Emilia Sanabria

From Sub- to Super-Citizenship: Sex Hormones and the Body Politic in Brazil

Sex hormones in Brazil are mobilised as modes of regulatory control and to discipline subjectivites. Their packaging effectively differentiates between two forms of citizenship. The first, available to those with private health, is founded on notions of personal autonomy, individual choice and self-enhancement, while the second frames decisions in terms of the individuals moral responsibility to the wider collectivity. Here, technical and biomedical interventions on middle-class bodies have personalising tendencies, while those effected on the bodies of the urban poor can be read as modes of inclusion through standardisation. Personalisation, in the Brazilian sense, concerns the attribution of privileges which place a person above the undifferentiated mass of individuals. The paper critically engages with approaches to bio-citizenships developed in contexts where biological inclusion is predicated on patient activism and shows how, in Brazil, complying with medical regimes is an integral part of constituting oneself as a citizen

Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil

This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazils regulatory context and societal expectations placed on medicine as a means for managing womens reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of womens health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.

What’s in a Context? Tenses and Tensions in Evidence-Based Medicine

Sackett and colleagues (1996:71) originally defined evidence-based medicine (EBM) as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of i...

“The Same Thing in a Different Box”: Similarity and Difference in Pharmaceutical Sex Hormone Consumption and Marketing

The contraceptive pill has given way to a multitude of products, kinds of packaging, and modes of administration. This article draws on work on the pharmaceutical copy, extending the analysis to differentiating between forms of administration for contraceptive medicines as well as between brand-name drugs, generics, and similares, as they are known in Brazil. It explores how Brazilian prescribers and users-within the divergent structural constraints afforded by private and public health-apprehend and negotiate distinctions between the drugs available to them. This ethnographic account of hormone use reveals new fault lines through which the pharmakon exerts its influence. The attention that industry places on pharmacodynamics as it produces new products from similar compounds suggests that pharmaceutical effects are at once symbolic and real. The article concludes with a reflection on the future of the generic form in a field increasingly crowded by branded copies.

Sensorial pedagogies, hungry fat cells and the limits of nutritional health education

This article examines the way the category of ‘the sensorial’ is mobilised across obesity research and care practices for overweight persons in France. The ‘natural’ body is understood to have developed mechanisms that motivate eaters to seek out energy-dense foods, a hardwiring that is maladaptive in today’s plethoric food environment. The article analyses the feedback models mobilised in scientific literature on the neuroendocrine processes regulating appetite. The analysis of how ‘the sensorial’ is studied and used to treat patients provides a vantage point onto the ways foods and bodies transform each other. Recent findings show that fat cells influence metabolism by secreting hormones, revealing that eaters are affected by the materiality of the foods they ingest. ‘The sensorial’ functions as a regulator in the feedback mechanisms where social norms regulating foodscapes become enfolded in the molecular processes that control appetite regulation. The article traces the work that the category of ‘the sensorial’ does as it flows through the loops and feedbacks between scientific evidence, policy and care. It examines the way pleasure and the sensations of eaters are increasingly foregrounded in French nutritional health promotion strategies in a context where informing eaters is increasingly deemed ineffective.

[Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil].

This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazils regulatory context and societal expectations placed on medicine as a means for managing womens reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of womens health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazils regulatory context and societal expectations placed on medicine as a means for managing womens reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of womens health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.

Ayahuasca’s entwined efficacy: An ethnographic study of ritual healing from ‘addiction’

Background A range of studies has demonstrated the efficacy of the psychoactive Amazonian brew ayahuasca in addressing substance addiction. These have revealed that physiological and psychological mechanisms are deeply enmeshed. This article focuses on how interactive ritual contexts support the healing effort. The study of psychedelic-assisted treatments for addiction has much to gain from ethnographic analyses of healing experiences within the particular ecologies of use and care, where these interventions are rendered efficacious. Methods This is an ethnographically grounded, qualitative analysis of addiction-recovery experiences within ayahuasca rituals. It draws on long-term fieldwork and participant observation in ayahuasca communities, and in-depth, semi-structured interviews of participants with histories of substance misuse. Results Ayahuasca’s efficacy in the treatment of addiction blends somatic, symbolic and collective dimensions. The layering of these effects, and the direction given to them through ritual, circumscribes the experience and provides tools to render it meaningful. Prevailing modes of evaluation are ill suited to account for the particular material and semiotic efficacy of complex interventions such as ayahuasca healing for addiction. The article argues that practices of care characteristic of the ritual spaces in which ayahuasca is collectively consumed, play a key therapeutic role. Conclusion The ritual use of ayahuasca stands in strong contrast to hegemonic understandings of addiction, paving new ground between the overstated difference between community and pharmacological interventions. The article concludes that fluid, adaptable forms of caregiving play a key role in the success of addiction recovery and that feeling part of a community has an important therapeutic potential.

A BIOMEDICALIZAÇÃO DE CORPOS BRASILEIROS: PERSPECTIVAS ANTROPOLÓGICAS

This special issue brings together work on the “biomedicalization” of Brazilian bodies, examining the way biomedical techniques are taken up across the divergent structural constraints afforded by private and public health in Brazil. Biomedicalization – or “technoscientific interventions in biomedical diagnostics, treatments, practices, and health to exert more and faster transformations of bodies, selves, and lives”1 – forms an assemblage that is both global and highly local. Our aim is to interrogate this phenomenon from Brazil. The authors, writing from Brazil, Europe, and North America, share a long-standing commitment to analyzing the specific local biologies2 – and local politics – of Brazilian approaches to health and the body. They probe the incursion of biomedical technologies within richly depicted social worlds, revealing quotidian violence (particularly where women’s bodies are concerned), exceptional forms of care within conditions of precarity, and the intersections of kinship, class, work, and the symbolic capital afforded by biomedical consumption in Brazil. They share a commitment to critically engaging with biomedical conceptions of disease and illness, destabilizing the body as a stable referent (implicitly grounded in a biomedical ontology), analyzing health as a deeply relational, situated, and political process.3 The articles draw on critical theory and science and technology studies,4 departing from a practice of medical anthropology subservient to biomedical concerns. They reveal the vitality of Brazilian anthropology of medicine and anthropological studies of medicine in Brazil. We believe that the main obstacle to the wider circulation of Brazilian studies in medical