Machines, medication, modulation: circuits of dependency and self-care in Las Vegas

The contagion of mental illness: Insights from a Sufi shrine

In this article, an anthropologist and a psychiatrist examine a Sufi shrine-based concept of affliction known as asrat (an "effect" in Hindi-Urdu, "difficulty" in Arabic) and related practices of healing in urban north India. Rather than being located in an individual body, asrat afflictions are shared, most often within a household or kinship group. Through surveys, clinical assessments, and ethnographic work, we track three different ways in which afflictions move between bodies, and the mechanisms at work in asrat healing processes. Rather than a "collectivist" concept of the psyche, we suggest that a key role of shrine-based therapeutic processes is to manage a "suspicion system," related to experiences of psychic and economic injuries and conflict between intimates and kin. Through a multi-sited research design that moves across a leading Sufi shrine, an urban poor neighborhood in Delhi, and one of India's leading psychiatric facilities, we argue that within asrat-related processes, psychic vulnerabilities are addressed by "re-combining" relations through forms of inter-subjective attunement within a smaller segment of the kin group, potentially making symptoms and the burden of care and conflict more livable. We suggest that shrine-based concepts and practices may be cross-culturally significant, even for secular understandings of the inter-subjective dimensions of mental illness.

Politics of hesitance and the formation of ethical subjects through responsible gambling practices

INTRODUCTION

Instead of harm prevention and risk related to gambling products, responsible gambling discourse emphasizes the importance of voluntary measures. From the point of view of governmentality, the responsible gambling practices produce, rely on, and call forth subjectivities. The aim of the study is to find out what kind of subjects are being produced through the responsible gambling practices of four Nordic state-owned gambling companies. As the companies are state-owned and operate on different types of markets, there are reasons to suspect that the companies could endorse different versions of the figure of responsible gambler. Previous research indicates that responsible gambling practices typically presuppose or aim to produce a self-governing subject making informed choices. Less attention has been given to detailed analyses of the heterogeneous factors contributing to the ethical subject formation. Moreover, there is a growing body of literature indicating, that along with the use of detailed behavioral data (big data), new forms of governmentality, that are highly relevant from the point of view of subject formation, are emerging.

METHODS

The responsible gambling practices are analyzed along Michel Foucault's four aspects of ethics. First, there is ethical substance, the problematic aspect of the self that is taken as the target of the ethical work. Second, the subject needs to have a certain relation to social norms and moral codes. Third, ethical work is needed to mold the problematic aspect of the self. Fourth, the aim of the ethical work is a certain mode of being or relationship to oneself. The analyzed material consists of the annual reports of the companies between 2019 and 2021.

RESULTS AND DISCUSSION

The results show that the figure of subject making informed voluntary choices is deeply embedded in the responsible gambling practices of the companies. The companies entice the gamblers to think about themselves and to act upon themselves as subjects capable of self-control. Hesitancy to intervene characterizes the activities of the companies, even if all the companies collect and use detailed behavioral data. The inclusion of the precarious subject of gambling harm would allow the companies to do much more to prevent gambling harm.

Distinguishing Core from Peripheral Psychiatric Symptoms: Addictive and Problematic Internet Gaming in North America, Europe, and China

We explore the problem of distinguishing the relatively constant versus culturally variable dimensions of mental suffering and disorder in the context of a cross-cultural study of Internet gaming-related distress. We extend the conceptual contrast of "core" and "peripheral" symptoms drawn from game studies and use a framework that synthesizes cultural and neurobiological understandings of emotional distress. In our framework, "core" symptoms are relatively constant across cultures and therefore presumed to be more closely tied to a neurobiological base. By contrast, we treat as "peripheral" symptoms those that are more culturally variable, and thus less directly tied to the neurobiology of addiction. We develop and illustrate this approach with a factor analysis of cross-cultural survey data, resting on previous ethnographic work, through which we compare online gaming distress experienced in North America (n = 2025), Europe (n = 1198), and China (n = 841). We identify the same four-factor structure across the three regions, with Addiction always the first and most important factor, though with variability in regional factors' exact item composition. The study aims to advance an integrative biocultural approach to distinguishing universal as opposed to culturally contingent dimensions of human suffering, and to help resolve debates about whether problem gaming represents a form of addiction.

Online self-expression and experimentation as ‘reflectivism’: Using text analytics to examine the participatory forum Hello Sunday Morning

Hello Sunday Morning is an online health promotion organisation that began in 2009. Hello Sunday Morning asks participants to stop consuming alcohol for a period of time, set a goal and document their progress on a personal blog. Hello Sunday Morning is a unique health intervention for three interrelated reasons: (1) it was generated outside a clinical setting, (2) it uses new media technologies to create structured forms of participation in an iterative and open-ended way and (3) participants generate a written record of their progress along with demographic, behavioural and engagement data. This article presents a text analysis of the blog posts of Hello Sunday Morning participants using the software program Leximancer. Analysis of blogs illustrates how participants’ expressions change over time. In the first month, participants tended to set goals, describe their current drinking practices in individual and cultural terms, express hopes and anxieties and report on early efforts to change. After month 1, participants continued to report on efforts to change and associated challenges and reflect on their place as individuals in a drinking culture. In addition to this, participants evaluated their efforts to change and presented their ‘findings’ and ‘theorised’ them to provide advice for others. We contextualise this text analysis with respect to Hello Sunday Morning’s development of more structured forms of online participation. We offer a critical appraisal of the value of text analytics in the development of online health interventions.

Addiction in the Making

This review traces the literatures in cultural anthropology and neighboring disciplines that are focused on addiction as an object of knowledge and intervention, and as grounds for self-identification, sociality, and action. Highlighting the production of disease categories, the staging of therapeutic interventions, and the ongoing work of governance, this work examines addiction as a key site for the analysis of contemporary life. It likewise showcases a general movement toward accounts of addiction that foreground complexity, contingency, and multiplicity.

Promise and deceit: pharmakos, drug replacement therapy, and the perils of experience

The problem of lying as a feature of medication compliance has been well documented in anthropological and clinical literatures. Yet the role of the lie-its destabilizing effects on the continuity of drug treatment and therapy, as a technology of drug misuse, or as a way to understand the neuro-chemical processes of treatment (pharmacotherapy "tricking" or lying to the brain)-has been less considered, particularly in the context of opioid replacement therapy. The following paper is set against the backdrop of a three-year study of adolescents receiving a relatively new drug (buprenorphine) for the treatment of opiate dependency inside and outside of highly monitored treatment environments in the United States. Lies give order not only to the experience of addiction but also to the experience of therapy as well. In order to better understand this ordering of experience, the paper puts the widely discussed conceptual duality of the pharmakon (healing and poison) in conversation with a perilously overlooked subject in the critical study of pharmacotherapy, namely the pharmakos or the personification of sacrifice. The paper demonstrates how the patient-subject comes to represent therapeutic promise by allowing for the possibility of (and often performing) deceit.

Deleuze and the theory of addiction

This theoretical article presents and applies the theories of the French philosopher Gilles Deleuze. The article takes as its starting point the observation that current biomedical, social and psychological research does not provide a coherent view of the nature of addiction and there is a great deal of controversy in the field. The material philosophy of Deleuze provides the opportunity to introduce new ideas and bridge the gaps between different theories and approaches. Deleuze's philosophy is especially useful since neurological research on addiction has developed rapidly. Deleuzian concepts have implications not only for the general theory of addiction, but also for different theories on treatment and recovery. A Deleuzian theory, developed in this article, analyzes addictions as situational and interactional processes. Alcohol and drugs are used because they are connected with situations and interactions that enable the production of desire. They change and alter the body. Addiction alters the production of desire and life itself begins to be reduced to alcohol, drugs or a specific mode of behavior. Recovery from addictions is connected with the changes in life that offer subjects an open future. A recovering body must increase its capacity to be affected and be capable of creating new biopsychosocial connections of desire.

The experience of addiction as told by the addicted: incorporating biological understandings into self-story

How do the addicted view addiction against the framework of formal theories that attempt to explain the condition? In this empirical paper, we report on the lived experience of addiction based on 63 semi-structured, open-ended interviews with individuals in treatment for alcohol and nicotine abuse at five sites in Minnesota. Using qualitative analysis, we identified four themes that provide insights into understanding how people who are addicted view their addiction, with particular emphasis on the biological model. More than half of our sample articulated a biological understanding of addiction as a disease. Themes did not cluster by addictive substance used; however, biological understandings of addiction did cluster by treatment center. Biological understandings have the potential to become dominant narratives of addiction in the current era. Though the desire for a "unified theory" of addiction seems curiously seductive to scholars, it lacks utility. Conceptual "disarray" may actually reflect a more accurate representation of the illness as told by those who live with it. For practitioners in the field of addiction, we suggest the practice of narrative medicine with its ethic of negative capability as a useful approach for interpreting and relating to diverse experiences of disease and illness.

The Real of problem gambling households

In this article, problem gambling stories of eight Norwegian households are interpreted in the light of Jacques Lacan's concept of the Real. It is argued that the concept of the Real may help us to see, formulate, and visualize aspects of these stories that usually elude our attention: the hidden and incomprehensible order of a household that impacts its members' everyday lives and concepts of self.

The (un)managed self: paradoxical forms of agency in self-management of bipolar disorder

Self-management of mental illness is a therapeutic paradigm that draws on a distinctly biomedical conceptualization of the isolability of personhood from pathology. This discourse posits a stable and rational patient/consumer who can observe, anticipate, and preside over his disease through a set of learned practices. But in the case of bipolar disorder, where the rationality of the patient is called into question, the managing self is elusive, and the disease that is managed coincides with the self. While humanist critiques of the biomedical model as applied to mental illness have argued that its logic fatalistically denies patients intentionality and effectiveness (Luhrmann, Of Two Minds: The Growing Disorder in American Psychiatry, 2000), biomedical proponents claim that psychiatry's way of envisioning the body as under the control of the intentional mind actually returns agency to the patient/consumer. Rose (The Psychiatric Gaze, 1999) remarks that biomedical models have the potential to "[open] that which was considered natural to a form of choice" (p. 37), and that techniques of medical self-control help constitute the free embodied liberal subject who is obliged to calculate and choose. Through an examination of clinical literature as well as the practices and narratives of members of a bipolar support group, this paper explores ethnographically the possibilities for subjectivity and agency that are conditioned or foreclosed by the self-management paradigm, which seems to simultaneously confer and deny rational selfhood to bipolar patients. To express their expertise as rational self-managers, patients/consumers must, paradoxically, articulate constant suspicion toward their present thoughts and emotions, and distrust of an imagined future self. I argue that through their self-management practices, bipolar support group members model provisional and distributed forms of agency based on an elusive, discontinuous, and only partially knowable or controllable self-revealing, perhaps, the limits of the contemporary reification and medicalization of both selfhood and disease.

Medical anthropology enters the 21st century

Medical anthropology is the smallest and perhaps least understood of the social and behavioral sciences of medicine. In this article, we indicate what makes the field distinctive and describe significant developments during the past two decades.

Post-soviet placebos: epistemology and authority in Russian treatments for alcoholism

The dominant modalities of treatment for alcoholism in Russia are suggestion-based methods developed by narcology-the subspecialty of Russian psychiatry which deals with addiction. A particularly popular method is the use of disulfiram-an alcohol antagonist-for which narcologists commonly substitute neutral substances. Drawing on 14 months of fieldwork at narcological clinics in St. Petersburg, this article examines the epistemological and institutional conditions which facilitate this practice of "placebo therapy." I argue that narcologists' embrace of such treatments has been shaped by a clinical style of reasoning specific to a Soviet and post-Soviet psychiatry, itself the product of contested Soviet politics over the knowledge of the mind and brain. This style of reasoning has facilitated narcologists' understanding of disulfiram as a behavioral, rather than a pharmacological, treatment and has disposed them to amplify patients' responses through attention to the performative aspects of the clinical encounter and through management of the treatment's broader reputation as an effective therapy. Moreover, such therapies have generally depended upon, and helped to reinforce, clinical encounters premised on a steeply hierarchical physician-patient relationship.