Petra Yang 杨澹里

This is a reflection paper I wrote on May 6, 2023 for college course Anthro 216GH: Case Studies in Global Health with Professor Felicity Aulino.

Word Count: 927

In this essay I ask, through what pathways of causation have neoliberalist policies, with other social-economic factors, created the malnutrition crisis in Maiduguri, Nigeria? I argue that similar to IMF policies’ pathways to exposing women and children to HIV/AIDS (de Vogli & Gretchen, 2005), pathways happen at macro, meso, and micro levels; the poverty-malnutrition interplay led to sicker people.

Neoliberalism is an economic and political theory. Neoliberalism intends to form a world (market) without state involvement. Individuals are rational beings who know the market and can always make perfect choices for their benefits. Clark Simon (2005) argues that “the point for [those who espouse] neoliberalism is not to make a model that is more adequate to the real world, but to make the real world more adequate to its model.” “Neoliberal rationality,” Wendy Brown (2003) argues, “…it involves extending and disseminating market values to all institutions and social action, even as the market itself remains a distinctive player.” 

After World War II, the Bretton Woods Agreement was established to stabilize the international monetary system and reconstruct postwar Europe through the working bodies of the International Stabilization Fund (the later International Monetary Fund, IMF) and the International Bank for Reconstruction and Development (IBRD, core of the World Bank). In the 1980s, the World Bank changed from seeing health as a basic human right to adopting neoliberal policies of structural adjustment. When poor countries in the 1980s faced economic crisis and had the only option to borrow money from outside, the IMF announced that the poor countries could get money only after undergoing structural adjustments of stabilization, liberalization, and privatization to their economies. Stabilization is achieved through limiting monetary growth. A frequent method is cutting state spending on social programs. Liberalization aims to clear all state interventions in the market such as subsidies. Individuals are charged user fees and need to pay to use public goods such as healthcare, food, water, and education. Privatization is achieved when the government sells state assets to private owners, leaving little control of the state over economic policies and development, so that the state needs to ask for loans from other countries (through the World Bank). 

When neoliberalist policies of structural adjustment are applied to healthcare, “public health system is only a distortion that should get out of the way.” (Rowden, 2009, 157) Stabilization stops governments from running their own healthcare and education programs, disrupting self-reliance and training for expertise. Liberalization decreases the local health services (which are increasingly private) utilization because service is expensive. It also enlarges the informal drug market where alternatives of expensive drugs are sold, however, the quality of drugs are “expired, prohibited and/or incorrectly prescribed.” (Rowden, 2009, 158) Privatization makes health services private, overly concentrated in high-income areas, and too scarce to meet the needs of poor patients, and the state has no power to pull services together to serve the poor since public services are sold and development is prohibited. The state has to comply to foreign aid.

In Maiduguri, Nigeria, malnourished children coming to international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF)’s therapeutic feeding center reached an increasing rise in spring 2023. “‘The number of weekly admissions is two to three times higher than [what we’ve seen] over the past five years, and it’s still rising,’ said Htet Aung Kyi, MSF medical coordinator.” Admissions also started earlier than the June-to-November annual hunger gap, suggesting that other factors play in the malnutrition crisis. 

At the macro level, funds requested not through the humanitarian response plan were secured at a low percentage. Food subsidies were fertilizers. Evidence for subsidies for other commodities was limited. Nigeria food import dependency remained high in 2021, especially for wheat and sugar (Jung 2023, Figure 13). Although Nigeria set foreign exchange restrictions, the US turned its focus and exported “private sector investments in the agribusiness value chain” to Nigerian farmers who “cheaper, basic, easy-to-use-and-maintain farm machinery from Asia.” A 2021 report by U.S. Commercial Service suggested that Nigerian public healthcare infrastructure was “underdeveloped.” (critical analysis can start from this word choice) Not enough healthcare professionals were in place. Planned construction of primary health care centers (PHCs) in both urban and rural areas were inconsistent. Less than 5% of Nigerians were enrolled in the National Health Insurance Scheme (NHIS).

At the meso level, beds ran short in the MSF feeding centers. People in Maiduguri were forced to move out of their homes and travel to official camps. After 2021, official camps were closed. People arrived, in poor health, at transit camps with harsh conditions. A redesign of Nigerian currency made people unable to buy food. Food prices underwent post-pandemic global inflation and became higher. A fire destroyed the largest physical market in Maiduguri. Climate change decreased the quality of crops and challenged food production and supplies. People need to pay user fees to receive healthcare. 

At the micro level, adults and children could not afford food, reach food supplies, or farm, leading to higher susceptibility to disease for malnourished children, adults, and newborns. People might not be able to turn food they eat into energy due to illnesses such as TB, HIV, and measles, which can be created by water scarcity, concentrated harsh living conditions in the transit camps, and prostitution as the only source for income. Since people could not earn wages, they became poorer, and in turn, have less access to treatment of malnutrition.

Through macro, meso, and micro level pathways, neoliberalist policies and other social factors affect malnutrition and health of people in Maiduguri, Nigeria.

Writer’s Reflection:

Due to word limits, I cannot incorporate more historical context of Maiduguri, Nigeria. The social factors in this analysis are limited. I also did not get into feasible strategies and interventions for this case. 

I wrote on how neoliberalism engages social construction of reality:

Social construction of reality (Peter L. Berger and Thomas Luckmann) states that the perceived reality and knowledge we have are socially constructed through habituation, institutionalization, and legitimization. Neoliberalism reflects institutionalization since it utilizes law and institutions to set up rules of doing things, and actors go through the cyclical stabilization – liberalization – privatization – loaning again and again. Neoliberalism engages habituation when local people had to pay for healthcare and take paying as part of their routine. When neoliberalism as an ideology is promoted and used more and more in the local communities, it becomes natural. This process is hegemony (Jean and John L. Comaroff).

Bibliography

Clark Simon. “The Neoliberal Theory of Society” (2005)

Brown, Wendy. “Neo-liberalism and the End of Liberal Democracy.” Theory & Event 7, no. 1 (2003) doi:10.1353/tae.2003.0020.

Rick Rowden, 2009. The Deadly Ideas of Neoliberalism: How the IMF Has Undermined Public Health and the Fight Against AIDS. Zed Books. 

De Vogli, R., & Birbeck, G.L. (2005). Potential impact of adjustment policies on vulnerability of women and children to HIV/AIDS in sub-Saharan Africa. Journal of health, population, and nutrition, 23 2, 105-20 .

Jung, I. (2023). Food Insecurity in Nigeria: Food Supply Matters: Nigeria, Selected Issues Papers, 2023(018), A001. Retrieved May 6, 2023, from https://www.elibrary.imf.org/view/journals/018/2023/018/article-A001-en.xml

MSF,2023.https://www.doctorswithoutborders.org/latest/nigeria-msf-treats-unprecedented-number-malnourished-children-maiduguri

MSF,2021.https://www.doctorswithoutborders.org/latest/msf-speaks-out-about-health-and-humanitarian-impacts-climate-change

MSF,2022.https://www.doctorswithoutborders.org/latest/catastrophic-malnutrition-crisis-northwest-nigeria-demands-international-response

2001. https://www.trade.gov/market-intelligence/nigeria-food-and-agriculture

This is my final project (May 8th, 2023) for college course Anthro 216GH: Case Studies in Global Health with Professor Felicity Aulino.

Word Count: 4397

In this essay, I explore the clinical and community mental health care in Chengdu, China. Using the biosocial theory of Local Moral Worlds, I argue that the nonalignment of the morals of mental health care providers and receivers is the root cause of the inaccessibility of mental health care in Chengdu. I propose three steps as a solution: 1) aligning the profiles of populations the providers are targeting and the actual receivers of care, 2) carefully examining the influence of care providers’ morals on the receivers, and 3) recognizing marginalized groups that are invisible in Chengdu and including them as mental health care receivers.

Kleinman (2010, p.1518) wrote on the biosocial theory of Local Moral Worlds. Local worlds are places and networks where people’s lived experiences happen. The values of each local world, including local cultures, law and policies, social norms, personal experiences and beliefs, history and hegemony, economic rules, and important interactions within and beyond communities, create local moral worlds that influence people’s health (cognitive, emotional, and physiological) in global health issues. Ethics are announced to justify certain values and promote certain outcomes. Yang et al. (2006, p.1524-1535) argued that stigma – the experience of being discredited – is a moral one, and it impacts people’s health through threatening the loss of values (and important things these values promote) or destroying these values in local worlds. Guo (2008) argued that in China, stigma transformed a normal person with HIV/AIDS or mental illnesses to nonpersons in the way they were perceived and treated.

What Are Clinical and Community Mental Health Care in Chengdu, China? 

The Local Worlds of Chengdu people’s lived experiences of mental health care

Chengdu is the capital city of Sichuan province in southwestern China and the sixth largest city in China. The population is 16.33 million (2019). Clinical mental health care in Chengdu happens in places and networks of general and specialty hospitals, school and district (community) mental health service centers, online and in-person private clinical practices, and free crisis hotline 96008.

Although more civilian-run mental health care facilities appear, mental health care in general and specialty hospitals are mostly state-owned. The Fourth People’s Hospital of Chengdu, or Mental Health Center of Chengdu and The Clinical Hospital of Chengdu Brain Science Institute, founded in 1906, is one of the two largest mental health facilities in Chengdu. It offers care, training, research, prevention, rehabilitation, counseling, and psychotherapy. Its annual outpatient visits are 500,000 and the inpatient visits are 12,000. The Mental Health Center at West China Hospital, Sichuan University, is the largest psychiatric specialties of general hospitals and a co-establisher of psychiatry practice in China. It offers clinical care, training, and research. Its annual outpatient visits are 300,000 and the discharges are 6,000. Other mental health centers in Chengdu include Chengdu Mental Health Research Center for Youth at Chengdu Southwest at Children’s Hospital, Chengdu Jinxin Psychiatric Hospital, Mental Health Center of Chenghua District, and Chengdu Wenjiang District No.3 People’s Hospital.

Clinics take place on some campuses of universities, colleges, high schools, middle schools, elementary schools, nurseries, and kindergartens. Examples are the Mental Health Care Education Center at Chengdu University of Technology and Children Mental Health at Star River Nursery. A proportion of which schools offer mental health care is unknown. According to Chengdu Municipal Health Commission, each community within each district in Chengdu has its own health service center, where general care is offered without mental health care. This community refers to people living and acting in a certain area of several streets. People can find the address and line of these centers online. Examples of community (district) health service centers are Health Center, Jianshelu Community, Chenghua District and Chenghua Wannian Community Health Service Center. For mental health care on the community level, a list of mental health care facilities (enrolled in the yangguang mental health care program, 精神卫生阳光救助定点医疗机构) is offered with address and line. These are actually the hospitals mentioned above that offer mental health care. A free crisis hotline 96008 was set up to connect you to mental health services in several yangguang hospitals.

Psychotherapists and counselors are trained at different levels in Chengdu, China. The system of training is not standardized or rigorous, leading to chaotic experiences of seeking and doing therapies. Many psychotherapists and counselors offer online and/or in-person private practices. An example of online platform for mental health private practice is MyTherapist (简单心理). It offers assessments, therapies, tests, free hotline, physical service at Feeling Matters Wellness Center, and training. A psychotherapist can rent an apartment, set up the apartment as a counseling space, and offer therapies for people. Other private practice therapists can register and practice at private mental health centers like Chengdu Ruishi Mental Health Counseling Center (成都瑞时理心理咨询中心).

For community mental health care in Chengdu, where community refers to non-clinical, non-state institutions, facilities, or networks outside private practices, limited information can be found online. Know Yourself (知我) is the largest community mental health care provider. It focuses on NeoMeditation (textual, visual, audio, and physical workshops of meditation), Daily Practice (self-help textual narrative), Text Counseling (the only clinical part, textual Q&A that combines Therap-e-mail and CBT), Psychological Assessments (professional and for entertainment), retreats, thematic peer support tea parties, corporate services, and media content about psychological topics like romantic relationships.

Local Moral Worlds of mental health care in Chengdu

As an example of local moral worlds in Chengdu clinical mental health care, Chengdu Mental Health Research Center for Youth at Chengdu Southwest at Children’s Hospital (成都市儿童青少年心理健康(家庭教育)研究中心) was founded in 2018 based on the aim of offering convenient one-stop shop mental health care hospital for youth and their families. Its core values are helping youth achieve physical and mental health, promoting youth mental health care, and guiding and helping Chengdu families form healthy family education values and have the right family education. It receives funding from Sichuan (province) Youth Concern Foundation (四川省关心下一代基金会) and is organized by Chengdu Family Education Promoting Association (成都市家庭教育促进会). It targets mental health issues of youth under 17 that take over 250,000 lives annually and emphasizes the inadequate family relationships and education environment behind these issues. It realizes the financial and psychological burden and illnesses of caretakers for youth with mental health issues. It recognizes itself as the most comprehensive and professional youth mental health care team in Chengdu. 

As an example of local moral worlds in Chengdu community mental health care, Know Yourself (知我) has the mission of “helping people develop skills of happiness and lead a wellness lifestyle with an emphasis on mental wellness within the society.” It aims to promote a new value of health in China: a transition from traditional physiological health to both body and mental health. It hopes to make pursuing mental health a popular lifestyle like fitness. Its customer profile is people earning high salaries living in first-and-second-tier cities in China. Over 80% of their customers hold a degree above undergraduate.

Other values of the local world of Chengdu mental health care include categorizing mental health services by levels of the professionals and charging different fees for each level at The Fourth People’s Hospital of Chengdu. The hospital established this policy on May 4, 2023 to satisfy diverse needs of mental health and offer tailored mental health care for each visitor. To receive care, visitors are required to make appointments of 30-40 minutes with professionals categorized to four levels. Visitors pay 800 yuan for a 40-minute appointment with a level-one mental health professional, 600 yuan for a 40-minute appointment with a level-two, 400 yuan for a 30-minute appointment with a level-three, and 300 yuan for a 30-minute appointment with a level-four. The average monthly wage in Chengdu was 9696 yuan for the first 2023 season. The average monthly house rent is 2500 yuan.

Another value of the local world of Chengdu mental health care is the constant recruitment for the professional, free, and convenient Chengdu mental health hotline for over ten years as a response to the 2008 Sichuan earthquake of 8.0 M_s magnitude. The earthquake led to 69,227 deaths, 374,643 injured, and 17,923 missing. Earthquakes happen frequently in Sichuan province. Local news broadcasts earthquakes on time. First aid and emergency response and practices to earthquakes are integrated in Chengdu elementary school curriculum, and Chengdu people share a calm attitude towards earthquakes. This Chengdu mental health hotline provides mental health education, psychotherapies, and mental health crisis intervention for the general public, families where the only child is injured, disabled, dead and those have no babies or adoption after (as a response to the One-Child Policy), and middle-and-elementary students, parents, and teachers. Its values are caring for people’s mental health, guarding their peacefulness, and becoming the light in the dark. The Chengdu mental health hotline and the cultivated local mentality of being calm, positive, and prepared in the face of frequent earthquakes are in an interplay.

What’s the problem?

The key problem of mental health care in Chengdu, China, is that it is inaccessible. Specific issues demonstrating this inaccessibility include shortage of mental health facilities and professionals, difficulty in making appointments with professionals, unequal distribution of healthcare, limited forms of mental health care, no mental health care offered in the northern Sichuan area, high user fees of mental health care (not included in medical insurance), limited law strategies of caring for the mentally ill, marginalized, and poor groups, inconsistent quality of private practice, histories of abandoning mental health care that contribute to lingering rejection of care, criminalization of the mentally ill, economic instability and public health concerns, industrial development’s challenges to personal, relationship, and social functioning, stigma about mental illnesses, blaming people for having mental illnesses, and invalidating families, friends, visitors, or self’s experiences of mental illnesses.

During my years of elementary, middle, and high schools in Chengdu, people in my network talked about how difficult it was to make appointments with doctors in large hospitals in Chengdu. During the COVID-19 pandemic, beds offered at hospitals were always full and healthcare professionals were lacking and exhausted. In smaller cities and towns, there were even fewer care facilities. Mental health care resources were allocated unequally among urban, suburban, and rural areas. Many patients had to travel to other districts for care. To address the unequal distribution of healthcare in Sichuan, in June 2022, Health Commission of Sichuan Province published a plan (《四川省“十四五”医学中心和区域医疗中心设置规划》) that cut the province into five areas and redistributed resources among each area. This initiative aims to construct an efficient and integrated healthcare system, reduce cross-district seek for care, promote level-based care, and ultimately provide people in Sichuan, the western China, and countries and regions of the The Belt and Road Initiative with quality, efficient, and accessible healthcare. However, the resources redistributed were general and specialty hospitals, excluding clinics, private practices, other networks and organizations, and community mental health care. This redistribution engaged healthcare in general, with mental health care offered at four out of five areas. The Northern Sichuan area did not offer mental health care, which means that people living in northern Sichuan still need to travel for mental health care. Also, the number of facilities or beds in hospitals remained the same.

Values that this initiative promotes in the local worlds of Sichuan health care are Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, the spirit of the 19th Central Committee of the Communist Party of China, the idea that people’s health is key, and establishing the advantages of the unique Chinese healthcare system. Chengdu local government promotes political thoughts, theories, and core values through media and policies, the party-directed organization structure of clinical mental health care centers, clinics, and hotlines, and meetings and training for mental health professionals. 

More cases of mental health concerns and illnesses appeared in recent years when the pandemic and quarantine brought challenges to people’s lived experiences in their local worlds. The pandemic directly increased stress levels, separated intimate relationships, led to injuries, deaths, chronic illnesses, trauma, and disabilities, complicated the relationship between government and the people, grew unemployment and business bankruptcies, turned the macroeconomy and daily lives unstable, and doubled the consequences of inappropriate policy. Meanwhile, as the need for mental health care rose, the state leveraged resources to meet the need. It announced its work in investing in mental health care and declared a focus on offering mental health care, which closed some gap between the need and service in mental health care and alleviated stigma towards mental health illnesses.

Qin Lu, Deputy Secretary-General of Chengdu Municipal Committee of the Chinese People’s Political Consultative Conference and Professor of Psychology, argued that the district (community) mental health care in Chengdu lacks support from the healthcare system, falls short on mental health professionals, and has limited forms of services. District mental health care in Chengdu works to promote residents’ living conditions and happiness, and in turn, creating a safe, healthy, and civilized Chengdu city culture.

Chengdu medical insurance does not include mental health care. Visitors need to pay from their pockets. In 2012, the Mental Hygiene Law of People’s Republic of China (《中华人民共和国精神卫生法》) was passed on the 29th meeting of 11th National People’s Congress (NPC) Standing Committee as the first national law for mental hygiene. It states that people with severe mental disorders can access free public health services, and the poor among them can enjoy government-funded basic medical insurance, the priority of being cared for, and potentially subsistence allowance. Still, people’s social functioning is far from being guaranteed, and mental health care needs to be paid. Further, while the poor and mentally ill were addressed, other marginalized groups who are susceptible to mental illnesses were not discussed. So was comorbidity of mental illnesses or mental and other medical illnesses.

On mental health care in China, Zhang (2020, p.9-21) presented that in China today, estimating who has mental illnesses and what illnesses (epidemiological study) is difficult because mental disorders like depression and anxiety disorders were not introduced until the 1990s; people in need for mental health care could reduce their conditions to somatic and physiological and sought help from traditional Chinese medicine and Western medicine ([]); stigma makes coming out with having mental concerns and illnesses and looking for help challenging. Mental health facilities are too few for a large population in China, hospitals offer mostly drugs to people with psychosis, and the quality of psychotherapists and counselors is inconsistent. Zhang (2020, p.150-174) explained that introducing psychology to China renovated people’s values about the mind/mental (xin, 心); political governing was involved in therapeutic practice; therapies for individuals with anxiety are digesting the influences of rapid economic reform on people in China.

Nine years ago, similar problems about mental health care in China were raised and researched. Jinhua and Kleinman (2011, p.237-238) presented that in China, current epidemiological data could not inform the actual number of cases of mental illnesses due to reasons like various diagnosing criteria and difficulty in diagnosing psychosis. Available mental health care in Chinese hospitals did not meet the demand. Mental health care quality was lacking. Stigma blocked people from accessing care and added on to the suffering, making them socially dead. Mental illnesses were politicized as things to be abandoned during the Cultural Revolution. People of Chengdu who experienced the Cultural Revolution can find mental health care a threatening or bizarre idea, reject the existence of mental illnesses, project prejudice to people in their network, or miss the opportunity to understand themselves using psychological tools. Mental health care diminished then, and is now slowly growing. Baum (2018) traced the historical documents about mental health care in the early 20th century Beijing, China, and found the making and medicalization of madness.

Many people I met in Chengdu held their mental health issues and illnesses to themselves. Some reasons are families’ lack of understanding of mental health issues, not wanting families to worry about them, coming out would attract discrimination against them, explaining the whole situation of having mental illnesses is tiring and the listener might not understand, distrust of certified therapists, and more. When I went to a Chengdu certified therapist’s first private practice session in 2020, he blamed me for having depressive episodes as a privileged kid who did not acknowledge my privilege. He was invalidating my lived experiences of having Major Depressive Disorder and reducing my experiences to being vulnerable and spoiled. It took me a year to regain trust in therapists.

Other common issues of mental health care in Chengdu include reductive thinking of “you’re a negative person, why can’t you be positive?”, which rejects people’s experiences and relevant values like prioritizing their health. People with mental illnesses tend to be criminalized by misinterpretation of their presentation, when they have other marginalized identities, and more. When people go into jails without mental illnesses, they can come out with some, and depending on how much rehabilitation is offered, they face challenges of integrating into society.

What Are the Root causes?

Using the lens of Local Moral Worlds, I argue that the root cause of inaccessible mental health care in Chengdu, China is the nonalignment of the important values – morals or what’s at stake – between the provider and receiver of mental health care. 

Many stakeholders are involved in mental health care in Chengdu. Here, I put mental health professionals, professors, care evaluators, managers, and researchers into the provider category; and people with mental health issues and illnesses looking for care into the receiver category. The nonalignment takes five forms: opposite, branching-out, parallel, missing, and crossing-over. When the morals align in the forms of complete overlap or ending on the same point (although starting from different points), mental health care becomes accessible. This relationship between morals of the mental health care provider and receiver can be understood as two lines with both starting and ending points.

In the morals of mental health care providers, there are claims of serving a certain population such as youth, elementary and middle school students, the severely mentally ill, the poor, families of youth, and the general public. Nonetheless, people who ultimately access the care might not fit these profiles. For mental health care receivers, factors like user fees, the distance from residency to care, trust of care providers, fear of being discriminated against or treated as madpeople by the providers, worries about providers disclosing their information are at stake. Since providers fail to address these factors important to the receivers, and both morals do not align, mental health care cannot be delivered. In this case, the nonalignment takes the shape of crossing-over as providers profile receivers and acknowledge certain challenges, however fail to support receivers. 

Some mental health care providers serving the youth made clear that they promote certain familial relationships which they believe are right, and their care focuses on redirecting those relationships to the “right” direction. When the receivers disagree on the criteria for familial relationships (nonalignment – opposite), or the care fails to offer a step-by-step guide for those relationships (nonalignment – branching-out), the care is inaccessible because the morals of the providers and receivers do not align. 

In the morals of mental health care providers in Chengdu, the LGBTQIA+ community never appeared on the receiver list, making the community invisible. The morals of people with mental health care needs in the community and those of providers do not align (missing).

What Can Be a Solution?

Interventions for the nonalignment of the important values – morals or what’s at stake – between the provider and receiver of mental health care in Chengdu, China should aim to bring alignment (complete overlap or ending on the same point) between the morals so that care is accessible.

The first step is aligning the profiles of populations the providers target and the actual receivers of care. This means that the providers list and analyze what’s at stake for the populations they aim to serve. Morals and relevant strategies here should include:

• affordable or free care. Work to include clinical mental health care, both drugs and psychotherapy, in medical insurance for the general public in Chengdu. Do not raise the price of health insurance or take other actions to increase the uninsurance rate. Lower the current price of mental health care. Increase the frequency of free clinic services or establish free clinics in the form of voluntary organizations. Leverage funding from the saved cost of the original clinical care model.
• increased transparency of care. People worry about the quality of care. Host group discussions on the quality of care. Hire filmmakers to document receivers’ feedback of care, their thoughts on current care and suggestions for improvement, their experiences of receiving care, and do screenings in different districts and communities to inspire more discussions on the quality of care. Run a hybrid platform with frequent calls for submitting evaluations of care and art works and writings about mental health care. Share the evaluations with the providers. Announce the current evaluation system for the providers within the system. Encourage more care providers to talk about their working experiences and values in communities.
• Based on the evaluations above, set up a standardized system for evaluating all providers. Require providers who do not meet the standards to stop practice. Constantly meet and modify the system. Share the evaluations on websites and other media where people looking for mental health care can easily find relevant information and choose the care they trust. Send out surveys, conduct interviews, and use other research methods to collect data on whether that trust is met during and after the care sessions. Update the evaluations frequently. Study and analyze current law and policies of mental health care. Emphasize punishment when the providers and receivers violate the law.
• Reexamine the current training for mental health care providers. Standardize the training and offer more training spots. Aim to bring practitioners to the stage of performing their responsibilities fluently and understanding the group they serve.
• Continue to bring one-stop mental health clinics into all five areas in Sichuan. Establish more mental health care facilities, especially in the northern Sichuan area. Work to offer mental health care in the mental health center of every district. Encourage more students to study mental health. Save cars and fleet vans and hire drivers to transport people looking for care at a low price or for free. The drivers are employees of the care facility and are paid by the facility.
• Consider using the PACT model of community caregiving, Assertive Community Treatment (ACT) in community psychiatry (Brodwin 2012), recovery-oriented care (Myers 2015), People’s Free Medical Clinic of the Black Panther Party (Nelson 2011, p.75-114), peer support of the Wildflower Alliance (Lazović 2022), and other community mental health care models to align with the receivers’ morals of being accompanied, frequently checked-in, understanding more about mental health and themselves, participating in constructing the scientific knowledge of mental health and care, and advocating for themselves. Address the complexities of providers’ work in these models, where they struggle between following bureaucratic psychiatric practice handbooks and challenging these handbooks’ reductive approach on the mental health care receivers (as having abnormalities in their brain and biomedical systems). Discuss what recovery and care mean and what it takes to achieve them.
• Continue breaking the stigma of mental illness to respond to receivers’ fear of being discriminated against or treated as madpeople by the providers. Hold lectures, workshops, and discussions about stigma. Create interesting content about stigma and mental health and publish it in media such as Weixin and Toutiao. 
• Call for proposals of online and physical mental health services of various forms so that receivers have more opportunities and approaches of accessing care. Some receivers can benefit from online care if their morals include traveling far to receive care. In 2022, Qin Lu proposed building online platforms for mental health to diversify the care format, gather and share information, chat live with multiple stakeholders, and hold bulletins and salons about mental health. On May 8, 2023, The Fourth People’s Hospital of Chengdu called for projects that utilizes digital evaluation and care through online platforms.

The second step is to carefully examine the influence of care providers’ morals on the receivers. In July 2021, the Mental Health Center at West China Hospital, Sichuan University published a thank-you letter to PICU (急危重症精神障碍病房) from a patient with severe Major Depressive Disorder. This content was published on large Chinese media platforms of Sohu and TouTiao. In the letter, the patient described the unstigmatized gentle inpatient (isolated due to high risks of suicide and violence) care that mental health professionals in PICU offered over twelve days. She wrote how the care at PICU was patient, detailed-oriented, and undiscriminating: “when we mentally brokedown, mental health care professionals here did not leave us alone in ‘detention’ rooms,” “people sending food did not rush or say ‘don’t be picky,’ nurses did not yell at them, ‘go to bed now,’ and doctors did not leave with ‘keep observing, take meds, you’re not allowed to meet your families,’” “you did not treat us like ‘psychopaths or mad people,’ instead, you treated us as people who are more sensitive, gentle, and kind.” She continued that because of the delicate and undiscriminating care, she felt empowered, calm, worriless, and brave. In this case, care providers’ attitudes, responses, behaviors, the relationships between the providers and the patient validate the patient’s experiences of mental illness and support the patient on recovery. Different results would happen if the providers were exerting authority, treating the patient as a nonhuman, or blaming the patient for their conditions.

The third step is to recognize marginalized groups that are invisible in Chengdu, China, and include them in mental health care receivers. This recognition will challenge the morals of care providers. The biosocial theories of structural violence and social suffering can be useful in analyzing these morals.

Mental health care in Chengdu, China, has many strengths and issues. The key problem is its inaccessibility, which is rooted in the nonalignment of the morals of mental health care providers and receivers. Using the biosocial theory of Local Moral Worlds, I propose three steps in a solution to this problem: aligning the profiles of populations the providers target and the actual receivers of care, carefully examining the influence of care providers’ morals on the receivers, and recognizing marginalized groups that are invisible in Chengdu and including them in mental health care receivers.

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Guo, J. (2008). Stigma: Social suffering for social exclusion and social insecurity. From the ethnography of mental illness to the ethnography of HIV/AIDS in China.

Guo Jinhua and Arthur Kleinman, 2011. Stigma: HIV/AIDS, Mental Illness, and China’s Nonpersons. In Deep China: The Moral Life of the Person. University of California Press. (pp. 237-262)

Zhang, Li. 2020. Anxious China : Inner Revolution and Politics of Psychotherapy. University of

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Brodwin, Paul. 2013. Everyday Ethics : Voices from the Front Line of Community Psychiatry. University of California Press.

Myers, Neely Laurenzo. 2015. Recovery’s Edge : An Ethnography of Mental Health Care and Moral Agency. Vanderbilt University Press.

Alondra Nelson, “The People’s Free Medical Clinics,” in Body and Soul: The Black Panther Party and the Fight against Medical Discrimination (U. of Minnesota Press, 2011), 75-114.

Community Organizing and Community Building for Health and Social Equity, 4th Edition. (2021). United States: Rutgers University Press.

Sonja Lazović, 2022. Radical Openness: Potentials for Care through Peer Support in Western Mass. Honors Thesis, Department of Anthropology, Amherst College.

West China School of Medicine. (n.d.). Mental Health Center. https://www.wchscu.cn/details/54366.html

The Fourth People’s Hospital of Chengdu. (n.d.). About医院概况. https://www.cd4120.com/4120/Survey/yiyuanjianjie/

24小时在线 成都市有这些免费心理援助热线. (2022, February 14). Sichuan Online. Retrieved May 9, 2023, from https://sichuan.scol.com.cn/cddt/202202/58414586.html

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四川：成都市首家儿童青少年心理健康研究中心成立. (2018, April 9). National Working Committee on Children and Women under State Council. Retrieved May 9, 2023, from https://www.nwccw.gov.cn/2018-04/09/content_203033.htm

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I wrote this paper today as the FINAL project for college course History 411: History of Science Activism at UMass Amherst with Professor Sigrid Schmalzer.

Word Count: 1972

As responses to certain issues and social injustice, new knowledge, including theories and practices, about mental health was produced and used in the 1970-80s US in the ways of challenging current authority in hearing (law); intended or unintended simultaneous work between the public, companies, and states; generalizing the outcomes of certain practice to explain its biosocial nature in theory; valorizing the groups that were ignored and harmed in previous knowledge; utilizing personal experience for individual and group advocacy; Movements’ organizing in hospitals and streets; as a result of or avoiding previous failures or lack of time in utilization; creating new theories for future research and practice.

Between the 1970s and 1980s, the United States committed ground troops in Vietnam from 1965 to 1973 for the Vietnam War, and suffered physical and mental casualties. The anti-war movement rose to protest against the Vietnam War, and on November 15, 1969, “half a million people attended a mostly peaceful demonstration in Washington” (The Learning Network, 2011). As a response to the anti-war movement, Science for the People (“the most important radical science movement in US history” that aimed for science for social justice, 1969-1989) and the Union of Concerned Scientists (“a national nonprofit organization founded by scientists and students of MIT”) were founded in 1969. 

Although SftP worked on many issues across disciplines, fought against systematic “racism, sexism, and classism in science,” and “sought to demystify scientific knowledge and embolden ‘the people’ to take science and technology into their own hands,” SftP discussed little about mental health in their publications between 1969-1989. Under Chapter 4: “Biology and Medicine” edited by MD/PhD candidate in the history of science, Harvard University, Alyssa Botelho in the book Science for the People: Documents from America’s Movement of Radical Scientists (UMass Press, 2018), members of SftP reviewed the issues of genetic and evolution deterministic view of abnormal behaviors, recombinant DNA research, and cancer research. SftP also described the social responses to these issues, where debates and collaborations between researchers, administrators, and local residents happened. 

The one document tackling knowledge about mental health is The Genetic Engineering Group, “Actions on XYY Research,” Science for the People 7, no. 1 (January 1975): 4. The Genetic Engineering Group belonged to Boston SftP. This article was a mobilized protest against Boston Lying-in Hospital’s screening of newborns’ XYY chromosomes for mental disability (antisocial behavior). After explaining the no causal relationship between XYY chromosomes and antisocial behavior and the harms of claiming this relationship, the Genetic Engineering Group showed the process of producing new knowledge about mental health by challenging the review of this screening in a hearing (on October 4, 1975), before a special committee, against Harvard Medical School professionals. 

Advocates of the Genetic Engineering Group were not experts in the relationship between XYY chromosomes and antisocial behavior. Harvard Medical School Faculty Professionals thus viewed the advocates’ criticism unprofessional, “surprising and upsetting,” and even threatening to the faculties’ “academic freedoms.” (The Genetic Engineering Group, 1975, 93) The faculties did not consider the critique itself before jumping to judgment. 

The special committee accepted part of the critique and “recognized that truly informed consent was not being obtained,” and the research was potentially harming participants. Nonetheless, “the committee was clearly worried that if one study was stopped, the same could happen to other investigations with human subjects. The power of research precedent was also raised in the opposite context; the researchers implied that the existing screening programs (e.g. for the metabolic defect phenylketonuria—PKU) justified their chromosomal screening studies.” (The Genetic Engineering Group, 1975, 93) This clinical research also received support from the Crime and Delinquency Division of the National Institute of Mental Health. Together, the committee, research team, and the Crime and Delinquency Division of the National Institute of Mental Health suggested that clinical investigations should not be stopped even if they are risky and harmful, and that the mere existence of irrelevant previous research could justify this research. The Medical School Professionals considered the advocates’ critique untrustworthy because they were not trained in this field. There was a clear cut between professionals and advocates.

As a result of this advocates’ challenge in hearing, the committee was “deliberating the issue” and was “scheduled to report out their findings about Christmas time.” (The Genetic Engineering Group, 1975, 94) The advocates suggested that they would “bring the issue to public attention via newspaper coverage, magazine articles” if the committee decided to continue the research. The decision was still up to the special committee, which composition was opaque. The credibility belonged to Medical School Professionals who were trained in the particular field and proposed the clinical investigation. The advocates did not show enough credibility to end the research when the article was published, but their credibility might rise if they proceeded to advocacy.

What more was happening in the 1970-1980s US on producing and using knowledge about mental health? Isabelle Linguiti, class of 2020 at Hampshire College, briefly reviewed, in their Division III paper “Stigma and Mental Health Care: A Philadelphia Case Study,” (2020) the history of mental health care in the United States. In the 1950s, “the combination of public outrage, pharmaceutical treatment advances and the state’s desire to shift the cost to the federal government, led to the successful push for deinstitutionalization (Linz & Sturm, 2013).” (Linguiti, 2020, 7) In the late 1960s, state psychiatric hospitals were closed, leaving space for community mental health care so that people can “integrate into the community”. (Linguiti, 2020, 7) Deinstitutionalization happened as a result of the simultaneous voices from the public for inhumane conditions in the facilities, the pharmaceutical companies for more inquiries for meds and privatization, and the states for saving cost. The public, pharmaceutical companies, and states together produced the theory that institutionalization was no longer appropriate, and pushed for the practice of deinstitutionalization and community mental health care.

Linguiti argued that during deinstitutionalization, the states did not invest in the practice of mental health care and relevant social resources, leading to “dramatically increased rates of homelessness and incarceration of people with mental illness over the last 50 years (Perez, Leifman & Estrada, 2003).” (Linguiti, 2020, 8) The 1970-1980s US was thus a period of criminalization of mental illness, a theory “first used by Abramson (1972).” “It refers to people with mental illness being arrested and prosecuted for minor offenses. Compared to other inmates, people with serious mental illness are four times more likely to have been arrested on minor charges such as disorderly conduct or threats (Torrey, n.d).” (Linguiti, 2020, 8) In face of the higher likelihood of going into jails for people with mental health concerns, who had no proper treatment due to lack of treatment and resources, a new theory, as knowledge about mental health, was produced to explain the biosocial nature of community mental health care.

In this context of community mental health care and other radical health movements, Mental Patients’ Liberation Front (Boston, 1970s) and The Psychiatric Survivors’ Movement (a branch of previous MPLF, a result of divergent beliefs of mental health care in the MPLF, 1980s) rose in the US to “turn to one another [people with mental illnesses] for strength, for support, for understanding” (UMass Amherst Special Collections and University Archives, MS 768 Series 2 Organization: Conference on Human Rights and Psychiatric oppression, third, 1975), offer possibilities of treatment other than clinical, “challenge the power of psychiatry and the definition of madness,” valorize the knowledge of people with mental disorders, and advocate for human rights and resources for these people and against stigma of mental disorders. 

Judi Chamberlin, a founder of The Psychiatric Survivors’ Movement (also called The Peer Support Movement) and leader of Mental Patients’ Liberation Front, “psychiatric survivor” of chronic schizophrenia (as diagnosed by psychiatrists), challenged the medical etiology of mental illnesses and argued that “societal pressures caused her emotional distress that led her to voluntary and involuntary commitments to psychiatric hospitals in the late 1960s.” (UMass Amherst Special Collections and University Archives) Chamberlin used her knowledge and experiences of mental health care to advocate for psychiatric survivors as part of various mental health care and civil rights organizations and movements. Some methods she incorporated include delivering public speeches, writing about her own experiences of being treated inhumanely in psychiatric hospitals in the late 1960s, other forms of organizing, and collecting news, zines, letters, and other documents that discussed and spread knowledge about mental health. 

UMass Amherst Special Collections and University Archives wrote, in the background of Chamberlin, on MPLF’s organizing actions like distributing booklets and marching for liberation of people with mental illness, “when Chamberlin joined the group, they [Mental Patients’ Liberation Front] were focusing on in-hospital organizing by distributing a booklet called Your Rights as a Mental Patient in Massachusetts to the patients at the Boston State Hospital. The MPLF sponsored the Fourth Annual Conference on Human Rights and Psychiatric Oppression in 1976, marching around the Massachusetts Mental Health Center and the Harvard Medical School with a sign bearing the slogan: ‘Smash Psychiatric Oppression!!!’”

Loren R. Mosher, MD, the first Chief of the Center for Studies of Schizophrenia at National Institute of Mental Health (NIMH), published an article “A research design for evaluating a psychosocial treatment of schizophrenia” in Hospital and Community Psychiatry in August 1972 (Judi Chamberlin Papers MS 768, UMass Amherst SCUA). NIMH remained the “the lead federal agency for research on mental disorders” as part of the National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services. 

In this article, Mosher argued three reasons why little research was done to evaluate the effectiveness of clinical treatment of schizophrenia, “this lack of investigative interest may reflect a view of schizophrenia as an incurable disease, a view resulting from general frustration about its treatability. In addition, some psychological treatments – family and group therapy, for example – have only recently came into wide-spread use for schizophrenics, which perhaps accounts in part for the dearth of evidence about their efficacy.” (Mosher, 1972, 17) 

The first reason was that clinical researchers and practitioners believed that schizophrenia is untreatable because previous attempts at treatment were ineffective. In this case, the new clinical theory and practice (knowledge) about mental health – the belief that schizophrenia is incurable – was produced after previous failures. The second reason was that psychotherapy with more than one person was still new as a treatment option for people with schizophrenia. Here, knowledge about the clinical practice of family and group therapy was limited due to the short time they were utilized.

Mosher continued to suggest the third reason, “rather than accepting and building upon the contributions of past studies, psychotherapists have used the flaws as an excuse for eschewing further research and for continuing instead to present case reports – clearly a less arduous task.” (Mosher, 1972, 18) Here, clinical researchers and practitioners used their knowledge about mental health – being pessimistic about researching the effectiveness of treatment (individual, group, and family psychotherapy) for schizophrenia – to abstain from critiques and innovations of treatment by research and to move towards reporting the status quo. 

Mosher presented his criteria/theory (knowledge) of evaluating the effectiveness of psychotherapy in six categories: theory and technique, patient characteristics, therapist characteristics, process, context, and outcome. To apply these criteria, Mosher conducted a five-year case study in Soteria House, where people with schizophrenia could “explore, understand, and finally learn from it.” This project challenged the medical authority of psychiatrists and staff and the rigid performance of patients. It also built on previous failures as “each area covered is one that a previous study failed to address.” Mosher opened a gate for future research and practice of psychotherapy (knowledge) when this case study was published and cited.

To respond to certain issues, new knowledge, including theories and practices, about mental health was produced and used in the 1970-80s US in various ways.

Bibliography 

Isabelle Linguiti, 2020. Stigma and Mental Health Care: A Philadelphia Case Study. Division III, Hampshire College.

Botelho, Chard, Schmalzer, eds., Science for the People: Documents from America’s Movement of Radical Scientists (UMass Press, 2018). 

The Learning Network, “Anti-Vietnam War Demonstration Held.” Nov. 15, 2011. https://archive.nytimes.com/learning.blogs.nytimes.com/2011/11/15/nov-15-1969-anti-vietnam-war-demonstration-held/

Science for the People. “About SftP.” Accessed May 22, 2023. https://scienceforthepeople.org/about-sftp/

Union of Concerned Scientists. “About.” Accessed May 22, 2023. https://www.ucsusa.org/about?gclid=CjwKCAjwgqejBhBAEiwAuWHioI6hohDKGv984bN9c3p5dSpSLQgOairNc1_bt1haL2p5A6ZEh5eslhoCkA8QAvD_BwE&gclsrc=aw.ds

UMass Amherst Libraries Special Collections and University Archives. “Judi Chamberlin Papers.” Accessed May 22, 2023.

http://findingaids.library.umass.edu/ead/mums768

A research design for evaluating a psychosocial treatment of schizophrenia, August 1972. Judi Chamberlin Papers (MS 768). Special Collections and University Archives, University of Massachusetts Amherst Libraries

I wrote this paper today as part of my course project for History 411: History of Science Activism with Professor Sigrid Schmalzer.

Word Count: 1174

In this context of community mental health care and other radical health movements, in April 1970, Bobby Seale as part of the Black Panther Party announced the founding of The People’s Free Medical Clinics (PFMC) to offer accessible, free, and quality healthcare for the disadvantaged people. In these clinics, medical professionals were not medical authority; instead, laypeople’s opinion and choices were valorized by the Party. Laypeople and medical professionals (non-experts and trusted experts) collaborated to construct experience and knowledge about health. The Party “re-educate[d]” (Nelson, 2011, 80) medical professionals by giving ideas of radical politics. Together, the Party, medical professionals, and non-expert community members promoted this knowledge about health to more people who (might) shared their political belief in free, local, and quality healthcare and in a “critique of medical authority, professionalization, and the medical–industrial complex.” (Nelson, 2011, 79)

PFMC was a response to the challenges in healthcare “including inadequate facilities, negligent care, and paternalistic (and sexist) interactions with medical authorities.” (Nelson, 2011, 76) The medically underserved people also faced “medical discrimination, ranging from disrespectful or incompetent treatment to unethical experimentation, in both private and public healthcare settings.” (Nelson, 2011, 78) Researcher, writer, and policy advisor Alondra Nelson wrote “The People’s Free Medical Clinics,” in Body and Soul: The Black Panther Party and the Fight against Medical Discrimination (U. of Minnesota Press, 2011) to explain the operations of PFMC. 

The Panthers re-educated medical professionals in partnership on radical ideologies to “build a bridge of understanding.” The Party offered theories as knowledge about health for professionals. Nelson argued that “…as former Harlem Panther Cleo Silvers explained to me, the Party also sought to ‘reeducate’ the medical professionals who partnered with them by exposing them to the ideas of Mao Zedong, Frantz Fanon, and other political thinkers.” (Nelson, 2011, 80)

This reeducation of knowledge about health happened mutually and reciprocally. “Silvers explained how this reciprocal interchange between medical professionals and Panthers worked: I was responsible for giving political education to the doctor’s collective [that] had agreed to work with us . . . [and] they taught us. The doctors taught us to use the equipment. We didn’t come up with these ideas about the results of the ingestion of lead poisoning [by] ourselves, the doctors who did the research brought the [information] to us. We broke it down and explained it to the community and acted on it: We did this as a group. We had a doctor, a nurse, a community person and a Young Lord or a Panther. The Party thus held a pivotal place in the radical health community, linking the medically underserved and the wider health movement.” (Nelson, 2011, 87)

Community members including patients and volunteers worked with medical professionals in developing knowledge about health. The Panthers served as a bridge between these two groups and shared partnerships with them. “…at Party clinics volunteer medical professionals trained community health workers to provide basic healthcare; this transmission of expert knowledge was central to the Panthers’ health politics.” (Nelson, 2011, 79) Nelson argued that “the operation of the clinics would have been impossible without collaboration with its trusted experts, such as members of the MCHR. As the Panthers’ health work bore out, the Party did not reject medicine outright; rather, it sought to provide and model respectful and reliable medical practice.” (Nelson, 2011, 79) Nelson continued that “the Panthers partnered with health activists who were able to impart the knowledge necessary to administer Party initiatives and who also shared its commitment to patient empowerment to demystify medicine, to the deprofessionalization of medical practice, and to a conception of healthcare as a human right, rather than a commodity.” (Nelson, 2011, 80) 

When operating PFMC, the Party also got help from “activist–professionals in the radical health movement” who served “as personal physicians to cadre.” (Nelson, 2011, 80) These movements included MCHR and the Student Health Organization. Nelson argued that the Panthers provided the activist-professionals with opportunities to serve the underserved and thus realize their “political aims to assist medically underserved communities.” (Nelson, 2011, 80)

In PFMC, medical authority as a piece of knowledge about health was demystified; laypeople’s wisdom was valued. This process took the paths of “first, the valorization of nonexperts’ experience over physicians’ expert knowledge, and second, and related to this, the promotion of the practice of self-help healthcare, or ‘self health.’” (Nelson, 2011, 88)

For valorization, “…activists encouraged patients to have a voice in the medical encounter and urged laypeople to claim the mantle of expertise by taking a hand in their healthcare— and, sometimes, in producing medical knowledge as well. The democratization of both medical practice and biomedical knowledge, often in the clinic setting, was a tactical cornerstone of radical health politics. Members of the radical health movement worked in solidarity— and sometimes, in tandem— to provide inexpensive alternatives to mainstream medicine.” (Nelson, 2011, 82) Nelson continued that “in free clinic examination rooms in Berkeley and elsewhere, patients learned to ask questions of the health professionals who treated them; they ‘frequently challenge[d] the behavior of professionals’ if they found it to be inappropriate and, furthermore, were encouraged to do so. Additionally, during the height of the radical health movement, it was not uncommon for health workers to be dismissed from activist- run clinics if they were deemed disrespectful to patients. ‘We…require[d] the best from the doctors,’ Armour recollected. ‘People started complaining about…one pediatrician that came to work for us. The parents were complaining about some things that he said about their kids…Have you ever heard of firing a volunteer? I had to tell him we didn’t need his services anymore!’” (Nelson, 2011, 88)

Specifically, the white coat as a symbol of medical authority was demystified in PFMC. “Because the Party worked with populations that historically had not had regular contact with medical professionals, the white coat, worn by trusted experts, could be a welcome sign of long-sought access to quality healthcare as well as an emblem of the potential excesses of medical power. Accordingly, at the Party’s clinics, community volunteers, health workers, and Panther health cadre alike donned this symbol of medical science that had evolved from late-nineteenth-century lab coats.” (Nelson, 2011, 84)

For promoting the practice (knowledge) of self-health (health in people’s hands), Nelson invited a historical actor in PFMC, Armour, to describe the practice. ‘Know your body, know thyself. Own your own speculum. Do your own examinations,’ Armour remembered. She continued, ‘We practiced doing Pap smears on each other. And then, we sent them to the lab [for results].’ This would prove a life- saving practice for Armour, who was able to detect her own cervical cancer at an early stage. ‘Had I not been doing [self- examination], I might not even be here today,’ Armour revealed to me.” (Nelson, 2011, 89)

In PFMC, medical authority was demystified and laypeople’s wisdom was valued. Medical professionals and community members collaborated to contribute their experience and knowledge about health. The Party connected both and reeducated the medical professionals about radical ideologies, also receiving reciprocal education from them.

Bibliography

Alondra Nelson, “The People’s Free Medical Clinics,” in Body and Soul: The Black Panther Party and the Fight against Medical Discrimination (U. of Minnesota Press, 2011), 75-114.

This is a historical paper I wrote today as part of a college course, History 411: History of Science Activism with Professor Sigrid Schmalzer.

Word Count: 1802

I argue that merit in scientific research happens against a backdrop of context; truth holds its value (merit) not only through traditional methods to approach objectivity like replicable procedures and agreements, but also through recognizing truth’s relationships with forces which socially constructed it.

Pamela Paul, an Opinion Columnist of The New York Times, published “A Paper That Says Science Should Be Impartial Was Rejected by Major Journals. You Can’t Make This Up” on May 4, 2023. Paul, also a previous editor of The New York Times Book Review for nine years and author of eight books about book, family, and lifestyle, (outside the academia) argued in this opinion essay that scientific research should be evaluated by its objective merits, rather than by the scientists’ political beliefs. For this essay, Paul reviewed papers of several journals, analyzed and racial and gender demographics of current academia, and conducted interviews with scientists. Founded in 1851, The New York Times has been working with journalists reporting history from every corner of the world to present truths and inspire changes. Its mission is to “seek the truth and help people understand the world has remained constant.”

The paper Paul mainly reviewed was “In Defense of Merit in Science,” (Abbot et al.) published in The Journal of Controversial Ideas (founded in 2021) on April 28, 2023 by a team of 29 authors, made up of mostly scientists. This journal intends to “promote free inquiry on controversial topics” from a neutral stance of “political, philosophical, religious and social views” and calls for papers “addressing issues that have implications for society at large.” 

In the paper, the authors presented how “research is increasingly informed by a politicized agenda, one that often characterizes science as fundamentally racist, and in need of ‘decolonizing.’” They argued that “science should instead be independent, evidence-based and focused on advancing knowledge” and that “ideological concerns are threatening independence and rigor in STEM. Though the goal of expanding opportunity for more diverse researchers in the sciences is laudable, it should not be pursued at the expense of foundational scientific concepts like objective truth, merit and evidence, which they claim are being jeopardized by efforts to account for differing perspectives.”

These efforts include expanding positionality statements from social sciences to hard sciences and medicine, citation justice that aim to reference research produced by balanced demographics when mostly white male now publish research and wrote the foundational theories, and writing personal statements of diversity, equity and inclusion that do not align with personal beliefs when applying for jobs and funding.

While these efforts created problems like loss of faith in science, denying the work of scientists, and the risk of being fired if not committing to the statements of DEI, these problems appeared because the efforts were inadequate in addressing the political nature of science and sometimes executed to extremes. They did not appear as a result of merely rejecting the possibility of impartial science.

The Proceedings of the National Academy of Sciences (a prominent mainstream journal) argued against Abbot et al. (2023) that “the problem is that this concept of merit, as the authors surely know, has been widely and legitimately attacked as hollow as currently implemented.” In other words, merit is meaningless; what people value in science is hard to portray; current executions of evaluating valuable research are useless.

This generates the question of what merit means in science. Abbot et al. (2023) argued that “however imperfect, meritocracy is still the most effective way to ensure high quality science and greater equity….The focus should be on improving meritocratic systems rather than dismantling them.”

One of the authors, Anna Krylov, a chemistry professor at the University of Southern California, told Paul in a phone interview that those who rejected that science is impartial “denied that objective truth exists.” Krylov continued that this denial is problematic, but did not elaborate on the exact problems. Krylov fights for the equity of women in science and “prefers to be judged on the basis of her achievements, not on her sex. ‘The merit of scientific theories and findings do not depend on the identity of the scientist.’” Krylov expressed her belief in the meritocracy of science without defining merit or exploring what makes an achievement; so did Marisol Quintanilla, an assistant professor of nematology at Michigan State University. She argued that to advance science, people need to “hire the best qualified candidates.”

While the authors mentioned above believed in impartial science and related the merit of science to the vague concepts of achievements and qualifications, Ruth Hubbard, previous activist and professor of biology at Harvard University, challenged “contemporary biological thinking about sex differences and sex roles” (1) as she reviewed Darwinism, and suggested how science and reality are socially constructed, rather than impartially observed. This article, “Have Only Men Evolved?” (1979), was published in Women Look at Biology Looking at Women.

Hubbard argued that “there is no such thing as objective, value-free science. An era’s science is part of its politics, economics, and sociology: it is generated by them and in turn helps to generate them.” (10) She continued that “the mythology of science holds that scientific theories lead to the truth because they operate by consensus: they can be tested by different scientists, making their own hypotheses and designing independent experiments to test them….Scientists do not think and work independently. Their ‘own’ hypotheses ordinarily are formulated within a context of theory, so that their interpretations by and large are subsets within the prevailing orthodoxy. Agreement therefore is built into the process and need tell us little or nothing about ‘truth’ or ‘reality.’” (10) On reality, Hubbard argued that “what we notice and how we describe it depends to a great extent on our histories, roles, and expectations as individuals and as members of our society….our science is increaly affected by the ways in which our personal and social experience determine what we are able or willing to perceive as real about ourselves and the organisms around us.” (10)

Hubbard argued that science goes much further from discovering the truth; it actively shapes it. “What is often ignored is that science does more than merely define reality; by setting up first the definitions – for example, three-dimensional (Euclidian) space – and then specific relationships within them – for example, parallel lines never meet – it automatically renders suspect the sense experiences that contradict the definitions.” (9) Together with “lumping certain perceptions together and sorting or highlighting others,” science translates “sense perceptions into scientific reality.” (10) 

In her comics “Science Under the Scope: Putting Science in Perspective,” Sophie Wang, like Ruth Hubbard, challenged the objectivity of science and revealed the political nature of science in terms of who the scientists are, where science happens, who science benefits, who science harms, and what knowledge people are using. Wang argued that objectivity in science is “a background, keeping bias and emotion from interrupting and changing the conversation between the scientist and the truth.” Some of the ways to achieve objectivity include random sampling, double-blind trials, and repeated trials. Wang describes herself as “a big nerd and small zine gremlin who challenges our taken-for-granted assumptions about western science through comics and zines.” This comic was published for activist collective Free Radicals. In its vision statement, Free Radicals “envision an open and responsible science that works toward progressive social change.”

Further, Wang explained the implications of claiming objectivity of science, “the biggest danger of objectivity is that it allows us to pretend that science is entirely neutral, that we can separate ourselves from our experiences, perspectives, society, and humanity (we can’t, this will never happen)….We’re liable to draw conclusions that we shouldn’t be drawing, or ignoring parts of our science that we shouldn’t be ignoring. We need to recognize that we always exist in context.”

The new generation of Science for the People, which the old generation was active during the 1970s US, also wrote on the implications of claiming impartial science, in a critique of the March for Science in the essay “Which Way for Science?” published four days before the March. 

SftP argued that “Science is inherently political. What is studied, to what end, by whom and under what conditions, are all political questions integral to the very nature of science. By denying this fact, we risk erasing the struggle of scientists of color, women, disabled scientists, and scientists from the LGBTQ community who have had to fight for education, credibility, funding, and job opportunities within science, technology, engineering, and mathematics (STEM). Concordantly, we risk ignoring and diminishing the struggles of scientists who have resisted the use of science for making war, exploitation of workers, the enabling of environmentally destructive resource extraction, and the support of industries that harm people and the planet.” SftP continued that “as the Flint, Michigan, water crisis and the Dakota Access Pipeline (DAPL) fight have shown us, now is not the time for scientists to sit on the sidelines, claim neutrality or objectivity, and remain silent. Silence amounts to acceptance of the status quo, which could mean life or death for people and the planet.”

Science for the People argued that valuable science itself includes equity and fights for equity and social justice. This argument was not directly made, but is suggested by questions like “How can we enhance science access to local disenfranchised communities (e.g., indigenous, low-income, Black, Latinx) and how can we work with and for those communities? How can science serve humanity and the planet? Is it possible for scientists who desire meaningful social change in our society to put their talents to work for a movement capable of achieving that change, or must “politics” remain split off from their work? Can we ensure the use of evidence-based, ethical decision-making in public policy?” 

Dr. Marc Edward’s argued that the merit of science lies in the context of the public. Valuable science is a public good, and scientists should strive for higher goals than fame and funding. “Dr. Marc Edward’s, in an interview with The Chronicle of Higher Education about his and Dr. Mona Hanna-Attisha’s investigation that revealed the deliberate inaction of the city and state government to address the lead contamination of Flint’s water supply, shared:

I am very concerned about the culture of academia in this country and the perverse incentives that are given to young faculty. The pressures to get funding are just extraordinary. We’re all on this hedonistic treadmill—pursuing funding, pursuing fame, pursuing h-index—and the idea of science as a public good is being lost. [emphasis added]”

Pursuing the value of science and recognizing the social construction of truth do not contradict each other. Rather, they are in an active interplay and should be considered in terms of each other. Problems arise when rejecting this interplay and using inadequate approaches to address it.

Bibliography

Pamela Paul, “A Paper That Says Science Should Be Impartial Was Rejected by Major Journals. You Can’t Make This Up.” The New York Times. https://www.nytimes.com/2023/05/04/opinion/science-evidence-merits.html

McMahan, Jeff, Francesca Minerva, and Peter Singer. “Journal of Controversial Ideas.” Accessed May 20, 2023. https://journalofcontroversialideas.org/page/135. 

“Scientists Defend Merit in Science.” Accessed May 20, 2023.  https://indefenseofmerit.org/

Science for the People editorial team, “Which Way for Science?”, https://scienceforthepeople.org/2017/04/18/which-way-for-science/

Brian Martin, “The Critique of Science Becomes Academic,” Science, Technology, & Human Values 18.2 (1993): 247-259.

Sophie Wang, “Science Under the Scope,” https://freerads.org/science-scope-full/

Ruth Hubbard, “Have Only Men Evolved?” 1979.

An anthropological writing (March 10th, 2023) by Tongtong (Petra) Yang for the course Anthro 216GH: Case Studies in Global Health with Professor Felicity Aulino

What is Structural Violence?

Kleinman et al. (1997) created the concept of social suffering. Farmer (2004) wrote about structural violence that pain and suffering is caused by the institutions, policies, and systems’ constraint of choices of certain groups.

Structural violence is important because we can use it to analyze how violence in global health issues was created by race, gender, class, ideologies, and other systems of oppression and institutions in action. While sufferings of individuals are important, seeing the pain geographically broad and historically deep can offer insight into the engine of the suffering. Analyzing the policies and systems limiting the agency of LGBTQIA+ people can help us understand where their suffering from psychological disorders come from: bashing, stigma about HIV/AIDS, criminalization, no marriage allowed, discrimination at workplace, daily stress to hide identity, and more.

Structural violence can be applied in global health interventions by analyzing the health concerns and suffering with regard to how individuals’ choices are limited and relevant policies and systems, then designing, running, reviewing, and evaluating the interventions addressing these mechanisms. In DOT treatment for TB in rural Bangladesh, this means that:
– to address poverty, paying the shasthya shebikas for their work, offer food to meet nutritional needs, and refine water and sanitation;
– to address lack of health literacy, providing households with basic health education;
– to meet basic health needs, analyze the current health system and collaborate with the government to run health insurance;
– to understand other contributors to the suffering caused by systems, analyze how race and ethnicity, political ideologies, gender and patriarchy, and other types of oppression created the TB situation.

(ideas in italics are those I did not find in the BRAC’s TB Program report and might have been investigated)

What is Social Construction of reality/knowledge?

Berger and Luckmann (1996) created social construction of reality/knowledge. It is that all we know, despite perceived as objective, is socially constructed, specifically through habituation, institutionalization, and legitimation. Habituation is the process of learning through practicing routines to the point that the routine/action becomes a habit. Institutionalization is the process of establishing ways in which things are done and thus the way to do things, and maintaining “authority over the individual.” Legitimation is the process by which the institutions are justified through telling the new generations the institutional history while they are socialized.

This concept is important because it reminds us to examine our knowledge by thinking how it is embedded in the society, habituated, and institutionalized, and who defined and are defining the knowledge. When pharmaceutical companies developed the medicines and the clinics sell the medicines at certain prices, our knowledge of “we can access the medicines and health only by purchasing this medicine at this price” is habituated by seeing people around us buy medicines at a price and us buying more and more medicines; and institutionalized by pharmaceutical companies and clinics setting the needing-meds and being-healthy way as “buying meds at this fixed price and keeping yourself healthy,” also by limiting other ways to access meds and health.

This concept can be applied in global health interventions by analyzing what constitutes habituation, institutionalization, and legitimization within the region and health situation; designing the program addressing these constituents; and refining and evaluating the intervention with these constituents as part of the criteria. For HIV Care in Rwanda, this application means first analyzing the history of Rwanda politics, economics, and healthcare, how HIV and other health problems have been treated and the pros and cons of these interventions, the governmental and NGO relationships in the interventions, and the daily routines of local people of different generations and what they know and are used to about HIV care (by observation and interviewing). Second, designing the program responding to these analyses. Third, keep analyzing and refining in the intervention process by maintaining a good communication network. Fourth, assess the results of care and present the new knowledge formed (personal and institutional) after the intervention and new reality’s implications about healthcare, economics, politics, and the local life.

(ideas in italics are those I did not find in the Partners in Health: HIV Care in Rwanda 2010 report and might have been investigated)

————————————————————–

What is multi-drug resistant (MDR)-TB? What characteristics of tuberculosis transmission and treatment lead to drug resistance? Why is a biosocial lens particularly useful for understanding this disease and designing interventions?

Multi-drug resistant (MDR)-TB is the tuberculosis (caused by Mycobacterium tuberculosis) strain resistant to at least INH and RIF in the multiple drug chemotherapy treatment. MDR-TB occurs when naturally occurring mutants become favored during the course of inadequate therapy or being transmitted the drug resistant strain TB directly. It spreads by breathing in the air which TB bacteria is put into by coughing, sneezing, speaking, and singing. A biosocial lens is useful for understanding MDR-TB by looking into the biological, social, political, economic, historical, and environmental processes which led to the emergence and transmission of MDR-TB, which is more likely to happen in certain communities.

In 1990s Tomsk, Russia, TB and MDR-TB drug resistance emerged and stayed most in communities where social forces – of political changes, breakdown of health services, alcohol addiction, overcrowded and underfunded hospitals, overcrowded prisons and detention centers, poverty (unemployment and homelessness), and socioeconomic unequal access to care – were prominent. People facing these challenges were unable to complete 6 months of treatment for regular TB. More transmissions of TB and the drug-resistant strain happened in overcrowded areas. Homeless people were also vulnerable to MDR-TB after social services offering food and shelter disappeared. Before the ambulatory treatment program, people were unable to complete 18-24 months of inpatient treatment with second-and third-line medications given under direct observation and management of side effects for MDR-TB. Interventions including DOTS, DOTS-Plus, and Sputnik addressed these challenges. Social processes in the midst of a global health problem are important and a biosocial lens including the social theories can help stakeholders and others understand the problem and design interventions.

An anthropological writing (April 14th, 2023) by Tongtong (Petra) Yang for the course, Anthro 216GH: Case Studies in Global Health

Caregiving in community-based systems has been practiced in global health for its effect in transforming local systems of disconnected community and healthcare. This paper will compare the caregiving and community health in Boston, MA, USA and Okayama city, Japan, and use these comparisons to discuss the implications and actionable insights. 

Individual caregiving responsibilities and Organization operational structure

In Okayama city, Japan, Hiroko and Toshio Kashiwagi have multiple responsibilities as community care workers. They utilize their professional experience and knowledge about caretaking to serve their clients, the elderly and the disabled, train new care workers, and together run an NGO that offers community in-home help and affordable transportation services. The NGO sends home helpers to the clients to help with their daily routines, keeps an eye on their health condition, and contacts medical professionals if needed. The clients always have health concerns due to aging or disabilities. Toshio, using his knowledge as a retired special school principal, offers taxi transportation in a four-wheel welfare vehicle for clients to travel from their homes to nursing homes, hospitals, parks, stores, welfare facilities, and conveyor belt sushi restaurant. He also accompanies the clients throughout shopping and medical checks. Hiroko, as a professional caretaker, cooks for the clients, sweeps the home floor, does laundry, asks how the recent medical check went and whether the client took the medicine that day, and sometimes promotes the client to stop smoking because it is bad for their health. Although this NGO offers community in-home help, not community healthcare for the “indigent HIV-positive” patients like that of the Prevention and Access to Care and Treatment project (PACT) in Boston, MA, USA; individual caregivers’ responsibilities are similar and both act as the bridge between clients and doctors, except for the domestic housekeeping and welfare transportation parts. Working as either health promoter (HP) or directly observed therapy (DOT) specialist, community health workers (CHWs) in PACT visit patients’ homes regularly to talk about health, specifically on topics of HIV, the patients’ “health behaviors,” and social services available to them; they also help the patients learn about their medications and make sure they take the meds. CHWs do not help with housekeeping or transportation.

On the organizational level, PACT has a more role-specific operational framework. With PACT, CHWs practice community health caregiving and receive continuous training in medical science by the training and technical assistance team. The HIV program manager monitors CHWs and contacts patients on formal inquiries. The clinical supervisor makes sure CHWs are well, takes in patients, and outreaches the doctors locally. The accounts manager and administrative coordinator takes care of PACT’s financial situation and administrative work. The executive director and the director of operations supervise all. In Okayama city, however, Hiroko and Toshio perform multiple roles. Apart from caregiving and home helping, Hiroko works on the finance and administrative arm, also contacts local agencies and manages the NGO. Toshio offers more than welfare transportation. He connects with new welfare taxi drivers and trains them. 

Both the NGO and PACT function well. Although the roles are mixed or more concentrated, the caregivers offer actionable insights for community caregiving:

– going into clients’ homes

– performing their responsibilities fluently and understanding the group they serve (knowledge in HIV, aging, and disability)

– build relationships with clients, doctors, and more.

What is community?

In PACT, community is a metaphor of belonging; it is beyond physical space. Community takes the forms of understanding between CHWs and patients through shared experiences, as space and place of the clients, and as the relationships between CHWs and the patients. In Okayama city, the community takes similar shapes. It happens in the relationships between doctors, caregivers of the NGO (which literally translates as support group having tea together, 共助团体吃茶去), clients, and their families. It happens in clients’ homes, the NGO office, the hospital, and other places the clients and Toshio reach and explore together using the NGO’s welfare taxi. Both PACT and the NGO address the clinic-community gap by regularly visiting the clients’ homes and accompanying them, and the NGO goes further to offer convenient transportation for the clients.

Insights for community caregiving: 

• Share experiences with clients
• Respect and encourage clients’ space
• Accompany the clients and regularly visit them at home

Social and political economies

How has the community health workers and caregivers understand the impact of social and political economic forces on clients’ health and living? The Kashiwaga couple understand that these forces set roadblocks and created many rules for welfare transportation and in-home helping services because the government cut the budget and support. What the clients pay barely covers the cost like parking and gas. Toshio becomes a volunteer driver for the welfare not-free transportation. Hiroko says the NGO faces a financial crisis. Before 2006, the elderly and disabled could travel using the free extra service of home services companies. The normal taxi drivers claimed that these services influenced their business and campaigned against these free services, thus came the slightly-paid, almost-volunteer welfare taxi drivers. The drivers need to make sure they do not conflict with the taxi industry to become volunteers. Toshio had to purchase this welfare vehicle using his pension. Before PACT, the primary and rural community health field has a long history of various policies in different times and needs. PACT bases its framework on Partners in Health (PIH)’s Haiti work and has been training and supporting new health workers with its model.

Insights for community caregiving:

• Research and understand the impacts of previous practices and current local and national policies about community health and caregiving
• Communicate with other organizations offering care, provide training
• Be prepared for advocating for more support and taking risks as caregivers

Through what lens did the observation happen?

In his project on PACT, Mei acted as an “inquisitive observer,” observing different situations and listening carefully to understand “what it means for CHWs to work in the community and give care” and the local moral worlds (Kleimann 2006) through the interactions between stakeholders. Soda is also an observer. His documentary style is innovative observational. Using his camera, he observed the Kashiwagi couple and their clients’ work and life moments with least assumptions, has no scripts, previous planning, or theme, and uses least music, subtitles, and prologue, to encourage the audience to actively observe. Soda self-funded his films to stay independent of bias the funders would bring to the table. 

Bibliography

Soda, K. (Producer & Director). (2010). Peace [Motion picture]. Japan: Laboratory X, Inc.

Soda, K. (2023). Why I Make Documentaries. On Observational Filmmaking (S. Grasselli, Ed., M. Schley, Trans.). Viaindustriae publishing. (Original work published 2011)

John (Yuynag) Mei, 2012. “Caregiving Among Community Health Workers in Boston: The PACT Model.” Undergraduate thesis, Anthropology, Harvard College.

A Femme Shark + Eco-dystopian Sci-fi piece by Tongtong (Petra) Yang

⛰️🌗

“We have no categories. No gender, no mentally normal or ill, no official language, no government, no marriage, no money as currency, no race or ethnicity, no class. We make our own blades and our own moon.”

– Blade of HalfMoon Manifesto

How long can you stay mad/furious/enraged/irritated/indignant before losing it? I’ve been asking myself that question for a few weeks. People back in 2020 might use the pumping balloon and explosion metaphor. Plastic balloons, essentially fossil fuel, are extinct. Why do I know they exist? My generation’s kids grew up learning that history with balloons of all shapes and colors standing at the front of parking lots greeting customers to fast food places, clustering like grapes in birthday parties and graduation ceremonies, and carrying handwriting in oil black pen flying in the hallway of a gallery. They said the forests here avenged after going bald. The revenge lasted for a whole month when it was snowing and deadly quiet. A perfect time to bury bodies. Do you know pre-Blade people paid a lot to maintain their relevances’ graveyards? They could have gone into the ocean or flushed themselves down the K-toilet. During the revenge, people were silent like chickens and the recreation industry gradually died out. Bladers got to canoe (extravagant stupid tomato red like someone’s choked) from time to time, with wildflowers in our hair. Green is Bladers’ color. 

⛰️🌕

[Ebral singing]

Renovate

Add a B to your name

Study all Blader 

languages

And make a 

new one

新生

Walk barefoot in the Paper Excellence 

Remain

Iced lake

Gulp the now stream

Previous steam

Men hand logging 

Timber. Lean on

One and visit often

Visit The Shade

Stare at the newcomers

Through

Their waxing Gibbous Phase

Carve a Glittering Cave

Dry

A linen cloth

Put it on your Blade

Try

Double moon

Hunt a rabbit

Pick rosemary

Harvest a lemon

Cook in The Jut

Sit with solar panels

Charge a camera

Direct 

Film

Dance. Music. Art.

Mud

おやすみ

[Tonkba strolling in The Bmain]

Tonkba: Zeb will send me to North America Arm #4 next week to start my first-ever mission. I will then fly to #70 in Sept and #41 next year. I hope there’s coffee and Levofloxacin and moxifloxacin and all on that list. Ebral will take care of my eagles. Bladers prepared artworks, bows and arrows, some climbing stuff, and  Šebfika the healer. We will depart at dawn.

Nabomi: Oh, you got Zeb. Who were my first mission tutor again? Can’t remember. I see you got your double moon.

Tonkba: They’re all tight and sharp. Still practicing the Loi move. Can you show me?

Nabomi: Like this.

Tonkba: Can you do it again, please please please?

Nabomi: It’s deep in the night. I can’t hear my eagles.

[Tonkba blinking their starry eyes]

Nabomi: I’m hungry, sneak to The Jut and cook me proper ramen. I don’t get bribed by your beautiful face.

Tonkba: !!!I’ll be back in 20, before you fall asleep.

[Nabomi waving their hands, turning to their side]

⛰️🌑

“A group of sustainability advocates flooded the beautiful BC forests and set up another cult. Many young boys lost their lives there. These people do not use money. You can find photos of their exotic farms taken by our journalist Paul Bristle. They don’t get married. Naked dirty bodies run in those forests. They eat whatever they want. They are against human civilization. Do not go.”

An anthropological writing (Feb. 3rd, 2023) by Tongtong (Petra) Yang for the course Anthro 216GH: Case Studies in Global Health

Local Biologies sees biology and culture as contingent changing bidirectional influencers of each other, and, in turn, lead to biological differences in certain space and time (Situated Biologies) (Lock, 2017). These interactions are biosocial differentiation (Lock

& Nguyen 2010). Symptoms of certain conditions and both the social and cultural aspects of people differ from one society to another (Lock & Kaufert, 2001).

While Lock (2017) suggested that epigenetic adversity resulting from exposures to toxins are intergenerationally transmitted, neuroscience research by Marlin Lab showed that trauma can be inherited. Offspring can inherit, via germline DNA, the way a parent body responds to trauma. This phenomenon is transgenerational epigenetic inheritance. Furthermore, the concept of mismatch pathway is evident in offspring of Jamaica malnutrition (Forrester et al. 2012) and those of the Dutch Hunger Winter famine of 1944-1945 who had higher rates of physical illnesses and mental disorders.

Lock would respond to Marlin Lab that research on transgenerational epigenetic inheritance needs to go beyond the protocols and standardized lab environments, just like bell hook’s critique on the co-existing reality of imperialist white supremacist capitalist patriarchy. Lock (2017), “owing to space limitations,” did not write about how experiencing trauma influences development throughout lifespan; I will discuss, based on research by The TRUST Lab at UCLA led by Dr. Ng, local and situated biologies in Ethiopian and Botswanan people with Bipolar Disorder, Post-traumatic stress disorder (PTSD), and several mental illness (SMI).

Dr. Ng’s research showed one-directional correlational relationships between biology and environment, but not culture. Both study groups at Mass General Hospital in the US and rural Ethiopia suggested positive correlations between traumatic experiences and social functioning, where traumatic experiences were the predictors. Based on epidemiologic data, rural Ethiopia showed lower awareness of mental health, and stigma and discrimination, compared to US mental health. However, lifetime prevalence of bipolar disorder in Ethiopia, physiological pain of people diagnosed, social concerns of them fulfilling their roles, and health burdens on hospitals do not tell the complete story of culture about bipolar disorder in Ethiopia. Nor did current research demonstrate how culture influences mental health in Ethiopia, let alone with how interactions between biology and culture create biological differences between people in Ethiopia and other places in the world.

Ametaj et al. (2021) concluded that the team had developed a culturally appropriate psychological intervention for people with bipolar disorder in rural Ethiopia. They followed several steps for this development: a systematic review, a qualitative study with people with bipolar disorder and their caregivers, and workshops engaging mental health “experts” and other stakeholders. The intervention was an adaptation to psychotherapy methods used in the US like psychoeducation and problem-solving and behavioral techniques. Although workshops and interviews gathered information about mental health conditions in rural Ethiopia and the intervention included “Working with the community and religious leaders, and HEWs,” understanding of local culture was limited. 

Molebatsi et al. (2021) developed another culturally adapted intervention for people diagnosed with PTSD and other mental disorders in Botswana. The team was concerned with the feasibility of carrying out psychological interventions like CBT since training in therapy was limited in Botswana. Feasibility due to lack of “training” and translations of intervention plans into local languages and incorporation of local norms and concepts were the “adaptation.” Again, the team ignored the interactions between biology and culture and the changing nature of biology and culture.

People might take biosocial differentiation and use it to reinforce biological determinism, the false belief that there are essential and immutable biological differences among humans. Examples include racial essentialism (Rhodes & Mandalaywala, 2017). We should be mindful of attempts using biosocial differentiation to create essential differences in favor of certain people. Instead, local and situated biologies should be used to a) explore the nuanced and changing interactions between biology and culture, b) promote that health has an effect on everybody.

How do biological and cultural changes match/mismatch to the time needed to analyze local biologies? We look forward to more implications of Local and Situated Biologies.

Bibliography

Carcea, I., Caraballo, N.L., Marlin, B.J. et al. Oxytocin neurons enable social transmission of maternal behaviour. Nature 596, 553–557 (2021). https://doi.org/10.1038/s41586-021-03814-7

Rhodes, M., & Mandalaywala, T. M. (2017). The development and developmental consequences of social essentialism. Wiley interdisciplinary reviews. Cognitive science, 8(4), 10.1002/wcs.1437. https://doi.org/10.1002/wcs.1437

Forrester TE, Badaloo AV, Boyne MS, Osmond C, Thompson D, et al. 2012. Prenatal factors contribute to the emergence of kwashiorkor or marasmus in severe undernutrition: evidence for the predictive adaptation model. PLOS ONE 7(4):e35907

Ametaj, A. A., Hook, K., Cheng, Y., Serba, E. G., Koenen, K. C., Fekadu, A., & Ng, L. C. (2021). Traumatic events and posttraumatic stress disorder in individuals with severe mental illness in a non-western setting: Data from rural Ethiopia. Psychological Trauma: Theory, Research, Practice, and Policy, 13(6), 684–693. https://doi.org/10.1037/tra0001006

Molebatsi, K., Ng, L. C., & Chiliza, B. (2021). A culturally adapted brief intervention for post-traumatic stress disorder in people with severe mental illness in Botswana: protocol for a randomised feasibility trial. Pilot and feasibility studies, 7(1), 170. https://doi.org/10.1186/s40814-021-00904-1