Establishing Medical Benchmarks |
What constitutes health, what disease? What are the appropriate foundations for interpreting the emergence of a dysfunctional medical condition, whether physiological or psychological, genetic or environmental? The papers in this session consider: (1) how cultural background shapes researchers' interpretations of the specific etiology of stomach cancer (genetic v. environmental), and (2) how psychiatrists' attitudes shape the discourse on the effectiveness of antipsychotic drugs.
- Joao Nunes, University of Coimbra
"The Play of Environment and Genetic Susceptibility and the Differential Ecologies of Stomach Cancer"
- Recent research on the biology of stomach cancer has focused on the links between genetic suscpeptibility as it can be identified through polymorphisms of genes coding for gastric mucins and the action of factors defined as "environmental", such as infection by the bacterium Helicobacter pylori. A comparative study of two countries with high incidence of gastric
carcinoma - Portugal and Colombia - and a third country where incidence is almost non-existent - Denmark - suggests that the definition of genetic susceptibility is a situated accomplishment, dependent on the identification of environmental conditions such as infection by H. pylori. The paper, based on an ethnographic study of a team of oncobiology researchers who carried out this type of comparative work, examines the co-construction of the differential ecologies of gastric carcinoma defined by reserachers as a pathology emerging from gene/environment interactions and of research ecologies articulating epidemiology, environmental pathology, bacteriology, molecular genetics and immunochemistry.
- Andrew Garnar, Virginia Tech
"The Role of Subjectivity within Biological Psychiatry's Discourse on Antipsychotics"
- This paper will show that as psychiatrists came to employ antipsychotic drugs in their treatment of schizophrenia, their discourse began to treat a "thick understanding" of the subjective states of schizophrenics as irrelevant to the treatment and understand of the illness. The concern that motivates this paper is that by ignoring "thick understandings," i.e., those that take into account the numerous kinds of experiences that human subjects have, psychiatric discourse is loosing touch with its patients. This is because psychiatrists have focused almost exclusively on side effects and other biochemical reactions, which prevents these psychiatrists from addressing a wide of other experiential effects of these medications.
The paper reviews this discourse from the introduction of Chlorpromazine in the early 1950s to the present. The introduction of Chlorpromazine revolutionized the treatment of schizophrenics in particular and psychiatry as a whole. Throughout the 50s and early 60s, in addition to studies of the drug's biochemistry, there were numerous studies on the subjective effects of the medication on schizophrenic patients. By the mid-60s these studies fell out of fashion. With the decline of these studies a "thick understanding" of the subjectivities of schizophrenics also slipped away. Even with the troubling allegations regarding the connections between antipsychotics and tardive dyskinesia, a more robust conceptualization of schizophrenic subjectivity did not return. This has remained the case through the present, despite occasional cries from within psychiatry to reintroduce such a discourse.
I argue that three factors explain why subjectivity's importance has been reduced within this discourse. First, the place that "subjectivity" had within psychiatric discourse was tenuous before and after the introduction of Chlorpromazine. Second, another central reason "thick understandings" lost out was that subjective aspects of mental illness could not be easily operationalized. By focusing on biological aspects of schizophrenia, it was easier to quantify outcomes and market outcomes as successful. Lastly, economic forces have exerted pressure on psychiatry through this whole time period. This has been manifested in several different way included cost-cutting initiatives introduced in the 1960s through the rise of managed care in the 1990s. These economic factors have also encouraged "thinner understandings" of subjectivities.
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