The Institution(s) of Medicine III
Read: D.P. GORDON: Hospital slang for Patients
Luhrmann 84-118
I. Review of points made in the previous lecture:
A.
Like all institutions, medicine displays certain characteristics:
1.
Recruit and derecruit members
2.
Police themselves
3.
Perpetuate themselves
a.
II. Sometimes they seek to increase membership, other times no
4.
Provide for orderly succession to office
5.
Construct value systems
6. Subscribe to an ideology that explains and justifies their existence and
authority
How to study institutions: how to describe and analyze them?
A.
Possible methodologies:
1.
Examine the institution itself
a.
Institutions III Gordon, Luhrmann 2002
For example, the institution of American psychiatry
1) Discuss what did you learn about Mass General‘s psychiatry
unit from the video —Back from Madness“?
2)
Keep in mind the nature of your sources of information
a)
This
video presents a sympathetic, —insider“
perspective
b) Discuss: ways in which the video conveyed the
impression that a balanced, informative picture was
being drawn, as opposed to one created by a public
relations firm?
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b. 2.
c) Discuss: areas you think were not covered because
they would produce an unfavorable impression of
MGH?
d) By the way, you may write your weekly Reader
Response on a video if you want
The Rosenhan et al. article for Nov. 14 discusses psychiatric units
from a critical, —outsider“ perspective
1)
How much analysis of institutions does Luhrmann provide?
2) Luhrmann studied a number of institutions, but her main
concern is to examine the institution of psychiatry as a whole
Second approach: looking at an institution over time
a. Institutions may be studied ethnographically (Luhrmann and
Rosenhan et al.), and historically, through archival documents
1) The Fadiman and Farmer books present both present-day and
historical material
a) 2)
Discuss: examples of institutions analyzed in both books
3) The video we‘ll see called —The Lynchburg Story,“ on
compulsory sterilization in Virginia, relies on archives and
oral history
4)
As does the video —Simple Courage“ on leprosy in Hawai‘i
5) —Search for Satan“ on the satanic abuse —epidemic“ in the
1980s
a)
3.
They employ what‘s called oral history as well–
living people‘s accounts of the past
Is pretty much journalistic investigation–interviews,
no real ethnography, only a bit of historical
investigation
Third approach: compare several similar institutions
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4. Fourth: examine the way a given institution relates to, is embedded in, other
institutions
a.
Farmer: how medicine hooks up with politics
b. Film about the first decade of the AIDS epidemic in the US, —And
the Band Played On“ shows the inner workings of research science
and epidemiology
1) 5. Fifth: Cross-cultural comparison: compare institutions that are really not
very similar
a.
The Obeyesekere piece
b. The Payer article we‘ll read Nov. 20 looks at medicine in 4 Western
countries
1) 6.
Although all countries subscribe to Western medicine,
practices and policies vary from country to country due to
cultural differences, albeit slight ones
Sixth: doing close readings of texts, rituals, to uncover meanings, values
a.
Lévi-Strauss‘s piece
b. Gordon employs this approach: does a close reading of hospital
slang
1)
c. III. Government agencies like the Center for Disease Control
trying to get more funding
Has anyone read House of God?
We‘ll read about ritual in the operating room, an interpretive
analysis of the symbolic structures present during surgery
Why study the institution of medicine?
A.
First reason is obvious: it is important in itself
B.
Second reason: provides a window on the world
1. For example, doctors in the US and Great Britain used to perform
cliterodectomies
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2.
a. We see these as mistakes. But because they aren‘t random mistakes
they are revealing
b. As I said last time, you‘ll miss the point if you see the doctors at
Lynchburg as bad, or mistaken, and leave it at that
One can analyze these decisions as ideologically driven
a.
Ideology: a system of meanings and values which are the expression
or projection of a particular class interest
b. What happened at Lynchburg shows the workings of a heavily
ideological movement
c. 1)
One very pervasive at the time: Eugenics
2) And with us still: examples of 21st century behavior driven
by eugenic ideology?
Differences between Lynchburg and contemporary eugenics
ideologies?
1) Lynchburg involved clinicians and lawmakers deciding some
people were not fit to be parents
a) And coercively, in some cases deceptively sterilizing
them
2) Today: —designer babies“ œ egg donation, amniocentesis
followed by abortion
3)
Who is making the decision differs; the goal differs
a) Parents decide about egg donation, whether a fetus is
an acceptable one or not
b)
Explicit
eugenics control legislation works at
preventing a population from ever reproducing
c)
Would-be parents might try again
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d.
3. 1
4)
But, if enough people engage in this kind of selective
behavior, the overall profile of the population might be
affected eventually
5)
International examples?
a) Sex selection in India and China has had very
pronounced effects on the population
b)
Singapore‘s earlier explicitly eugenicist policies
1)
Ostensibly
to encourage highly educated
women to reproduce more, poorly educated
women to reproduce less–to improve the
gene pool
2) Are in fact driven by ethnic nationalist goals:
highly educated women in Singapore are
disproportinately Chinese; poorly educated
women are Hindi and Malay1
Other medical examples?
1) Why do people buy into an ideology of thinness so
thoroughly that it can result in death?
2) Why do women (and men) inject a poison, botox, into their
foreheads?
3)
We know why; we know what‘s in it for them
Let‘s employ Antonio Gramsci‘s notion of hegemony to explore this
question further
a. A more supple, nuanced concept–and with greater explanatory
power–than ideology
b. —Ideology“ can be too static a concept for the kind of analysis you‘re
carrying out: hegemony is conceived of as a process
c.
The notion of hegemonic power (hegemony)
Geraldine Heng and Janadas Devan: —The politics of nationalism, sexuality, and race in Singapore,“ in Roger
Lancaster & Micaela di Leonardo, The Gender Sexuality Reader: Culture, History, Political Economy. New York:
Routledge, 1997
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d. 1)
Asks
why do people choose to participate in power relations
that do not seem to be in their best interest?
2) Why do they accept systems of dominance, fervently believe
in them?
3) When, we, from our position as outside observers find such
acceptance so puzzling and disturbing and the reasons to
resist such dominance so obvious?
The advantage of the concept of hegemony is the challenge it poses
to earlier notions of false consciousness
1) To explain why people not at the top of systems that
distribute power, authority, prestige, etc. very unequally:
a) 2) Continue to buy into them, continue to support the
ideological structures that exploit, oppress?
The notion that they‘ve been brainwashed by the ideological
system
a)
So that they can‘t see what‘s going on
b)
Is too simple
c)
It makes them into dupes of the system
d) In effect, the explanation denies agency to those
being exploited or otherwise harmed
(1)
4. Of course some people are truly physically coerced: threatened, imprisoned,
etc.
a. 5. But people aren‘t stupid
But most systems of dominance don‘t depend on this kind of
coercion
So an outsider analyst trying to figure out why people inject poison into
themselves
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a. b.
Would discuss the hegemonic position of powerful multinational
corporations
1)
That allows them to manufacture drugs and devices
2) And successfully pitch products to consumers–to dominate
the market
She would also have to figure out what‘s in it for the consumers
1) 6. Note that hegemony has to continually be renewed, recreated, defended, and
modified
a.
And that it is also continually resisted, limited, altered, challenged:
1)
C. What are the benefits? This is a very different explanation
than the —brainwashed“ one
Wherever there is hegemony there is counter-hegemony
Ways we can analyze the functions of institutions: what they do, what they
accomplish
1.
First is the obvious one: when successful they restore sick people to health
2.
Second is the category of psychological functions
a.
b. 3. The D.P. Gordon piece analyzes the psychological functions of slang
1) He says the hypothesis that the function of derogatory
language is to release tension is not true–the most seriously
ill are not joked about
2) Rather, he argues that it‘s the psychological function of
expressing frustration re. care given that‘s not needed, or
isn‘t useful (they‘re going to die anyway)
Favret-Saada suggested that beliefs in witchcraft and in the
possibility of becoming un-bewitched–restoring the farm to
health–served psychological functions
Gordon also discusses a social function of slang: helping the group build
rapport
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4.
a. —…not support the claim that hospital slang for patients is an outlet
for personal reactions to illness and suffering, but the group concern
of hospital staff to provide meaningful, useful service“
b. Gordon also suggests the slang functions to build distance between
individuals, esp. the superior to the subordinate
Social control functions:
a.
b.
The
nurses and bomohs administering to victims of spirit possession
in Aiwa Ong‘s analysis of a multinational factory in Malaysia
1) Are engaged in a form of social control that serves the
company‘s economic interests
2)
This is control, strict control, but not coercion per se
Cliterodectomies can be seen as a form of social control:
1)
Of those who underwent surgery
2)
And, presumably, other women received the message as well