Alumnae/i Theses and Current Positions

Bailey, Hannah M. 2019. In/Visible: An Ethnographic Case Study of the Pursuit of a Good Life in Boston’s Little Saigon.

Little existing research examines how Vietnamese American individuals conceptualize wellness in relation to the community in which they live. Fewer studies examine the ways in which communities of Vietnamese expatriates form networks of support, based around community resources. Even fewer, if any, focus on these qualities within the context of Boston’s own Little Saigon – Fields Corner.

This ethnography analyzes discussions with and observations of individuals living in a predominantly Vietnamese neighborhood in Boston who are a part of a support group for families of children with special needs. Through this analysis, two key themes emerge. First, through the learning of information and sharing of knowledge, this Network’s connections have impacts far beyond the four walls of their bi-weekly meeting space. Second, wellness for the parents in this group is directly tied to existing as a part of a community support network which allows them to successfully navigate three distinct institutions of care for their children – the medical and special education systems, as well as the expression of Vietnamese culture that exists in this neighborhood.

I argue that in discussions with members of this support group, it is necessary to focus on channels alternative to biomedical mental health services when confronting the pursuit of a life worth living. This network acts as a site of social change through parental advocacy for their children’s flourishing within various institutions. Parents then act as vectors of consciousness to raise awareness for specific action. Within this context, parents are enabled to fight for their definition of a life worth living and their personal wellbeing.

Brown, Madisen E. 2019. Violent Encounters: Mediatization, Socio-Medical Legitimation, TBI, and CTE: Lived Experiences of NFL Players, Military Veterans, and Their Caretakers.

Clinical Researchers recently identified NFL players and US military veterans as high-risk populations for sustaining repetitive Traumatic Brain Injury (TBI) and developing the neurodegenerative disease Chronic Traumatic Encephalopathy (CTE). American culture celebrates military veterans as national heroes, and NFL players as popular athletes and social icons. Both subcultures are constructed around hyper-masculine ideals embedded in tenants of violence and aggression, suffer repeated TBIs due to this nature, and are ultimately at high-risk for developing CTE. The TBI/CTE phenomenon also affects family members who assume care-taking responsibilities for these first two populations as their loved one’s symptoms persist. The purpose of this research is to understand the TBI/CTE experiences of NFL players, military veterans, and their caretakers, and how all three populations intersect with mediatization and the social and medical legitimation of TBI/CTE in America. Using narratives from all three populations, I explore how power dynamics within the NFL and US military have intersected with modern media outlets and functioned to socio-medically legitimize a sick role for those who suffer from persistent symptoms of TBI and CTE.

Chuersanga, Geeranan. 2019. Traditional Thai Medicine in Eastern Massachusetts.

The growing Thai community in Eastern Massachusetts has an unofficial ethnic enclave that surrounds the neighborhood of Allston/Brighton. Studies of Thai communities in the United States indicate that Thai-Americans have limited access to quality health care in the United States due to factors that contribute to health disparities such as language barriers and cultural beliefs. As a result, Thai people have different approaches to how they treat illnesses through traditional Thai medicine (TTM), Western medicine (also called biomedicine), or a mixture of both medical systems. This study examines healthways Thai/Thai Americans in Eastern Massachusetts draw on in response to different illnesses. In-depth stories of how this community engages in illness prevention and responses to the experiences of illness illuminated by Thai people’s approaches to different medical systems helps us understand how they present their values when seeking medical care. I argue that responses to various illness episodes experienced by members of the Thai community in Eastern Massachusetts influence perceived health and health-seeking behaviors. Factors that contribute to Thai-American health practices include: religion, sociocultural elements (cultural identity, generational differences, cross-cultural differences, structural violence), and Thai constructs of illness and well-being.

Farthing, Rachel J. 2018. Structural Violence, Food Insecurity, and Chronic Disease in the Lives of Mattapan’s Black Women.

This is a qualitative study that seeks to understand the intersections of food insecurity and chronic diseases in the lives of women living in Mattapan. This research takes place in Mattapan, a neighborhood in Boston. Mattapan is a very diverse and unique community which is home to a majority of people of color. Mattapan is often criticized and viewed as an undesirable place to live for those who live outside of its borders. These negative stereotypes and the presence of structural violence have generated a built site of scarcity within the Mattapan community. This makes it incredibly difficult for Black women in Mattapan to be healthy because their environment actively prevents them from doing so.

It is important to give women special consideration when looking at food insecurity because more increasingly they are becoming the sole and primary caregivers in their homes. They are responsible for the production and preparation of food within their families. Therefore, it is necessary and important to focus on this particular population and obstacles they endure navigating those obstacles.

This research focuses on how past and present lived experiences of women of color in Mattapan inform how these women identify, understand, define, and interpret structural factors that contribute to food insecurity, and chronic diseases. Having access to fresh and affordable food is one of the most basic necessities of life. Yet, many communities of color across the country lack this basic access. Twenty percent of all African American household’s experience food insecurity compared 12.5 percent of the nation as a whole. In addition, African-American women are almost twice as likely to be overweight and obese compared to non-Hispanic White women.

With such grave proportions of African-Americans suffering from chronic diseases it is important to consider the ways in which obesity systematically occurs. Structural violence and the presence of structural barriers inhibit Black women from eating healthy. In predominately Black and immigrant communities like Mattapan the environment is a major barrier that women must navigate every day in order to achieve healthiness.

Gerlin, Gerpha. 2019. Autoethnographic Reflections on Subjectivity and Chronic Mental Illness

This project emerges from engaging and studying the lives, including mine, of the many who go—and stay—crazy. Here, I explore the kinds of existences that those impaired by severe and persistent mental illness(es), what I refer to henceforth as “chronic mental illness”— have had (or been able) to forge and leverage, as well as some of the resources and structures they have developed/manipulated in order to do so.

This thesis explores one way in which chronically mentally ill people exact agency over their own embattled personhood. The term “personhood” draws from existential traditions in philosophy and theology (Strawson 1959; Taylor 1989, 127-142; Rosfort 2018), though I understand and use it here as it is relevant to phenomenological psychopathology. By “personhood”, I mean the normative traits of a society wherein individuals are recognized by seemingly “common” traits of humanity. While there is not, as philosopher Robert Spaemann contends, “a [single] characteristic that can be called ‘being a person’” (Spaemann 1996, 14), to understand human beings (being) is to also grapple with the ethical demands of intentionality, autonomy, experience, and subjectivity.

By “subjectivity”, I refer to the innumerable and descriptive components that comprise individual, relational, and intersubjective experience(s). These components, and how they are known and described, emerges from a self-awareness in maneuvering the world and, consequently, developing a particular lifeworld. My interests in personhood and subjectivity emerge from the assumption that “the fragility of human identity is rooted in the various ways in which our biology challenges our experience of being an autonomous self” (Ricoeur 1966; Ricoeur 1970, 472; Rosfort 2018, 5). Part of what complicates personal identity is the impossibility of grounding personhood in either biological otherness or an intrinsic, pre-reflective selfhood. Being a person is “the task of becoming […] concrete […] through the constant encounter with the otherness that is an inescapable part of one’s identity” (Rosfort 2018, 6). Seeing a person, Ricoeur believes, requires the perpetual examination of experiential tensions among identity traits that go beyond biological reductionism and constancy. Illness narratives are useful tools for understanding the extent to which disability incites a fundamental interrogation of the self, as well as a reckoning of practices of self-recognition and phenomenological metamorphosis.

This multi-field site investigation engages self-identifying psychiatrically disabled people via participant-observation at three peer support networks within the greater Boston area. Data, by way of stories recounted and collected, is framed by my own lived experience participating in similar structures, both in-person and online. Stories from both occasions, including interview data and media analysis, are relayed as means of triangulation. This project relies on sociologist Noman Denzin’s concept of “cumulative epiphanies” (Denzin 1989), or, moments wherein ill authors/speakers recognize the extent to which their personhood was honed through the medium of the illness itself (Frank 1993, 46).

In large part, this project explores ways that people experiencing disabling effects of mental illness learn to take care of themselves. It pays particular attention to how the personal views of people with such illnesses shape the construction and layout of varied peer support networks. Although it considers general psychiatric practice involving prescribing clinicians (e.g., physician or nurse practitioner) and non-prescribing clinicians (e.g., talk therapists), the central objective is to consider the emergence of mutual support, or “self-help” models, as a mode of constructing a new sense of self/advocating for unmet needs within traditional medical practice.

More broadly, this project maps the reflexive transformation(s) of person into patient and the varied methods of healing and treatment that the chronically mentally ill utilize in such contexts. It considers the emergence of PSNs as a counter/cultural borderland (Kleinman 1980; Garcia 2016) between the social “psy”ences (Matza 2013; Raikhel & Bemme 2016) and psychiatry. As a theoretical fusion of history of psychiatry, sociology of mental health, and phenomenology, I trouble the parameters within which PSNs and their participants help craft, shape, and directing a particular kind of experience of mental illness, suffering1, and/or convalescence.

Koenders, Sedona. 2019. Veteran Experiences of Living With Chronic Pain in the Context of VA Care and an Opioid ‘Epidemic’.

While chronic pain is an increasingly prevalent condition in the United States, it is twice as common among the military veteran population. As many Vietnam War era veterans are aging and experiencing comorbid medical conditions, their chronic pain is becoming increasingly complex. Policies enacted in response to the ‘opioid epidemic’ have in some ways made treatment of pain safer, but have also left remaining questions regarding how to properly provide care. There are three fields of complexity that interact within this topic: patients with a clear need for care and pain management, providers committed to helping patients, and structural barriers that unintentionally interfere with the provision of care.

The lived experience of chronic pain and receiving care through the VA healthcare system combined with a common military culture exemplifies a lifeworld centered on pain—which I call a ‘painworld.’ This painworld is seen in the illness narratives of older, white, male veterans with chronic pain. Examining the way a single VA site provides pain care shows the providers are dedicated to treating veteran patients and offer a large number of treatment options. While the need for pain management services is clear from both the patient and provider perspectives, translating the lived experience of these veterans and their medical needs into a hierarchical bureaucratic structure is difficult. Furthermore, the bureaucratic nature of a large federal organization creates gaps in the healthcare system. This leads to the creation of informal systems through systems-correcting praxis to fill the gaps and attempt to prevent siloing and slippage throughout. Together, these fields of complexity are organized into three chapters, building the argument that the convergence of veteran painworlds, pain care, and bureaucracy can contribute to miscommunication, leading to unintended slippage through the system and inadequate care, despite good intentions of staff. Furthermore, the VA system and structure of providing pain care both influences and is part of the painworld, as are the interactions that occur between veteran patients and staff.

McNally, Kellan I. 2019. Hardily Working: Stories of Labor In A State Mental Hospital.

Nineteenth-century state mental hospitals across New England and the United States are linked today with images of confinement, forced treatment, torture, abandonment, and family separation. This project does not directly challenge those associations. An ethnographic study in medical anthropology, this study is based on three years of fieldwork observations and qualitative interviews with neighbors, townspeople, former employees, and visitors to the open campus of a decommissioned state mental hospital in Massachusetts. Excavated from that hospital’s annual reports dating back to 1896 and gathered from local memories and storytelling, this projects considers the central place that work once held in the lives of psychiatric patients at Medfield State Hospital and the place that idleness holds for patients living within today’s institution of community care. Participants’ memories track the shifting perceptions and meanings of mental illness that resulted once “industrial therapy” programs were ended in state mental hospitals. This inquiry describes the ways that the loss of work changed psychiatric patients’ experiences of suffering, promoting the use of new chemical treatments, accelerating deinstitutionalization, and catalyzing new patterns nationally of service utilization and psychiatric disability. From participants’ memories and the author’s reflections on clinical practice as an independently licensed social worker (LICSW) in Massachusetts, this analysis uncovers the social functions of staying sick within contexts of unequal opportunity and joblessness. This study reveals the complicated and punishing work of surviving and helping people survive across de-industrialized landscapes as mental health practitioners assist the disenfranchised by recasting social suffering into psychiatric illness with treatment-induced embodiments that simultaneously help to manage poverty and perpetuate risk within disabilized citizens.

Riley, Jessica T. 2019. Meanings of Wellbriety and Wellness among Urban Native Peoples in Boston.

The definitions of trauma and trauma behavior are expansive and have continued to grow in the past century. While biomedicine continues to expand the Diagnostic and Statistical Manual for cultural competency and subjective experience, the concept of trauma is still limited to certain behavior and events determined by hegemonic views. This becomes detrimental to families and children exposed to everyday instances of structural violence. Looking at major child care sectors— the education system, biomedical care, and the family unit—to understand the influences of biopower and the consequences of structural violence, data collected from the greater Boston area reveals the consequences of structural violence on both child behavior and the manifestation of trauma. This thesis reexamines the social construct of trauma and trauma behavior, and uses its own term, structural trauma, to account for the social frameworks that create a legitimacy deficit for the trauma-related behaviors children embody. Examination of these three main child care sectors and the barriers that contribute to, or try to deconstruct, structural trauma reveals that these institutions have organized themselves into a pastoral apparatus that can prove to be more harmful than helpful for addressing child trauma and family well-being. Through structural trauma, researchers and society can gain further insight on how policies and practices create additional, unintentional vulnerabilities in underserved populations, consequently inhibiting healing and understanding amongst families and institutions.

Patrick, Samantha. 2019. Child Trauma: Surviving Structural Violence in America.

The definitions of trauma and trauma behavior are expansive and have continued to grow in the past century. While biomedicine continues to expand the Diagnostic and Statistical Manual for cultural competency and subjective experience, the concept of trauma is still limited to certain behavior and events determined by hegemonic views. This becomes detrimental to families and children exposed to everyday instances of structural violence. Looking at major child care sectors— the education system, biomedical care, and the family unit—to understand the influences of biopower and the consequences of structural violence, data collected from the greater Boston area reveals the consequences of structural violence on both child behavior and the manifestation of trauma. This thesis reexamines the social construct of trauma and trauma behavior, and uses its own term, structural trauma, to account for the social frameworks that create a legitimacy deficit for the trauma-related behaviors children embody. Examination of these three main child care sectors and the barriers that contribute to, or try to deconstruct, structural trauma reveals that these institutions have organized themselves into a pastoral apparatus that can prove to be more harmful than helpful for addressing child trauma and family well-being. Through structural trauma, researchers and society can gain further insight on how policies and practices create additional, unintentional vulnerabilities in underserved populations, consequently inhibiting healing and understanding amongst families and institutions.

Still, Michael E. 2019. Rising Tides: An Ethnographic Case Study of Resident-Activists in an Environmental Justice Community.

Environmental justice communities in the US are located at a nexus of social justice, political and corporate interest, and public health. This paper explores how resident-activists, primarily those who identify as Latinx and female, simultaneously inhabit roles of resident and activist. In doing so, they create a space of equitable knowledge exchange, and support community members in realizing their own agency. Additionally, their efforts include, but are not limited to, collaboration with researchers in a way that promotes emancipatory education and culture-centered research models. The author spent over a year as a staff member of an urban EJ organization in Massachusetts, participating in and observing community meetings, fundraising efforts, municipal and state level environmental impact hearings, and organized protests. These community activists wrestle with the tension of simultaneously depending on and disrupting systems that have historically burdened their community.

Jolly, Divya. 2018. Navigating the Borderlands: Intersectional Healthcare Experiences of Queer and Trans People of Color

This mixed methods research study examines the experiences of multiply marginalized individuals in healthcare, and the ways in which structural systems produce and reinforce cultural norms and values, which simultaneously reproduce those same systems. Through a combination of semi-structured interviews, participant observation, and qualitative and quantitative survey data, I provide evidence that norms and values that emerge on the interpersonal, intrapersonal, and institutional levels drive perceptions of care among Queer and Trans People of Color (QTPOC). A critical discussion of the politics of identity, microaggressions, and perceived empathy demonstrates that structural and cultural violence shape perceptions of care for this community. I then explore how violence creates social marginalization and impacts the health of both the individual and the QTPOC community.

Publications:

Chan KJ, Jolly D, Liang JJ, Weinand JD, Safer JD. Estrogen Levels Do Not Rise with Testosterone Treatment for Transgender Men. Endocrine Practice. 2018 Mar 21; 24(4): 329-33.

Liang JJ, Jolly D, Chan KJ, Safer JD.Testosterone Levels Achieved by Medically Treated Transgender Women in a United States Endocrinology Clinic Cohort. Endocrine Practice: 2018 Feb; 24(2): 135-142.

Prezi Presentations

Seamon, Kevin. 2018. Connecting with the Healthconnector: Experiences of Massachusetts Latinx Patients with Subsidized Healthcare

While rates of uninsured have dropped in the United States, The Latinx population continues to suffer from the highest proportion of the uninsured (KFF 2016). Obstacles persist for Latinos/Latinas, even though health coverage appears to be at its peak. The purpose of this paper is to investigate the experiences of Latinx in the Greater Boston Area, who are eligible under the Affordable Care Act and/or state-subsidized health care. The focus of this investigation is the subsidized health plan enrollment process and health care experiences of those who are eligible and interested in enrolling. This includes obstacles to signing up for health plans offered on the state health care exchange, Latinx perceptions of and their experiences with the ACA and the HealthConnector, and how subsidized health care influences their perceptions surrounding access to care. To capture a more accurate image of the Latinx experiences with state-subsidized healthcare, this paper also explores the 2017 political climate, the proposal of Trumpcare, and the effects of the proposed healthcare reform on a vulnerable population.

St. Dennis, Victoria. 2018. Mis-Matching Structures of Breastfeeding Support

This ethnographic research study explores the interaction between peer, partner, and provider support and breastfeeding outcomes. And to argue that there exists a mismatch between breastfeeding ideals and realities. Breastfeeding has been proposed as the first choice in infant feeding practices beginning from birth until a minimum of six months, without the inclusion of other nutrient products. While breastfeeding remains the medical standard, rates across the United States have not reached the Healthy People 2020 goals. The purpose of this study was to address the outcome of shared breastfeeding knowledge, in relation to the interaction between chronic individual stress, access to supportive resources, and the immediate stress involved with breastfeeding. Relying on Modified Grounded Theory (mGT), participant observation, surveys and interviews, the original aim of this study was to provide information about the role of social support, stressors and breastfeeding. There ultimately exists a mismatch between the ideals of breastfeeding and application of breastfeeding resources in the United States. For breastfeeding to be successful there needed to be a culture of support from peers, providers, and partners (or family members). This overlap of care results in breastfeeding mothers feeling more capable in handling their individual experiences of stress, as well as stress directly related to their infant.

Waller, Katherine (Kat). 2018. Taking a Closer Look: Negative Reporting and Positive Experiences with Healthcare for East African Refugees in Boston

This thesis explores the experiences of the health care system for East African refugees in Boston. I argue that refugee experiences lie on a spectrum ranging from inadequate to exceptional, and that by exploring what makes care both a negative and positive experience for refugees it may be possible to better serve the community. I conceptualize these experiences using the metaphor of a rope bridge: at the beginning, refugees are stuck in a formal structure that limits their movements and agency; throughout the middle, they are forced into a liminal space in which both their identity and experiences are made ambiguous; on the far end of the bridge; they have mitigated the deleterious effects of structural violence and liminality through practices involving selective acculturation, resilience, and self-verification. My participants reported being dissatisfied with the bureaucratic barriers to health care they encountered and with the power imbalances they felt when interacting with clinicians. They also spoke about the encounters they had with clinicians that made them feel listened to, cared for, and empowered. Much of the distinction between good and bad care relied on whether the patient felt like they were respected by their doctor, and whether they felt like they had a say in their own care and treatment. Due to the limited nature of this endeavor, further research is recommended on: 1) the role of memory in recovery; 2) liminality as it applies to the resettlement experience; 3) maintaining and bolstering the assets that allow refugees to mitigate the effects of structural violence; and 4) in what ways the health care system is working for refugees, and how those can be expanded upon.

Cabral, Naciely. 2017. Structures of Risk: Lived Experiences of Multi-Syndemic Clustering in the Greater Boston Area

People who experience structural violence are an increased risk for health conditions including HIV and Hepatitis C. Particularly they are at greater risk for experiencing known syndemic interactions between these two chronic infectious diseases. The risks are mediated bio-socially through the ways that structural inequality increases social and biological vulnerability to illness and suffering. Structural inequalities, or experiences of structural violence shape environments of risk; environments of risks increase social and biological vulnerability to the structures of risk promoting syndemic interactions between biological, behavioral, and psychological conditions.

The lived experiences of people diagnosed with a combination of HIV, HCV, and mental health conditions (MHC) (e.g., mood disorders and depression) are, however, thus far understudied. Many aspects and consequences of structural violence and social suffering; poverty, homelessness, substance use, lack of access to healthcare, and structural risks for HIV, HCV, MHC and interactions between the three. Through this mixed-methods, primarily qualitative, ethnographic fieldwork with individuals in the Boston area living with HIV, HCV, or both HIV and HCV, or suffering from MHC I ethnographically explore people’s perceptions of their vulnerability to these syndemic interactions. I also investigate their experiences of being at-risk for these conditions.

Through this process, I seek to illuminate individuals’ understandings of the impact structures of risk (i.e., substance use, food insecurity and unstable housing) have on lived experiences with HIV/HCV, HIV/MHC, and HCV/MHC syndemics. The perceptions of the lived realities of disease-behavioral-psychological interactions and health consequences are analyzed in the context of substance use. Substance use’s biological and social dimensions have a role in promoting syndemic interactions for each of the syndemics experienced within this population.

Therefore, substance use is a syndemogenic factor because of its role as a mediator for environments of risks, and as a structural risk factor in all three of these syndemics. These interactions, and consequential health outcomes, in sufferers’ own words, enrich the landscape of syndemics research, producing a clearer picture regarding the structures of risks affecting this vulnerable group in the greater Boston area.

Kelleher, Charlotte. 2017. When the Hearing World Will Not Listen: Deaf Community Care in Hearing-Dominated Healthcare

The Deaf Community has faced a great deal of historical oppression from hearing people that still resonates throughout the Community today. Recent literature has acknowledged the disconnect between the Deaf and hearing worlds, particularly in healthcare and education settings. Likewise, there have been many advocacy and service projects and programs to try to improve these situations. However, much of the existing literature and projects have failed to include input from Deaf Community members. As such, hearing perspectives dominate the lives of Deaf individuals. This study examines how the dominant biomedical perspective of deafness affects Deaf individuals’ ability to receive adequate healthcare.

Using standard ethnographic methods, including in-depth, open-ended interviews, and immersion in the research population through ongoing participant observation at a Deaf agency and Deaf Community events, this study highlights the perspectives of Deaf Community members themselves. The findings confirm previous studies’ assertions that the dominant biomedical perspective toward deafness negatively affects Deaf people overall, particularly because of communication obstacles and a lack of understanding about Deaf Culture, specifically in the realm of access to biomedical care. This has never been more worrisome for Deaf people in America than in the current unstable political climate that now threatens access to subsidized healthcare, disability services, and legally protected accommodations.

Morillo, Meghan. 2017. Refugee and Asylum-Seeker Health Seeking in the Greater Boston Area

In this research project, I examine the role that three organizations play in the greater Boston area. I sought to understand how these organizations were offering care to this population, and, in a broader sense, what it means to care for asylum-seekers and refugees. To answer this question, I developed a qualitative study that consisted of semistructured interview and participant observation at three different sites from August 2015 through February 2017. I argue that the agencies where I did my research demonstrated that healthcare does not equal medical care. These agencies offered an integrative approach to overall care for those refugees and asylum-seekers utilizing their services. This care reflected the pre-defined needs and desires of refugees and asylum-seekers while also remaining fluid and adapting to individual cases.

Nicklas, Jeffrey. 2017. Through the Lens of Exploitation: Landscapes of Care of Identified Trafficked People

In this qualitative research project, I examine the development of landscapes of care for, and by, identified trafficked people and its implications for rebuilding a sense of place and identity. Through in-depth interviews and ethnographic data, I argue that discourse, place and identity interact to form complex landscapes within both providers and clients/patients that emerge as distinct experiences of care or non-care experiences.

Each analytical chapter examines a particular production of care: a merging of psycho-legal care, the interactions of formalized informal caring relationships, and the burden of external identification in the configuration of self-identity among identified trafficked people. Building on anthropological theories of care (Giordano 2014; Mulla 2014; Stevenson 2014; Mattingly 2010), these chapters build the argument that, in contrast to humanitarian human trafficking and trauma discourse that focuses on a specific kind of trafficking experience; the complex assemblage of trafficking experience and subsequent care should be considered within what I term “structural trafficking.”

Becoming identified as trafficked is beneficial for receiving specific rights and services. However, this identity can also be detrimental for rebuilding a sense of self and place, because it assumes a fixed experience that translates to fixed care packages. I examine multiple landscapes of care to better understand potentials for care by expanding identity and coordinating existing and novel systems of care.

Emard, Nicholas. 2016. Biomedical Moralities: A Syndemic Approach to Stigma, Community, and Identity in HIV-Positive Boston

Stigma is multi-faceted and intersects with other damaging forms of social suffering. The evolving nature of HIV stigma is particularly evident in HIV communities, where community members adopt hegemonic views of biomedicine and incorporate them into their shared social space. I argue that such structural discrimination is a product of embracing “biomedical moralities,” where older community members adopt biomedically defined medical management as the standard of conduct. Such standards of living become so pervasive that HIV stigma nearly functions as a form of structural violence producing negative stereotypes of members who do not demonstrate “correct” ways of living with HIV.

These “biomedical moralities” lie at the nexus of community formation, contingent identities, and perceived stigma that members of HIV communities enact and embody. In this work I propose a newly identified stigma-linked syndemic which is thought to contribute to HIV spread, pose challenges for HIV medication adherence, and promote known syndemic interactions between HIV and other STIs. Through ethnographic research I present HIV communities’ experiences with stigma and how that can worsen overall health effects. I suggest that such research highlights needed improvements in anti-stigma campaigns and calls for an expansion of existing stigma-related HIV syndemics research.

Publication:

Emard, Nicholas. 2017. Biomedical Moralities: HIV Community Stigma and Risks for HIV/STI Syndemics. In Shir Lerman, Bayla Ostrach, and Merrill Singer, eds. Foundations of Biosocial Health: Stigma and Illness Interactions. Lanham, MD: Lexington Books, pp. 157-184.

Houston, Ashley. 2016. (In)Visible Embodiment: Somali Perspectives of Diabetes and Mental Health in Diaspora

Somalis represent the largest consecutively displaced and resettled group in the United States yet, little is known about their experiences with and perceptions of illness in diaspora. In this research project, I examine how Somalis’ understandings of the body and embodiment shape perceptions of diabetes and mental health. In addition, I ask how are the effects of migration and diaspora embodied among Somalis in Boston? To answer these research questions, I developed a qualitative study among Somali Muslims in Boston. I utilized information from semi-structured interviews (n=6), informal interviews (n=4), and participant observation at a local mosque from March 2015 to March 2016. I argue that for Somalis, diaspora is embodied through: bodily practices based on fluid and complex body ideals and values, food ritual and practices of consumption, and chronic physical health and mental health issues resulting in culturally relevant somatic explanatory models.

Lynch, Kathleen. 2016. “The Land Tells Our Story”: Urban Native Place-Making and Implications for Wellness

In this mixed-methods community-based participatory research project I examine the ways in which sense of place (or lack thereof) is developed for Native Americans living in the urban Boston area, and the implications this has for physical health and social wellbeing. Through in-depth interviews, ethnographic data, and community photo-voice, I argue that a triad of Place, Stress, and Identity configure and act upon the bodies of urban Natives in complex ways, creating a paradoxical sense of place in the city. Each analytical chapter examines particular interactions of this triad: place as a physical and socially-experienced phenomenon, the interactions of place and stress, the process of “place-making”, and social stress surrounding “urban Native” identity.

Developing a framework of “place/body multiple” (Eyles and Williams 2007, Scheper-Hughes and Lock 1987; see background chapter), these chapters build toward the argument that, in contrast to “sense of place” literature that focuses on reservations (see Background Chapter), urban “sense of place” operates within what I term a “landscape of distress.” Forming an urban “sense of place” is beneficial to overall well-being because it leads to support networks and creates a proxy for “home”, building on current literature on social support and anthropological literature on Indigenous place-making. However, it is also detrimental to health because it creates an identity that is inherently separate from tribe and traditional land, creating both social and physiological distress.

Publication:

Lynch, Kathleen. 2015. Review: Mosquito Trails: Ecology, Health, and the Politics of Entanglement by Alex M. Nading (2014), Oakland: University of California Press, 2014. 288 pp. In Student Anthropologist 4(2): 55-57.

Major Diaz San Francisco, Carolina. 2016. Migration, Transnationalism, Illness and Healing:  Toward the Consolidation of the Self among the Congolese Diaspora in Boston and Lynn, Massachusetts

This thesis explores the perceptions of illness and healing among the Congolese diaspora in Boston and Lynn, MA, and within the contexts of migration and transnationalism. With this thesis, I argue that the Congolese who participated in this study perceive illness as social suffering, and healing as the consolidation of the self. Participants express their perceptions of illness and healing according to their identities, or the orientations of the self. Perceptions of illness were expressed as illness narratives framed under the theories of structural violence, and from the perspectives of the Congolese as displaced and migrant people. Congolese extend their perceptions of illness also to other non-Congolese communities they have come to belong to through transnational and global social formations. Congolese demonstrate that healing means the consolidation of their self, or identities, as Catholic Congolese in diaspora, advocates for refugees, African-Americans, Blacks, and “the Priest” in Lynn. Congolese emphasize that building and maintaining their newly acquired identities form part of their strategies to establish themselves in the USA, and bring healing to themselves and others. This exploration is limited, and thus, further research is recommended on: 1) other Congolese community groups; 2) the local and global Congolese diasporic activism for conflict resolution directed to the DRC; 3) practical proposals for collaborative research in order to resolve the socio-cultural and economic barriers that Congolese have in clinical settings.

Publication:

Nvé Díaz San Francisco, Carolina, 2019. An Ethnographic Experience: Freedom, Fiction, and Medicine Women in Afrofuturist Contexts. Irish Journal of Anthropology, 22(1): 138-146.

Nvé Díaz San Francisco, Carolina. 2019. Mis madres son estrellas. Revista Cronopio (September 29). (See also: Briseida Cidoncha. 2019. La escritora hispanoguineana Carolina Nvé Díaz San Francisco presenta su nueva novela “Mis madres son estrellas”. Toda Literatura [May 29]).

Nvé Díaz San Francisco, Carolina. Skins, Identities, and Their Tragedies: The Learning and Healing of a Hispano-Guinean Woman in the Diaspora. In Msia Kibona Clark, Loy Azalia, Phiwokuhle Mnyandu, eds. Pan African Spaces: Essays on Black Transnationalism. Lexington Books, pp. 53-60.

Presentations:

Panel 15: Biomedicina y salud pública, en la colonia y en la postcolonia Carolina Nvé Díaz San Francisco y Mayra Alicia Overstreet Galeano, “Mortalidad, inseguridad y disparidad: bienestar social y acceso al sistema de salud después de 50 años de dictadura en Guinea Ecuatorial” Wenceslao Mansogo Aló, “Sanidad pública en Guinea Ecuatorial hoy”.

Mellett, Erin. 2016. Cochlear Implants and CODAs:  The Impact of a Technology On a Community

There has been a great amount of debate between the medical community and the Deaf community regarding cochlear implants. Indeed, some factions of the Deaf community have reacted with hostility to the development of the technology and have protested its implementation. Existing literature examines Deaf individuals’ perceptions of cochlear implants, however there has been a significant lack of academic attention paid to the hearing children of deaf adults (codas). As children of deaf parents, codas grow up simultaneously inhabiting two worlds: the Deaf world of their parents and the hearing world of their peers. It is codas’ unique position and loyalties between the Deaf world and the hearing world that make them important to the cochlear implant debate. This study investigates codas’ perceptions of cochlear implantation using standard ethnographic methods, including in-depth, open-ended interviewing with codas, and immersion in the research population through ongoing participant-observation at a deaf school. The findings suggest that (1) codas’ interstitial identity impacts their perceptions of and attitudes towards cochlear implantation and (2) cochlear implants have contributed to a refinement of Coda identity in relation to the Deaf community.

Proctor, Dylan A. 2016. Growing Narrative, Conviviality, and Security: Community and Gardening in the North Shore of Massachusetts

Growing Narrative, Conviviality, and Security: Community and Gardening in the North Shore of Massachusetts is an ethnography of the Highlands neighborhood of Lynn, Massachusetts. In this thesis I argue that the efforts of this community to combat the ills of their neighborhood seen through the lens of a community garden rely on three key factors. The first is their reliance and sharing of a narrative that reminds fellow community members of the difficult points in their past, but with the message that there is always a possibility of a brighter future. The second aspect is the reliance on the shared moments of celebration that the neighborhood actively supports and engages, which instill the bonds of community in an otherwise disparate, and multicultural setting. Finally, the narrative and celebration of community would not be sustainable if the community did not also provide the structure for security upon which the neighborhood can continue to improve their communal and social wellbeing. The lessons learned from this community are useful to understand how a multiracial, multicultural urban site can turn around their violent past in order to create a livable space.

Resnick, Kirsten. 2016. Bridging Birth: The Birth Sisters as an Adaptation to Hospital Birth

This study was designed to explore the mediated experience of supported birth in a hospital setting by examining the role of the Birth Sisters, with a focus on how the individual Birth Sisters perceived the impact of their role. The goal of my research is to understand the ways in which having a Birth Sister assist women in emerging from birth empowered and achieving better psychosocial and medical outcomes. I hope to contribute to the growing research on the role of doula support by providing a focused examination of the lived experiences of the women providing this support as part of a hospital setting. As such, this study examines the ways in which Birth Sisters act as a mitigating force to bridge the biocultural, cultural and structural aspects that emerge in a U.S. hospital birth.

Rosenthal, Staci. 2016. Birthing into Death: Stories of Jewish Pregnancy from the Holocaust

This thesis investigates the stories of Jewish women and men living in Europe during the Holocaust who made decisions related to pregnancy, abortion, birth, and ‘parenting’ in ghettos, concentration camps, and in hiding. By reviewing existing, publicly accessible survivor testimonies, and by interviewing still-living survivors, I analyze the various ways Jewish women and men used available but limited forms of reproductive assistance to preserve their own lives and to secure the safety of their unborn or born children. Jewish women and their doctors or other ad-hoc medical providers weighed the risks of possible illness or diseases resulting from clandestine care against the seemingly greater or graver risk of Nazi exposure. By highlighting stories from Holocaust survivors who speak about experiences receiving or providing reproductive “health care” during the Holocaust, this study emphasizes what survivors say about seeking or providing abortions under conditions they might not have otherwise accepted, pursued, or suggested. Women who became pregnant during the Holocaust embody the unspeakable dilemma of “birthing into death,” as reproduction often meant murder for Jewish mothers. Pregnant Jewish women and their partners, the medical providers who attended to them, and their witnesses during the Holocaust all have unique perspectives on their own in-themoment responses to pregnancy under extreme conditions. Their testimonies speak to how the decisions they made involved Jewish cultural notions of childrearing in Europe during the time of the Holocaust, and to the complex shaping of traumatic memory.

For Related Papers

Loomer, Stephanie Treadwell. 2016. A Paradox of Support: The Department of Children and Families and Their Construction of the “Good Mother”

Pregnant women with substance use issues are a doubly at-risk group in desperate need of support. Using open-ended interviews, participant-observation, and media analysis, I examine the support provided by the Department of Children and Families (DCF) in Massachusetts for pregnant women who seek treatment at Project Empowerment. Project Empowerment provides prenatal care, maintenance therapy, and other services to expectant mothers who struggle with substance use issues. Drawing upon Foucault’s (1975) notion of surveillance, I explore how pregnant women with substance use issues are surveilled by agencies, and how these surveillance agencies structure their care and policies through their definitions of what it means to be a “good mother.” I argue that through the Department of Children and Families definition of the “good mother,” DCF produces an unintended paradox of support for pregnant women with substance use issues in Massachusetts.

Bracho-Perez, Bianca. 2015. Cellf-Care: The Role of Smartphones In Decision-Making And The Formation of Health and Self

Smartphone technology has transformed the process by which women understand themselves, manage their care decisions and access health information, while also creating a space for more integrated and individualized understandings of wellness. Using exploratory, semi-structured interviews (n = 27) and observation of phone use, this study examines how minority women in Boston engage with smartphones through healthrelated mobile applications and web searches. Drawing upon postphenomenology, I examine the way smartphones have become both a regulatory force and motivational tool in the formation of self. I argue that the integration of smartphones into user identity positions them as the primary entryway for health decision-making (Garro, 1986, 1998), patient-clinician interactions.

Petrov, Svyatoslav. 2015. “Such Cases Are Awakenings!” Transforming Clinical Relationships Through Critical Incidents In Refugee Care

A positive physician-patient relationship is crucial for high quality and effective health care. Yet, cultural and language differences between providers and patients often challenge the establishment of effective physician-patient relationships. These challenges are especially evident in provider-refugee-patient interactions in which patients have experienced loss, torture, and trauma. Understanding of what constitutes a positive doctor-patient relationship is fundamental to diagnosis and treatment and is crucial for the delivery of quality care for diverse patient populations, including refugees. This qualitative, phenomenological case-study focuses on physician-reported experiences caring for refugees in order to identify what experiential factors contribute to effective therapeutic relationships.

Publication:

Petrov, Svyatoslav. 2015. Living on the Edge: The Role of Critical Incidents on the Development of Secondary Resilience in Physicians. International Journal of Emergency Mental Health and Human Resilience 17(4): 714-716.

Christian, Robert J. 2014. “You Know a Girl When You See One”: Experiences of Surgeons Who Perform Gender Affirmation/Reassignment Surgery

Most recent research on gender affirmation/reassignment surgery focuses on discrimination and health disparities faced by the transgender community, and on perspectives and identity constructions of patients transitioning from one gender presentation to another. However, few studies address perspectives and experiences of the surgeons performing these operations. This exploratory study examines narratives of some of these surgeons in order to understand how they entered this particular practice, and how they perceive and classify these procedures. This study also aims to show the affect these procedures have on these surgeons and their discipline, and how these surgeons navigate the complex relationships between patients, healthcare providers, and surgeons, in the context of social values and popular media perspectives in the United States.

Poster Presentation: “You Know a Girl When You See One”: Experiences of Surgeons Who Perform Gender Affirmation/Reassignment Surgery (GAS)

Featured in: Toni Cardarella. 2014. KU Medical Center gives back during the holidays. KU Medical Center News Dec. 22.

Garza, Rebecca D. 2014. Delivering Diversity: Meanings of Cultural Competence Among Labor and Delivery Nurses in an Urban Hospital

Nursing theory has contributed significantly to discussions of so-called culturally competent biomedical healthcare delivery. This study explores how Labor and Delivery nurses at a large, urban teaching hospital negotiate the care of a hyperdiverse patient population and construct working understandings of competence. Archival research, semi-structured interviews and participant observation demonstrate that cultural competence is not a distinct concept, but rather functions as an ambiguous symbol used to discuss a variety of challenges with advocating for patients and delivering care in communities faced with issues of racism, immigration, low socioeconomic status, and multiple comorbidities.

Melstrom, Eva R. 2014. “Who Minus Who”: Suicide in Boston’s Ethiopian Community

This thesis examines suicide in Boston’s Ethiopian Community. The act of suicide and individual cases are explored through participant narratives. Narratives from family members and acquaintances of those who died by suicide are examined. I rely on in-depth (N=8) and follow-up interviews (N=7). Drawing heavily on culturally constructed notions of self, this thesis explores what it has meant for persons of the Ethiopian community to lose fellow members to suicide. Intersections of emotions, constructions of choice and agency, and idealized notions of self emerge as central themes. The body, in life and death, is situated as a vehicle for communicating dis-eased social relationships and unrealistic cultural expectations. Participants position their perceptions of the deceased in relation to popular preconceived notions of life in the United States and stresses encountered during and after the immigration process. Memory of Ethiopia, the United States, immigration, and the suicide are significant for understanding the rigidity of culturally authoritative truths.

This thesis emphasizes the progressive and beneficial methodology of an anthropological investigation into suicide. Understanding the reasons and acquiring specific knowledge about Ethiopian suicide in the United States can contribute to current conversations regarding immigrant suicide. Ultimately, this study aims to contribute to comprehensive prevention measures, which support every individual.

Melstrom, Eva R. 2019. Seeking Change: Ethiopian Migrant Domestic Workers’ Predicament. UCLA Center for the Study of Women.

Turner, Katie-Elyse. 2014. In Practice: Narrative Care & Decision-Making among Pediatric and Adolescent Health Providers

This thesis explores the experiences of several pediatric health care providers in the Boston area. It identifies and examines the stories told by providers to discuss their profession, their decision-making processes, and the methods that they use to “know” themselves and their patients through the lens of current topics of interest in pediatrics, including the Human Papillomavirus (HPV) vaccines. Pediatricians, pediatric nurse practitioners, adolescent health providers, and pediatric focused gynecologists were recruited from several private, community-based, and academic medical center practices in the Boston area. This study used several qualitative data collection methods, focusing primarily on the use of semi-structured interviews while including participant and non-participant observations in two distinct clinical settings.

Welch, Michelle. 2014. Sexual Orientation and Identity in Diabetes Health Care: the Experience of Type 2 Diabetes among Lesbian, Queer, and Women-Loving Women

This Master’s Thesis reports on the experiences of Type 2Diabetes of Lesbian, Queer, and Women-Loving Women. The thesis examines the impact of sexual orientation on experiences with diabetes, and how this chronic disease affects the way a woman views herself, her health, and her body image. Each participant presented her narrative and world views in regards to her diabetes health care and management, stress and trauma, and management of relationships. Through narrative analysis, I have revealed differing mechanisms of coping and explanatory models; the many women of this study selectively chose to be more open about her sexual orientation than her diabetes status.

Doran, Heather M. White. 2014. “What Am I Supposed To Eat?”: Nutritional Messaging in an Inner-City Integrative Medicine Clinic

Public health has developed education campaigns based on nutritional messaging to alleviate illnesses related to food consumption.  This thesis examines cultural factors affecting the accessibility of such messaging, such as economic status, ethnicity, role in the family, access to transportation and markets, and familiarity with the topics of messaging. I explore how these variables affect learning and applying new nutrition knowledge in an individual’s daily life. The methods used were semi-structured interviews (n=11) and participant observations conducted in an Integrative Medicine clinic at an urban hospital.

Xin, Tong. 2014. Covering Health: Healthworlds of First-Generation Chinese Immigrants in Boston Chinatown

This study examines the healthworlds of first-generation Chinese immigrants in Boston’s Chinatown.  Through participant observation and interviews conducted within a local church and a local park community, three key issues emerged: how the space of Chinatown influences people’s post-immigration healthworld, the dynamics of community health supports and health challenges, and the daily health lives of these immigrant individuals within their respective families. Likewise, complex understandings of health coverage emerge that include not only health insurance, but also social forms of insurance. Community integration becomes not only a cultural tradition, but also how health resources and health support are linked and provided. This social form of insurance makes it possible for community members to reach out cultural and religious health resources and support in the context of everyday life.

Sullivan, Eileen C. 2013. From Washing to Whitening: The Cosmetic Practices and Beauty Politics of Vietnamese-American Women in Boston

This thesis examines perceptions of normative beauty ideals among Vietnamese-American women and the impact of these ideals on beauty seeking behaviors. I explore women’s lived experience of beauty via practices pursued and products consumed, and frame beauty work as a disciplinary practice, as well as an investment in embodied species of capital. I query how ideals of appearance relate to being Vietnamese within American culture and the critical role of appearance in affirming identity. The methods used were in-depth interviews (n=5), an open-ended response Internet survey (n=19), and a content analysis of a transnational Pond’s advertisement to which both Internet participants and in-depth interview participants contributed.

Kelly, Masami Tabata. 2013. Becoming a Kidney Transplant Citizen: Kidney Transplantation, Race and Biological Citizenship

I conducted a four-month ethnographic fieldwork study to document the stories of thirteen post-kidney-transplant minority patients and three nephrologists at Boston Medical Center. My research explores how patients’ interactions with health professionals, medical regimens, dialysis treatments, and adaptation to living with transplanted kidneys constantly shape their identities and perceptual worlds. Patients’ narratives highlighted the emotional struggles they encountered along the path of End-Stage Renal Disease, which unfolded as distinct experiences influenced by their varied backgrounds. The majority of my patient-participants lived on the verge of poverty, and in some cases, their insurance status caused delays in their being registered on the transplant waiting list, making them endure a long wait. Some patients were afraid of wearing short sleeves because they thought the scars on their arms from dialysis treatment would lead others to think they were gangsters. Instantiations of various theories emerged from the saturated data and narrative analysis, from Bourdieu’s concept of habitus with regard to the process of how patients alter their consciousness through interactions with medicine to Foucault’s ideas of power relations and technologies of the self that address the issues of agency and power that influence the formation of patients’ identities. The intersection of these theoretical frameworks led me to develop the critical medical anthropological-oriented concept of biological citizenship. This paper examines 1) the ways in which “race” interacts with the theoretical concept of biological citizenship and 2) the ways in which socioeconomic status and race tailor a kidney transplant patient’s illness experience, and related discourse.

Silver, Kristina Fenn. 2012. Developing A Dialogue Between Refugee Patients and Their Healthcare Providers About Traditional Medicine Usage: Why Context Matters

Traditional medicine use is common and diverse among patients in the United States. Many do not tell healthcare providers about their traditional medicine use or remedies nor do healthcare providers typically have the time to ask. This creates a barrier to the care received because the patient and healthcare provider do not communicate fully about treatment options. The goal of this study was to increase communication about traditional and integrative medicine by putting together a survey following the analysis of these ethnographic interviews.

Working within the Boston Center for Refugee Health and Human Rights at Boston Medical Center, I interviewed refugee and asylum seeking patients and their healthcare providers about traditional medicine use. This included a demographic survey and qualitative, open ended interviews. I formally interviewed 27 refugee and asylum seeking patients and spoke with several healthcare providers throughout the study. The majority of interviewees were female (n=22) and from Africa (n=19), reflecting the demographic of patients throughout the clinic. Eighteen patients we interviewed reported using herbal remedies at some point in their lives, more than half (n=13) in the United States. Participants were much more open to discussing herbal medicine and religious healing than other types (e.g. ancestor worship).

Through this survey, I hope to increase health care practitioner’s awareness of these issues and help them effectively navigate this conversation topic. Demonstrated understanding of their patients’ views of disease and medicine will potentially help the patients feel more comfortable in the clinic. In addition, it will enable both sides to be as open as possible with one another about treatment pathways.

Hill, Stephanie L. 2012. The Meaning of Diabetes for Boston Latinos

The purpose of this study is to understand the health beliefs and behaviors of Puerto Rican and El Salvadorian adults’ living with Type 2 diabetes in the Jamaica Plain neighborhood of Massachusetts. What explanatory models do Puerto Rican and El Salvadorian adults’ frame with regard to Type 2 diabetes mellitus? Which of the multiple etiologies and available treatments shape diabetes health beliefs, and how do these relate to the explanatory models of physicians, and how might they impact diabetes behaviors? I sought to gain understanding of these ideas by looking beyond the biomedical definition that may have been imprinted into their descriptions to examine these Puerto Rican and El Salvadorian adults’ point of view of diabetes. The research will aid health care professionals in understanding how Puerto Rican and El Salvadorian adults’ perceive and discuss diabetes prevention, etiologies, treatments, and aid in creating a care management plan for patients. This project is designed to learn about the views of diabetes causation and treatments for Puerto Ricans and El Salvadorians living with type 2 diabetes in the Jamaica Plain neighborhood.

Laurens, Vivian. 2012. Developing a Sense of Belonging: The Immigration Experience of Latin American Women in Boston

This thesis explores the experience of immigration of Latin American women living in Boston, and how they develop a sense of belonging and identity in American society. By looking into different aspects of participants’ lives (work, family life, community, healthcare), I examine various circumstances in which their sense of belonging is supported and those in which it is jeopardized. The primary site of recruitment for this study was a Baptist congregation, which serves the Latino population in the Boston area. I used qualitative data collection methods including, individual interviews with the women and participant observation at the congregation, to gather participants’ immigration stories. As an in-depth grounded theory analysis this study reveals the fluid nature of participant’s sense of belonging; it is ever-changing, it is always moving back and forth from insider to outsider, and it is constantly brought into question. As a result the immigration experience of participants is immersed within tensions between a cohesive and fragmented sense of belonging.

Palmer, Alexandra M. 2012. Pathways Into Care for Pediatric Asthma

Studies have demonstrated that patients may not adhere to the treatment prescribed by the physician because their respective models of the disease are different. Studies have also demonstrated that the patient may feel inferior to the health care provider and not share his or her model with the doctor for fear of being perceived as ignorant. The interaction between the provider and patient is especially significant to asthma because asthma is a chronic condition that may require management for life. However, there is a gap in the social science literature for studies related to asthma. This thesis presents the way pediatric asthma health care providers and a sample of Boston Puerto Rican parents of children with asthma perceive asthma based on data collected through informal interviews. Puerto Ricans are one of the Latino subgroups who remain most at risk for asthma morbidity and are the most represented Latino subgroup in Boston. Research tends to generalize all of the Latino subgroups and it is important to consider each one separately in order to develop effective public health prevention and intervention strategies. Making each other aware of the other’s asthma model will provide an avenue to help the health care providers and Puerto Ricans work together through any differences to an agreed-upon management regimen for the child’s asthma. An understanding of why the health care provider is suggesting a particular treatment and why the patient is managing the disease in a particular way may help improve outcomes.

Soya, Christine. 2012. The Effects of Direct-To-Consumer Antidepressant Advertising on Doctor-Patient Relationships

Objective: This qualitative study looks at how doctors and patients feel direct-to-consumer antidepressant advertising affects the doctor-patient relationship. Methods and Results: I conducted open-ended interviews with eight primary care physicians to understand their feelings about direct-to-consumer antidepressant advertising. I performed a content analysis of eight antidepressant and antidepressant add-on advertisements available on YouTube. I also collected and analyzed comments for each YouTube ad to represent the general public’s opinions. Using an ethnomedical framework, I looked at the many factors surrounding direct-to-consumer antidepressant advertising including: the object of concern (depression), the social practice of advertising, patients’ cultural specific concerns, doctors’ values, and managed care organizations (the institutional level). Conclusions: My study points to both physician and societal perceptions of the current practice of direct-to-consumer antidepressant advertising, and its perceived risks or benefits to the doctor-patient relationship.

Aba Jebel, Sofia. 2011. Parkinson’s Dance!: A Meaning-Centered Analysis of the Emergence of Dance Therapy

Objectives: The purpose of this study is to understand the experiences of dance advocates, instructors who engage in either dance therapy or dance in health-related settings, and Parkinson’s dance students who participate in the Jewish Family & Children’s Center’s (JFCS) Dance for Parkinson’s program. The study is designed to collect narratives from participants, to gather meaning-based definitions of therapy and healing. Methods: In order to collect data reflective of participant experiences, I participated in and observed dance classes held at the JFCS over six weeks. I conducted qualitative interviews with dance advocates, instructors and students. Dance students were all recruited from JFCS Dance for Parkinson’s program, whereas the advocates and dance instructors were recruited from both JFCS and Boston dance therapy networks. Results: The data collected from the study reveal that participants’ explanatory models of illness and health are complex and multi-dimensional. Similarly, the unique dynamics of dance indicate that it functions as a viable intervention to address the complex and multidimensional aspects of Parkinson’s disease (PD). Dance students heal through dance because dancing is fun, liberating and provides a social context that Parkinson’s Disease would otherwise remove. Conclusions: The professionalization of dance therapy has resulted in the specific appropriation of the term, requiring a certified dance therapist to be present. Dance students are affected by the narrow use of the term “dance therapy” and offer conflicting statements about the beneficial nature of dance; sometimes therapeutic, sometimes not. As a creative art therapy, programs like Dance for Parkinson’s have a long future ahead as long as they are not subject to qualification by the biomedical community.

Crespo, Cristina M. 2011. Experiences and Barriers to Engagement of Low Income Urban Minority Expectant Fathers

Expectant fathers‘ experiences of their partners‘ pregnancy and their own transition to parenthood has not been significantly researched across demographic differences to include low-income African American, Haitian Latino men in an urban environment. This is a qualitative case study of a health center in Boston, Massachusetts that examines what men in this category expect, perceive and experience during the prenatal process and what, in turn, the health professionals who interact with them expect and perceive. Research participants include men who are engaged in the prenatal process and healthcare professionals who interact with expectant couples at the chosen health center. This study focuses on a population scarcely addressed in the literature of fatherhood and who has historically experienced low levels of paternal engagement. As an in-depth grounded theory analysis of the experiences and opinions of expectant fathers and health professionals, this study reveals the pervasive influence of an idealized trope of American fatherhood which, in actuality, is often inaccessible to low income minority expectant fathers. The social barriers to involvement are discussed and clinical recommendations to improve paternal engagement are suggested.

De Santa, Meghen. 2011. “It’s About Having a Fertile Mind”: A Meaning-Centered Analysis of Hypnosis for Infertility

Objectives: This study examines the use of hypnosis for fertility and reproductive health in the United States.  I present practitioners’ views on the nature and causes of infertility, and on its treatment in both biomedicine and hypnotherapy.  I discuss the social and cultural significance of hypnosis as an alternative and complementary therapy for infertility. Methods:  I used anthropological research methods, including interviews, surveys, and participant observation, to gather the narratives of HypnoFertility consultants in the U.S.  I invited all 208 consultants certified through the HypnoFertility Foundation, Inc. to participate in an interview and/or anonymous online survey, and to extend the same invitation to their current and former clients, as appropriate.  In addition, I participated in a Fertility and Birth by Hypnosis training course with a Foundation-certified trainer. Results: The data I collected for this study is based on in-depth, semiformal interviews with 15 HypnoFertility consultants, and the survey responses of 18 consultants and five clients.   Detailed field notes document my interactions with participants, and my experience as a participant in the Fertility and Birth by Hypnosis training program. Conclusions: The use of hypnosis for fertility has social and moral significance for its practitioners.  The definition of infertility according to consultants differs markedly from biomedical definitions in its inclusion of social, emotional, and spiritual factors that contribute to the condition.  Hypnotherapists feel that the medicalization of fertility can obscure patients’ self-knowledge and intuitive reproductive abilities.  Gender-power disparities and shifts in family structure are said to be stressors that contribute to the degradation of clients’ self-healing abilities.  Social critiques present within consultants’ narratives inform the significance of the practice as a complement to biomedical treatments for infertility.

St. John, Meryl Kopy. 2011. Virtual Lay Therapy: The Role of the Internet, Illness Narratives and Experiential Knowledge in Health Decision-Making

This thesis describes and analyzes the culture and behavior of an online health community focused on female sexual and reproductive health. 263 participants were asked to describe the ways in which they utilized the community and how their health-seeking behaviors and interactions with medical professionals had altered since they had turned to the Internet to supplement their medical care. The women reported using the community not just for medical information, but in a search for empowerment and a medical space perceived as non-judgmental. Often, participants had been inspired to use the Internet to cope with or evade feelings of marginalization they received when engaging in professional care. Study participants described sophisticated methodologies for evaluating online information, and some then used this information in an attempt to transform and improve both their clinical encounters and their medical decision-making. Lay And experiential knowledge contributed by community participants was used to evaluate, and sometimes challenge, expert knowledge offered by medical professionals. The study has implications for a new era of medical pluralism in which individuals negotiate and combine traditional care avenues with a virtual form of lay therapy management. The thesis also reviews the history of both self- care and Internet communication, traditions whose legacies eventually led to modern communities like the one investigated here.