Medicial Anthro Midterm 2

different terms for disability

"1: to deprive of legal right, qualification, or capacity; 2: to make incapable or ineffective; esp: to deprive of physical, moral, or intellectual strength. DisabledDisabled"incapacitated by illness, injury or wounds." "Disability "1a: The condition of being disabled; b: inability to pursue an occupation because of physical or mental impairment; 2: lack of legal qualification to do something 3: a disqualification, restriction, or disadvantage. disqualification, restriction, Cripple "1: a lame or partly disabled person or animal; 2: something flawed or imperfect; 3: to deprive of strength, efficiency, wholeness, or capability for service." Handicapped "2: a disadvantage that makes achievement unusually difficult;esp: a having a physical or mental disability that substantially limits activity disability; esp. in relation to employment or education."

Body Silent

"I'd rather be dead." -Overhearing a congressional aide when Murphy is lobbying Congress for the Americans with Disabilities Act. -Loud enough to be heard -Reflects a profound lack of understanding and value of differences in experiences of life. "The long term physically impaired are neither sick nor well, neither dead not fully alive, neither out of society nor wholly in it. They are human beings but their bodies are warped or malfunctioning, leaving their full humanity in doubt.

Disease vs Illness

"Objective" categorization of signs and symptoms •Int'l Classification of Diseases •Decimal system •Diagnostic and Statistical Manual •ILLNESS: Subjective experience of not being well / fit / functioning

3 levels of causation complex interactions

(1) Microbiological [proximate causes] (2) behavioral [microsociological] (3) political-economic [macro level] *As you go upstream, the solutions are harder to ID and implement

Schizophrenia In India v. USA---how psychiatric illnessess differ between cultures?

*In India, the family remains fully involved in the treatment, unlike in America. *In India, unlike in America, ascribed family roles are important to one's social status and sense of self; patients do not have to be primary bread- winners or primary caretakers to be considered valuable members of the household; people may live in joint families. *In India, unskilled and semi-skilled work, such as agriculture and home- based artisan piecework, may be less stressful and less demanding than entry-level jobs in America, which are often in fast-paced, high-social- contact settings like McDonald's. *In India, fewer families exhibit expressed emotion than in America. *In India, while psychiatrists diagnose schizophrenia in patients, they do not use the label in interacting with the patients and the patients do not use the label for themselves. *In India, the auditory hallucinations of persons with serious psychotic disorder may be more benign. *In India, there are subtle psychological features that may shape an individual's reactivity: psychotic hallucinations may seem more similar to standard religious practice than they do in America; there may be a different understanding of self-coherence; there may be a different degree of stigma attached to mental illness as, for example, compared to divorce; there may be different expectations of professional achievement; and there may be different degrees of comfort with allopathic medicine.

obesity epidemic

-2200 surgeon general's report childhood obesity not so rare anymore

Conceptual Tools. Structural Violence.

-Absolute poverty- for example, not having money to buy enough food to eat- deeply affects health. -relative poverty also affects life expectancy, even when basic needs for survival are fulfilled -other social factors in addition to income also affect health outcomes. One of these is gender. sex- biological gender- refers to the more important and more pervasive social, cultural. economic, and political differences between men and women access to resources or exposure to both social and epidemiological stressors.---> problems of underreporting and under recognition of diseases An important critique of the literature on women's health is that women have been "essentialized" as reproducers: their most essential characteristic has been their ability to reproduce Men have gender too, which affects their health men report less race is not a useful biological category but is an important social category race---lacks biological basis (lack phenotype and genotype) The North American rule of racial hypodescent is one indication of the social construction of race. Race affects health outcomes because of its importance as a social category Ethnicity is a useful and important social construct Ethnicity interacts with social class (those f ethnic minorites are in lower social class), but everyone in America thinks were in the middle class The impact of social inequalities including class, gender, and race-on health is structural violence ex) slavery Cultural explanations for health disparities can cover up structural violence

#38 Ron Barrett and Peter Brown. Stigma in the Time of Influenza: Social and Institutional Responses to Pandemic Emergencies

1) In a practical sense, how do you go about reducing the fear and stigma associated with a particular infectious disease? more education 2) Could one argue that a certain degree of social stigma is healthy. because of social isolation reduces the chances of spread of infection? yes 3) To what extent might other forms of social discrimination, such as those against women, homosexuals, and ethnic minorities, affect people's attitudes toward certain disease? make them be more reluntact to seak treatment What could happen when a society focuses mainly on certain kinds of diseases and not others? get diseases that get worse have no treatment ppl dont come forward when sick To what extent are people's anxieties about avian influenza (bird flu) linked to anxieties about other kinds of threats, such as terrorism or economic collapse? VERY much linked 1918 influenza model-proved stigma was huge stigma used to be greek word for mark Leprosy is a stigma---> way worse than what ppl say about it Same with AIDS and HIV stigma can be a biosocial phenomenon 1) barriers in health seeking reduces early detection and treatment 2) social marginizaltion can lead to poverty and neglect 3)stigmaized group may have less trust in health porfessionals Bird flu in India--->many fled, many ppl avoided this area or blocked it off, ppl not only got worse health but loss money (econmics) and bad social rap, but also some (+) bc helped with connections between mulsims and hindus Spani flu was more stigma than India got censorship, all the blame was put on Spain, can be more prepared and public Stigma and worry about stuff can waste monetary resources Need less stigma so ppl can seek treatment and get less ppl sick

Culture and mental health: culture bound syndromes

1) labelling theory 2) mental pathology---as a mechanism of social control, how if you dont support the state they lock you up 3) culutre bound syndromes- controversises 4) Latah, Koro, Susto, amok, artic hysteri (Pibloktoq), ataques de nervios Latah---indonesia and Asia, hyper startling illness, when starlted they lose it and have a hard time to get them out of the state (old ladies), get scared several times a day. Did it also on Harvard men (freshmen) Koro-labeling of normal thing, belief and reaction in Nigeria (only in men), fear that penis will retract into body and disappear, idea that witches do this, they tie weighs on them--> anxiety and fear Amok- indonesia and men, sudden mass assualt syndrome, start to hurt people, men with swords Artic Hysteria--eskimos, with fear started running and running into the cold Ataques de nervios--having a mental breakdown, like you have allergies Helps you get out of your duties Idioms of destress--saying you are suffering of a culutral bond syndrome is a way of trying to communicate you are in destress and asking for help. things get explained in different ways Labeling for austim/adhd---> more people getting more diagnosis (happening more or expanding definition of medicalizing normal behvaior)

5 Models of disability ( theoretical approaches to disability: medical, charity, economic, religious, social)

1) medical model Biological-Inferiority or Functional-Limitation Model Individualistic Disability as largely unconnected to environment Employs biomedical constructs and definitions Criticized for: for: -characterizing people with disabilities as "lacking" or "abnormal"" curative focus/ goal is making disabled people more "normal" - limited biomedical solutions 2) Tragedy/Charity Model Victims of circumstance, objects of pity Employed by charities to fund-raise Criticized for:- negative victim image offensive to disabled persons- lowering disabled person's self-esteem/ recipients of charity- creating an expectation of gratitude /imposed on the beneficiary 3) Economic Model Defines disability by inability to work Evaluates individual worth based on economic productivity Assesses how much impairment interferes economic productivity for individual, employer and state Used to distribute benefits Criticized for: 1.- pitting individual against employer- 2.- stigmatizing disabled person's for failing to match other's performance 3.- quantifying human value based on economic efficiency 4) Religious Model Views disability as: punishment from an external force due to misdeeds of individual or family members due to misdeeds result of actions committed in previous incarnations necessary suffering for a future reward Criticized for: 1.- stigmatizing, lowering status and increasing social isolation 2.- requiring acts of exorcism, persecution and even death 5) social Model Aka Minority Group Model Views disability "as a consequence of environmental, social, and attitudinal barriers that prevent people with impairments and attitudinal barriers form maximum participation in society - if the problem lies with society/envrn then society/envrn must change Onus lies with society NOT the individual. Criticized for:1.- too much emphasis on environment and social attitudes 2.- problems of multi-positionality (i.e. black and disabled)

4 Elements of Stigma

1.Barriers against health care seeking 2.Social marginalization leading to poverty and neglect 3.Distrust of health authorities 4.Distorted perceptions of risk

3 types of sick role

1.Conditional 2.Unconditionally legitimate 3.Illegitimate role: condition that is stigmatized by others

Anthropogenic Sources of Social Suffering in the Illness Experience

1.Created by inequities 2.Compounded by inappropriate use of resources 3.Magnified by discrimination 4.Augmented by fear 5.Amplified by social death

Critical Variables

1.Epidemiological character and diagnostic specificity of the illness 2.Social status of the susceptible population 3.Media Attention 4.Biomedical champions 5.Overall cultural context --

A Revised Cultural Formulation Kleinman and Benson--revision of problem in the clinic

1.Ethnic Identity .2.What is at Stake? .3.The Illness Narrative 4.Psychosocial Stresses 5.The Problem of Cultural Competency Why is culuture so difficult to define? Why do people working in the health care system tend to believe that they do not have a culture? What does it mean to say that culture is not static? both have it, it's changing (evoluting), doctors see themselves as unbias "Competence" Implies that an individual has the knowledge and skills to do something. What is that cultural-competence course are trying to teach? how to not sterotype, be racist What do the authors mean by explanatory models? Is a physician asked the "eight questions" how would you react? mean ways to explain social world affects and is affected by illness What is the new "cultural formulation" and how is it different from the explanatory model approach? asking patients questions more enthnographic How might perceptions of what, in general, is at stake influence a patient's ability to heal? can actually trust and seek help cultural competency training is now required need to be aware of culture in order to treat better problem is it reduces culture to technical skill culture is typically the same as ethnicity, nationality, and language culture comp---a list of dos and donts:::: can be dangerous because we then steretoype culture is econmoic, poltical, religious, psychological, and biological cultre is relgious, common sense interpretations, and collective individual idenitty 1) ask about ethnicity can help but also leads to stereotypes 2) what is at stake? (relationships? moral live of patients with their family) 3) illness narrative: EXPLANATORY MODEL aimed at acquiring an understanding of the meaning of illness 4) psychosocial stresses: consider on going stresses and social supports that characterize people' lives 5) influence of culture on clinical relationships---need to unpack info need to see effects of culture of biomedicine 6) the problems of a cultural competency approach does the intervention actually work??? health professionals can restore broken relationshoops do not stigmaize or steroetype patient culture is no just what the patient has, doctor also has culture

*************Galtung's 3 levels of violence

1.Interpersonal violence .2.Social violence- between ppl and group .3.Structural violence- poltical organizations, police oppression Gault says sturcutral violence is invisble, but results are visible and real Structural violence refers to "taken for granted" cultural assumptions of how the world works

How Stigma Affects Health: Four Elements

1.Stigma as barrier to health seekinga. Reduces early detection / treatment 2.Poverty of discredited groups increases the susceptibility and transmission of disease 3.Distrust of government and health providers during emergency 4.Stigma can distort perceptions of riska. Mass panic can resultb.Disproportionate allocation of resources

Sick Role Rights

1.The sick person is exempt from normal social roles 2.The sick person is not responsible for their condition

Sick Role Obligations

1.The sick person should try to get well 2.The sick person should seek technically competent help and cooperate with the medical professional

Review session

2 types of ciritcal med anthro---poltical economy***** and crituques of biomedicine/social inequalities Margret Lock----died if ppl got dead organ from corspe, dead- no breathing and non heart beat, but now the deifiton is brain death to see if there was activity in the brain and i not e can keep them be alive and use them to organ donate hierarchy of restort: the order in which we seek care. (ex go to mother and then mayb doc, but in other places mayb they go to mother and then folk healers) Read: #24, 25 (know about her methodology and textual anaylsis and what ppl and docs say about menstruation, 26 (know about two groups in Islam, Sh'in and shitte and how they feel about IVF and reprodcutive technology), #27, 28, 29, 30, 31, 33***** (cultural formulation-->substitute for cultural competnece and a better version on if...cultural humility is a better form of cultural competnecy (but has some stereotypes pg. 334 cultural humilty--uselful alternative to CC), 34 (********Kleinman and the explanatory model and critcizes of it know gray box on 327 and know the seven questions are look at pp slide 18-all the above but use the 8 from the slides) revision----explanatory model not enough, ***what is at stake and identity -----syndemics cant be addresses this way, and the way clinics use 8 questions to end convo not start one, need to change the way the docs ask these questions Expressions of pain---diffference between genders, cultures, and idioms of destress somatization---mental stress become physicial pain (ex. middle east, hurt in the heart) Irish being stoic Jews complaining WASP were "perfect" legal aspects: some court said they said to a translator/interprettors civil rights in the 60s--- right to transportation, public buildings need ramps, mutlilanguage ppl need translator, HOSPITALS HAVE TO SUPPLY ADQUIT LANGUAGE TRANSLATION (obligation in many states, to have culturally competency hospitals) 16. language and cross-cultural medicine: our mental illnesses are not the same everywhere (depression and schzio), 7. Courtesy stigma---like the guy who taught english was able to skip the line, a lot associtation ****the stigma rubbs off when u affliated with the person with the disease you obtain the stigma as well In'l classification of disease (ICD)---widiely used and accepted ways of defining an illness, very standard Social construction of illness categories---dont fit in the social definition of the norm you are considered abnormal so your ill liminality--- human behinds go through these phase, going to one social role to another, (ex. like puberty being a child to an adult), unstable stage not fullfilling any certain social role ***know disability,that list, sick role: pg. 366: conditional , unconditional and illegitmate AND WHAT ARE YOUR RESPONSIBILTY (obligations: get well and seek help, expected from normal roles, need seek hep, and rest, and less dependent) new definition because of death bc brain death is invisible 9 defintions 2/3 listing? coutersy stigma?????

NPR Podcast. The International Trade in Organs. Nancy Scheper-Hughes (30 min)

A black market in organs may evoke images of faraway places with impoverished donors, shady brokers and seedy clinics, but Rosenbaum's arrest, the first of its kind in the United States, appears to confirm that the buying and selling of human organs is also conducted right here, with transplants by American surgeons in American hospitals. Transplant surgeons and their teams here in the United States are, you know, trained to screen donors and to, you know, go through a kind of psychological profile and a series of questions with them to weed out this sort of thing. They came home very sick with HIV and Hep-C and other problems. So India kind of dropped out, Pakistan moved up, but the Israeli network is the most extensive, as I said, in terms of its organizational power, is quite incredible. I'm sure there are many more now - in several villages of Moldova, had been recruited by brokers, local kidney hunters, and then passed on to higher-up brokers, trafficked to Turkey, and then some of them even came into New York City.

Many Critiques of "Competency

Arrogance Smokescreen obscuring social injustice A stagnant view of culture (stereotype) How different from patient-centered? EMs; communication skillscare? Enable patients not doctors

Leprosy/Hansen's Disease is the Archetype of Stigma

Bible - "unclean" Social rejects Leprosarium - Leper Colony HANSEN DISEASE Mycobacterium leprae•Closely related to M. tuberculosis •Very low contagion•Est. 90% of infections are subclinical Transmission unknown•Cannot be cultured on artificial media Readily treatable•MDT: dapsone; clofazamine; rifampicin

Sara Bartman and phernology

Brought back to Britian from Africa, and considered a strange body and objective Cesare Lombroso---phrnology racial determinism atavasim--animalistic tratts could tell about people with shape of heads---said it was genetic (people has genetically criminal)

Paul Farmer - clinical medicine and structural violence

Can clinicians use this political economic understanding in practice?practice? What can be done with a treatment plan? The need for a team approack

Obesity

Clinician's view: one patient at a time evidence-based therapies, tailerd for the individual patient (evidence and personal experience) scientist--- comparing groups of ppl, stats results for generalizations central question: describe pehnomenon, explain process problems in sitching from population measures to clinical pratices Obesity is an excess of adipose tissue: TOO MUCH body fat, typically measure in weigh, a RISK FACTOR for chronic diseases: diabetes, hypertension, some cancers A stigmatized social coniditon, an epidemic Funcion of fat: store engery

Challenging th Ntions of Brain death

Compares Japan and the US in the way they define death, and transplant technologies Lock's task=not to determine the morally correct path The way we define death is way more complex Brain death is invisible--can only see in brain waves Brain death is ambigous it's culturally bound concept, not an universal or objective death Brain Death is a New Death in hisotry (traditional death was with the heart) Brain death is not a moment of deth but a process of dying

Dissociation and Self-Neglect

Concealment of affected limbs (discoloration) •Non-use of affected limbs for gesturing •Reference to affected parts in non-possessive •Neglecting treatment of wounds because of lack of pain and shame •Ulterior motives in begging?

Compliance

Conforming to a request or demand Why were Nao Kao and Founa not compliannt in giving her medicine?? Think about how Lia was moved to foster care In this regard, you may want to consider whose interests did the social worker (Jeanine) represent?

The opposite of CC (and the goal of patient centered care)

Cultural Humility 1. Incorporates a lifelong . commitment to self evaluation and self-critique, 2.Incorporates a lifelong commitment to redressing the power imbalances in the patient-physician dynamic, 3. incorporates a lifelong commitment to developing mutually beneficial and nonpaternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations Biomedical Practitioners need to first understand their own first understand their own culture Conclusions 1 A (baby) Step in the Right Direction? -Expedient thing to do--Consumer oriented Within jurisdiction of Health Care organizations What should be the content?-Awareness of the general range of cultural variation in ethnomedical beliefs is not common Conclusions 2 Does anyone really believes that cultural competency training is going to significantly decrease disparities? (mistaken) Conclusions 3 American cultural belief system overestimates the agency of individuals - both healthcare providers and clients.

CULTURAL COMPETENCE (and the critiques)

Cultural sensitivity Cultural awareness Cross-cultural medicine Cultural appropriateness CULTURAL COMPETENCE Where does the "competence" noun from? certification & teaching for professional skills -Medicine/Health education / Nursing Linguistic competence required (ADA 1990) Lack of definitionsLack of definitions Combination-Adequate language translation--Multiculturalism(ethnicity, sexual orientation)orientation) --Racial and Ethnic Disparities Legal Issues--Title VI, Civil Rights Act -Torts, many state and medicaid laws

Conceptual tools: Culture, illness, and mental health

Culture defines normality, and cultural rules determine who is crazy---> biased on comparision We diagnosis with DSM, but also need to keep in mind other cultures Some mental conditions may be more pronounced or elaborated in particular cultural settings; these conditions have been labled "culture-bound" or "culture-specfic" syndromes ex) latah, koro, pibloktoq, amol, and susto also ppl say PMS and PMDD Some cross-cultural psychiatrists believe that there are a very small number of universal mental illnesses, two of which correspond to biomedical labels of "schizophrenia" and "depression" Different cultures have their own ethnopsychiatric systems for diagnosing and curing mental illness. All ethnopsychiatric systems are based on cultural assumptions and social role expectations (Euro is very body-mind is diff) Because mental illnessess are so difficult to define, it is sometimes difficult to know if they are increasing or decreasing Social stress is a serious cause of illness Mental health problems are not limited to the developed world--- must focus on DALYs (disability-adjusted life years) Structural violence is related to trauma and Post Traumatic Stress Disorder (PTSD)

Inequality in Treatment Decisions

Diagnoses and treatment options Preventive services Worse outcomes ~ delayed treatment seeking How much of the health disparity is due to health care system think about how Blacks arre typically an example of this

Battling Stigma

Disclosure•Bravery •Pride•Political Action•Public Presence - breaking stereotypes•"Normalizing" Culture DOES change-----but takes time

Health Beliefs - High Blood vs High-Pertension (Tension)

Documented 1.Existence of health beliefs related to hypertension in AA women in New Orleans 2.Measurable relationship between beliefs and compliance 3.Doctors were unaware 4.Suggests value of training doctors about this - choosing therapetics

Language and culture

Dr. Dan Murphy said, "The language barrier was the most obvious problem, but not the most important. The biggest problem was the cultural barrier. There is a tremendous difference between dealing with the Hmong and dealing with anyone else. An infinite difference"

Doctors and Rules

Dr. Neil Ernst said, "I felt it was important for these Hmongs to understand that there were certain elements of medicine that we understood better than they did and that there were certain rules they had to follow with their kids' lives. I wanted the word to get out in the community that if they deviated from that, it was not acceptable behavior"

Political Ecology: the Unnatural History of Disease

Elites' unconscious strategic reasons for "naturalizing" the discourse on for ecological and social relations Elites can't see themselves as a source of problems Industrial Revolution, coal pollution and the Peppered mothI 'malaria blocks development' cultural model •Relationship between disease and poverty •Use disease eradication to "naturally" spur economic development

What's the problem when Epidemiology stops short?

Essentializing race/ethnicity/gender as if they are purely biological factors as if in etiology. Failing to go "upstream" think of how it does 2x2 Implies that health issues are a "separate capsule" from other social problems. This means that proposed Public Health solutions health problems are set apart from larger public health policy debates IDEA OF SYNDEMICS COUNTERS THIS MISTAKE ex) race--has no bio basis but is the reason for many problems ex) gender---> many people mixed up gender and sex, BUT Are higher male mortality rates result of biology and Y result gene disability? or learned sex roles and "masculine" behavior? ex) social class---we dont get health stats based on social class

Arthur Kleinman: Psychiatry (Explanatory models)

Explanatory Models Illness NarrativesIllness 8 questions 1. What do you call the problem? 2. What do you think caused the problem? 3. Why do you think it started when it did? 4. What do you think the sickness does? How does it work? 5. How severe is the sickness? Will it have a short or a long course? 6. What kind of treatment do you think the patient should receive? What are the most important results you hope s/he receives from this treatment? 7. What are the chief problems the sickness has caused? 8. What do you fear most about the sickness?

Stress on Doctors and Staff

Fadiman says "I was struck...by the staggering toll of stress that the Hmong exacted from the people who took care of them, particularly the ones who were young, idealistic, and meticulous" (p. 75). Dr. Roger Fife is liked by the Hmong because, in their words, he "doesn't cut" (p. 76). He is not highly regarded by some of the other doctors, however. One resident went so far as to say, "He's a little thick."

Stigma about influenza

Fear, Stigma, and Social Responses to Pandemic Influenza Why do some diseases provoke more social response?•Classic examples•STIGMA: Leprosy, Epilepsy, HIV/AIDS•FEAR: Cholera, Plague, Ebola, SARS

Seth Homes Fresh Fruit and Broken Bodies

Fieldwork - participant observation Multi-sited work MD/PhD Ethnography - field and clinic Low placement of Triqui Mexicans in the labor hierarchy is considered "natural" hierarchy is considered "natural" - and unquestioned- and unquestioned

Explain the etiology of obesity

Genes enivornmnet (nature v nuture) Personal choice ----is there an american culutral emphasis on the individual Anthropological perspective -evolution-biological and cultrual higher level of analysis than individual cross-cultural comparison Can we blame and stigmatized ppl even in itlaty they have an increase in this chronic disease

Understanding Biomedical Culture

Good - Medicine, Rationality and Experience --Ethnographic studies of medical school, residency, doctors, surgeons Emphasis on time, efficiency, laboratory tests -All linked to the economic system of health care financing

Culture Mental Health- Austime, PTSD, Schizphernia

Grinkley--> look at Western populations everything depends on how they were raised in urban society: it's a spectrum so it depends on everyones ability in social interactiosn, Lurhman, Finley Have ppl in commintie that vote that makes you have this illness less silence=less stigma Shell shock---traumatic injury from being close to bomb and trama of being killed that---old name for PTSD -intervieweed partners to see if the men have PTSD Men get sense of belonging and botherhood in the war, because most had no plans after the army, so there's a lost of community Got a lot of vets hooked on herion, but came back to place where they were dispised. Irish culture--dont express sexual desire had the highest of schiizo most men who had schizo were bachelors Couldn't marry becaue got farm and needed a match for marriage, butif not farm they could never have a marriage---no sex, more drinking, lots of isolated men who are put in to elder house. Irish pscyhirsats had diff way of diagnosing Lurham--illness has identiy Byron good's hypotheses- prescence of extended family, experience of mental illness is a social one is it conict, happens over and over 1) local culutral interpretation of Mental Illness a) inevitably chronic b) broken part of the self 2)Prescene of extended family 3)Basic Social Environment a living conditions

Conclusions about HD

HD is a prototype for other stigmatized diseasesBiocultural linkages between the social and physical stigmata of discredited diseasesDiscrimination is an illness that is inclusive of the marked physical condition Questions of etiology...

Public Health: Ben Paul

Health, Culture and Community-- 16 Case studies in public in public reactions to health programs reactions The importance of understanding local cultural beliefs and social organization Harvard School of Public Health

role of discrimination and stigma

How can one fight stigma and discrimination? makes stuff way harder

Disability Studies

How is disability to be understood?? - not as an individual flaws but as society's problem - minority group status: analogous to other socially oppressed groups value-neutral or even positive experience

#41 Brewis. Expanding Bodies in a Shrinking World: Anthropological Perspectives on the Global "Obesity Epidemic"

How might overweight and obesity be culturally constructed? What is a normal weight? Who decides? Seen as socially lazy or bad, not normal, society deciced How does evolution help to explain the human predisposition to overweight and obesity? we are good at getting fat Why does the author put "obesity epidemic" within quotation marks? bc its not really Why do you think that plumpness has been a marker of beauty in women in so many cultures throughout the world? bc have some money and some resources BMI aint everything -cardo vas. disease largest single cause of mortality in the world fatness is a porb bc of lifestyle and eating used to rare to elites Samaos are now wayyy more obese get diabetes, hypertension, musculoskeletal disease, cancers, depression Classify obesity as a disease obese ppl are seen as damage to society socialetal neg to be fat---> ugly, but it's not like that everywhere more stigma if larger being fat= sociocultural beliefs--->seen as immoral, lazy They themselves are to blame need good framing diff in gender-->women biol more fat wealth and poverty are shapers lower income, no time to work out, can only afford bad food o tend to b fat SYNDEMIC_---clustered and entiwned with social inequalities and other diseases in ways that solidify and reinforce manifold intersecting vulnerablities within communities and populations 1) obesiy is becoming more normal 2) obs. not always a biological, unhealthy state 3) obs. is increasingly socially damaging 4) most of the approach to treating obesity are fighting against our evolved biologies, as well as our contemporary physical and social environment

Euro-American Classifications

How most Western/white people define mental way -use DSM -update -they choose the category/symptoms they define what the certain mental illness is See us as MIND V. BODY Used to have AXIS I v. AXIS II ----Affective Disorders and Psychotic Disorders •i.e. Depression; Anxiety •i.e. Schizophrenia; Acute Psychosis

#29 Arthur Kleinman. Do Psychiatric Disorders Differ in Different Cultures?

If illnesses are socially constructed, how is it possible to compare mental illness rates and symptom complexes across cultures? How can one compare psychiatric diagnoses across cultures when standards of normal behavior differ from culture to culture? Is this a pointless endeavor? Need to know lang very hard to do Although it is clear that family patterning and/or genetic predispositions are involved in schizo and depression, the author says that the actual causes of these illnesses are not known. Why do you think this may be the case? bc its mutl factied What is somatization in the expression of psychological discomfot? WHy might it be important for a healer to be aware of the process of somatization? when you get back aches but nothing is really setting them off need to know bc can be stress or worry need other cultures def to know what mental illness is shizo lower in poor countries than high No one knows what shciso comes from, but very genetic schizo based on poltical economy depression defin can vary more culturally approp. more depression each country has diff set of definitions for what is depression symptomatolody---> have more physical symptoms if lack cultural knowledge then we dont know go recorded less for poorer countries for some stats men also carry it out way more than women diff groups treat diff, white use medicine treatment is culture bound

#11 Social Inequalities and Emerging Infectious Diseases

If the political-ecological argumemt is true what are the implications for the distribution of resources to deal with emerging infectious diseases? hard to get things done Why do many people (including physicians and epidemiologists) feel uncomfortable when an ecological analysis is expanded to the world of politics? Are political dimensions so complicated and thorny that they make solutions seem less imaginable? a lot, makes it hard bc of poltical tension emergining diseases include old disease like malaria but dont talk about povery and inequalities need a critical approach-->need to ask these hard questions poltical ecology challenges some of the standard presuppositions that are used in defining health problems AIDS have allowed for other diseases to come back like TB New categories- benefits and limitatiions get sense of urgency, notoriously difficult to have higher ups do anything about it change in ecology is result of this (farming, travel etc) Also have microable mutations epistemology--> units of analysis and key terms will be scruntized and define more than once, process will include regular rethinking not only of the methods and study design but also of the validity of causal inference and relfection on the limits of human knoledge Poverty keeps these dieases, but imporvement in sanitaiton et get rid of them explanatory power is needed ot track things that are rapidly changing need critcal approach to anythong emergin can see ebola from trade networks disease visiblity matters ignorance to TB made it come back- was always with the poor so lack of attention maing it come back Blamed Haiti for giving HIV HIV because of urbanization TRAVEL ---but also social inequalities

Patient-Centered Care

In 2001, The Institute of Medicine (IOM) defined patient-centered care as "providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions."

47- the hisotry of organ donor in US

In the US- the fresher the better the essence of the person is only in the brain

#25 Emily Martin. Medical Metaphors of Women's Bodies: Menstruation and Menopause

In what types of metaphors are women "essentialized" as reproducers from the biomedical viewpoint? like factory workers Is it possible for this type of metaphorical analysis to fit with evolutionary medical analyses introduced in the first part of this book? Yes, change in lanague Is the use of negative metaphors in texts a male plot? OR do women also incorporate these cultural models in this discourse and thinking? it's both How might Martin's analysis fit with the creation of premenstrual syndrome as a pathology? Maybe this is normal and we just make it sound bad This article is 30 years old. Do you think sexist metaphors and language still exist in modern biomedicine? YESSS a lot of this is socially constructed why are periods and menopause seen as soemthing negative women parts are male but inside out strucutrally similary but not equal men--more heat--more perfect blood turned into fat during meopause seen as flushing blood menstrual blood as unclean Hobbes and locke--natural order need a a balance of building and breakdowning saw females as inferior to men Geddes--doctrine of seperate spheres menstration as a disorder menopause seen as econommic later get hormones and cell sginaling Gets more complex as time passes on hierarchy or hormone and how it actually biologucally happnes with aging womemn get negative words a long with menopuase description we menstrauct because we want a bby God make no idel workers---see women's parts are factory worker still have neg words for periods compare males and female gametes and what we both start with women's centeral purpose is to make estogren but now women use birth control and other methods, may seem weird to men

Schizophrenia

Is it purely biological? •More men than women affected (1.4 to 1) •People in poorer countries (like India) often have better treatment outcomes than those in places like the United States •Why?

Why might stigma exists

Is stigma a part of human nature or is it culturally constructed?

Health Effects of Structural Violence

LBW babies and infant mortality in educated African American women

L.E.A.R.N Model for effective Cross-cultural communication

Listen Explain Acknowledge Recommend Negotiate only used in the US

Concealment and Under-treatment OF LEPORASY

Majority of informants reported >3 month delay between 1st symptoms and diagnosis.KSA = 10/17 (59%) DAS=19/31 (61%)Concealment is the chief factor given by South Asian families for late detection of HD.

Early Clinical Applications Ethnicity and Pain

Marc Zborowski (1952) "Cultural Components in Response to Pain"-- White ethnics in NE: Jews, Italians, Irish, WASP --Exaggeration? Stoic?Exaggeration?

Medicilization of sex

Masters of sex good or bad? controversial why?? Many of these stigmas with women's gential cancers, sex info---no one talked about it, or sexual dsyfunctions got a scientiic approach of it

Peter Brown conclusions

My conclusions 1 of 4 A (baby) Step in the Right Direction?--Expedient thing to do--Consumer oriented improve quality of care Health Care organizations should be responsible My conclusions 2 of 4 What should be the content of training?-- Awareness of the general range of cultural variation in ethnomedical beliefs is not common-It needs to be STRUCTURAL COMPETENCY--With encouragement of CULTURAL HUMILITY My Conclusions 3 of 4 Does anyone really believes that cultural competency training is going to significantly decrease disparities? My Conclusions 4 OF 4 American cultural belief system overestimates the agency of individuals - both healthcare providers and clients. Health care providers are not really in control of the system.

Globale level of obesity

Obeity is an urban problem "Nutritional transition" -urban poor (slum dwellers) in India-metabolic syndrome and signs of obesity Rural poor- PEM malnutrition Green revolution -produces more food, but requires investments in fertilizer and irrigation Favors larger farmers displaces rural poor into urban poor poor ppl in urban bc of argiculutre and hybrid plants, really favor large farmers NOT a small land owner, they get displaced Obesity related to weath of the economy corn syrup takes over diet in corn

#13 Seth Holmes. "Oaxacans Like to Work Bent Over": the Naturalization of Social Suffering among Berry Farm Workers

Paul Farmer defines structural violence as "violence exerted systematically-that, is, indirectly- by everyone who belongs to a certain social order. What is the "certain social order" causing structural vioelnce in this case? middle clas Beyond the farm managment that Holes mentions, who is indirectly causing the suffering of the migrant farmworkers in this piece? Do these people mean to cause suffering? Do they even know they are causing suffering> How much responsibilty should they take? yes and no, but we should all do better to get fair trade Why don't most of us know, or think about, the human story behind our food? bc we dont want to be sad How do ideas baout race shape structural violence? oppress a group because of racism migrant laborers live in poor conditions and hidden away in plain site farm executives then crop managers, then supervisors, then admistravtive assistants, then checkers, then hourly field workers then the contract field workers Tanaka farm says their family friendly but they aint Anglo-Americans live in good houses many feel as though they are abused some give workers respect others are racist Mexicans immgrants oppress Triqui indigenous Heirarchy of race: white and asian-america US citizen, then Lation US citizen or resident, undoc mestizo Mwxican, undoc Indigenous mexican ethnicity esatblishes one occupation PG 146 for actual diagram got lots of prvilegdges as white guy but many thought he was a spy Triqui have most stressful and orpressice job many self treat---alcholoism which leads to women being abused made fun of for having pain Tanaka owners are nice prob is with checkers, crop managers many docs didn't see how racism and problems effected Triqui medicine is so called anti poltical but that's not true behavoir being apart of illness---can also blame victims behavior (such as how htey bend) is the reason for them being sick Opression from farm to migrant clinilc (in this loop) never represent the pickers symbolic violence is the naturalization including internalizaion of social asymmetries say because of hieght the Oaxaques can pick- say they belong picking, and that they are strong so pestcide doesn't effect them symbolic violence becomes internatlized we also create oppression by not picking fair trade things

Obesity Epifemic solutions

Primary Prevention: children (decrease TV watching) Treatment: a hisotry of poor results -the diet industry: weight regained (FINISH LOOKING AT SLIDE)

PTSD Case

Remember the reading about returning veterans Men less likely to seek help but of male role (cultural role) If men couldn't have the "man of the house role" they knew it was bc of the illness

Sick Role

Sick role is a term used in medical sociology regarding sickness and the rights and obligations of the affected. The individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. •cultural norms... Being sick is a type of social deviance•Temporary and excusable

Structural Violence and Social Class

Social Class: "Differential access to strategic resources •What are these strategic resources that affect health? •More of a materialist approach SES: Socioeconomic status: hierarchy of prestige •More of a cognitive/cultural approach

anorexia nervosa

Social epidemiological distribution Who: young adolscents, young adults, females social class: middle and upper class personality: prefectionists, can also b males: like high school westerles Very hard to get out of cycle tend to be very skinny beliea---hidden stigmatized illnes biological and psychological markers they also have distrubed body images, think they are still fat, and try to become even more thinner Men also can have distrubed body images, think their fat is ok relates to Nacirema---> control part, body is naturally ugly, so must hard or else body will look bad The amount of disphoria is striking and sad

Stigma and disease types

Stigma and infectious disease•Leprosy•Influenza Stigma and non-infectious disease•Mental illness•Chronic illness

HIV / AIDS

Stigmatized •Lower prevalence = greater stigma Stigma and public protest: getting attention, embracing identities, and demanding public health policy change campaigns

structural violence

Structural violence is invisible, but its results are visible and real. Structural violence refers to "taken for granted" cultural assumptions of how the world works. The "isms": ••racism, ••sexism, ••classism, ••colorism,, ••slavery, ••indentured servitude••agism•Anti-immigrant The idea here is that socioeconomic game is rigged in favor of rigged in favor of elites • Example in terms of race - 13th amendment and and Jim Crow laws; literacy literacy tests for voter registration housing and red-lining and mortgage access Sentencing guidelines for crack vs powder cocaine

Ethnopsychiatry

The application of cross-cultural study to the diagnosis and treatment of mental illness -Examines cultural views on mental illness •Local practices surrounding mental illnesses •Based on cultural assumptions and social roles •Idea that if we understand how culture creates and shapes mental illness, we can better treat it Think of Balinese man and how his schizo is with religious figures and they chase him---violent, due to war? poverty?

Liminality---death

The critically important marginal or in-between phase of a rite of passage The long term physically impaired are not ill, for illness is transitional to either death or recovery. Indeed, is transitional to either death or recovery. Indeed, illness is a fine example of a nonreligious, nonceremonial liminal condition. The sick person lives in a state of social suspension sick person until he or she gets better. The disabled spend a lifetime in a similar a similar suspended state.

Conceptual tools: The meaning and experience of illness

The illness experience may be powerful: patients point of view is emic, need to have a personal relationship The illness experience may include social and pscyhological dimensions that cannot be cured with medicine illness experience is pateint-centered view od sicknss (social and psychological) Illness-- and the sufferng associated with it- is a human experience profoundly shaped by culture Often the meaning of an illness is a particular setting is reflective of larger social, political, economic, and/or moral concerns People use narraives to help understand illness and also to forge a way of better managing their own and other's suffering The sick role is an important concept: being sick can have benefits (dont have to go to work), but have social expections (follow docs orders), if they dont follow social role they are considered faking Illness and healing can be transformative experiences (kind of like a rite of passage)

Origins of "Handicapped"

The word "handicapped" was first used in Great Britain after the Crimean War. Medicine had advanced to a point where large numbers of soldiers were returning home with injuries that would have proved fatal in earlier wars. To aid the severely disabled men, Parliament made it legal for war veterans to beg on the streets; they could keep a "cap handy" to accept donations from passerby. Because the word handicapped implies making beggars out of people with disabilities, the term is no longer acceptable. The preferred term is "people with disabilities."

Political Ecology Means Going Upstream in the Causal Chain

This is important because it identifies the intersection of biology and society materialist view of culture

organ transplant

Topics about medicilization, death and brain death, intensive care unit, organ transplants and commodification of organ (trade), international/illegal markets Microcredit schemes, from loan shark or an NGO, and the individuals get in debt and they are not able to repay People are tricked into selling their organs Take something as basic as life and death and how they get way more complex use prisoners in China for organs also get lots of pain, don't get paid properly

Implicit Bias

Unlike explicit bias (which reflects the attitudes or beliefs that one endorses at a conscious level), implicit bias is the bias in judgment and/or behavior that results from subtle cognitive processes (e.g., implicit attitudes and implicit stereotypes) that often operate at a level below conscious awareness

Female Hysteria

Unmanageable emotional excesses. Symptoms included faintness, nervousness, insomnia, fluid retention, heaviness in abdomen, muscle spasm, shortness of breath, irritability, loos of appetite for food or sex, tendency to cause trouble Treatments: Psychotherapy, hypnosis, manipulating pressure points on the forehead, insane asylums, hysterectomy, genital massage and "hysterical paroxysm" (causing orgasm) ---cant assume the cultural role of being a "woman" hysteria is the uterus leaving the body and going around the womans body

VIdeo of bambang

Video:::Mental illness place in Java Banbang windos have bars and are locked in Dunia---most isolated, most distrubed Dutch occupied Indonesia for good- teach us about planting and tobacco schizoaffective Relasped 3 times Bambang one year later--more cleaned up. Hospitalized bc got upset girlfirend, now has a wife Cousin says he never got anrgy at home But he was poor compared to his peers got expelled because of being poor When sick always sings, wants to be normal the news affected his visions is not the man of the house- does the house chores because he is mental disable he cannot return to work still very religious community helps him need for family support *thinking too much losing control This is a personality disorder globalization of psychiarty

#12 Nancy Scheper-Hughes. Culture, Scarcity and Maternal Thinking: Maternal Detachment and Infant Survival in a Brazilian Shantytown

What did the researcher gain by collecting reproductive histories of the women from Alto? Were you surprised by tha statistics from that survery? 70% of the babies die within the 1st year, no Why don't women believe in the sufficiency of breast milk for infant feeeding for the 1st six months (as reccommended by WHO) women who have too many babies is too weak to support new baby, transfer that weakness to new baby many give blood for breast feeding, it is watery sour or bad milk, so baby rejects it--mother see it as own weakness Is there any advantage for mothers in limiting their attachment to infants? Or do you think that this is a question of cultural rules about the expression of feelings? lack of attachment, able to cope and move on, able to not be blamed or be excluded Some people are offended by this selection. Why do you think that is the case? yes bc theyre stupid Is malnutrion a medical problem or a politcal problem? poltical maternal deattachment from infants that are failing to thrive Mothers in 3rd world conditions a lot Brazilian babies die childhoo mortalty is political economy not of medicial technology if baby doesn't try why waste breast milk Rosa in jail for killing son Lourdes and Ze- containmented water, food shortages, very poor Lourdes focuses on baby on not him bc that baby is stronger If baby wants to die let it die Mothers love not always common sense not classic chlid abuse both sexes values- sons could forage, while daughters were to do household chores and livelong friend mother liked fighter babies believe babies die because they are poor and hungry doenca de crianca---death by neglect (when child is permantely disabled) mother not blamed for death, just seen as child being weak see mother child bonding as typical one but it is not, but that is only for white rich mothers neglect of high risk babies is a type of statergy people dont cry at these funerals- can't grieve but have no energy

#15 Emily Mendenhall. Syndemic Suffering: Rethinking Social and Health Problems among Mexican Immigrant Women.

What does Mendenhall mean when she says that "disease and suffering are as much social as they are biological"? social things can cause them how and why is diabetes syndemic with depression? What might this connection tell us about the relationship between the "mind", the "body", and society? they both can occur mind and body are super connected What is the relationship between structural violence and what Mendenhall calls "everyday violence" such as domestic abuse? sturcutral is instutioniled and domestic is normalized syndeic- when two or more epidemics occuring simultaneously and interacting with each other intersectionality with epidemics--> llike poverty and abusive relationships VIDDA 1) violence- emcompasses sturctural, symblic and everyday forms 2) immirgation related stress, fear of deporation, experience of migration, social isolation 3) depression- chronic diorser which few poor women get treatment 4)Diabetes (type 2) 5) intepersonal abuse---all verbal, emotional, physical, and sexual abuse in women 1) structural violence-polticsl-economic and social inequalities that can both cause poor mental and physical health Becomes visible in hegemony discrimination, sexism, racism women being subjationed like abuse 2)symbolic violence- racism, sexism and classim dosn't necessary prohibit or limit agnecy but can effect reatment and decision making internalized sociocultural expection 3) everyday violence is normalized- acts against women and children that happen so often they become routine social sig of a disease through material prescnece and representation double burden disease is diabetes and TB (both comminuable and non) depression and diabetes--depression gves on diabetes need to also exxamine one's exoerience

#30 Richard Roy Grinker. What in the World is Autism? A Cross-Cultural Perspective.

What does it mean that autism is "culturally constructed?" society defines what's wrong with u Why is it difficult to know the frequency (prevalence) of a mental illness across time or between nations if the defition of the condition is unclear? bc not sure if better defining or more ppl What are those roles of stigma and blame in autstim? Why might parents in the United States often prefer a genetc explanation for thier child's symptoms, while parents in Krea often prefer an explanation that partially blames the mother? Parentin US like to know its genetic bc they raised child right In korea blame is on mom, RAD-reactive attachment disorder (lack of love or care) bc that wAY chilf still has future..this way it's not genetic Makes sense to them bc of rapid change and Korean War Is austim really a mental illness, or is it simply another dimension of human difference? difffernce What accounts for the growing awareness of austim across cultures? increase in definition and more talking How do cultural understandings of autism (the illness) affect the life course of not just the child but also the parents? effect child treatment if parents get blame or love THinking of families you may know with someone who has been diagnosed with autism spectrum disorder: Do you agree with Grinker that in the united states, the austim label "helps far more than it hurts" yes, bc more programs on a spectrum is number of children increasinf and why? Or are rates of diagnosing increasing? Has unknown source People don't vaccinate child more people came out because of soical norm and cutlural histories people go to witch doc insteead Depends on the culture: believe women's part are just inside out \1) science is a culturally and historically constituted system of knowledge that imposes categories are products of particular times and places, yet to appear to us 2) community does not share with other communities the same concepts about health, illness, and the body does not mean that its indigenous concepts are scientifically or intellectually inferior. have new terms, ways of diagnosing so austim is now more narrowly defined but if have this condition they can have more educational help, In india dont like to diagnosis bc of social stigma families also help out more give child emotional support but also stigma and fear some hide disease so child is not stigmatized but stil help kids

#27 Monir Moniruzzaman. Spare Parts for Sale: Violence, Exploitation and Suffering

What does the author mean by the commodification of the body and it's organs? Does this term reflect a cultural metaphor of the body as machine? Yes, selling body helps one gain money What do you think about the authros's argument of the impossibility of a legal open market for organs? If a person has two kidneys, why prevent him from selling one? What explanatory model of kidney function do brokers use to convince poor people to sell their kidneys? How is the model deceptive? How is it manipulative? It's wrong, say that one kidney is asleep, and they wake the other up. They are lying Also use microcredit- small loan offered to ppor person then they start a small business this has contributed to organ selling the people harrass the poor to pay off their loans, and then they embarrass them the microcredit people claim they cannot exert coercion Do you think that the 150 reusable parts of the body are usually taken from the poor and given to the rich? Why is that the case? Yes, have evidence of Chinese execution prisioners Also rich have the money to buy parts What is bioviolence? Should organ sellers be called "Living cadavers" body parts are used for commodities, and no they should not most brain dead people are the ones who donate organs most of the time organ donating is a gift, but when stolen it's bad Poor people are explotied for their organs Have liver sellings in Bangladesh---> Passed the Organ Transplant Act: imposes a ban on trading body parts. Many sell organs to escape poverty have flow of organs from third to first world Medical divide of organ donors and sellers Selling organs, illegal and disgraceful 1) entering the organ market-see in newspaper or in an ad would lie to the sellers, saying on kidney is used and the other sleeps so when doc does surgery they put the used one out and take the newly awaken one they promise money, visas, none of which they keep many make fake documents to get donation in process 2) surgery---seller have to go to India, stay in one place until they take out the kidney, many sellers feel regret 3) Postsurgery---many have to explain long abscence from family, have periodic pain, fever, infection, remorse, despair, anxiety.Sellers can get infections, HIV, other viral diseases Many feel half human if recipient died they felt weird half of their body is dead but they are alive they have no real connection with recipient many lose connection---religous, feel as if they betrayed God, and many do not escape poverty after sellign organs Those who sell organs can't go back to demadning jobs many could only use convict bodies or dead ppor ppl (very rare to find) this is very close to human slavery many feel family obligation to not donate kidney, alturism is not enough to donate enough organs If we regulated trade then less shady stuff would happen

#31 Erin Finley. "I Came Back for This?"; Veterans Living with PTSD

What effect did the diagnosus of PTSD have on these veterans' experience of their illness? can seek help, some too late What were the social factos that influenced veteran's path to treatment? being a man, family, society, police How do American ideas about masculinity shape the lives of vets with PTSD? How might this b different for female vets with the disorder? doesn't include females much can stigma them Why does Finely think that individual experience is more important than ethnicity in shaping veterans' experiences of PTSD? because depends on the trauma how do we define this when men come home from wr, can't be a man anymore??? very culturally constructed some black out and get high on drugs--ways to cope many had suicide, domestic violence, race/ethnicity can play a role wifes pointed out inability to be male go seek help for family have nightmare irrtatily many don't know until diagnosis also on a spectrum PTSD hard to sometimes see bc its very masculine maybe also smoke so why latinos have it worse--personal hisotry like dude from Honduras also latino confused PTSD with ataques de nervios also latinos have macho culture VA tries to spread word and normalize the disease

Menal Illness

What is abnormal Society plays a role normal v. abnormal 1) cultural assumptions and social roles

#14 Merrill Singer. Does America Really Want to Solve Its Drug Problem"

What is the answer to the author's question in this title? Do profits have anything to do with this? No and yes Why does the author use a historical approach that emphasizes the cultural factors shaping drug policy? too show the complexities of the problem and how it came to be where it is today shows how Nixon messed us up From a medical anthropological viewpoint, why do some people become drug users? oppression, stereotype How might political policies like the War on Drugs affect the environment of drug use? makes it harder for them to leave How is drug use in the United States related to the global political economy? a lot like wow we spend so much on drugs also spread diseases liek HIV and have the highest jail time for it War on Drugs is a social war on those who are drug users jazz players and blacks use drugs more---> make it bad Corrupt history with Cuba, China and the Golden triangle, and drug problem with Vietnam, he increased the war in Laos drug at home bad, but aboard bc of money is ok some drugs helped rebuild their society bc of depression (CHINA) Black cant use drugs bc they might atack white society----fear dropped harder drugs but weed was everywhere drugs helped with illgeal and unpopular political stuff---castro also drug users are scapgoats, only high people are excluded from this also drugs and their association are super racist There is a cycle with low paid workers and drugs- ppl use drugs to cope with living situation

. # 40 Richard O'Connor and Penny Van Esterik. De-Medicalizing Anorexia: A New Cultural Brokering

What is the role of culture in the etiology of eating disorders? How has anorexia been medicalized? How might the incorporation of anorexia as a biomedical problem actually make treatment more difficult? Considering the explanation of asceticism, why might we view upper-income, high-achieving adolescent females as being at greater risk for having anorexia? Can humans be "hungry" for more than food? What are the three dispositions of constitution that are related to anorexia Is "healthy eating" and exercise and new hegemonic ideology among certain groups in the United States? Anorexia is culturally constructed medicalization--?process by which issues that might fall in the realm of normal human variation are incororprated into biomedicine Hegemony---domanice of ideology over others state regulating bodies---biopower anorexia---self control and delayed gratification for some people it can come out of now where not always for apperance---varies for parts of the globe -can become an adictive pattern Cartesian dualism- mind and body are seperate Answer is medicialization label them as anorexia they live up to the expectations medicilaization saves lives but hegemony hurts anroexia follow culutral rules for hygeine virtuous identity family pushes to be healhty fat ppl sen as letthing themselves go age matters also bioculutral, bc organism adapts 1) performative disposition: perform for admiration for parents and teachers, perfectionist, 2) ascetic disposition--> mastered deferred gratification long before they took up restrictive eating in adolescence 3) virtuous disposition-- a major figure in the sutdy of anorexia, see themselves as good see anorexia as coming up as mysterious use simplest way to figure out why

#34 CDC staff under Suzanne Huertin-Roberts. Health Beliefs and Compliance with Prescribed Medication for Hypertension among Black Women, New Orleans

What kind of confusion might arise if a health care provider does not know that her patient bleieves in "high pertension" instead of the biomedical category "hypertension?" woulndt undertsnad y they dont take medicine Why would MMWR onsider this study important enough to publish it as timely medical news? because it helps with treatment What kind of education project seems to be suggested by this research? DO you think it would be best to focus on health care providers or on patients? ethnographic research more on patients Why does it seem logical that a person who believed that she had "high pertension" would not think that taking medication reguralry would be an important thing to do? because it's episodic Why might a person who thinks she has "high blood" believe that taking hypertension medication regularly is a reasonable thing to do? to thin the blood and refulate blood pressure becaus it's chronic As a physician, how might you ascertain whether a patient's explanatory model includes this distnction between the two conditions? Would it take too much time to have suc a conversation? no very fast folk categorization is less compliant high blood vs. high pertension high blood is considered to be a persistent condition of blood that is too thick, too rich or too heavy., makes the blood rise to the head because heart is working too heard---. red eyes, nosebleeds, heaaches, tasting of blood can get because of dier in rich red, heavy, and sweet food---> treated by blood thinning or pickle juice more blacks take high blood pressure medidcine have poor compliance, but understanding them could reduce this poor compliance bc of folk belief that pressure troubles high blood as physical disease of blood and heart in which the blood was too hot, rich or thick--> bc of poor diet, and heat, can be controled by dietary control high pertension---> to be a disease of nerves, by stress, worry---> is violatile adn episodic: because of stress blood shoots up to the head compliance is based off of whether they self diagnosis

Maternal behavior and infant neglect in Brazilian shantytown

What maternal behaviors does NSH say are not universal? •Why is there "Death Without Weeping?" the chlid needs to fight or it isnt worth keep alive

#24 Robert Murphy, The Damaged Self

Why are children often afraid when they see a disabled person? How are defintions of "normal" learned? Hey do not know, think something is wrong with them. Social definitions Murphy's paralysis developed relatively slowly, whereas most spinal cord injuries occur suddenly as a result of car crashes and other accidents. Would the cause of the injury have any relation ot the illness expereince? TO the way that others treat the disabled? Makes it harder and longer treats them diff Does Murphy's discussion of sexuality make you uncomfortable? Why? a bit , but it's natural What does Murphy mean by :unmarked categories" and the creation of the "other"? Is his analogy to the importance of race and the experience of racism relevant here? When you don't fit into one category, very elated to racism Think for a moment about what your life would be like if you were suddenly confined to a wheelchair. How would your life be different? How owuld your relationship with your body be different? How would people treat you differently? Very much, yes, and yes Do you think an able-bodied medical anthropologist could do this kind of research? Are there any advantages to "auto-ethnography"? No, it's more intimate, more eye opening I am not my body-disassociation changes life, sexually, and self esteem is able to see how ppl are ore awkward with him' can't escape in his dreams stigma---spolied ID more socially isolated harder for males bc can't be a man don't know his own legs black ppl see race bc everythng for them as been based on race invades even his sleep

#36 Joan Ablon. The Nature of Stigma and Medical Conditions

Why does stigma exist? How can stigma be reduced? Is there any way that stigma might be contagious? because of socity, more attention more visiblity. Stigma can be learned What are the five dimensions of stigma that the author describes? Nature, source, population, treatments coping What is the difference between having a visible stigmatized condition and an invisible one? invisible if exposed then ur outta luck How is stigma related to issues of beauty? What do you think of the "ugly laws" described in the article? Not considered normal, they're stupid What happnes in the vignette described at the beginning of the article? Do people with these kinds of conditions face job discrimination? Social discrimination? Dwarfs is discriminated against. YES, and yes. If you were affected by dwarfism, what aspects of society's reaction would you resent the most? What kinds of reactions might be the hardest to handle? every part, ppl staring What are the best ways for stigmatized people to maintain positive psychological attitudes? coping, support groups, supportive families Illness--subjective experience (bio, social, and psychological) Stigma depends on what society thinks is normal stimga can be worse than disease bc of isolation and humilation, discrimination some people are jsut diff. abled society categorizes ppl so that's why there a stigmas differentness is seen as deviance certain social prescriptions for "beauty" and it is reinforced in the media ***deviant state: "the sick role" 1) sick person is exempt from normal role responsiblities, relative to the nature and severity of the illness 2) the sick person cannot be expected to get well purely by an act of will---illness is not his or her fult 3) the state of being ill is, in itself, undesirable and carries an obligation to get well 4) there is the further obligation to seek technically competent help, usually a physician, and to cooperate in the process of trying to get well. some illlnesss have history of stigma like leprosay, or STDs seen as being a sexual person (bad in our society) Master stima;;;can be discerned when it is inappropriately or gratutiously mentioned in a context that is totally unrelated to the stigmatized characterististic ex) homosexuality, mental illness, cancer Have invisble and visble---> people can be descredited if one figures out their stigma Sources::community can make the stimga better or worse, such as family being ashamed or kids teasing can make employment hard many feel liable to charity Populations of stigma: ppl of color, poor treatment: may go and do CAM and other fin it bad or weird or not valid Coping: need family support, can have good coping new way of thinking about disability is the minority model make support groups

Illness Experience

Why me? •What caused this problem? •Patient's "explanatory model" of illness--mean ways to explain social world affects and is affected by illness •What is the purpose of suffering?

#37 Gaylene Becker. Coping with Stigma: Lifelong Adaptation of Deaf People

Why might an "invisble disability" involve a different set of problems than a visible one? because it's not noticeable until certan time or condition Why do some deaf couples hope that their children will be deaf too? deaf parents see their deaf to deaf kid has carrying on culture. Is the creation of social stigma simply a part of human nature? Or does one's culture define what is normal? Yes, a bit of both to what extent does the term adapt used in this selection have a meaning similar ot the concept of adaptation used chp: 2-7 of this book? What are the advantages and disadvantages of hearing-impared people attending separate schools of being mainstreamed? Is particpation in a separate community a normal human need or an adaptation to ostracism? can have own culture, but seperate others both because need child to learn stigma means ppl fear the person who is sick many people very much aware of stigma deaf people form their own groups deafness is invisble, only visible when person tries to communicate people freeze and with draw many deaf ppl stigmaized in 1t couple years of life hearing parents get worried, can't communicate with them. Have to send child to asylum deaf parents see their deaf to deaf kid has carrying on culture. still get stimga if apart of deaf when family is hearing but having this group gives ID insult of the word deafy deaf also like their own space ID is shaped by social factors---> if normal then it helps conformity to a group can actually help deaf have superficial interactions with hearing, but intimate with other deaf ppl

#26 Marcia Inhorn. M. Religion and Reproductive Technologies

Why should medical anthropologists be interested in the globalization of new biomedical technologies like IVF? To provide access to others, make sure it is religiously ok Why might couples think that infertility is such a terrible thing? think they can't fullfil social roles, punishment How are Muslim interpretations of IVF- including that of the clergy-different from those you are familiar with? Can work if they are seen as adoption, more strict because of "many partners" How are religious beliefs and medical decision making linked? Can affect how one gets treatment or defines the medical term What are the differences between Sunni and Shi'ite beliefs and practices related to the new reproductive technologies? Sunni and Shi'ite define stuff diff:::See below Sunni---most dominat in egpty they allow IVF if ova is wife and sperm is husband (NO third party allowed)**** Shiite-- can have donor, and but parents are like adoptive parents (have different hertiage), also husband has to have mute (breif marriage) reproductive health is typically gendered IVF- in vitro fertilization stem cell, surorogate motherhoods is a widely debated Stigma is cant make a child need to know morals of ppl in muslim world that match relgious guidlines fatwa---nonbinding but authoratiative religious proclamation made by an esteemed religious scholar Sunni---most dominat in egpty they allow IVF if ova is wife and sperm is husband (NO third party allowed)**** sperm donation not always allowed Shi'a---is the minority can use IVF, infertily parents seen as adovptive still has to follow relgious codes. egg donating is like polglyn, getting sperm like polyandry is not allowed Can have embryo donation because it's like adoption egg donation allowd as long as muta--marriage Iran only place for surrgancy many quietly save marriage by doing this (IVF)

Cultural Competence" as a Phenomenon

Widespread use (Google) Training companies and materials Big money Unspeakability of social class in American culture Competent Systems 1.Language 2.Staff diversity .3.Cultural sensitivity .4.Continued monitoring/research

#43 Ellen Gruenbaum. Sociocultural Dynamics of Female Genital Cutting.

Women in societies that practice FGC?FGM are motivated, in part, by issues of beauty and aesthetics. Given that fact, can you think of practices of body modification done in North America for the same reasons? Do people from other societies call women who have gone through FGC "mutilated"? Can you think of ways in which FGC health risks might be reduced? What are the linkages between FGC and patriarchy? Is the custom supported by women, men, or both? Is this procedure a violation of human rights? Why might this custom persist? Is it done by loving parents who want their daughters to be "normal" and marriageable? Are similar surgeries done in the Untied States? Anthropologists struggle to explain things in cultural relativistic way Different names for this show diff attitudes 1st) not required by Islam 2)practice is motivated by notions of beauty, marriageability, and what is normal and expected 3) active discussions are ongoing about the practice, even in societies with high rates of the surgery, and that are indications that the custom is changing in media cutting seen as male dominance need sociocultral research because of roots of this tradition ppl are not prisioners to their culture, culture changes cut because they love her value her marriage and virginity or protecting health need to talk to those who follow this or who have had this done to them ***participant obseveration there is also peer pressure in that other girls taunt others more talking=healthly changes many traditons made fun of because of Europeans ----colonization getting medicial professionals to do it media states this is oppresision cut for feminity and having values for aesthic and comethic moral code: be a virgin for marriage: not interested in prematrial sex or make it harder to have sex circumsion also gives money and resources to mid-wives that have it done infibulation and reinfibulation seen as making men have more enjoyable sex maraige, love, happiness stability> sexual orgasm (not everyone thinks the same) baby shouldnt touch clitoris during birth

The Spirit Catches You and You Fall Down Ann Fadiman (1997)--explanatory models, Kleinman and Benson's revision of problem

a Hmong child, her doctors and a collision of cultures Lia Lee narrative--Many other conflicts; particularities of Hmong history Structure of a tragedy think about the importance of their history think about how Hmong are not a model minority and culture clash, Explanatory Models: Multiple Etiologies---the person's own story What was the etiology of Lia's illness, according to her parents and Hmong ethnomedical system? According to the doctors at MCMC? For both groups, what does it mean for someone to have this particular illness? Personalistic or Naturalistic? How do etiological beliefs affect diagnosis and then therapy in this case? think carefully about the concept of soul throughout the book. What does the "soul" have to do with Lia's illness? What does the concept of "soul" have to do with Lia's personhood? We discussed the idea of soul and Tylor's theory of the origin of religion... Kleinman and Benson's article "Anthropology in the Clinic: The Problem of Cultural Competence and How to Fix It" is relevant to this story. This article is different from the description of Kleinman's "explanatory model" concept that Fadiman discusses at the end of the book.

Gender

a socially constructed term referring to roles, behhaviors, activiteies and attributes that a given society consideres appropriate for men and women. Trans ppl don't fit heteronormative way---seen as strange or other Gender roles are socially constructed and usually framed as an extension of biologically determined social funcitons male and female are sex categores, while masculine and feminine are gender

master status

a status that has special importance for social identity, often shaping a person's entire life we can have many status but one dominates, like illness dominates

Disability

any lost, absent, or impaired physical or mental function think about Dr. Brown's ankles injury---a stupid injury •Recuperation and the wheelchair •Caring for my brother with AIDS •1995 AAA meetings (non-observant and unwilling participant) •ABOUT PAIN •About mobility and effort •Life is unpredictable (we are temporarily able-bodied) •ABOUT GENDER •I didn't like being "helped"; bad patient. •I didn't like being different/stigmatized or having such a "stupid" illness narrative. •AAA meetings - people remember 20 years later •Healing needs time -The body heals itself - not much I could do-adapt -Remolding, scar tissue, -I took up bicycle riding

Obesogenic culture and the illusion of personal choice

are diet and activity patterns really a reflection of personal choice? -poltical economy creates a cultural current -habitual thought and behavior follows that cultural current result---blame the vicitm can be a positive deviant

Evolutionay underpinnings

biological predispositions to enjoy sweet tastes and the texture of ft :adaptive in the context of scarcity Energy storage and reprouctive success Venus figures: premament settlers, runned by a big woman, Environment of Human evolution -gatherer hunters (since 3 million BCE)---have food shortages/high energy output Beginns of agriculutre

cultural competence v "cultural Humility"? ( Tervalon and Murray-Garcia 1998 Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. Journal of Health Care for the Poor and Underserved. )

cultural competence is knowing about a culture (but can an outsider ever be a master) humility is being senisitve and willing to learn doctors typically unsenstive to patient's history and way of life. Having optimal care means understanding their life experiences. cultural competence in clinical practice is best defined not by adiscrete endpoint but as a commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with patients, communities, colleagues, and with themselves. The doctors need self reflection and life learning, shows that docs are racist and help white more than latinos. Docs must be constructive and rethink they're own things. AND use more patient centered care.---interviews are less demanding and rude too. ALSO more work in the communities, and need higher up insitutions to do their part

cultural concepts in the DSM-5

cultural competence??? But also makes these illnesses not seem real because other cultures do it and we have our system ex) amok and susto

Many problems with BMI

culutral constrsuct doesn't measure FAT ignores the critical difference between central body fat (apple shae_ and perupheral body fat (pear shape) -centeral fat is the risk factor -peripheral fat is epidemiological bengin (waist- hip ratiol waist circumference measures) -ignores fitness easy to measure (just biomedically esoteric enough) no gender difference obesity more of a male problem

Modern culutre: Creates an obesogenic environment

diet: ast food as a "fat delivery system" industrial food system and profit--limited choices, more high density foods emotional stress and eating, TV and eating Also activity patterns changes: settlement patterns and auto dependence--zoning and suburban development -TV a a "Inactivity Delivery Systemz' --tv watching as a sig cultural change -time famine: decreased social capital -here's not enough time to exercise how bowling as stopped We spend a lot of time watching screens The car is king::: this is the cause and effect of automobile-focused zoning and planning glutnoy or sloth Urban design makes it hard to travel so use the car

Understanding obesity: deinition

difficult history of definitions body mass index use weight bc it's easy to measure body fat weught itself is hard to measure

violence

extertion of physical force so as to injure or abuse, tends to be personal

Culutral evolution and the challenge of Food Shortages

food storage knowledge of alternative foods friendly social relations (exogamy) Trading partners and markets cutoms for fattening Social Stratification --poor buffer the rich used to to form communties between different groups One grop has food shortage so the two share WHy do we eat the wrong things? Or work out all the time? Use to get it through work, and now physical activity is a lesiure time 75% don't get the right amount of execrise Those with higher education have higher leisure time so more knowledge about execersie Obesity is NOT a disease, but a high risk factor

Biological evolution

genotype---selection for thrify gene in context of frequent food scarcity maladaptive in present culutre ----discordance hypothsis: our genes haven't changed, but our culture and way of life has phenotype -barker hypthses: nutritional contest of inter0uterine development sets physiological sensitivity can breed mice to be obese, if they have obese ancestors they will become obese some ppl more enegry effecinet and store it in fat cells The role of genes: adoption studies Data about adoptive children and

#28 Margaret Lock. Inventing a New Death and Making It Believable

hat was the previous defintion of death, and why did it become inadequate? when the heart stops beating not accurate because the body still does a lot after the heart stops, and we can reverse death by starting heart up again (most social way of death) How did the new defintion of death get decided on, and what were the central arguments about it? if resuscitation is attempted and then discontinued and all concerned agree that an irreversible process of dying has set in about which nothing can be done. Most see it has when as the 1st instance where the brain does this not the heart What is the difference between whole-brain death and brain-stem death? whole brain cannot recover, brain stem might be able to whole brain death is irreversible loss of all brain function meanng absolutely no brain activity brain-stem death causes whole brain to die Are you a designated organ donor? Why or why not? no, because no If a healthy persons own their organs, is it their right to sell them? Why do separate medical teams work with patients who are potential organ donors and with potential organ recipients? Body and mid are seperate recognizing death as a social convention transformation for social recognition of dying to declared moment of death demaractes the transition from life to death---> status change for the individuals living cavaders---brain dead ppl 1st an accident takes place, in which the brain suddenly flows with blood (or trauma in which they cannot survive on their own) breathing machines---artificial ventilators or respirators some cannot breath on own, bc of brain to brain stem, some have breathing machine but damage is irreverisble even with technology some still die because heart gives up or blood pressure cannot be sustained most organ donors are brain dead ppl need to define death so that doctor doing transplant is not charged with murder focus on the brain in America ppl sometimes dont get consent--like the case in Japan when elderly or very sick person has irreversible no effort made to diagnosis donor health and young, no suffering from a disease but rather just not responsive less organ donors bc we practice more saefty need constent in most 3rd countries family protested dont need to be listen in some countries where they take out the organs but in pract they r many diff terms b4 living cavader faux vivants--> brain dead living patients -1st new defintion for new death;;;coma depasse (irreversible coma), hoplelessy unconsious patient redefined death bc 1)increased burdens on patients, families, and hospital resources caused by improvements in resuscitative and supportive measures 2) obsolete criteria for the definition of death can lead to controversy in obtaining organs for transplanation Organs to be procured legally 2 death definitions: heart stops, brain dead US has no clear agreement -give funding to define death better death of human being not tissue, or organs death and living different, but not all living can yawn so it's hard to define---use whole brain to understand death whole brain death is irreversible loss of all brain function In order to take organs, donor must be alive so that they can be harvested person is now in second state--no soul even though body functions properly hard to not mix religion, wording is everythig doctors have doubt even when they say that the pateint is dead the body wants to die but tech stops it nurses believe brain dead test result think of body as a vessel so it doesn't make the doctor insane

Obesity epidemic: consequences

health costs: major risk factor of CVD and other chronic disease (type II diabetes; cancers; hypertension; stroke) Major health costs

sex and gender in the context of health

improved living conditions better public health and sanitation, better nutrition, and improved medical care and services have benifited men and women women live longer than men (CHECK THOSE SLIDES) fundamental, big medicial anthro literature on infertility Say couples are infertibale, not just the women---in Egpty Islam---male can get around, but if male if infertible and women can have sec with male on the down low, but pressure of having male children is very very strong--accept in virto fertilization

sex

is defined biologically and physiologically not interchangeable terms sex refers to the biological and physiological characteristics that define males and females sex-linked biology may seem clear, yet so much variety sex can be determined by-social interactions in certain fish, incubation temperature for some reptiles, diet quality in mice Intersex- turner syndrome: females lacking 2nd X chromosome (Xo) Klineflelter syndromes males with extra X-XXY

The Burden and the Bacteria

leporasy----classic stigma example, not contgaious "The burden is worse than the bacteria. You see, the infection is easily treated - easily cured with MDT" [Multi-Drug Therapy]... "...but even when the leprosy has been totally eliminated, many people will treat you as someone who is cursed for all time. That is the major problem."

theoretical approaches to disability (4)

medical, charity, economic, religious, social

interpersonal violence

physical violence against a partner or child think of relationships

Gender and women's health-our bodies ourselves

play 2nd wave feminism consciousness raising movement is partially about sex, sexual revolution and the birth control pill have info about women's health, sexuality, including sexual health, sexual orientation, gender identity, bitrth control, aboirtion, pregnancy, and child brth OBO was revol. bc the move toward women's active engagment with their actual sexual desires was contradicting the popular gendered myth of "women as docile and passive" and "men as active and aggressive" in a sexual relationship

Fat: stigmatized social condition

psycholosocial dimensions being fat and fit how to fight stigma women have a lot of disphoria with their bodies many women unhappy with their bodies

Menstruation as a metaphor

sexism in biology "males are more engertic, passionatic, eager" women are passive, conservative nothing about hormonol profiles medicial has taken normal things about womens period and have stigmatized them

what about women who don't get pregnnt

sociocultural attitudes affect how women's bodies are seen and perceived even (especially) in medicine and health women's natural bodies are seen as defective and flawed health is being used to push particular aesthetic ideals normal, natural bodies are medicalized medicalization benefits corporations and the status quo

Conceptual tools: Stigma and Coping with Chronic Illness

stigma is the negative social attribution places on people because of their disability or illness. Stigma is a sociological phenomenon in which an individual is devalued and shinned because some illness of disability makes her or him different or "not normal" When stigmatized conditions are "invisible", they involve the dilemma of disclousre. Chronic illnesses have different and more complex coical dimensions than acute illnesses do. sick role ususally has a time limit, chronic illnesses since they are longer become a apart of the persons ID The anthropological study of aging has much in common with medical anthropology: elderly are segreation, separated from their families Stigma is often the result of fear: also scapegoatinf and discrimination

today in papers: women's health

still sexist still use language that's problematic menstrautiopn has words- lack, sastic, ceases, denuded, dies, sloughs, expelled mark of a failuer to get pregnant men do not get neg language women get bad wrap for having diseas--women more able to get disease not the same with men natural selection for certain characters;;;female choice, want less violent, more nutruring males need to change masculine behavior

medical pluralism

the existence of more than one health system in a culture; also, a government policy to promote the integration of local healing systems into biomedical practice kind of like hierarchy of restort, like multiculturalism it can systems themselves are plural

social violence

the pervasive indifference, endemic oppression, and sense of abjection that can make a person feel as though he or she is a mere object, nameless, of no account, ground down, where agency seems to be entirely in the hands of others structured, groups, police

Mohammed Kochi

think about how communciate and cultural barriers stop from him doing chemo

Stigma

think of the branded show E. Goffman - Stigma: Notes on the Management of a Spoiled Identity (1963) •The dwarf, the disfigured, the blind man, the homosexual, the ex-mental patient and the member of a racial or religious minority all share one characteristic that they are all socially "abnormal". This a study of of the ways in which a stigmatised person can develop a more positive social identity. SOCIAL The stigma can cause more suffering than the condition itself

A different view from japan: koneki

traditionally- no reported symptoms of menopause manopuase is medicalized by biomedicine (hotflasha hoteria---housewive syndrome) hormone replacement therapy in US might diet of fermented soy products (nagato_ be a reason

Obesity person

we believe that one we reach height we should have the same weight, but shoudl actually b a small upward incline Ideal body type?? also in diff culutres they fatten the women up so they can be present for marriage

Women's health, feminism and the new reproductive technologies

why should med. anthro be concered about sex/gender? Lingusitic and scientific writing harmful description of male and female sex organs ---result: over emphasis on female reproduction

Thomas Perls &Ruth Fretts. Why Women Live Longer than Men

women develop problem early so they have more time to get it fixed Iron plays a very important part in the reactions in our cells that produce damaging free radicals, which glom onto cell membranes and DNA, and may translate into aging the cell. In fact, in our diets, red meat is the main source of iron, and lack of iron is probably one major reason that being vegetarian is healthy for you. women have two X chromosomes, while men have one.--->When cells go through aging and damage, they have a choice in terms of genes — either on one X chromosome or the other. Consider it this way: you have a population of cells, all aging together. In some cells, the genes on one X chromosome are active; in other cells, by chance, the same set of genes, with different variations, are active on the other X chromosome. X chromosome. So, in women, cells can perhaps be protected by a slightly better variation of a gene on the second X chromosome. men also have worse behaviors---smoking/Men in their late teens and 20s go through something called "testosterone storm." The levels of the hormone can be quite high and changeable, and that can induce some pretty dangerous behavior among young men. They don't wear their seatbelts; they drink too much alcohol; they can be aggressive with weapons and so on and so forth. These behaviors lead to a higher death rate. men commit suicide more Men smoke more, and eat worse, and men internalizes stress----> worse heart

Nemesius

women have the same gentials as men, but they are inside out both are the same in terms of reproductive organs, homolgies are smiliar, and develop very similariy male and female gentials are the same in the most of the reproductive oragns of both sexes develop from similar embryonic tissure

Becoming a Doctor versus Becoming a Patient

•Choice •Pain, Fear, Existential Experience •Illness behavior •Who is in control of the system? •SICK ROLE - patient as a temporary role? •We are temporarily able bodied