Family Life

I'm leaving my job in a few weeks, a job I've been at for over 3 years now. I've only touched on a few issues worth exploring in my blogs, of the many many hundreds possible, but perhaps that is how research in social science goes; water water everywhere with too many drops to drink. Lately I've been digesting situations I encounter at work more from a researcher's perspective and less from a worker's perspective. Critical distancing from work issues has not been something I've been able to exercise as much as I'd like because of myriad ethical boundaries that must be respected. A lesson learned; the 'nosey' anthropologist's work will sometimes be viewed as suspect. Now that my days left are numbered, interesting people, relationships and norms are seeming to surface through from the aqueous warp of desk jockey drudgery. Ethically, I haven't been able to fully engage this field as a researcher while I remain committed to a professional bias. I always thought law was boring, and I'll admit I still do find it boring but gosh darn if boringness doesn't produce its own rich meaning eventually (and with enough analysis). Thankfully, I work in family law, which isn't terribly boring, and I assist attorneys on cases of child custody, divorce, separation, child support orders and modifications and parenting plans, all involving their fair share of drama. One accumulates a lot of peripheral knowledge about american family life working in this field and I really feel the urgency to make use of that information what I can. Law pays well and is very emotionally involving and intellectually satisfying so there proves little incentive for legal professionals to leave the field to apply their knowledge elsewhere and they have precious little time outside of practice to work with that knowledge in fresh ways. I feel there are many latent anthropologists among us, family law layers in this case, that could contribute greatly to our body of research if they used their experience to educate others on not the law but the social effects of the law. I secretly wish more professionals,  like attorneys, would step out of practice and into social science research but for now I happily carry that burden with me to grad school.
     Now, I have never been particularly interested in family life, my first real job out of college just happened to be in the family law field and I was drawn to it for no particular urge to learn more about american families. In fact, my perception of family law matters prior to my job was that of messiness, so-called broken homes and a lot of import placed on child rearing, which I feel varies so widely cross-culturally that the law should have little say in how 'good parenting' is interpreted. The law has a big say in it, however, because whenever two adults come together to raise a child, conflict is bred, no matter the compatibility or resources. Indeed, parenting plan disputes rage regardless of how much money one or the other is willing to part with or how much time either parent wants to devote to the child. There are simply too many variables in raising a child to warrant any predictability or simplicity in parenting plans. One of the things I identified early on in my job as something to look further in to is the involvement of health issues in family law cases. Health can come into play in any number of ways but I am continually surprised at just how much health is used in rulings. There exists extreme prejudices against those of ill health in family law cases and there is something profoundly regressive about such contingencies. The verdict? It is good to have a clean health record if you plan to enter into a family law case and if you are unhealthy in any way or have been in the past, plan to fight a little bit harder and a lot more cautiously with a substantial increase in paperwork. I can't quite argue that this complication is unfounded; parents with health issues do face more challenges to effective parenting and when the effectivity of a parent is compromised it would ne natural for the Court to lean towards the healthy parent in awarding visitation. What is difficult to digest about this is the lack of resources and/or support for disabled parents or parents with near permanently ill health. I don't equate these to because some people who are ill for long periods of time still do not self-identify as being disabled and that is a stance that should be respected, as should the stance that being sick or disabled does not have to compromise parenting actions.  With the way parenting is treated as more of a human right than a privilege in our culture, I wonder why there isn't more help to access this right for disabled americans. Then of course, immediately upon wondering this, I have to also question why there isn't more support for any and all rights for disabled americans. It is this sort of double-bind disability brings about that makes it a fascinating contradiction in logic. Parents of all abilities have the right to struggle in their roles, in the end, because parenting is a challenge by its very nature, even in ideal circumstances and struggles will come about nonetheless. So it remains, disabled parents face more challenges to parenting, a fact that is self-evident, but they also can face prejudices from the Court during family law cases because of that disability. Troublesome though it is, this is a problem that I suspect will not welcome solution through legislation alone but will require a profound reassessment of what it means and what it should mean to be a parent. It involves more than resources, good decision making, responsibility and morality; indeed, it involves the entire physicality of a person.

Pamawaluukt or "each person raising himself up"

Psychology has always interested me because it is one of the last great mental frontiers of our time. Occluded with the haze of recognition, parts of our understanding of the human mind remain, in a blind sort of way, out of reach of our objective consciousness. It is less that we know so little and more that our 'knowing' is subject to the wills of our own psychology in a way that does not allow for self-reflexivity the way studying the life sciences, medicine or engineering does. Can we never 'truly' know the processes of depression or anxiety, insomnia or addiction given they are simply experiences of human excess and amplification? How can a team of researchers transcend their own faint brushes with any of these mental afflictions in order to understand them in an absolute way? Anthropologists have long been interested in these subjective and intersubjective dilemmas and indeed, I can't think of a better discipline to takle this last great frontier of human knowledge. I recently did a book review for Elizabeth Anne Davis's Bad Souls: Madness and Responsibility in Modern Greece. Touching on subjects of patient responsibility and the moral accountability all sentient beings carry, Davis brought to light the ethical gray area of holding those with severe mental illness responsible for themselves in the same ways other patients, with illnesses like type II diabetes or cancer are.  If we agree that mental illness has strong genetic causative factors and that it is a 'real' illness like any other (although this dispute rages on), then how and in what ways can we hold the mentally ill accountable for their behaviors and thoughts? From Davis's account, it is clear the 'helpless' model of severe mental illness does not hold, at least in modern Greece's psychiatric reform era. Our own psychiatric reform in the U.S. did not do a particularly stellar job of understanding the experience of mental illness and patients here too were scooted off into the community for 'community-based' care and autonomous patienthood, even though it is clear some could not assume the degree of responsibility expected, hence homelessness and incarceration are sometimes where these most severe patients fall. In a political milieu with a cleaner logic of mental illness, a more accommodating model of treatment would be implimented and these kinds of patients would not suffer on the streets or at the hands of the judicial system. But it remains, mental illness is not a true cognate of any other 'physical' or somatic illness. It is not like cancer, diabetes or HIV/AIDS. It cannot be cured in an absolute sense, is not transmitted from person to person and, despite mountains of effort, is not simply manageable. All three of these caveats place undue burden on the sufferer themselves while casting away social and political responsibilities. Perhaps it is the spirit of inclusion that drives so many institutions and organizations to frame mental illness as just another physical problem of biology, genes and chemistry. These key words pepper research articles and materials from the National Institute of Mental Health, the World Health Organization and various other health organizations. Davis's ethnography shows us, however, that adhering to this model of mental illness as a physical illness and therefore subject to the power and control of the human hand can be problematic and at times can bind patients so tightly to typical disease models of recovery that their condition worsens under the expectations. Neither is mental illness as ephemerally located as previously thought, in Freud's era of the ego, superego and id. Mental illness must find its place in the middle of these two extremes, between pure biology and pure psyche. The responsibility and accountability Greece's psychiatric reform held over the mentally ill in Bad Souls did little to heal and rehabilitate the most severe of patients, those who need the most support and care. Unfortunately, their needs go beyond the assumption that all people have the ability to recover and further a responsibility to keep trying, no matter how severe the case. Just as cancer patients are not held responsible for their blood cell counts, mentally ill patients lack the direct influential link to their neurological misfirings. This dilemma enclosed upon the patients in Davis's book, leaving them in a therapeutic standstill for years; the state provided what care the reform legislation recommended and the rest was 'up to them' to take responsibility for their conditions. While the disconnect here is clear, how to remedy this is uncertain.


Pamawaluukt is a Umatilla (Confederated Tribes of the Umatilla Indian Reservation) term for "each person raising himself up".

References:

2012     Davis, Elizabeth Anne
             Bad Souls: Madness and Responsibility in Modern Greece. Duke UP.

Better Sore than Sorry

     I have been wanting to spend some time exploring pain as a cultural process for a while now. While not a direct insight into the process of pain, fitness movements and subcultures provide valued frameworks of health ideologies that give insight into a culture's view of pain. With a little digging, fitness beliefs often incorporate views of pain into their discourse. Seattle is a really health conscious city and so approaches to health and fitness flourish and are diverse. One of the fitness movements to open up shop here is the CrossFit training method. At first, CrossFit seems somewhat unique in an area where more spiritual and holistic movements such as yoga and pilates have long been thriving. CrossFit emphasizes qualities of endurance, durability, adaptability and capability and uses somewhat graceless pieces of equipment like dumbbells, pull-up bars and kettlebells. Workouts are challenging, simple, 'results-orientated' and are modeled off of military and police force training camps.  The CrossFit movement endorses these terms and qualities as assumed 'goods', therefore laying the moral groundwork for health and fitness emphasizing the transformative power it brings. Sometimes termed 'Elite' fitness, the implicit point of view is that CrossFit training brings one to the highest level of fitness they are capable of, according to idiosyncratically set goals but held against the same standard (e.g. military and police training). This both pushes trainees to meet what are societally expected fitness goals and pulls them into the not so personal state of mind that links together form and function (common terms in CrossFit advertising and text), thus supporting the problematic binary of "no pain, no gain". For example,  web-text on gym websites emphasizes strength with an implicit moral underlay; "The stronger I am in here the better I will be out there"(CrossFit Belltown). "Out there" is a big motivating component in CrossFit; the qualities and characteristics one cultivates in CrossFit training theoretically should help you face your everyday life with more confidence and resilience. Coincidentally, these are two qualities crucial in a recovering economy. Below are some images from gym websites that I found particularly supportive of these links:

CrossFit LiS

The Spartan reference is pretty self-explanatory, with strong valuations placed on the bodily aesthetics of Ancient Greek athletes and a battling mentality, even posing personal challenges as a battle against one's self. 

South Seattle CrossFit

Redefinition of the self is stressed ; vocabulary revolves around transformation, evolution (a glossed usage here) and meeting challenges.

The Lab on Eastlake

This gym's ethos is centered on one of the dominate trends in CrossFit discourse, that of the scientific object/subject and the scientization of fitness. Many gyms focus on fitness as an experience in and of itself which contrasts to this gym's focus on fitness as an obtainable standardized object that can be measured and weighed.

What makes this movement so interesting to me are the many ways the CrossFit mentality penetrates other health practices the individual participates in. In this case, CrossFit's influence can be seen in eating habits (e.g. the Paleo diet), birthing and even child rearing practices (which will be the topic of my next post on this subject). I find an important link here between the moral 'good' of strength and the experiences of pain and challenge in the other 'goods' characteristic of CrossFit (e.g. self-sufficiency and independence). Morality can be curiously linked to health states at times and these links can be very telling of the psychology of a culture making CrossFit a good subject for the study of health and disability. 

CrossFit Belltown

Tiger Bones and Vashon Elm

I recently read an article in Quartz about the supposed explosion of vulnerable and endangered fish-part imports to China for 'medicinal purposes' (Guilford 2013). I put this phrase in quotes because it is clear this issue goes far beyond just medicine and to reduce it to a simple procurement practice for China's medical industry is to discredit what else is at stake here; Western medicine v. Traditional Chinese Medicine (TCM), the omnipotence of medical science and 'scientific truth' v. 'traditional medicine' just to name a few. This wasn't a particularly strong article, and so from here I diverge, but it did do a good job of positing TCM against logic (suggesting the two were mutually exclusive) and I feel this juxtaposition is a good jumping off point for discussion. Popular Western discourse and texts that address TCM as an alternative health strategy often take an immediate position of resistance when the animal parts is discussed.  That resistance often divides 'moral' therapeutic options from 'immoral' and 'unnecessary' use of animals and consent to their use only if 'the benefits outweigh the costs', regardless how little these benefits and costs are understood. This need to compartmentalize and crystalize medicine and its justifications may be a little reckless and I think we get ourselves into ideological trouble here if we ignore this misunderstanding. We can recognize the importance of sharks, tigers and seahorses to our eco-system and the global tourism economy but should be able to do so in collaboration with, rather than in opposition to, Traditional Chinese Medicine. 

But it is not just TCM that is being framed as an issue of scientific rationalism and exceptionalism. Threat of species decimation is not reserved solely for over-fishing and poaching but reaches to all other vulnerable biological populations that are capable of exploitation, more often than not by the advanced industrialized world. Unfortunately this advancement does not equate to mutual respect and appreciation between exporter and importer and so those doing the importing of vulnerable populations all too often do so to the detriment of the exporter. Regardless, 'resource talk' is a good discourse to analyze when trying to better understand things like shark fin soup and rhino poaching that persist despite decades of initiatives and 'bans'. Our Western, 'rational' selves hold the sentiment that if there is a viable alternative treatment, further threatening these species is in moral negation with any medicinal benefit offered. This is a big "if" because with the tenuous understanding Western Medicine has of TCM the judgment of what is a "viable alternative" to say, the use of tiger bone for arthritic pain (Bensky, D., Clavey, S. & Stoger, E. 2004) is subject to all manner of contingencies, speculations, disbelief and otherwise unstable beliefs.

Timber imports to the U.S. resonate here along side the vulnerable and endangered fish-part issue in China. Similar to the continued use of vulnerable and endangered species in TCM despite there being Western surrogates (e.g. chemotherapy, radiation, biopharmaceuticals), though there are alternatives to Amazonian hardwoods (e.g. composites), we continue to import the real-deal at harmful rates (Bueno de Camargo 2008). We are Brazil's biggest timber importer and since we have these alternatives readily available, I see nothing more elusive and exotic about fish-part consumption in China compared to deforestation in the Amazon. The Seattle Urban Hardwoods showroom location is a few blocks from my work and I walk by often on my lunch breaks. Filled with furniture made from large slabs and beams of solid wood, the store evokes a timber butcher-shop more than it does a furniture store. While many of the pieces are salvaged locally, using wood in this way and charging what they do (you don't even want to know) provides fuel for the ongoing timber trade that is wiping out forestlands globally.  Some of the woods they use are endangered but were growing with some effort in Washington when they were salvaged; trees grow great and plentiful here which can deceive an otherwise eco-conscious individual. A significant number of elm pieces were claimed from Vashon Island, a tiny island just a short ferry-ride away from the Seattle waterfront. My grandparents lived there on several forested acres while I was growing up. I can only imagine that many of these Vashon pieces were taken directly from their land, eroding away Vashon's jungley charm and making it more welcoming to day-trippers from the city, taking away with them the very authenticity that brought them there in the first place (!). Authenticity matters though. According to Globalwood.org, some towns rebuilding their waterfront boardwalks after Hurricane Sandy choose to re-build with a tried and true Brazilian hardwood, Ipe, over composite or native alternatives, which some towns have chosen, because they did not "offer the same experience" aesthetically. (Wood Products Prices in the U.S., 2013).  This "experience" is what can be culled from the fish-part trade argument as a major source of conflict and perhaps, if left unaddressed, the reason why these species will eventually vanish. 

It is this taste for exoticism that I want to highlight from the exotic fish-part trade in TCM as an attempt to reconcile the East v. West divide we reinforce with evidence-based medicine (or Chinese Elm I-beams) involving double-blind trials and big data. Western Medicine is often framed as being 'backed-up' by data from scientific and clinical trials while TCM is swindled of its legitimacy, 'backed-up' by no less than several millennia of usage and cultivation.  Here's some data of another kind:  A 2008 study on the use of tiger in TCM for medicinal and health tonic (wellness promoting) purposes revealed that although 93% of participants agreed the ban on farmed tiger parts trade should be kept in effect, 43% admitted to using tiger containing products (e.g. plasters, wines) with 71% of this group showing preference for products from wild tigers as opposed to products from farmed tiger, a dangerous partiality if I ever saw one (Gratwicke, B., Mills, J., Dutton, A., Gabriel, G., Long, B., et al. 2008). These attitudes show that the Chinese are aware of and purport to be in support of tiger conservation but nonetheless choose tiger products anyways, a rationality that tends to confound Western media. It is this gap in understanding, on both sides of the Pacific, that will be crucial to a more sustainable management of this issue. This article also suggested that a lot of these products could contain counterfeit tiger bone but that it is difficult to decipher this in the market and, while meaningful nonetheless, is a little outside my argument.  

I only hope this portrait takes away some of the mysticism of TCM believers and their seemingly irrational choices. A deeper understanding is urgently needed, however, as medical pluralism spreads globally and as popular presses, like Quartz, pick up stories for exploitation and exaggeration to the Western public. Reconciling these disparities between suspicion and belief, logic and experience may help throw in to relief the deeply held judgments against believers of an ancient and intricate form of medicine and, just maybe, furniture makers alike.

References

Bensky, D., Clavey, S. & Stoger, E.

     2004     Chinese Herbal Medicine Materia Medica 3rd Ed., Eastland Press: Seattle. 

Bueno de Camargo, Mariane

     2008     United States Markets for Brazilian Plantation Wood. World Forest Institute.

Globalwood.org

     2013     "Wood Products Prices in the U.S.," accessed May 7, 2013,    http://www.globalwood.org/market/timber_prices_2013/aaw20130201f.htm.

                          

Gratwicke, B., Mills, J., Dutton, A., Gabriel, G., Long, B., et al.

     2008     Attitudes Toward Consumption and Conservation of Tigers in China, PLoS ONE 3(7): e2544.

Guilford, Gwynn

     2013    "China is plundering the planet's seas-and it's doing it 12.5 times more than it's telling anybody," Quartz, April 30, 2013, accessed May 4, 2013, http://qz.com/78803.

no health without mental health

Recent news from the NIMH (National Institute of Mental Health) suggests a call for more attention paid to data culled from co-morbidity and mortality studies in both the United States and Sweden (Director's Blog, 3/29/13) to address the alarming life-expectancy rates among those with severe mental illnesses. It goes without saying these two countries have vastly different reverences for and interpretation of good health however (!) these studies both showed increased co-morbidity and mortality rates among those with severe mental illness when compared with the general population. The schizophrenic patients that were the focus of the study in Sweden even saw health care providers more often than the general population, a trend in opposition with what is going on in the U.S., where access to care for those with a severe mental illness is ponderously out of reach. In Sweden, the problem was not with access to treatment but early detection; when detected too late, ischemic heart disease, pulmonary disease and cancers reduced life years in schizophrenic women by 12, men by 15 (Crump et al). Numbers in the U.S., where individuals included in studies have the societal advantage of accessing our notoriously inaccessible mental health care system, are equally macabre, with 8.2 years average years less lived by those with any severe mental illness diagnosis (Druss et al). I'm reading Bad Souls: Madness and Responsibility in Modern Greece (Duke 2012), by Elizabeth Anne Davis right now, who's discerning look at Greece's psychiatric reformation considers 'responsibilities' as they shape the clinical and broader therapeutic encounters between patients and psychiatric staff. These 'responsibilities' employ clinician expertise to diagnose (my use here) deceptive and performantive measures taken by patients that give form to the clinical encounter. Compliance with treatment programs and an interest in self-help are some of the identifiers of a 'responsible' patient and while mental illness itself can impede both of these characteristics, they nevertheless persist as cultural accessories to moral patienthood. These characteristics may also play a role in the lived years reduction among the severely mentally ill. The patients involved in the Swedish study on co-morbidity and mortality, despite the safety net that is universal healthcare, lived significantly shorter lives than the general population because of late detection of non-communicable (arguably 'life style') diseases. In Davis' modern Greece, as in the U.S., patients are held accountable for maintaining treatment, even though in these socio-political spaces health care is not as accessible as it should or could be. Responsibility is emphasized as a means to not only well-being but perhaps even greater care exercised by clinicians (who deal often with unruly patients and/or are held in positions as 'gate-keepers' to care). With Obamacare looming near, can we argue our numbers in co-mortality and co-morbidity studies relating mental health with life years will improve because of access or will early-detection plague us too as a silent precipitator of premature death? With the U.S. psychiatric reform era decades behind us, and a more universal health care system in the near future, are we in a position to learn from both Greece and Sweden in changing these numbers for the better? In what ways will patient responsibility interact with healthcare access to decrease these co-morbidity and mortality rates? In Sweden, early detection certainly remains stubbornly elusive for the mentally ill so we may remain hesitant to see greater access to health care in the US as an agent of longer lives lived. Despite the increased access to healthcare on the horizon, the Swedish study shows us access alone is not enough.



References:

Crump, C., et al.
2013     Comorbidities and Mortality in Persons with Schizophrenia: a Swedish national cohort study.        American Journal of Psychiatry 170 (3): 324-33.

Davis, E.A.    
2012     Bad Souls: Madness and Responsibility in Modern Greece. Durham: Duke.

Druss, B.G., et al.
2011     Understanding Excess Mortality in Persons with Mental Illness: 17-Year Follow up of a Nationally Representative US Survey. Medical Care 49 (6): 599-602.

Thomas Insel
2013     Director's Blog Schizophrenia as a Health Disparity, 3/29.