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This paper explores the moral implications of treatment of young people with functional somatic symptoms. Based on an ethnographic field study at a Danish pain clinic for youngsters (age 8 to 18), the paper seeks to unearth the cultural, moral values that clinical practice steers by and upholds, and the implications this has for the assessment and management of ill body-selves. Through an exposition of the general practice of the clinic and an investigation of two specific cases of youngsters, it is found that the assessment of symptoms and selves and the goals of treatment are informed by cultural ideals of 'the good self' and 'the good life' in which agency and work ethic – both pertaining to the notion of individual responsibility – figure as prevalent virtues. The study underpins the findings of other researchers who have found that ideals of individual autonomy and responsibility for own life and health permeate the Western health care system and the discourses of ill individuals. The contribution of this article is to portray in ethnographic detail how such a cultural ethics manifests in practice and what implications this have for the treatment of young people with functional symptoms at a specific location and in specific cases. The two cases illustrate that the underlying norms and values can give rise to very different moral assessments of symptoms and selves within the same diagnostic category. [ABSTRACT FROM AUTHOR]

Drawing on a comparison of two ethnographic research projects on surrogacy in the United States and Israel, this paper explores surrogates' views about motherhood and parenthood, relationships and relatedness. The paper challenges three myths of surrogacy: that surrogates bond with the babies they carry for intended parents, that it is immoral not to acknowledge the surrogates' maternity, and that surrogacy upsets the moral order of society by dehumanizing and commodifying reproduction. Contrasting the similarities and differences in the voices of surrogates from these studies, the authors argue that surrogates draw on ideas about technology, genetics and intent in order to explain that they do not bond with the child because they are not its mother. This is followed by an exploration of surrogates' definitions of what constitutes parenthood, suggesting that in both contexts, surrogates draw clear boundaries between their own family and that of the intended parents. Finally, it is suggested that surrogates expect a relationship, or a bond, to develop with the intended parents and view their contribution as exceptional moral work which involves nurturing, caring, friendship and solidarity. The paper concludes that for surrogates in the USA and in Israel, maternity, bonding and kin-ties are not automatic outcomes of pregnancy, but a choice. Surrogates in both contexts hold that bonding with other people's children as if they were one's own is wrong while bonding with their couple and creating 'fictive kin' ties with them is the logical outcome of the intense and intimate process of collaborative baby-making. [ABSTRACT FROM AUTHOR]

Drawing upon the narratives of 23 single heterosexual women in the UK thinking about and pursuing motherhood through sperm donation, this paper explores how solo motherhood can be construed as a 'risk' to the identity of a 'good' mother. It shows how, for these women, solo motherhood was a departure from an imagined life of having a child within the context of a stable relationship and was a prospect viewed with much ambivalence and uncertainty. Choosing to become a single mother challenged their conceptualisation of a 'good' mother, someone who puts their child's interests above their own. By examining the flexible and creative ways these women navigate the field of reproductive technologies in the pursuit of motherhood, this paper explores how the women engaged in a process of 'damage limitation', becoming 'moral pioneers' of family and relatedness, as they realigned their ideals versus realities of family building and tried to make solo motherhood as 'good as it can be' for their future child. [ABSTRACT FROM AUTHOR]

The paper analyses the experiences with government sanctioned Ayurvedic college education of 14 young Ayurvedic doctors working at the Integrative Health Centre in Bangalore, India. Unfamiliarity with Ayurvedic logic and Indian natural philosophies, lack of clinical training and the mixing-up of Ayurvedic and biomedical notions are their main complaints. The 14 young Ayurvedic doctors also missed a convincing perspective on how to integrate Ayurvedic logic, modern scientific knowledge and biomedical diagnostics. Ayurvedic state sanctioned education seems to be caught between Ayurveda's natural philosophy of health and the techno-science of biomedicine. The Ayurvedic doctors under scrutiny face the danger of becoming ‘half-baked products’ when they do not learn to reflect on the tension between Indian traditional knowledge and biomedical learning. The paper argues that the logic of modern science and biomedicine's claim to value-free knowledge captivates Ayurvedic education and research. This hinders Ayurveda's development as a vibrant alterity to biomedicine. What is needed is a critical social science perspective on the construction of medical knowledge and India's hierarchical medical landscape. [ABSTRACT FROM AUTHOR]

Cultural psychiatrists and medical anthropologists have collaborated to help clinicians screen for culture-related issues in patient explanatory models of illness and to enhance the clinical processes of engagement, diagnosis, and treatment planning. This effort prioritises patient perspectives on suffering and healing to counter the trend of symptom-based interviews which assume biologically determined models of mental disorders. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes the Cultural Formulation Interview (CFI), a semi-structured questionnaire for eliciting patient explanatory models. This paper analyses specific linguistic meanings and practices that could account for patient perceptions of improved rapport with clinicians, clinician perceptions of improving information gathering, and cultural models of health and illness during the DSM-5 field trial piloting the CFI. Twenty-seven audiotapes were analysed through the Roter Interaction Analysis System (RIAS), a standardised method for examining medical interviews based on ethnographic studies of small-group communication. After an introduction with procedural and reassurance statements to orient communication, the CFI's open-ended questions elicited patients' opinions on interpersonal, environmental, and biomedical information. Clinicians made facilitation and activation statements for patients to speak more and informed patients about what to expect. Patients constructed cultural models of illness that weaved interpersonal, environmental, and biomedical information. Clinicians and patients made rapport-building statements to each other. A RIAS-derived patient-centred score indicates that CFI sessions addressed patient concerns. Our work offers a way to analyse the discursive construction of culture in health settings and patient-centredness through detailed examinations of linguistic meanings and practices. [ABSTRACT FROM AUTHOR]

This paper explores the productive tensions occurring in an interdisciplinary research project on weight loss after obesity surgery. The study was a bio-medical/anthropological collaboration investigating to what extent eating patterns, the subjective experience of hunger and physiological mechanisms are involved in appetite regulation that might determine good or poor response to the surgery. Linking biomedical and anthropological categories and definitions of central concepts about the body turned out to be a major challenge in the collaborative analysis. Notably, the conception of what constitutes ‘appetite’ was a key concern, as each discipline has its particular definition and operationalization of the term. In response, a material-semiotic approach was chosen which allowed for a reconceptualization of appetite as a ‘fractional object’, engaged in multiple relations and enacted differently in each instance. This perspective produced creative contrasts and offered alternative explorations of both scientific knowledge production and anthropological practices. The paper thereby explores the interfaces between anthropology and medical science by attending to the challenges and opportunities that result from destabilising an assumed fixed and well-defined concept associated with the body. [ABSTRACT FROM PUBLISHER]

Drawing on participant observation in a ‘mindful weight loss’ course offered in the Netherlands, this paper explores the normative register through which mindfulness techniques cast people in relation to concerns with overeating and body weight. The women seeking out mindfulness use eating to cope with troubles in their lives and are hindered by a preoccupation with the size of their bodies. Mindfulness coaches aim to help them let go of this ‘struggle with eating’ by posing as the central question: ‘what do Ireallyhunger after?’ The self's hungers include ‘belly hunger’ but also stem from mouths, hearts, heads, noses and eyes. They cannot all be fed by food. The techniques detailed in this paper focus on recognizing and disentangling one's hungers; developing self-knowledge of and a sensitivity to what ‘feeds’ one's life; and the way one positions oneself in relation to oneself and the world. While introducing new norms, the course configures ‘goods’ and ‘bads’ in different ways altogether, shaping the worlds people come to inhabit through engaging in self-care. In particular, the hungering body is foregrounded as the medium through which life is lived. Taking a material semiotic approach, this paper makes an intervention by articulating the normative register of nourishment in contrast to normalization. Thus, it highlights anthropologists’ potential strengthening of different ways of doing normativity. [ABSTRACT FROM PUBLISHER]

It is an oft-repeated trope that the recent medical advances in the field of assisted reproduction have radically transformed the ways in which we can achieve, practice and imagine parenthood. This development has enabled new forms of non-heterosexual family constellations, including same-sex nuclear families and solo-parents by choice, and as a result an increasing number of groups are mobilising politically for access to fertility treatments. Swedish transgender patients are one of these groups; after many years of political mobilisation, they are no longer required by law to go through sterilisation as a compulsory part of gender corrective surgery, and instead today, all transgender patients are offered fertility preservation through gamete freezing. This, in turn, has meant not only that Swedish fertility clinics have faced an entirely new patient group - the transgender fertility patient - but also that the cultural imagination of who can become a parent and what a family might look like is becoming further destabilised. Building on interviews with medical staff, LGBTQ-advocates and complementing qualitative data, this paper seeks to shed light on the very process by which these new rights are translated in the practical context of the fertility clinic, and also what it means, more generally, for cultural imaginations of parenting when a group whose reproductive futures were previously considered either impossible or undesirable are now 'anticipating infertility' and engaging in 'family planning' as central parts of their lifecourse and medical engagements. [ABSTRACT FROM AUTHOR]

Blood transfusions belong to standard and commonly utilised biomedical procedures. Jehovah's Witnesses' transfusion refusals are often referred to in bioethical and medical textbooks. Members of this globally active religious organisation do not, however, challenge biomedical diagnosis and treatment as such. A result of both their trust in and their interpretation of the Bible, they question only this medical treatment. In spite of the global presence of this religious community and its uniformly practised teachings, including those pertaining to blood, experiences and choices of Jehovah's Witness patients have been understudied. Drawing on a nine-month fieldwork with Jehovah's Witnesses and physicians in Germany (mainly in Berlin) between 2010 and 2012, the paper addresses treatment choices made by Witness patients and their relationship with physicians. In light of the long tradition of 'medical heterodoxy' established in German culture and society, Germany constitutes an ideal point of departure for such a study. By utilising the concept of 'medical landscape' it is argued that Jehovah's Witnesses in my field site find themselves at the intersection of different medical landscapes: in the 'immediate' surroundings of the German healthcare system that is open to different 'treatment modalities', and that of the United States, which favours biomedicine. The paper also argues that Jehovah's Witnesses' position towards blood transfusions can further be used as a lens to shed light on the German (bio)medical landscape itself. [ABSTRACT FROM AUTHOR]

Village dwellers in Central Ukraine have access to various types of therapy that comprise diverse medical landscapes. Patients' movements within these landscapes are possible thanks to each person's web of relations. Medical landscapes are not fixed, but vary and dynamically change for each person, depending on their fluid and interchanging, hierarchical webs of mutual relations with other people, personal bodies, institutions, discourses, political powers, other non-human organisms, or objects such as medicines. This paper was inspired by the medicoscape concept (H€orbst and Krause 2004) as well as Ingold's idea of meshwork analyses of relations between various actors: in this case, patients, healers, a weak state, official healthcare providers, pharmacists and medicinal plants, in the context of patients' therapeutic choices. Self-medication based on herbal remedies is a very important feature of people's medical landscapes in Central Ukraine and usually the first therapy choice for most interlocutors. That is why this paper is focused on the presentation of the means through which people acquire knowledge about medicinal plants, and the ways they interact with plants and plants interact with them. In this way, showing the complexity of villagers' webs of relations is possible. The analysis is based on ethnographic research conducted between 2009 and 2013 in the Vinnytsia region (Central Ukraine). [ABSTRACT FROM AUTHOR]

This paper introduces the notion of 'risky encounters', referring to the way in which contacts with doctors are commonly perceived by the inhabitants of Bishkek, the capital city of Kyrgyzstan. The author's research conducted between 2011 and 2013 revealed that most people were extremely critical of biomedical personnel, despite positive assessments of healthcare reforms expressed by experts. Owing to the prevailing distrust of doctors, their interventions are often considered risky to one's health, which strongly influences people's health-related strategies in the context of medical diversity. This perception of risk is deeply embedded in feelings of uncertainty and anxiety, which should be viewed from the more general perspective of the political, economic and social uncertainties resulting from the difficulties of the period of post- Soviet transformation. It is evident that medical diversity in Bishkek provides people in need with many non-biomedical treatment options, and a distrust of doctors significantly contributes to the popularity of complementary medicine. Economic constraints and local concepts of health, illness and efficacy are among the many other factors that play a role in therapeutic choices. However, the current paper focuses on risk, uncertainty and trust, as emotions that are central to an understanding of the health-related strategies and tactics used by the inhabitants of present-day Bishkek. [ABSTRACT FROM AUTHOR]

The category of community health worker applied within the context of health intervention trials has been promoted as a cost-effective approach to meeting study objectives across large populations, relying on the promotion of the concept of ‘com-munity belonging’ to encourage altruistic volunteerism from community members to promote health. This community-based category of individuals is recruited to facilitate externally driven priorities defined by large research teams, outside of the target research environment. An externally defined intervention is then ‘brought to’ the community through locally recruited community volunteers who form a bridge between the researchers and participants. The specific role of these workers is context-driven and responsive to the needs of the intervention. This paper is based on the findings from an annual evaluation of community health worker performance employed as community counsellors to deliver semi-supervised HIV self-testing (HIVST) at community level of a large HIV/TB intervention trial conducted in urban Blantyre, Malawi. A performance evaluation was conducted to appraise individual service delivery and assess achievements in meeting pre-defined targets for uptake of HIVST with the aim of improving overall uptake of HIVST. Through an empirical ‘evaluation of the evaluation’ this paper critically reflects on the position of the community volunteer through the analytical lens of ‘failure’, exploring the tensions in communication and interpretation of intervention delivery between researchers and community volunteers and the differing perspectives on defining failure. It is concluded that community interventions should be developed in collaboration with the population and that information guiding success should be clearly defined. [ABSTRACT FROM PUBLISHER]

This paper presents three embedded episodes in the life of a polyherbal drug indicated as a preventative measure for hangovers. Invented and marketed in 2005 by a leading ayurvedic pharmaceutical company in India, PartySmart is a reformulated compound based on ayurvedic, biomedical and phytochemical sources. This creative process has involved multiple translations, resulting in hybrid pharmacological models, including, for instance, ayurvedic post-digestive tastes and biomedical effects on enzymatic activities. These modes of therapeutic action are conceptualizations of an active drug – i.e. a digested and metabolized drug. A problem arises, however, in the fact that the ingestion of this drug is linked to alcohol consumption in a country where it is widely considered in negative terms. For this reason, PartySmart was seen as an ambivalent presence in the firm's catalogue and thus a series of interventions aiming to uphold the image of this drug transformed both its social inscription and its materiality. This transformation also took a different, global trajectory as the drug gradually developed as a transnational pharmaceutical commodity and became a new object in new latitudes. By focusing on the social and material dimensions of this drug in these contexts, this paper calls upon science studies to expand the scope of pharmaceutical anthropology. It brings together various layers of analysis to offer new perspectives on contemporary herbal formulations as they traverse material cultures, medical epistemologies, sociopolitical borders, legal environments and social practices. [ABSTRACT FROM AUTHOR]

Despite the recent growth of social science literature concerning the traditional medicine industry in Asia, insights into the contemporary dynamics of so-called ‘classical formulae’ remain relatively scant, as do studies of small-scale, less capitally intensive and technologically advanced modes of production. This paper seeks to address these gaps by considering a single Sowa Rigpa (Tibetan medicine) formula known as Samphel Norbu, or ‘wish-fulfilling jewel’, which appears in numerous texts and is today among the most popular Tibetan medicines in the world. Drawing primarily upon long-term fieldwork in Himalayan India, the paper follows Samphel Norbu's rise from exclusivity to popularity and examines the ways it has been transformed in the process, both materially and in its economic, social and clinical significance. The paper shows how Samphel Norbu acts as a marker of inequality between different groups of healers, and examines the role the medicine played in the development of commercial pharmacy and the proliferation of complex medicines. Tracing out wide variations in the medicine's formulation, composition, mode of production and pattern of circulation places the issue of multiplicity at the centre of analysis, and leads to a questioning of the assumptions that underpin the category ‘classical formula’. The paper reflects upon the repositioning of such formulae within emergent configurations of knowledge, power, industry and market, and on their transformations and transformative effects both over time and in the present moment. [ABSTRACT FROM AUTHOR]

Based on ethnographic fieldwork in a coastal village in south-eastern Tanzania, this paper examines how social inequalities and social suffering become embodied in the lived experiences of hunger. The paper explores local meanings of food, fertility and hunger and how these concepts interconnect and materialize on a landscape impacted by two large-scale conservation and development projects, the Mtwara Development Corridor and the Mnazi Bay Ruvuma Estuary Marine Park. Fourteen in-depth interviews Sinde villagers were conducted to elicit narratives about their food experiences in addition to 24 hour food recall and pile sort to explore local taxonomies of food. One focus group discussion with six women was also conducted. The study finds displacement from resources by the conservation and development projects has exacerbated existing food security issues of irregular rains, increasing food prices and malnourished bodies. The downward cycle of food insecurity has local villagers worried about the viability of their community's future, embodied in the health of local children and their performance in school. Increasing food insecurity is internalized within the community as infertility where the health of the landscape is connected to the health of society. [ABSTRACT FROM PUBLISHER]

Based on an ethnographic analysis of religious healing rituals in Israel, this paper addresses the question of how healer–client relations are structured on these rituals. An examination of what takes place at the rallies held by Rabbi Amnon Yitzhak indicates that, apart from the regular blessings, which can be referred to as ordinary healing, there are some ritual events that can be referred to as ‘deep healing’. The current paper demonstrates how deep healing rituals are generally conducted in severe cases through give-and-take between the rabbi and the person upon whom the blessing is bestowed, and that they are linked to relationships between people and the ethic of mutual support. [ABSTRACT FROM PUBLISHER]

Kleinman pioneered the use of intensive case studies in China and elsewhere. Drawing on this approach, this paper shows how two rural Chinese converts to Christianity recovered from prolonged mental sickness incurred during the Cultural Revolution many years earlier. The apparent ‘cure’ is part of local narrative in which rural Chinese Christians' first contact with Christianity has the pragmatic aim of seeking treatment to relieve physical pain, but leads to conversion and believed divine deliverance from psychological as well as physical suffering. In acquiring what they regard as new moral life and becoming dignified ‘divine selves’, they adopt new language and behavior and subtly change their relationships with family and the local power structure, thereby establishing a ‘holy local system’ that is regarded as able to withstand external crises and temporary setbacks. Setting up the holy local system highlights the inadequacy of rural bio-medical assistance, provides treatment for sickness and pain often blamed on Chinese society's relentless pursuit of economic development, and so introduces some compensatory if illusory rural stability. [ABSTRACT FROM AUTHOR]

Experiences of autism-spectrum disorder are now increasingly studied by social scientists. Human-animal relations have also become a major focus of social inquiry in recent years. Examining horse-assisted therapy for autistic spectrum disorders, this is the first paper that brings these fields together. Drawing on participant observation and interviews at a UK horse therapy Centre, this article examines how staff and the parents of riders account for the successes and limitations of equine therapy. To the respondents, horses ‘open up’ autistic children and make possible interactions that seemed impossible before. Horses were regarded as facilitating the emergence of apparently social behaviours, which included eye contact, pointing, and speech. Three key explanations emerged for therapeutic success: the sensorial, embodied experience of riding the horse; the specific movements and rhythms of the horse; and, the ‘personality’ of the horse. Equine therapy can be regarded as enabling a form of multispecies intersubjectivity, with the resonance between rider and horse seeming to make possible a new attunement between humans. Practices of equine therapy, and perceptions of its efficacy, serve in turn to attune social scientists to a version of empathy constituted through lively and sensorial interactions, as opposed to one that is restricted to particular kinds of humans. [ABSTRACT FROM AUTHOR]

By briefly exploring three different examples where the existence of mental illness and developmental delay has been presumed, this paper sheds light on the way what Foucault calls the emergence of a regime of truth, i.e. where something that does not exist is made to exist through the construction of a system of truth around it. The first example concerns the direct marketing of pharmaceutical products to consumers in the US, the second the use of psychology in semi-post-Cold War Korea, and the third the persisting authority of psychology in the treatment of the developmentally delayed. While these instances are not innately connected, looking at these as part of the process by which the authoritative knowledge is established will help us understand, albeit partially, the mechanism by which mental illness penetrates our lives as truth, and how this regime of truth is supported by the authority of psychology, psychiatry and psychoanalysis, what Foucault calls the ‘psy-function,’ reinforcing the medicalisation of our lives. [ABSTRACT FROM PUBLISHER]

This paper addresses the working practices of a mobile mental health outreach team in a large French city, one that ‘targets’ homeless people with severe psychiatric disorders who are considered ‘hard to reach’ by the public health authorities and medical services. Analysis of the team's work – where acts of curing and caring are closely tied – reveals the importance of moving beyond a polarized vision ofcureandcare. The paper departs from much of the literature on the medicalization of social problems by arguing that medicalization is not only a means of social control, but has ethical value as well. In examining the practices of frontline health workers, it aims to show that integrating the methods and theoretical approaches of social work in medical practice is necessary to address the specific problems of homeless people, to enable health professionals to pursue medical cures, and to challenge the shortcomings of public policy. [ABSTRACT FROM AUTHOR]

This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazil's regulatory context and societal expectations placed on medicine as a means for managing women's reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimentalsocialuse: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of women's health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices ofcuidar-se(self-care) seen in Brazil as essential for modern femininity. [ABSTRACT FROM AUTHOR]

This paper is an ethnography of a four-year, multi-disciplinary adolescent sexual and reproductive health intervention in Bolivia, Nicaragua and Ecuador. An important goal of the intervention – and of the larger global field of adolescent sexual and reproductive health – is to create more open parent-to-teen communication. This paper analyzes the project's efforts to foster such communication and how social actors variously interpreted, responded to, and repurposed the intervention's language and practices. While the intervention emphasized the goal of ‘open communication,’ its participants more often used the term ‘confianza’ (trust). This norm was defined in ways that might – or might not – include revealing information about sexual activity. Questioning public health assumptions about parent–teen communication on sex, in and of itself, is key to healthy sexual behavior, the paper explores a pragmatics of communication on sex that includes silence, implied expectations, gendered conflicts, and temporally delayed knowledge. [ABSTRACT FROM AUTHOR]

The everyday lives of contemporary youths are awash with drugs to boost pleasure, moods, sexual performance, vitality, appearance and health. This paper examines pervasive practices of chemical ‘self-maximization’ from the perspectives of youths themselves. The research for this paper was conducted among male, female and transgender (male to female, so-calledwaria) sex workers in Makassar, Indonesia. It presents the authors’ ethnographic findings on how these youths experiment with drugs to achieve their desired mental and bodily states: with the painkiller Somadril to feel happy, confident and less reluctant to engage in sex with clients, and contraceptive pills and injectable hormones to feminize their male bodies and to attract customers. Youths are extremely creative in adjusting dosages and mixing substances, with knowledge of the (mostly positive) ‘lived effects’ of drugs spreading through collective experimentation and word of mouth. The paper outlines how these experimental practices differ from those that have become the gold standard in biomedicine. [ABSTRACT FROM AUTHOR]

This paper examines how men's reproductive bodies are problematised in rural northern Malawi as access to biomedically defined diagnoses of the health of men's sperm contribute to the visibility of male infertility. Ethnographic research with infertile and fertile men explored pathways into the sexual health and fertility services offered in district hospitals, men's clinical engagements and masculine imaginaries. The research suggested that men's willingness to be referred for semen analysis is an extension of intensive and persistent help-seeking for childlessness instigated by couples and encouraged by families. Within the laboratory, acceptable social arrangements for semen sample collection are negotiated between male clients and laboratory staff, which emphasise heterosexual and marital virility. Following diagnosis, counselling by clinical officers, without any significant therapeutic interventions, focuses on compassion in marriage. This paper considers: what is the role of semen analysis within public health facilities and why do men participate? How do men experience an infertility diagnosis and what do they and their partners do with this knowledge? In addition, how do these practices shape gendered relationships in families and communities? The analysis builds on Inhorn's (2012) concept of ‘emergent masculinities’ to better understand the connections between male subjectivities, medical technologies and the globalisation of male reproductive health, as they relate to men's lives in rural Malawi. [ABSTRACT FROM AUTHOR]

This paper focuses on the diversity in patients' experience of biomedicine and contrasts it with the normative view characteristic of health professionals. Ethnographic fieldwork among Polish migrant women in London, Barcelona and Berlin included interviews about their experiences with local healthcare and health professionals. Themes drawn from the narratives are differences between the cities in terms of communication between patients and health professionals, respect for patients' choices and dignity, attitudes to pregnancy and birth (different levels of medicalization), and paediatric care. It is argued that patients continuously negotiate among their own views and expectations based on previous experiences and knowledge from personal communication; internet forums and publications; and the offer of medical services in the countries of their settlement. Patients experience pluralism of therapeutic traditions within and outside bio-medicine. In turn, representatives of bio-medicine are rarely aware of other medical practices and beliefs and this leads to various misunderstandings. By highlighting the pluralism of medical practices in European countries and the increasing mobility of patients, this case study has useful implications for medical anthropologists and health professionals in a broader Western context, such as raising sensitivity to different communication strategies and a diversity of curing traditions and expectations. [ABSTRACT FROM AUTHOR]

This paper is based on ethnographic fieldwork at an obstetric ultrasound unit in Denmark and explores the few, intense minutes of clinical interaction following a high-risk screening result for Down's syndrome. The category of high-risk transforms the routine ultrasound into a situation of inescapable choice, where the health of the foetus is questioned and decisions must be made. The clinical interactions following a high-risk result are investigated as processes of production, and the concepts oflogic of choiceandthe logic of careare employed as analytical tools for identifying different rationales at play in the situation. The analysis shows that sonographers and women/couples collaboratively engage in logics of choice and care. Their mutual aim is to make the high-risk results meaningful and manageable so that a decision can be made. In this process initiative is shifted back and forth. Through a logic of care, complexity is reduced and statistics transformed by emphasising certain interpretations and leaving others unspoken. However, the logic of choice is also collectively maintained by positioning the women/couples as decision-makers. It is argued that in the obstetric ultrasound unit, the logic of choice provides a powerful frame, with the logic of care filling in the gaps and discontinuities to facilitate decisions. In this context, the logics are complementary rather than competing, and thus the analysis add new perspectives to the original concepts. In sum, the logics of choice and care provide a valuable analytical tool for interpreting and understanding the complex and collaborative practices of clinical interaction. [ABSTRACT FROM AUTHOR]

Building on fieldwork carried out in a clinical trial looking at early antiretroviral treatment for HIV in Abidjan, this paper aims to analyse the way relations emerge during trials and the consequences of the end of participation. Instead of discussing it using the register of ethics, understood as a universal set of principles, the trial is analysed for what it means locally for its actors, mainly patients. From this standpoint, the trial can be defined as both a promise of life and of new possibilities embodied in what is often described as new family ties. How are such ties formed and what does it mean when these ties are broken at the end of patient participation? Discussing the failure of family ties commented upon by patients and dealt by physician researcher is a way to look at ethics from below. [ABSTRACT FROM AUTHOR]

This paper describes the appearance and subsequent disappearance of ‘Barrow Man’ and uses anthropological and social psychological theory to examine the socio-cultural, psychological and economic conditions for the existence of the phenomenon. It argues that these conditions were the result of both specific local labour market circumstances and of the effects of global political changes, and argues that to talk about ‘Barrow Man’ as if it was a psychiatric diagnosis was to identify a moral construct as a mental disorder. It also argues that at the same time the phenomenon was expressive of certain core values that were not readily acknowledged in everyday clinical practice and that it might therefore best be understood as an institutional category. [ABSTRACT FROM PUBLISHER]

Individuals with eating disorders often exhibit profound ambivalence towards taking prescribed medications. They may actively restrict their intake of medications, take them and then purge them, or hoard them and ‘binge’ on them. Such behaviors are often labeled clinically as ‘treatment resistance,’ and power struggles over medication adherence between clinicians and clients often ensue. This paper advances an alternative perspective. Based on extensive ethnographic and clinical engagements with women with eating disorders who restrict their medication intake, the analytical focus is pivoted to consider medication refusal not only as communicative in the interpersonal realm, but also as a powerful means of self-communication within the context of a larger ethical and moral project. This larger project makes visible the underside of what Lakoff (2008) calls the logic of pharmaceutical reason, which presumes that people naturally strive for optimal health. For these clients, by contrast, the optimal state is not health, but deprivation, which is experienced as a moral imperative extending well beyond issues related to body weight and shape. Within a broader cultural context where medication use is increasingly viewed as a legitimate and even superior means of self-management, medication restriction among people with eating disorders signals layers of meaning far beyond ‘treatment resistance.’ Refusing needed or useful medication can become a private and personally meaningful practice, largely independent of the material or interpersonal effects of the drugs. This suggests that the symbolic significance of medications must in some cases be discerned by their selective absence. [ABSTRACT FROM AUTHOR]