pronounce her?” …

    Declaring death is not technically hard but it is weird and sad and requires reams of paperwork. It is usually done by an intern, but my intern was busy so I said I would do it.

    The first time I declared a patient dead was nearly six years earlier. I had been a doctor for a few months when I was summoned overnight with a page that told me that my patient’s heart had stopped. When I got to his room I was out of breath and his nurse smiled at me and told me that there really wasn’t urgency; he wasn’t going anywhere. It was only when I walked into the room and saw my patient still and utterly silent, his tired family sitting around the bed, that I realized no one had ever told me precisely how to declare death. I wished I could come back later, but it didn’t seem right to leave him there, so I thumbed through my pocket-sized intern survival guide. The manual was alphabetized, and the discussion about declaring death came somewhere before a section on diabetes management. (“Pronouncing the patient dead.” Lamas, Daniela, New York Times, October 30, 2014)

This pronouncing is, of course, a major speech act.  It is also a subsequence in what Glaser and Strauss described as a “non-scheduled status passage” (1965).  The total organization of dying in the modern world (whenever that is) is clearly something that could trigger, in a cultural anthropologist, the emotions that lead Bourdieu and Passeron to write about “symbolic violence … as … imposition of a cultural arbitrary by an arbitrary power” (1977 [1970]: 5).
Continue reading Wondering about authoring one’s self →