Biomedicine as Culture

Instrumental Practices, Technoscientific Knowledge, and New Modes of Life

Regula Valérie Burri, Joseph Dumit, Regula Valérie Burri, Joseph Dumit

• Publisher: Taylor & Francis
• Year: 2007
• Print ISBN: 9780415957984
• eBook ISBN: 9781135905743
• Edition: 1
• Topic: Medicine
• Subtopic: Ethics in Medicine

This volume offers interdisciplinary perspectives on contemporary biomedicine as a cultural practice. It brings together leading scholars from cultural anthropology, sociology, history, and science studies to conduct a critical dialogue on the culture(s) of biomedical practice, discussing its epistemic, material, and social implications. The essays look at the ways new biomedical knowledge is constructed within hospitals and academic settings and at how this knowledge changes perceptions, material arrangements, and social relations, not only within clinics and scientific communities, but especially once it is diffused into a broader cultural context.

Part I
Social and cultural studies of biomedicine

1
Medicalizing culture(s) or culturalizing medicine(s)

Stefan Beck

In December 2003, the Cyprus Bone Marrow Donor Registry—funded by a charity, the Karaiskakio Foundation—arranged a celebratory meeting of Cypriot donors and recipients of bone marrow grafts. A few days before Christmas, the invited persons, adults with their spouses and children accompanied by their parents, convened in a reception room of a big hotel in the capital, Nicosia. Two long tables were set—one labeled “donors,” the other “recipients.” As people trickled in, a father of a 10-year-old child who had successfully received a bone marrow graft in the beginning of the year excitedly approached the director of the registry and asked him who his son’s benefactor was. However, the director, Pavlos Costeas, replied only, “At this table,” indicating the “donors’ desk” where already 10 people were sitting. Irritated, the father again asked who exactly the donor of the graft was that saved his son from dying of leukemia. Costeas repeated that this person was sitting at the “donors’ desk” but firmly declared that he would not point him out. He explained that all donors present were united in the struggle to save the lives of leukemia sufferers. His rationale behind this policy is straightforward: Since only a fraction of all grafts provided by donors will actually be transplanted successfully, only some donors would be able to celebrate that they in fact had saved a life. What matters for Costeas, then, is the willingness to give and not the actual success of a transplantation; accordingly, the yearly celebration focuses on giving, not on saving.

In the present article, I will use the ethnographical account of this event (Badiou 2005:173–83) as a focus to organize my argument.¹ The example I have chosen is somewhat distant from medical practices in the narrow sense; however, it will allow me to hint at some of the benefits and some of the problems that might occur when medicine is made into an object of anthropological scrutiny while using culture as a conceptual lens. This argument will be embedded in a rather sketchy critique of the specific disciplinary configurations in German-speaking countries, namely, the rich and highly problematic traditions of different anthropologies, a constellation most influential in defining disciplinary proximities and distances, research policies, and thought styles. It is argued that these intellectual traditions are not especially conducive for a research agenda that aims at analyzing recent biotechnological developments; therefore, some suggestions for amendments and disciplinary borrowings are made. It is claimed that a much broader account of medicine’s direct and indirect effects on shaping professional as well as vernacular episteme and practices is vital. And it is suggested that medicine should take on the challenge to reflexively coproduce a vocabulary that allows others to come to terms, both socially and culturally, with its interventions. Of course, this would necessitate a sustained collaboration with the social sciences and the humanities that surpasses fashionable interdisciplinary conversations and enters into a mode of in(ter)vention that coproduces instruments for cultural reflexivity.

MICRO EVENT: THE CREATION OF DIFFERENCE

New conceptual instruments for understanding novel entities, facts, and relationships brought into being through the application of biomedical technologies—of course—are not only wanted in the domain of transplantation medicine, though the obvious challenges for body images and the many social ambivalences immanent in donor-receiver relations provide a testing ground for the problem at hand. The guiding motivation of the director of the Cyprus Bone Marrow Donor Registry at these celebratory meetings is to protect the donors. As he told me, he had learned his lesson the hard way: Some years ago, he had to ask a donor to provide for a graft a second time because the first transplant had been rejected by the immune system of the receiver. The donor experienced this query as a devastating revelation. As he told Costeas, after having given the graft, he had lived for months in the elated conviction of having saved a life—an act, as he saw it, that had fundamentally changed his life. “But by asking me to give again,” he said, “you have robbed me of my new identity and you have cast doubt on whether it will make sense to provide bone marrow again.”

His experiences with the powerful effect of transformed self-perceptions of donors who “gave life” motivated Costeas to implement a policy of strict nondisclosure and anonymity in order to secure for all donors the conviction that they had contributed in a collective effort to save a life. As a result of this policy donors are removed from the registry to avoid a situation where they are asked to donate a second time. That this rule of strict, mutual anonymity between donors and recipients provides the framework for the intimate coming-together of donors and recipients in the Nicosia hotel a few days before Christmas might seem odd at first. It may appear particularly exotic if you compare this event to conventional practices in, for example, the United States, where meetings between donors and recipients are highly publicized, show-like happenings. There, survivors and their donors are meeting on the stages of big convention halls, falling into each other’s arms under the applause of kin, friends, and a large audi-ence. These events dramatize individual generosity that successfully has responded to individual suffering, followed by individual salvation of the sick, and resulting in individual pride on the part of the donor: a congregation of like-minded individuals is demonstrated. In contrast, the ritual developed by the Cyprus Bone Marrow Donor Registry celebrates donors as anonymous constituents of a collectivity. Salvation here is depersonalized, and altruism is collectivized.

It is noteworthy that Costeas shaped his policy in explicit contrast to the “American model” depicted before, a practice he had experienced during his education and work in an east coast university hospital. The creation of this highly ambivalent and even contradictory anonymous intimacy of the meetings has two purposes: first, to protect the donors from grief, namely, the realization that the recipient of the provided graft had died. However, what might even be more important in a small island society of merely 600,000 persons, where everybody is only some handshakes away from everybody else, is to reduce possible feelings of dependency or superiority between donors and recipients, a pressing problem, as will be demonstrated below.

A promising approach to investigate the implied problematics in the event might be to look at it by analyzing instances of social control at work on the micro level of interactions. And indeed, most anthropological studies in German-speaking countries, analyzing similar situations, are focusing on phenomena of domination and the transformation of “vernacular” practices working with the concept of medicalization. However, I suggest that this perspective—while affording a powerful tool—might not be the ideal candidate to analyze the heterogeneity of processes observable in this situation. Let me briefly explain why.

MEDICINE AS AGENT OF SOCIAL CONTROL: MEDICALIZATION AND ITS DISCONTENTS

Generally, medicalization signifies a process in which a medical frame or definition is applied to understand or manage a problem. Well-known examples are the emergence of professional groups such as physicians in the eighteenth century, the founding of medical institutions such as birthhouses in which poor women had to give birth under medically controlled conditions, or much more recently the emergence of new syndromes like attention deficit disorder that define a complex behavioral phenomenon as being caused by neurological states. Specifically, medicalization describes a process of social control in which phenomena, formerly understood to be nonmedical or nonproblematical, “become defined and treated as medical problems, usually in terms of illnesses or disorders” (Conrad 1992:209). Early studies in medicalization processes in the late 1960s and early 1970s took their inspiration in part from Talcott Parsons (1951), who was “probably the first to conceptualize medicine as an institution of social control” (Conrad 1992:210). More often than not, medicalization is understood to be a linear process unfolding in modernity parallel and in part linked to secularization. To quote a famous definition from the early 1980s, it is a “process whereby more and more of everyday life has come under medical dominion, influence and supervision” (Zola 1983:295). As such, medicalization is conceptualized as part of the disenchantment that is emblematic for modernization.

These processes can be observed on at least three levels: (1) on a conceptual level, for example, when a medical model is used to “order” or define a problem at hand; (2) on an institutional level, for example, when an organization or a political actor adopts a medical approach to treat a particular problem; (3) and, finally, on an interactional level “as part of the doctor-patient interaction” (Conrad 1992:211).

Medicalization, understood from this perspective, is a multilevel controlling process (Nader 1997) that tends to unseat vernacular notions of health and disease and that substitutes popular customs in the domain of healing and curing with scientifically informed, therapeutic practices. In German-speaking cultural anthropology, this understanding of scientific medicine dominated discussions until recently. Of course, there are marked differences between two varieties of anthropological practice that emerged in German-speaking countries in the nineteenth century. It suffices to say that there is an institutionalized division between Volkskunde (folklore: the ethnology and anthropology of European cultures), on the one hand, and Völkerkunde (devoted to the anthropological study of non-European cultures), on the other. However, for the purpose of my argument, I can ignore most of the implications of this split here (Hauschild 1983). What is more important in the context of this line of reasoning is that both disciplines are still biased by the legacy of exotistic approaches to culture. As Beatrix Pfleiderer remarked in a review of ethnological and anthropological work in the domain of medicine, the disciplinary perspective was intricately shaped by studying “exotic,” small-scale, nonindustrialized societies (Pfleiderer 1993:365). Similarly, Volkskunde invested much of its energy in describing and recovering the exotic, the vernacular, and the suppressed in the margins of industrialized societies, to be found either in the distant past or in “distant” social strata, far removed from mainstream social life. While Völkerkunde specialized in describing Ethnomedizin (ethnomedicine), Volkskunde focused by and large on Volksmedizin (folk healing and traditional medicine under a well-defined historical perspective), analyzing those beliefs, concepts, and practices regarding disease and healing that were as far removed from scientific medicine as possible.

However, the 1970s and early 1980s saw a growing critique of these rather descriptive approaches that both tended to construct their objects of inquiry as bounded, essentialized entities, purged from influences of modernity. At the same time, German-speaking anthropologists gradually followed the international trend in their discipline to turn their professional attention on industrialized societies. One of the consequences of these critiques was a major reorientation of research programs in the 1980s. As Eberhard Wolff analyzed in a review of studies in cultural anthropology—that is, Völkerkunde and Volkskunde—this development brought about a growing interest in those problems, tensions, and conflicts that are produced by the clash of p...

Table of contents

• Routledge Studies in Science, Technology and Society
• Contents
• Foreword
• Introduction
• Part I Social and cultural studies of biomedicine
• Part II Epistemic practices and material culture(s)
• Part III Biomedical knowledge in context
• Contributors
• Index