Medical Humanities Blog

On Mental Health of Indigenous Peoples in Latin America

From the open text BMC family of journals comes a terrible but compelling article published in BMC International Health & Human Rights.  The article is authored by Mario Incayawar and Sioui Maldonado-Bouchard, and is entitled The Forsaken Mental Health of the Indigenous Peoples - A Moral Case of Outrageous Exclusion in Latin America.

Here is the Abstract:

Background

Mental health is neglected in most parts of the world. For the Indigenous Peoples of Latin America, the plight is even more severe as there are no specific mental health services designed for them altogether. Given the high importance of mental health for general health, the status quo is unacceptable. Lack of research on the subject of Indigenous Peoples' mental health means that statistics are virtually unavailable. To illustrate their mental health status, one can nonetheless point to the high rates of poverty and extreme poverty in their communities, overcrowded housing, illiteracy, and lack of basic sanitary services such as water, electricity and sewage. At the dawn of the XXI century, they remain poor, powerless, and voiceless. They remain severely excluded from mainstream society despite being the first inhabitants of this continent and being an estimated of 48 million people. This paper comments, specifically, on the limited impact of the Pan American Health Organization's mental health initiative on the Indigenous Peoples of Latin America.

Discussion

The Pan American Health Organization's sponsored workshop "Programas y Servicios de Salud Mental en Communidades Indigenas" [Mental Health Programs and Services for the Indigenous Communities] in the city of Santa Cruz, Bolivia on July16 - 18, 1998, appeared promising. However, eleven years later, no specific mental health program has been designed nor developed for the Indigenous Peoples in Latin America. This paper makes four specific recommendations for improvements in the approach of the Pan American Health Organization: (1) focus activities on what can be done; (2) build partnerships with the Indigenous Peoples; (3) consider traditional healers as essential partners in any mental health effort; and (4) conduct basic research on the mental health status of the Indigenous Peoples prior to the programming of any mental health service.

Summary

The persistent neglect of the Indigenous Peoples' mental health in Latin America raises serious concerns of moral and human rights violations. Since the Pan American Health Organization' Health of the Indigenous Peoples Initiative 16 years ago, no mental health service designed for them has yet been created.

At risk of sounding like a typical academic, the health of indigenous peoples in the West is important because it demonstrates the dialectic nature of history.  Colonialism is not something that simply happened centuries ago; its effects continue to this very day.  Nor is it confined to the global south, as I will have a post up shortly on the mental health of indigenous peoples in the U.S.

Such stories also emphasize the horse I flog here, that social and economic conditions are prime determinants of population health, in both the developed and the developing world.

On the Painless Brain

One of my favorite journals, Perspectives on Biology & Medicine, has published its autumn issue, TOC available here.  Among several interesting articles, my attention was immediately drawn to Mical Raz's The Painless Brain: Lobotomy, Psychiatry, and the Treatment of Chronic Pain and Terminal Illness.  Raz does fascinating work in the history of psychiatry and psychosurgery, and it is particularly exciting to see her turn her attention to pain, my dissertation topic (although I am somewhat surprised to see it linked to terminal illness, because the vast majority of contemporary chronic pain sufferers are not terminally ill).

Here is the Abstract:

This article examines the use of lobotomy as a treatment for chronic intractable pain and reconstructs then-common perceptions of pain and of the patients who suffered from it. It delineates the social expectations and judgments implicit in physicians' descriptions of the patients, analyzing what was expected from such patients and how the medical establishment responded to non-normative expressions of suffering. I argue that the medicalized response to an expectation for normativity demonstrates the convergence between psychiatric and palliative interventions. Based on a historically informed perspective of psychiatric interventions in the field of pain medicine, I examine the use of psychiatric medications for pain syndromes today and evaluate the interface between depression, chronic pain, and terminal illness. While not detracting from the medical imperative to alleviate pain, I question the usage of social criteria and normative judgments in the clinical decision of how to treat pain. What normalizing social function does the use of psychiatric interventions in pain treatment fulfill? This approach leads to a reexamination of perceptions of dualism in pain medicine.

I will undoubtedly have further thoughts after I finish the article.

Call for Proposals: Society for Disability Studies

SDS 2010, 22nd Annual Conference Call for Proposals

THEME: DISABILITY IN THE GEO-POLITICAL IMAGINATION

Dates: June 2-5, 2010

Host: Institute on Disabilities, Temple University

Location: Howard Gittis Student Center, Temple University, Philadelphia, Pennsylvania Submission Forms: All proposals must use the SDS CFP submission form available at the 2010 SDS conference site Proposal Deadline: Midnight EST, December 15, 2009.

The board of the Society for Disability Studies recognizes the unfortunate scheduling conflict of this year's annual conference with that of the Canadian Disability Studies Association. In keeping with this year's theme of the "Geo-Political Imagination," and in order to encourage continuing productive exchange of knowledge across our borders, both groups are making all efforts to adopt innovative strategies for connecting the events virtually through live interactive video and special programming. Look for an addendum to this CFP with the details of these opportunities in the next few weeks.

DISABILITY IN THE GEO-POLITICAL IMAGINATION

The development of global studies has increasingly called for a cross-cultural and comparative approach to questions of marginalization, stigma, diaspora and resettlement, labor and exploitation, climate change, and the world-ranging production of impairment and disability from violence, inhumane treatment, crumbling infrastructure, and environmental degradation. A significant amount of scholarship also examines new resistance cultures and the galvanization of global networks as members of diverse disability communities try to navigate productive collaborations across newly wired cybernetic systems and claim the possibilities offered by globalization. New opportunities and new problems abound around forging transnational communities, increased mobility, health and charity tourism, the implementation of universal rights, increased transparency of states and organizations, better community-based rehabilitation, and more varied work possibilities.

This years Society for Disability Studies conference features the theme Disability in the Geo-Political Imagination to spur ongoing efforts in interdisciplinary analyses. Such a theme arrives at a timely moment in the wake of the signing of the United Nations Charter on the Rights of People with Disabilities by leaders in 140 nations (including, most recently and somewhat belatedly, the United States).

As a result of the emergence and ratification of this convention, disability has become a more visible topic within the public sphere.

Nations, perhaps including the United States, that previously undervalued disabled populations now contend with what it means to be truly inclusive. Likewise, Disability-advocacy organizations now seek to make further claims upon the state as a guarantor of rights and liberties. This SDS conference theme includes proactive responses and solutions to the critique that disabled populations particularly those which are disproportionately poor and people of color are ill represented, under-analyzed, and under-theorized, particularly in the context of global studies. As the local and global may be seen as intertwined and haunting each other, so can questions of disability, race, class, and gender.

Disability studies explores the distance that exists between popular representations of disability as tragic embodiment, and politically informed disability cultures that define themselves against such devaluing views. Authors of panel and paper proposals will ideally feature new ways of conceptualizing people who experience disability as social actors connected or disconnected on a global scale. In particular, the SDS Program Committee seeks entries from those areas of inquiry that resist, revise, and re-imagine contemporary understandings of human differences and embodiment such as critical race studies, feminist/womanist studies, class-based analyses, queer studies, trans-gender studies, and other critical perspectives linked to social justice initiatives.

While proposals for any topic are always welcome at SDS, we offer a suggested theme each year. This year’s theme encourages submissions that attend to local conditions, including those in our host city of Philadelphia, within a global context and to cultures of empowerment and resistance within the complexity of global exploitation and opportunities.

Questions about the application process or other administrative matters may be directed to the SDS Executive Office.

Overall questions can be directed to either of the Program Committee Co-Chairs:

•    David Mitchell

Temple University

•    Devva Kasnitz

University of California, Berkeley

To read the full CFP, review application guidelines, or to submit a proposal, visit:

http://www.disstudies.org/conference/2010/cfp

We look forward to your submissions!

(h/t MEDANTHRO, Lit_Med_ASBH listservs)

Call for Reviewers: Eä - Journal of Medical Humanities & Social Studies of Science and Technology

Call for reviewers

Eä - Journal of Medical Humanities & Social Studies of Science and Technology has opened a call for people interested in reviewing papers that are submitted for publication. We look for people with broad research experience, sound training in their respective disciplines, with interest in becoming a part of the staff of Eä and in being enriched by the joint work and the acquisition of knowledge. 

All those who are interested should send an e-mail to info@ea-journal.com (Subject: "Call for reviewers") with the following information: name/s and surname/s, nationality, date of birth, academic affiliation, contact data (mainly e-mail and phone number), languages domain (please clarify each case whether it is comprehension, writting skills or both), obtained degrees, studies in progress (master, doctoral, postdosctoral studies), areas of knowledge, and a list of published papers in the last 10 years. We would also need to receive an abridged CV. 

For more information please write to info@ea-journal.com.

You will also find more information in our website, Join our team. 

(h/t MEDMED-L)

Call for Papers: Dissecting Anatomy

Dissecting anatomy – historical, cultural and ethical perspectives on teaching and research [deadline: 10 January 2010]. Themed issue of Medicine Studies. 

International Journal for the History, Philosophy and Ethics of Medicine & Allied Sciences, 2.1 (2010) 

"A necessary inhumanity” is what Edinburgh anatomist William Hunter expected students to gain from the dissection course they went through as a “rite of passage” at the beginning of their university careers. Learning human bodily structure by performing hands-on dissections in the anatomical theatre has become a fundamental element of modern medical education, almost everywhere on the globe. Only recently, concerns have been raised over the pedagogical adequacy of using cadavers in first-year training. “Living and Virtual Anatomy” has been proposed as one possible alternative approach to students’ first encounter with the human body.

Historically, opportunities for “doing” anatomy were restricted by various and varying prohibitions and taboos. Apart from brief episodes in Antiquity, the interior of human bodies was not available for examination by physicians nor for the instruction of their pupils. When public dissections were first permitted, professors had prosectors demonstrate the accuracy of authoritative texts, long before empirically-based criticism of received opinions was encouraged. Ethical debates about the status of the dead human body have changed over time, between cries of desecration and calls for democratic knowledge, with different connotations in different cultures. This themed issue encourages papers dealing with questions such as the following: 

• How is the ontological status of the dead person affected by various forms of preservation and preparation, dissection and display?
• What epistemological changes between “knowing” and “doing” anatomy are effected by different methods of teaching?
• Is there a specific impact of different cultural environments on the generation, development, and reproduction of anatomical practices, and to what extent are these processes gendered? 
  

Papers from a variety of disciplinary or interdisciplinary perspectives are invited. 

For details of aims and scopes and formal aspects, including style sheet, etc., please consult the journal’s website <http://www.springer.com/philosophy/philosophy+of+sciences/journal/12376 > Manuscripts need to be submitted online by 10 January 2010 at <http://www.editorialmanager.com/meds/default.asp>. Please, follow instructions provided on the site. For any preliminary inquiries, contact one of the issue editors: 

Samantha Regan de Bere <S.Regandebere@plymouth.ac.uk>; Alan Petersen <Alan.Petersen@arts.monash.edu.au>; Rainer Brömer <Rainer.Broemer@gmx.de>.

(h/t MEDMED-L)

On Disease Causality

I have the great honor of having a guest-post up at Felice Aull's marvelous Literature, and Medicine Blog.  The subject of the post is disease causality, and discusses stigma, fatness, the SDOH, and public health ethics/policy.  Mosey on over if the mood strikes you.

On the WHO, the CSDH, and "Closing the Gap"

It has been one year since the World Health Organization's ("WHO") Commission on the Social Determinants of Health released its Final Report, entitled Closing the Gap in a Generation.  To mark the occasion, the current issue of the outstanding open-text electronic journal Social Medicine has several pieces devoted to the Report.  I am still reading through them, but have finished Anne-Emmanuelle Birn's provocative piece entitled Making it Politic(al): closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health (PDF).  Here is the Abstract, after which I'll offer some comments:

The anniversary of the publication of Closing the Gap in a Generation (CGG) offers a moment to reflect on the report’s contributions and shortcomings, as well as to consider the political waters ahead. The issuance of CGG was not the first time the World Health Organization (WHO) raised the problem of global inequalities in health. Numerous analysts and advocates have compared CGG to the 1978 Declaration of Alma-Ata. Some see CGG as a continuation of Alma-Ata; others malign it for paying insufficient attention to the principles, background documents, and lines of action proposed in the Alma-Ata declaration. 

We might understand the two reports as bookends to 30 years of brutal global capitalism, punctuated by the “lost decade” of the 1980s, the end of the Cold War, and, more recently, the implosion of global finance. This period saw the publication of two seminal neoliberal health manifestos –the World Bank’s 1993 World Development Report and the WHO’s 2002 Commission on Macroeconomics and Health report. Both feature the term “investing in health” in their title, conveying “a double meaning—investing [through “cost-effective,” narrow, technical interventions] to improve health, economic productivity, and poverty; and investing capital, especially private capital, as a route to private profit in the health sector.”

For anyone interested in the social determinants of health -- which, frankly, should be everyone with an interest in health and illness in society -- Birn's essay is a must-read.  Birn, of course, is a preeminent SDOH scholar, and details a number of strengths and weaknesses in CGG.  

(An aside on terminology: She argues that the term "societal determinants of health" is more accurate than "social determinants of health" because the former refers to the "broader array of historical, political, and other structural influences" in comparison to the latter, which refers "to those factors related to interactions among people and communities."  (Birn, at 167).  I have heard this argument before, and remain frankly unconvinced.  Social is social.  Sociopolitical structures are in no ways I can tell less "social" than community level interactions).

Substantively, Birn tracks a recent and equally provocative piece (PDF) on the SDOH by Vicente Navarro, in arguing that assigning causation for the preventable deaths and suffering to inequities is not equivalent to assigning culpability to moral agents who benefit from inequities.  This is, to the best of my knowledge, an overtly Marxist argument, an interpretation buttressed by Birn's discussion of Engels's concept of social murder.

This leads into what I take to be Birn's central point; that CGG is "profoundly apolitical" (Birn, 172, quoting Navarro, at 15).  "The report says almost nothing about the causes of the "'causes of the causes," viz., what creates inequity in the first place" (Birn, 172) (footnote omitted).  Essentially, CGG fails to document how the distribution of raw political power is the primary determinant of inequitable social, political, and economic structures.  Hence, CGG is relatively silent on how political action is needed to ameliorate these structures.  Birn observes 

This criticism seems to imply that radicalization is needed to address the SDOH, and Birn confirms this, arguing that what is needed to ameliorate the SDOH is the disempowerment of moneyed "private-sector" interests who wield that power "block the passage or enforcement of laws and regulations aimed at protecting the public good" (Birn, 174).

As I said, provocative.  I personally have neo-Marxist tendencies, so I am somewhat disposed to agree with her, but I am also a pragmatist and a public health policy scholar, and at least in the U.S., am quite confident that the state of the political culture is exceedingly unlikely to support radical redistribution of wealth, which I agree could only proceed by upsetting dominant power structures.  I think such action is similarly unlikely to occur on the global scale as well.

Of course, what can happen and what ought to happen are not equivalent.  This is what I have referred to as the ethics of health policy paradox: what we can do may not be what we ought to do, and what we ought to do may not be what we can do.  At one point in her article, Birn acknowledges that the practical realties of global health politics may impede the activity Birn is recommending: "Surely CGG cannot be as incendiary as Engels!" (Birn, 174).  Indeed, they cannot.  CGG would never have gotten off the ground had it advocated radicalization, which (again), does not mean that it ought not have done so, but does present a practical policy problem.

Once again, the Aristotelian concept of phronesis matters here; we are looking for practical wisdom, what some have referred to as the least worst solution.  Note also that parallel processing is tenable; there is no rule which says one cannot attend to some of the intermediate "causes" CGG identifies while at the same time pushing for more radical alteration of power structures.

Thoughts?

New York Academy of Medicine, Section on the History of Medicine & Public Health, Lecture Series: With Coverage for All?: Health and the State in Twentieth Century America

The New York Academy of Medicine's Section on the History of Medicine and Public Health, with the support of the New York Council for the Humanities, presents: With Coverage for All?: Health and the State in Twentieth Century America, a series of four public lectures on the contentious history of efforts to guarantee health care coverage to all Americans. Explaining this history takes scholars to the heart of American culture, exploring such long-standing structural factors as the country’s comparatively weak labor movement and the political strength of both its medical profession and commercial health providers and insurance companies, and the ongoing conflicts between national ideals the health care debates always prompt, such as the question of how to balance America’s faith in self-reliance and economic laissez-faire with its definitional commitment to economic justice and opportunity.

This lecture series brings together four eminent scholars — authors of dozens of books, journal articles and other studies on the history and economics of health care in the United States. Three historians of medicine will present case studies from the twentieth century, and an eminent health economist will take the long view with his analysis of the roles American presidents have played in the health care debates.

Tuesday, October 6, 2009

Insurance or Rights? Debates over Health Coverage and Access to Health Care in the U.S., 1912-1950 Beatrix Hoffman, Ph.D.

Is health care a right? Although the U.S. has not resolved this question, Americans have debated it for nearly a century. This talk will discuss the origins of the idea of a right to health care, and the ways in which ideas about rights (for or against) have been put into practice in the U.S. health care system, with particular attention to debates over universal coverage.

Beatrix Hoffman is a historian at Northern Illinois University. She is the author of The Wages of Sickness: the Politics of Health Insurance in Progressive America. She is currently working on a history of the right to health care in the twentieth-century United States.

Tuesday, October 27, 2009

Industry vs. System: US Health Policy 1948-2009 Rosemary Stevens, Ph.D., M.P.H.

This talk will examine the history and implications of two major thrusts in government policy since 1948: first, the efforts to expand population coverage to selected groups, most notably through Medicare, Medicaid and child health programs, and on to current interest in those who remain uninsured; and second, partial, non-controversial investments in the health care infrastructure, notably through subsidy of biomedical research, buildings, and professional and specialized education.

Rosemary Stevens is the DeWitt Wallace Distinguished Scholar in the Social Medicine and Public Policy Program of the Department of Psychiatry, Weill Cornell Medical College. She is the author of many books, including The Public-Private Health Care State: Essays on the History of American Health Policy. Her current research is on the invention of US federal veterans’ hospitals and related services after World War I.

Thursday, November 12, 2009

What is Wrong with Medicaid?

Jonathan Engel, Ph.D.

Professor Engel will address the shifting focus of the Medicaid program through the years from poverty acute care to middle-class long-term care, and discuss where it is falling short of achieving its original objectives, and why this is happening. Moreover, the talk will address the way in which the current healthcare debate in Congress dovetails with the long-term decline of Medicaid as a competitive insurance program.

Jonathan Engel is a historian at Baruch College He is the author of several books on the history of medicine and health, including Poor People’s Medicine: Medicaid and American Charity Care since 1965. 

Currently, he is working on history of the US health system since 1970.

Tuesday, December 1, 2009

Presidents and the Never-Ending Quest for Health Reform Rashi Fein, Ph.D.

Our series will conclude with Rashi Fein’s assessment of how America’s presidents have defined America's health "problem" and the different "solutions" they have proposed. He will examine the factors that helped lead to success and failure in Presidential efforts to extend health insurance, paying special attention to the role of individuals and ideology as well as the limits and strengths of presidential power.

Rashi Fein is Professor of Medical Economics, Emeritus, at Harvard Medical School. Among his many books are Medical Care, Medical Costs: 

The Search for a Health Insurance Policy, and The Health Care Mess; How We Got Into It and What It Will Take To Get Out (which he co-wrote with US Surgeon General Julius Richmond). He is currently working on a book narrating some of his experiences in the efforts to implement and improve health-care policies.

This series received funding from the New York Council for the Humanities. Any views, findings, conclusions or recommendations expressed in this lecture series do not necessarily represent those of the National Endowment for the Humanities.

More information about the Spring, 2010 lectures will be posted shortly, but the line-up includes Steven Peitzman, M. Susan Lindee, Jacqueline Duffin, and Wiliam Ashworth.

(h/t H-SCI-MED-TECH)

On the Economic Burden of Health Inequities

The Joint Center for Economic and Political Studies, a leading think-tank on health inequities and the SDOH (they co-sponsored Unnatural Causes), commissioned a paper on the economic burden of health inequities.  The paper, produced via a collaboration between researchers at Johns Hopkins University and the University of Michigan is available open-access here (PDF).  Here is the delightfully succinct Executive Summary:

We estimated the economic burden of health disparities in the United States using three measures: (1) direct medical costs of health inequalities, (2) indirect costs of health inequalities, and (3) costs of premature death. Our analysis found:

• Between 2003 and 2006 the combined costs of health inequalities and premature death in the United States were $1.24 trillion.
• Eliminating health disparities for minorities would have reduced direct medical care expenditures by $229.4 billion for the years 2003-2006.
• Between 2003 and 2006, 30.6% of direct medical care expenditures for African Americans, Asians, and Hispanics were excess costs due to health inequalities. 
• Eliminating health inequalities for minorities would have reduced indirect costs associated with illness and premature death by more than one trillion dollars between 2003 and 2006.  

This kind of quantification is helpful for a variety of reasons, not least strategically, because issues of cost and waste are prime currency for political discourse on health inequities.  However, I do want to sound a note of caution with these kinds of studies, because, as I have mentioned before here on MH Blog, the naturalistic fallacy looms large in discussions of public health policy.  The mere fact that we expend a certain amount of money does in and of itself license a particular normative conclusion, because, while the presence of massive health inequities is an injustice to which I hope to center my life's work, the ethical deficiencies in the situation are assuredly not reducible to whether funds are saved or wasted.  Even if health inequities were perfectly efficient, they would still be unethical.

Thoughts?

CFP: Madness & Literature

1ST INTERNATIONAL HEALTH HUMANITIES CONFERENCE 2010

“Madness and Literature”

The Institute of Mental Health is hosting The 1st International Health Humanities Conference at The University of Nottingham, UK from Friday 6th to Sunday 8th AUGUST 2010.

Keynote Speakers:

Emeritus Professor of English Elaine Showalter (Princeton University).

Elaine Showalter is a feminist, a prolific writer and world-leading literary scholar.  She is author of several highly acclaimed texts, including The Female Malady: Women, Madness, and English Culture, 1830*1980 and Hystories: Hysterical Epidemics and Modern Media.

Professor Kay Redfield Jamison (Johns Hopkins University School of

Medicine). 

Kay Redfield Jamison is a leading expert in Mood Disorders.  Her best-selling books include a clinically acclaimed textbook on Bipolar Affective Disorder (BPAD), as well as Touched With Fire, examining BPAD and creative temperaments and a study on suicide, Night Falls Fast.  Her autobiography, An Unquiet Mind documents her personal battle with BPAD.

The theme of the conference, Madness and Literature, seeks to bring

critical focus to three areas:

Literature, Psychiatry, Philosophy

Reflecting the interdisciplinary work of the Institute of Mental Health, and the multifaceted nature of the conference’s theme, we invite the participation of colleagues from both the humanities and from clinical backgrounds who wish to participate in an exploration of the conceptions of “Madness and Literature”.  Furthermore, to be genuinely inclusive we encourage presentations arising from completed projects and work that is in progress or of an exploratory nature.

The Institute of Mental Health welcomes abstracts of approximately 250 words in length for twenty-minute papers in English dealing with the themes outlined above. We would also welcome the organization of panels (consisting of three speakers and a moderator) dealing with specific issues related to the overall themes of the conference.  Issues to be considered at the conference may include:

-       What are the critical intersections between literature, psychiatry

and philosophy?

-       How and why is psychiatry reflected and represented in fiction?

-       In what ways do fiction and autobiography treat issues such as gender, ethnicity, age, economics, sexuality and power in psychiatry?

-       How far can we pursue ideas concerning creativity and madness?

-       How might debates about literature and madness influence or be influenced by other disciplines, such as anthropology and sociology?

-       How can literature influence the education and practice of medical, health and allied disciplines?

-       What can literary studies learn from the ‘psych’ disciplines?

The Institute of Mental Health foresees the publication of papers (expanded, revised and submitted to a peer-review process) in one or more volumes post-conference, according to principles of intellectual and theoretical coherence that will give such publications editorial consistency.

Please send your abstracts as a Word attachment by email to Paul Crawford -paul.crawford@nottingham.ac.uk by 5th February 2010.

(h/t Lit_Med_ASBH listserv)