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CULTURE, MEDICINE AND POLITICS Spring Term 2014 Mondays and Wednesdays 2 – 3:20 Instructor: Professor Cheryl Mattingly Office Hours: Monday 12 – 2 and by appointment TA office hours TBA Course Description: This course brings together medical anthropology and visual anthropology. Narratives, and other poetic or expressive forms (films, photography etc.) have become central media through which the experience of suffering is communicated and made meaningful. Through these aesthetic modes of expression, disease and pathology become visible as personal and social experiences that shape the lives of sufferers. In many ways, this is a course about vulnerability and hope. It concerns bodily suffering that comes with life altering medical conditions – critical or chronic illnesses or disabilities. Hope and vulnerability may be universal human experiences – as is bodily affliction -- but they take particular shape within particular cultural contexts. So, too, practices of healing are shaped by specific cultural, political and social forces. In this course, we will investigate western biomedicine as experienced and practiced primarily – but not exclusively -- within the United States. We will consider health care practices from multiple perspectives, including health professionals, patients and their kin. We will consider the world of clinical care, the hospital and the practice of health care from a cultural perspective. In short, we will examine medicine as a cultural practice. What is the experience of being a patient in a hospital like? How is biomedicine imagined? How is it represented in popular culture? What are some of the fundamental concerns, commitments and dilemmas of health professionals? How are these expressed in their practices? Western biomedicine has historically been faced with a kind of paradox, one that plagues many health professionals. Should the patient be treated primarily as a “site” of disease? This, after all, is what the science of medicine has overwhelmingly been about. Or should professionals treat patients in a personal way, trying to individualize care to the particular needs and life situations of patients? Is it possible to do both? Are these two in conflict? We also pay special attention to illness and disability from the point of view of patients and their family care givers. What is it like to suffer from chronic, severe or disabling illness? What kinds of stigma are faced? How does this suffering shape perspectives about life possibilities? How do encounters with health professionals affect not only medical conditions but also experiences of living with chronic illnesses? What do sufferers come to hope for, even if cure is not possible? How do hopes change over time? 1 The final sections of the course are devoted to addressing the issue of power as it influences the practice and our popular understandings of biomedical practice. Foucault is a key intellectual figure influencing much of this work. The readings in these sections situate biomedicine from a global perspective and within what has come to be called “global health.” They also foreground the political and economic factors shaping illness and health, the way that disparities arise and how these are developed not only within particular countries (through differences in social class, for example) but also transnationally, through global economic forces. Required Readings: The books listed below are required readings. From time to time, written lecture notes may also be distributed by the professor (i.e. posted on blackboard). These will supplement course lectures. Bauby, The Diving Bell and the Butterfly (1997) Garcia, Angela. The Pastoral Clinic (2010) Good, Byron et. al. A Reader in Medical Anthropology (2010) [Referred to in syllabus as “reader”] Green, John. The Fault in Our Stars (2012) Additional Course Readings posted on blackboard. Graded Assignments: Course requirements include two examinations (a midterm and a final) and one written assignment based upon original research by the student. The examinations will cover material from the course readings and lectures. The exams will include multiple choice, short answer and essay questions. Please note that not only regular attendance but also active participation in discussion sections will have direct bearing upon a student’s grade. Midterm: (30%): Final Exam: (40%) Written assignment – Narrative Interview: 20% Attendance and Participation (Including Discussion Sections): (10%) Narrative Interview Assignment: There are three parts to this assignment. (1) Write a short story (two pages) about a significant sickness or other medical event (like an injury) experienced by you, or someone you are close to. Tell it from your perspective. Do this part of the paper first. 2 (2) Then, when you have finished this portion of the assignment, give a short description of the diagnosis that you find on a medical website or in a medical textbook. (No more than one page.) (3) Third, compare and contrast these two versions of your “case.” What are the divides? What are the overlaps? (One to two pages.) Total Pages: Approximately 4 – 5. University Policies on Disability and Academic Integrity Statement for Students with Disabilities Any student requesting academic accommodations based on disability is required to register with Disability Services and Programs (DSP) each semester. A letter of verification for approved accommodations can be obtained from the DSP. Please be sure the letter is delivered to me as early in the semester as possible. DSP is located in STU 301 and is open 8:30am-5:00pm, Monday through Friday.The phone number for DSP is (213) 740-0776. Statement on Academic Integrity—USC seeks to maintain an optimal learning environment. General principles of academic honesty include the concept of respect for the intellectual property of others, the expectation that individual work will be submitted unless otherwise allowed by the instructor, and the obligations both to protect one’s own academic work from misuse by others as well as to avoid using another’s work as one’s own. All students are expected to understand and abide by these principles. Use of the Electronics- The use of laptops, Ipads, and other electronic devices within the classroom will be allowed. However, students are expected to use such devices for solely academic purposes while within the classroom, i.e. notetaking. Please be aware that if the use of electronics is abused and becomes distracting or inhibits the learning experience of other students, this will negatively influence the “class participation” part of a student’s grade. Part One: Medical Anthropology -- Culture and Belief The course begins with an introduction to medical anthropology and its contribution to the comparative study of illness and healing. When anthropologists originally became interested in the comparative study of healing systems across cultural contexts, they often focused on differences and similarities around belief. How were illnesses named and identified within a particular society? What were the beliefs about causes of illness? What were the techniques of cure? What were training practices and forms of expert knowledge? The lectures and readings in this section of the class review classic anthropological discussions that have helped to shape the way these questions have been addressed within the discipline. Class One: Introduction: Monday, January 13 3 Class Two: Wednesday, January 15 Evans-Pritchard “The Notion of Witchcraft Explains Unfortunate Events” (Reader) Class Three: Monday, January 20 UNIVERSITY HOLIDAY Class Four: Wed, January 22 Miner, “Body Ritual Among the Nacimera” (Blackboard) Byron Good “Medical Anthropology and the Problem of Belief” (Reader) Geertz, “Thick Description: Toward an Interpretive Theory of Culture” (recommended, Blackboard) Part Two: Illness, Healing, Narrative and Experience While there are many directions medical anthropology has taken, we will focus here especially on how it has contributed to new ways of understanding illness as an experience and not merely a body pathology.There is a new movement within clinical practice that has involved clinicians, scholars in the humanities, and social sciences, like anthropology. This has come to be called “Narrative Medicine.” Arthur Kleinman’s classic work, The Illness Narratives, provides an intial entrance into narrative from the perspective of anthropology and clinical practice. This section thus begins to look at why stories are so important to clinical practice – and why they ought to be. We also consider narrative from the perspective of the sufferer – the one who tells personal stories of illness, disability, stigma. We consider not only how this experience has shaped their perceptions of themselves, but also how they have experienced health care – specifically, what it is like to make a home in the hospital. Class Five: Monday, Jan 27 Kleinman, Ch 1 The Illness Narratives. (Blackboard) Class Six: Wednesday, Jan 29 Mattingly, “The Concept of Therapeutic Emplotment” (Reader) Class Seven: Monday Feb 3 Bauby, The Diving Bell and the Butterfly Class Eight: Wednesday Feb 5 Csordas, “Elements of Charismatic Persuasion and Healing” (Reader) Class Nine: Monday Feb 10 Desjarlais, “Struggling Along” (Reader) 4 Part Three: The Clinical Imaginary: Biomedicine, Clinical Practice and Popular Culture Class Ten: Wednesday Feb 12 M.J. Good “The Medical Imaginary and the Biotechnical Embrace” (Reader) Class Eleven: Monday Feb 17 HOLIDAY Class Twelve: Wednesday Feb 19 Janelle Taylor – “Confronting Culture in Medicine's ‘Culture of No Culture’" (Blackboard) Class Thirteen: Monday Feb 24 Rapp and Ginsburg “Reverberations: Disability and the New Kinship Imaginary” (Blackboard) Class Fourteen: Wednesday Feb 26 Dumit “A Digital Image of the Category of the Person” (Reader) Class Fifteen: Monday March 3 Green, The Fault in Our Stars (first half) Class Sixteen: Wednesday March 5 NO CLASS Class Seventeen: Monday March 10 Green, The Fault in Our Stars (second half) Class Eighteen: Wednesday March 12 MIDTERM EXAM SPRING BREAK MARCH 17 – 21 Part Four: Power: Clinic as “Prison” and The Critical Imaginary Class Nineteen: Monday March 24 Foucault, “Panopticism” (Blackboard) Class Twenty: Wednesday March 26 Rhodes, “Dreaming of Psychiatric Citizenship” (Reader) PAPER ASSIGNMENT DUE Class Twenty-One: Monday March 31 Foucault, “The Power Over Life and Death” (Blackboard) 5 Rabinow and Rose, “Thoughts on the Concept of Biopower Today” (Recommended: Blackboard) Class Twenty-Two: Wednesday April 2 Petryna, “Biological Citizenship” (Reader) Part Five: Social Suffering and Social Space: Political, Economic and Cultural Perspectives Class Twenty-Three: Monday April 7 Reading Due: Garcia, Introduction/Ch 1-Graveyard/Ch 2-The Elegiac Addict, in The Pastoral Clinic Class Twenty-Four: Wednesday April 9 Reading Due: Garcia, Ch 3-Blood Relative/ Ch 4- Suicide as a Form of Life, in The Pastoral Clinic Class Twenty-Five: Monday April 14 Reading Due: Garcia, Ch 5-Experiments with Care/ Conclusion: A New Season, in The Pastoral Clinic Class Twenty-Six: Wednesday April 16 Das, “The Figure of the Abducted Woman” (Reader) Class Twenty-Seven: Monday April 21 Farmer, “The New Malaise: Medical Ethics and Social Rights in the Global Era” (Reader) Class Twenty-Eight: Wednesday April 23 Good and Good, “Amu in Java: Madness and Violence in Indonesian Politics” (Reader) Class Twenty-Nine: Monday April 28 Willen, “Darfur through a Shoah Lens: Sudanese Asylum Seekers, Unruly Biopolitical Dramas, and the Politics of Humanitarian Compassion in Israel” (Reader) Class Thirty: Wednesday April 30 No Reading Assigned: Overview of the Course FINAL EXAM: 6 7