Stuck in the Clinic: Vernacular Healing and Medical Anthropology in Contemporary sub-Saharan Africa

"Sex is supposed to be naturally more pleasurable": Healers as providers of holistic sexual and reproductive healthcare in Uganda

Global health researchers often approach Traditional, Complementary, and Alternative Medicine (TCAM) from a health efficacy perspective, asking whether the presence of plural medical systems helps or hinders the uptake of biomedicine. Medical anthropologists, by contrast, typically emphasize how plural medical systems encourage us to rethink health ontologies-that is, who and what comes to constitute the experience of health and illness, and through which practices. Building on both approaches, we explore the role of "healers," a term we use to encompass several different kinds of TCAM providers, in the sexual and reproductive healthcare (SRH) of young people from southcentral Uganda, a region well known as an HIV/AIDS epicenter. Drawing from ethnographic data, we describe three reasons that young people seek SRH from healers. First, they associate stigma, scarcity, and high costs with biomedical SRH. Second, healers work across biomedical and non-biomedical therapeutic divides, prescribing herbs for sexually transmitted infections while simultaneously referring clients to biomedical HIV clinics. Third, healers provide counseling focused on pleasurable and economically-motivated sex. Because these therapies diverge from international and national HIV prevention messaging that frames non-marital and transactional sex in terms of danger and disease, healers' holistic approach to SRH may help to reconstitute the meaning, practice, and experience of "sexual health" in contemporary Uganda. This has important implications for improving global SRH programs and for understanding the continued appeal of TCAM more generally.

Visceral Visions: Rethinking Embodiment and Desire in Global Mental Health

The globalization of biomedicine poses the problem of finding cross-culturally valid criteria for mental health. Undue pathologization is a major risk for global health, especially when diagnoses rely exclusively on Western nosology. This article focuses on the clinical conflation between involuntary mass possession and conversion disorder. Originally, the diagnosis of "conversion disorder" evolved from the notion of hysteria. Even though the category of hysteria disappeared from psychiatry many decades ago, some of its undergirding assumptions have survived under the new label of conversion. Namely, the assumption that hysteria/conversion is caused by repressed sexual desire is still implicit in widespread explanatory models for mass possession worldwide. Drawing upon an ethnography of demonic possession (grisi siknis) among the Afro-Indigenous Miskitos of Nicaragua, I argue that (1) the label of conversion is eurocentric and inappropriate for mass possession; and (2) emic perspectives on mass possession offer a critical counterpoint to rethink Euro-American and globalized understandings of embodiment and desire.

Medical pluralism, Pentecostal healing and contests over healing power in Papua New Guinea

This paper is based on long-term ethnographic fieldwork among the Lelet of New Ireland Province, Papua New Guinea. It draws on qualitative interviews with Pentecostal Christians intended to examine their understanding of Christianity and how this relates to their cultural practices - in this case, how their Pentecostalism affects their therapeutic beliefs and practices. The frequent observation that therapeutic repertoires are becoming less discrete is substantiated by the Lelet case, for in their search for therapy, the Lelet often cross the borders of different repertoires, seeing no contradiction, for example, between combining a vernacular therapy with biomedicine. With the advent of Pentecostalism, the issue has become far more complex. The Lelet therapeutic culture remains pluralist, but the research shows that Lelet Pentecostals are increasingly viewing their own Christian-based forms of healing as in competition with other therapies, especially vernacular therapies. This competitive outlook has brought a demonization of vernacular therapies, which are labelled 'satanic' and their use discouraged. In fact, Pentecostalism is refashioning the realm of therapy: rather than border crossing and mixing of therapeutic repertoires, the situation is increasingly dominated by notions of mutual exclusivity. In order to comprehend the full complexity of medical pluralism, it is now necessary not only to examine how the borders of the different therapeutic repertoires are blurred, destabilized or reconfigured but also how they may be demarcated and policed. In other words, we argue that medical pluralism is being eroded by its interaction with Pentecostalism.

Falling, Dying Sheep, and the Divine: Notes on Thick Therapeutics in Peri-Urban Senegal

Peri-urban Senegal lies outside the influence of both the nation's historic public mental health model and contemporary global mental health. This paper examines how cultural logics in this underserved region spill over from social domains to widen the therapeutic sphere of psychoses and epilepsy. Observations and 60 carer and/or patient interviews concerning 36 patients afflicted by one or both conditions illustrate how the "crisis of the uncanny", a spectacular eruption of psychoses and seizures into the everyday, triggers trajectories across these domains. To resolve the crisis, patients and carers mobilize debts and obligations of extended kin and community, as well as a gift economy among strangers. The therapeutic and non-therapeutic are further linked through the semantics of falling, which associates this local term for the crisis with divine ecstasy and the slide from human to non-human forms of life. We introduce the concept of thick therapeutics to capture how the logics of sheep- other animal-human relationality, secular-divine politics of giving, and payment/sacrifice for healing imbue a therapeutic assemblage continually constructed through actions of patients, carers and healers. We ask what implications therapeutic thickening might have for mental health futures, such as monetized payment under global mental health.

Physician Anthropologists

Physician anthropologists have contributed extensively to the anthropology of biomedicine, as well as to other aspects of medical anthropology. Their use of detailed clinical case narratives allows elucidation of what is at stake for individuals and communities in the course of any given illness. Biomedically informed observations of bodies illustrate the connections between microscopic harm and macrosocial arrangements, while observations of clinical spaces and medical knowledge production contribute to current debates over evidence, metrics, migration, and humanitarianism. In moving away from culturalist explanations for illness, physician anthropologists have drawn attention to the manifold workings of structural violence—and have often sacrificed the possibility of deep epistemological challenges to biomedicine. While raising a note of caution about the moral authority of physician anthropologists, I recognize that much of this scholarship has laid the intellectual groundwork for a movement toward equity that refuses to justify poor-quality health care for poor people.