Mary-Jo DelVecchio Good

American oncology and the discourse on hope

From the perspective of medical anthropology and comparative research, American oncology appears as a unique variant of international biomedical culture, particularly when contrasted with oncological practice in societies such as Japan and Italy. Based on interviews with 51 oncologists in Harvard teaching hospitals, this paper argues that American oncological practice draws on distinctive cultural meanings associated with “hope” and is infused with popular notions about the relationship between psyche and soma, the progressive efficacy of biotechnical interventions, truth-telling, and the nature of the physician-patient relationship.

The Meaning of Symptoms: A Cultural Hermeneutic Model for Clinical Practice

Any good doctor knows … that the patient’s complaint is more extensive than his symptom, and the state of sickness more comprehensive than localized pain or dysfunction. As an old Jew put it (and old Jews have a way of speaking for the victims of all nations): “Doctor, my bowels are sluggish, my feet hurt, my heart jumps — and you know, Doctor, I myself don’t feel so well either.” (Erikson 1964:51)

Toward a Meaning-Centered Analysis of Popular Illness Categories: “Fright Illness” and “Heart Distress” in Iran

In recent publications, Marsella outlined an approach to cross-cultural psychiatric epidemiologies. He suggests that such studies begin with an “emic determination of disorder categories”, utilizing ethnoscience techniques “to evolve categories of disorder and their experiential components which are meaningful to the cultures under study” (Marsella 1978:351; cf. Marsella 1979:246; 1980:49). These illness categories should then be submitted to epidemiological research, establishing baseline data and using multivariate analysis to determine objective patterns of disorder for particular societies. Such culture-specific studies should precede cross-cultural comparison. This approach will be welcomed by many anthropologists as having significant advantages over traditional psychiatric epidemiologies, of the sort Kleinman has called “the old transcultural psychiatry” (Kleinman 1977). Anthropologists experienced in studying illness across cultures will recognize also that the most fundamental aspect of such research — the emic determination of categories of disorder — is fraught with important methodological and theoretical difficulties.

The Biotechnical Embrace

This essay discusses three interpretiveconcepts that link bioscience and biotechnologyto society: the medical imaginary, thebiotechnical embrace, and the clinicalnarrative. Drawing on research carried out inthe United States and internationally on theculture and political economy of biomedicine,the essay examines these interpretive conceptsthrough examples from studies of patients,clinicians, scientists, and venture capitalistsengaged in the worlds of oncology and hightechnology medicine. These interpretiveconcepts contribute to an understanding of howthe affective dimensions of the experience of patients, clinicians and scientists invested inhigh technology medicine are fundamental tobioscience and biomedicine, and to thepolitical economy and culture of hope.

Ritual, the state, and the transformation of emotional discourse in Iranian society

This paper explores the social and cultural organization of Iranian emotional discourse and its transformation in post-revolutionary Iran. First, the Moharram dramas we participated in during field research are described, indicating how these performances organized a ‘prototypical’ view of the social order, the self, and the passions. Using Kapferers distinction between “transcendental” and “transformative” rituals, we argue that these dramas were traditionally organized as “transcendental” rites. Second, data on grieving rituals and depressive illness among Iranians is introduced, focusing on the “transformative” qualities of mourning rites and suggesting an interpretation of depression as a failure of the “work of culture.” Third, the appropriation of these symbolic forms of society, self, and the emotions by the current Iranian Islamic state and the role of the state in defming the meaning and legitimacy of emotions and their expression is analyzed.

The Semantics of Medical Discourse

Steven Toulmin (1977) recently observed that during the 1960’s, students of the history and philosophy of science began to shift their attention from the comfortable study of the inner logic of scientific systems — the genetic history of science — toward a serious examination of the relationship of scientific systems to other aspects of society. As it became politically fashionable to expose the link between scientific practices and the interests of those who support it, and as it became theoretically clear that changes in scientific systems are linked to broader social changes, the easy divorce between studies of scientific ‘context’ and ‘content’ was recognized as impossible. As a result, the prohibition against confusing formal or logical issues with empirical matters broke down, and philosophers began to move beyond studying the formal logic of scientific knowledge to studies of scientific practice. Among historians of science, the clarity of the distinction between issues ‘internal to’ the intellectual development of the various sciences and their ‘external context’ was called into question, and studies previously considered unsound — studies of the social and institutional context of science, of the role of economic motivation and political priority in the shaping of scientific practice — became legitimate.

Social status and fertility: A study of a town and three villages in Northwestern Iran

Summary Studies of the relationship between social status and fertility in developing societies have shown diverse results. This study suggests that such findings result in part from problems in the conceptualization of social stratification and social status. In developing societies such as Iran the differentiation of modern and traditional cultural (and occupational) groups within social classes has resulted in the emergence of a dual hierarchy. Measures of social status must therefore reflect these conceptually distinct hierarchies, rather than be limited to linear scales. Figures from a study in a town and three villages in northwest Iran undertaken in 1973 are analyzed. Findings indicate that for women in towns, as social status increases within both traditional and modern occupational hierarchies (husbands occupation) and as measured by income, education and index of modern items, there is a general and almost monotonic decrease in the number of living children, children ever-born, and ideal number of children, with an increase in age at marriage and contraceptive use. The social and cultural homogeneity of the village sample is reflected in the relatively small variations in fertility-related behaviour and attitudes; however, fertility differences between landed and landless villages appear similar to the pattern found in the urban samples. The differences in the fertility behaviour of village and urban women of similar income and educational status indicate that fertility behaviour is related partially to class and partially to status distinctions between urban and rural communities.

Of blood and babies: the relationship of popular Islamic physiology to fertility.

A simplified folk version of the Galenic-Islamic medical tradition furnishes Iranian provincial women with models for understanding conception, pregnancy, contraception, and the effects of the contraceptive pill on womens bodies. Data collected in the town of Maragheh in northwest Iran concerning common assumptions about the nature of female temperament, the structure of the reproductive system, the function of blood, and the role of the heart and nerves are presented, discussed in relation to the classical theory of Galenic-Islamic medicine, and illustrated with case studies. The relationship between popular beliefs and fertility-related behaviors is then explored. Common beliefs about female physiology encourage conception soon after marriage and discourage contraceptive use. Disorders of women including heart distress, weak nerves, lack of blood, and aches and pains are believed to be aggravated by use of the pill. Discrepancies between the views of female physiology held by patients and physicians hinder communication between them and result in dismissal of symptoms related to pill use as hypochondriacal by the doctors, all of whom are male.

Women, poverty and AIDS: An introduction

By the mid-1990s, global human immunodeficiency virus (HIV) infections among women are expected to equal those among men. This trend reflects economic, political, and cultural factors that limit womens ability to protect themselves from HIV transmission. Studies in developing countries have indicated that HIV-infected women (other than sex workers) do not average significantly more sex partners than uninfected controls; the chief risk factors are poverty, migration to urban centers for employment as domestics, and sexual contact with soldiers or truck drivers. Social marketing projects aimed at increasing condom availability overlook the fact that, in many cultures, fidelity is confirmed by having sex without a condom. The same social forces that place poor women at greater risk of HIV infection are responsible for the inadequate allocation of resources to assist women with HIV and those who serve as caretakers of infected family members. The articles in this monograph illustrate the interaction of acquired immunodeficiency syndrome (AIDS), gender, and poverty in North America and on a global level.

Patients' preferences for learning the results of mammographic examinations

The communication of diagnostic test results is an important aspect of the interaction between doctors and patients. Communication of mammogram results is of particular interest because the test is used to detect a common and potentially dangerous malignancy and because patients in the United States are able in some locations to obtain mammography at their own request, rather than being referred by a physician. We conducted a survey to learn about the preferences of a group of women at a traditional mammography center for learning the results of this commonly performed test. We asked women undergoing mammography to respond to questionnaires designed to learn: 1) How they felt about different methods of telling patients the results of mammograms; 2) How they were informed of the results of previous mammograms; 3) How they were told the results of the current mammograms.Patients indicated that if no abnormality is detected, they prefer to have their doctor call with the result, but if the study is ‘abnormal’ they wish to be told by their own physician in the office. Failing to notify the patient if the study is normal was the least preferred outcome. This group of patients did not express an interest in the most immediate form of notification (i.e. learning the result from the radiologist performing the test).Analysis of how patients felt about ways in which they were previously informed of the results of mammograms suggests that their reactions are influenced to a large extent by their clinical status. Patients undergoing mammography for diagnostic purposes, for example, were less pleased by a ‘preferred’ method (i.e. being told by their physician) than were those undergoing screening mammography. While patients have opinions about how they would prefer to be told their mammogram results, they are accepting of a variety of methods of telling, if they are receiving good news. If abnormalities are found, patients prefer to be told in person by their own physician. Interpretations of surveys of patient satisfaction should be tempered by the finding that the clinical status of the patient alters their perceptions of satisfaction with this aspect of their physicians behavior. Patient preferences may change if increasing numbers of women are told their results by the radiologist.