Abstract
In this short essay, I wish to briefly discuss smoking, polypharmacy, the human biome and multispecies relations, and biomedicalization as a means of stretching the common ways we think about comorbidity. My intent is to expand our thinking about comorbidity and multimorbidity beyond the individual as a unit of analysis, to reframe comorbidity in relation to trajectories of risk, and to address comorbid states of our own making when the treatment of one health problem results in the experience of additional health problems. I do so as a corrective to what I see as an overly narrow focus on comorbidity as co‐occurring illnesses within a single individual, and as a complement to critical medical anthropological assessments of synergistic comorbid conditions (syndemics) occurring in structurally vulnerable populations living in environments of risk exposed to macro and micro pathogenic agents.
The idea for this special issue arose when I was conducting my doctoral fieldwork in India in 2011. I went there to study type 2 diabetes among women, but I quickly realized that by focusing on only one disease I would be missing others. Nearly everyone I met with diabetes was also grappling with some other health problem too–among others, hypertension, cardiovascular disease, and life distress significant enough that seemed to be impacting their quality of life. Anthropological studies had told us much about multiple therapeutic choices and about how multiple symptoms could be associated with single diseases that vary cross-culturally. At the time, however, few had explicitly grappled with the problem of co-occurring diseases, or, as it is called in the medical world, comorbidity. I wanted to know what leaders in the medical social sciences were thinking about the overlaps of disease categories, and that is how this special issue came to be.
The papers collected here address a wide variety of diseases and behaviors: chronic pain, diabetes, depression, interpersonal violence, tick-borne diseases, climate change, smoking, medication side effects, risk states. In so doing, they build from the long tradition in medical anthropology of pushing the boundaries of what “counts” as a disease in the first place. But they each go beyond this to address important questions related to comorbidity that have not been directly addressed in medical anthropology before: Does it matter which disease is diagnosed first, and if so, how? Do people experience their overlapping diseases and risk states as separate entities, or as a single force in their lives? Do they prioritize one over the other(s)? How does one disease predispose someone to another, both in a biological and a social sense? Where do health-demoting factors such as violence, insects that spread disease, climate change, medications, and other risk states come into play? What territory do our existing theoretical and methodological approaches cover, and not cover?
Putting together this discussion on comorbidity in medical anthropology has helped me broaden how I think about the overlapping disease states of the people with whom I work, and I hope it will do the same for you. Happy reading.
For the peer-reviewed introduction by Lesley Jo Weaver, Ron Barrett, and Mark Nichter see the Wiley collection.
If you are interested in augmenting current issue article pages with an author interview or other supplementary discussions, please contact Vincanne Adams vincanne.adams@ucsf.edu