Table of Contents
Knowing Better? Articles from the MAQ Archive
Pedagogical Materials: Knowing and/as Doing
Pedagogical Materials: Knowledge and/as Ignorance
Pedagogical Materials: Knowing and/as Disqualifying
This issue examines questions of epistemology in the MAQ archive from 1975 to today, exploring assumptions and interventions over what counts as knowledge, who is presumed to know, and how knowledge is understood to be generated by/about/with our interlocutors. Approaching this question laterally, I read the archive to ask how scholars have engaged, implicitly or explicitly, with thorny questions around knowledge, its margins and limits. Over MAQ’s half century, epistemological practices have been made and remade across shifting methodological frameworks, political commitments, disciplinary norms, and (bio)cultural assumptions. Situated by my own positionality, I focus on a comparatively small subset of themes and problematics. I attend to how reading the archive challenges us to think capaciously and reflexively about what knowing does as a form of world-making, as well as what values we ascribe to ignorance and ambiguity, epistemic authority and delegitimization, certitude and incertitude.
The title—“Knowing Better?”—is something of a pun, asking both if we know better (or differently) than we used to and also if/how we (presume to) know better than others. Meanwhile, “Epistemological Bounds” seeks to capture the nonlinearity of the archive, with “bounds” referencing both limits and leaps. For instance, one perennial epistemological tension is our field’s relationship to biomedicine and its hegemony among diverse healing practices. As an example, Paul Unschuld (1985) interrogated traditional Chinese medical theory, arguing that it lacked the objectivity or universal applicability of biomedicine, thus being unable to treat “real nosological units” like Hansen’s disease (leprosy). He averred that leprosy “is ‘real’ in the sense that it is caused by a microorganism,” has been identified in different cultures, and biomedical treatments “are effective regardless of the sociocultural background of the patient” (5). Although Unschuld’s piece provided a laudable rethinking of Chinese medical history, it also policed epistemic boundaries even while other medical anthropologists were demonstrating that biomedical treatments are culturally constructed and that sociocultural and political-economic background impact efficacy within as well as between cultures (in MAQ, see O’Neil 1989, Singer 1986; see also Gordon 1988, Martin 1987, Obeyesekere 1985). Thus, while significant epistemological bounds are evident in the archive, these were often slower, more fragmented, and less linear than typical historiographies suggest.
Certain patterns emerge as generations of medical anthropologists have (re)thought what knowledge is, what it does, and how we should position our knowledge in relation to our interlocutors’. One approach has been to critically interrogate epistemological assumptions, at times debunking others’ erroneous or deleterious knowledge claims. For instance, Allan Young (1988) shows how psychotherapy’s “demoralization thesis” is just as much of a culturally-specific “myth” as the various other therapeutic “ideologies” it seeks to demystify. A danger in this approach is that anthropological analysis becomes the arbiter of truth, standing above rather than alongside other epistemologies. As I discuss below, this orientation has been challenged and dislodged by critical feminist interventions in the field. Today, medical anthropologists are increasingly turning a critical gaze back towards our own knowledge practices, identifying our own omissions and inequities. For instance, calling out dead zones in the medical anthropology of Africa, China Scherz (2018) argues that we have come to prioritize biomedicine, clinics, and global health to the extent of overlooking vernacular therapies and the “other ways of healing, knowing, and being” that they entail (543). Critically examining the epistemological commitments of our field also demands a recognition of persistent structural racism and coloniality, which contribute to the stark whiteness of the MAQ archive. Much is lost and many epistemological injustices perpetuated in the absence of scholars writing from a wider range of positionalities.
Recent scholarship in MAQ has attended to the import and significance of inclusivity, in our own work and in medical research more broadly. For instance, Robert Lorway (2020) reveals how patients’ involvement and activism has the potential to transform scientific practices. He writes about program and implementation science frameworks that combine medical research with healthcare delivery to produce “living laboratories” (Tilley 2011) in which the production of evidence informs treatment and justifies health interventions to donors (see also Biruk 2018). Lorway specifically details how male sex worker activists in Kenya successfully prevented the “undemocratic imperatives of an encroaching experimental order” (2020, 398) that sought to impose biometric registration protocols at HIV clinics. He develops the concept of “evidentiary politics” to capture this entanglement, interdependence, and coproduction in which “the aims of surveillance science, health protection, and human rights development are increasingly confronting and reckoning with each other” (416). Evidentiary politics may also be a generative concept for thinking about the entanglement of institutional priorities, political commitments, interpersonal obligations, and knowledge production in our own scholarship.
Addressing another set of epistemological problematics, some scholars eschew notions of truth as representational, focusing instead on what knowledge practices do. For instance, Thomas Csordas (1988) writes about “discernment” as a “divinely heightened intuition” that allows priests to know others’ afflictions in Catholic Pentecostal Charismatic healing in the U.S. (125). Part of what makes this religious healing efficacious is the enrollment of the afflicted in a reordering and changing of their “assumptive world” and its attendant possibilities (134). Knowing oneself differently also transforms the self. Other times, the production of knowledge serves political ends, as Matthew Kohrman details in his analysis of disability statistics in China (2003). Drawing upon Ian Hacking’s work on enumeration (1990), Kohrman reveals how actors create the very categories and subject positions they seek to know. Finally, not knowing can also be generative, as Cristiana Giordano (2020) elaborates in her work on the “refugee crisis” in Italy. She argues that dwelling in the very limits of knowing—by experimenting, exploring, and creating in ways that exceed recognized grammars—may hold the power to alter our forms of life. Thinking with her interlocutors’ artwork, Giordano approaches the space of the therapeutic as “an ethics of creation” (92) that interrupts and suspends dominant categories and grammars via an “exploration of the potentialities of life” (78). Apprehending worlds differently opens up the potential for making worlds otherwise. All of these approaches refract through the MAQ archive, settling loosely into three categories: Knowing and/as Doing, Knowledge and/as Ignorance, and Knowing and/as Disqualifying.
Knowing and/as Doing
In a special section of MAQ devoted to “perspectives on the placebo phenomenon,” Robert Hahn and Arthur Kleinman laid out their argument that “belief” can kill or heal and that this fundamental truth applies just as much to biomedicine—“the predominant ethnomedicine of our society”—as it does to any other form of healing (1983, 3). However, they argue, due to biomedicine’s “physicalistic and Cartesian ideology,” the profession “systematically obfuscates and stigmatizes this phenomenon” (16). Their intervention was to assert that “the mind is embodied, the body mindful” (18) and to highlight how all forms of healing are relational rather than merely a matter of discrete medicines operating on bounded bodies. Medical efficacy involves not just the object being given, but the interpersonal and relational act of giving it (17). Finally, they contend that medical anthropology needs a “different ontology” in order to understand the complex interweaving of the “chemical, physiological, conscious, and unconscious” as simultaneous and mutually constituted components of any event (18). In this approach, knowledge is understood as embodied, relational, and enacted by a complex mind-body (see also Lévi-Strauss 1963).
Extending these insights, Emilia Sanabria (2014) writes about how women in Brazil “apprehend and negotiate distinction” between different forms of contraceptives. In addition to brand-name medicines and generics, sixty-five percent of the pharmaceuticals in Brazil are other kinds of copies, known as similares. Sanabria ethnographically followed “the differences among what is commonly presented as similar and the similarities that insinuate themselves in things presented as different” (539). She demonstrates how pharmaceutical efficacy emerges as the “cumulative effect” of “chemical, structural, economic, and semiotic elements,” thus “collapsing the distinctions between biological and sociological factors” (545). Knowledge is one component of medicinal efficacy: it “seeps into the hormonal substance itself” (551). At the same time, pharmaceuticals can also be tools for knowing bodies, as Andrew McDowell (2016) elaborates in his piece on uncertified biomedical practitioners in India who, forgoing diagnosis, experiment with different drugs to treat their patients’ symptoms. As pharmakon, each drug administered reveals and conceals aspects of illness, a practice that also unsettles “unidirectional relationships between knowing and treating disease” (335; see also Etkin 1992, Henderson et al. 2021, Mol 2002).
In addition to challenging the containment of knowledge within the Cartesian mind, anthropologists have also emphasized how knowing is a storied form of doing. For instance, Parin Dossa (2002) explores storytelling in mental health treatments for immigrant Iranian women in Vancouver, Canada. Her questions were fundamentally “epistemological concerns: what is social knowledge, how is it produced, and for whom?” (342). She found that her colocutors faced structural barriers to social participation, including racialization, sexism, religious discrimination, and colonial perceptions of the veil, which compounded to render their past lives and identities (as professionals, mothers, and feminist activists) “subject to erasure upon migration” (353) to Canada. Yet, mainstream mental health institutions did not acknowledge these “invisible walls”; instead, they placed the onus on the women to overcome so-called “cultural barriers” to integration. For Dossa’s colocutors, storytelling offered an epistemological refusal of such “deficiency discourses” by clearing ground and creating space for an otherwise narrative to emerge. Their own stories told of how systemic social exclusion disrupted Salamat-e Ruh (roughly translated as ‘the peace of one’s soul’), shifting the terrain from medical to existential and from expert to experiential knowledge. Dossa’s article reimagines what health means and how it might be achieved by storytelling, as a form of knowing-as-doing.
More recently, Scott Stonington (2020) has explored knowing-as-doing in a U.S. cardiac intensive care unit (ICU). Here, doctors are not certain about diagnoses but must suspend this uncertainty long enough to “make moves” as they intervene in urgent cases. Stonington calls this practice “process certainty,” referring to a temporary and constantly reevaluated knowledge about what is “a good next thing to do” (350). In a twist on previous work on the placebo, in Stonington’s analysis, “the placebo is for the physician” (357). Taking us through cases as they unfold at the ICU, Stonington shows how physicians must act “as if” they know, an epistemological practice that becomes “an act of creation, of making reality, because the patient’s body changes as a result of interventions chosen” (358). Thus, while Dossa reveals the power of experiential knowledge to challenge institutionalized truths, Stonington deepens this insight by demonstrating how expert knowledge is also experiential and enacted in situated practices. Across each of these articles, knowledge emerges less as something people have or hold, and more as a verb—the active embodiment of specific practices, their emplacements, relationalities, and temporalities.
Knowledge and/as Ignorance
Medical anthropologists have also long been interested in the ways that knowledge practices simultaneously produce ignorance (see Last 1981, Littlewood 2007, Street 2011). This was even a point of contention in the 1983 MAQ special section on the “placebo phenomenon.” In Daniel Moerman’s essay (1983) therein he asks why randomized controlled clinical trials are designed so as to exclude placebo effects, rather than to learn more about them in order to maximize them, calling this avoidance an “anti-epidemiology” (15, see also Beecher 1955, Dumit 2012).
Decades later, Claire Wendland (2007) elaborated on this problematic, interrogating how the rise of randomized, double-blinded, controlled clinical trials (RCTs) have come to eclipse other forms of knowledge, including that of both clinicians and patients. She discusses how cesarean sections skyrocketed in the U.S. and globally due to a hierarchal ranking of medical knowledge, with RCTs taken as the gold standard and understood as “apolitical, scientific, and objective” as opposed to the “bias” and “subjectivity” of experiential knowledge (219). Yet, as she reveals, RCTs are epistemologically and politically fraught in numerous ways: everything from what research questions are pursued to what counts as evidence are influenced by “gendered ideas of nature, birth, and the female body” (219). Excluded from evidence in cesarean RCTs is the mother’s own experience of birth and complications, as well as the deleterious consequences that cesareans have for maternal-newborn dyads. And, when RCTs compare cesarean and vaginal delivery outcomes, “the most breathtaking move in the selection of evidence is that none of these authors considers the cesarean itself as injurious…the intentional wound is exempt by fiat” (223). Wendland’s trenchant critique is directed at the “interpenetration” of patriarchy, safety and consumer ideology, the institutionalization of birth, a culture of technological veneration, and hierarchal epistemologies. Offering a much-needed feminist intervention, she advocates for “situated knowledge” (Haraway 1988) that might displace the produced ignorance of standardized, universal knowledge claims, which, she reminds us, are always “dominant knowledge disguised” (226, see also Fisher 2020).
Sometimes the production of ignorance is actually the intentional objective of epistemological practices, as Peter Little (2017) reveals in his work on IBM’s corporate mortality files. Drawing on Kim Fortun’s writing on late industrialism (2012) and Achille Mbembe’s analysis of necropolitics (2003), Little develops the concept of “late industrial necropolitics” as a way to grapple with legal-epistemological regimes that produce mortality and (fail to) document it. His article focuses on a 2003 lawsuit against IBM that led to the largest electronics occupational health study ever, carried out in Endicott, New York, at the site of a former IBM plant. After over a decade of waiting, plaintiffs received the study’s results, which—while demonstrating “statistically significant relations” between disease and industrial exposures to solvents—nonetheless served as a “weak epistemic resource for those engaged in legal action” (166). Legal and scientific regimes of truth conjoined to make the evidence ineffective: while the study demonstrated mortality, lawyers needed to prove morbidity; they also had the near impossible task of trying to prove that a given solvent was “capable of causing various illnesses and that it actually caused a particular client’s illness” (167). Ultimately, the study was not even used in the lawsuit and the case was settled out of court. Little contends that the production of more numbers, data, records, and evidence does not translate into greater health or epistemic justice, but rather forms part of “a systemic effort to produce and disseminate ignorance” (169). Under conditions of late industrial necropolitics, neoliberal science is an instrument of corporate power, an anti-epistemological technology for producing knowledge as ignorance.
Yet, ignorance may have its merits, as Jieun Lee deftly demonstrates in her piece on dementia in Seoul, South Korea (2019). Lee explores the labor involved in keeping a dementia diagnosis secret, concealing this truth from loved ones who are terrified of becoming a burden, being disgraced, and living in abjection (following the popular imaginary around dementia in Korea). In such a context, Lee argues that deception and secrecy can be acts of care rather than forms of epistemic violence. She uses the term “living with/out dementia” to capture the duality of remaining ignorant of the diagnosis while simultaneously being cared for and undergoing treatment. Lee carefully attends to how secrecy is maintained in practice, what kinds of labor this requires, and how it might open up new subject positions for individuals living with/out dementia. We see how even institutional practices at medical facilities are refashioned as staff at Dementia Support Centers lead patients to believe that they are engaging in “dementia prevention” rather than “dementia treatment” activities. Dementia, diagnostic truth, and ethics emerge from Lee’s account as relational and processual, operating in the interstices of “constant recalibrations and experiments” (2019, 511). Rather than generalize about the value or harm of ignorance, concealment, and deception, then, medical anthropologists attend to their multiplicity and situatedness within local biologies (Lock and Nguyen 2010) and ethico-onto-epistemic formations (Barad 2007).
Knowing and/as Disqualifying
Throughout the MAQ archive, scholars also repeatedly critique the iatrogenic effects of dismissing patients’ knowledge, whether in clinical care or global health initiatives. Writing on the experience of individuals with chronic fatigue syndrome in Boston, Norma Ware (1992) demonstrates how their illness experiences were “delegitimated,” leading to escalating suffering, stigma, shame, and alienation. Ware’s analysis offers an early critique of the epistemological limitations of mind-body dualism in biomedicine, where practitioners presume that, in the absence of an identifiable physical pathology, their patients’ afflictions must be “imagined” and therefore either psychosomatic or nonexistent (352, see also Good and Good 1982, Kleinman 1988). Ware’s participants felt trivialized, humiliated, and even paralyzed by this systematic disqualifying of their experiential reality, some attempting to “pass” as healthy. Meanwhile, Susanna Trnka (2007) details how Indo-Fijian women’s pain is considered “unreal” by their doctors if it cannot be treated with painkillers at their clinic, “whereas the drugs’ efficaciousness is held up as unquestionable” (396). This example demonstrates how available medical treatments delimit which experiences are seen as credible or not. Taken together, such works caution against the caustic designation of “not real” as a form of delegitimation that wields biomedical authority as an onto-epistemic weapon: for these patients, “Their shame is the shame of being wrong about the nature of reality” (Ware 1992, 354).
Medical anthropologists have also levelled parallel critiques against our own epistemological practices, arguing that our scholarship needs to take seriously that which we cannot perceive (as real). A rather remarkable early intervention into these debates was Marlene Dobkin De Rios’ provocatively titled piece, “Is Science Catching Up with Magic?” (1975). Dobkin De Rios contended that cultures vary in the respective emphasis and value they place upon different epistemological practices, leading to “differences in modes of perceiving and organizing one’s experience” (5). She summarized literature on plant perception, hallucinogenic substances, human-animal relations, geography and environment, “paranormal phenomena” and “the supernatural,” in some ways presaging the ontological turn via her argument that practitioners like shaman may have techniques for acquiring knowledge that scientific methods cannot apprehend. As she put it: “peoples steeped in so-called magical thought processes, which are disdained by Western scientists as non-rational and often inferior, may have been able to achieve a level of problem solving not yet reached by the Western scientist, perhaps because he [sic] asks the wrong questions” (5). Importantly, Dobkin De Rios defends the epistemological validity of others’ practices, refers to them as a form of “knowledge” rather than just “belief,” and challenges the inequalities and hierarchies of onto-epistemological politics in ways that we are still grappling with today (see Good and McDowell 2015, Luhrmann 2020, Roberts 2016).
Finally, over the years in MAQ, medical anthropologists have experimented with methods of writing and analysis that do not reproduce colonialist epistemological hierarchies. This commitment has been especially important in relation to one of the most pressing concerns of our times: vaccine hesitancy. Back in 2000, Pamela Feldman-Savelsberg, Flavien Ndonko, and Bergis Schmidt-Ehry analyzed a rumor that tetanus vaccines would sterilize women in Cameroon, a fear so pronounced that schoolgirls jumped from their classroom windows to escape public health workers and roughly one-fifth of those vaccinated intentionally tried to conceive afterwards to test their fertility, leading to an upsurge in pregnancies and abortions for the next two years (167-8). Feldman-Savelsberg et al. interpret these sterility rumors as a “(subaltern) politics of the womb” (173) that, while biomedically untrue, congeals another kind of truth. They show how rumor and gossip attest to the longue durée of post/colonial medical violence, female disenfranchisement, widespread mistrust of the state amidst growing ethnic regionalism, and international pressure to adopt family planning—all of which compounded women’s experiences of the vaccination campaign as coercive. Sixteen years later, Tamara Giles-Vernick, Abdoulaye Traoré, and Louis Bainilago (2016) also looked at vaccine hesitancy in Africa, comparing perceptions of hepatitis B vaccines in Burkina Faso and the Central African Republic (CAR). They forego terms like “belief” entirely, in favor of an insistence that their interlocuters’ understandings of health and wellbeing constitute a form of (incomplete) knowledge.
I end with Giles-Vernick et al.’s piece because it also brings together my foregoing discussions around ignorance and knowing-as-doing. Giles-Vernick et al. (2016) nuance notions of ignorance by explicating different modalities of what they term “incertitude,” which includes ignorance as well as uncertainty and ambiguity. They write that “ignorance” may denote a situation in which people are unsure about what is possible or probable, whereas “uncertainty” captures moments when people do know the possible outcomes but just not their respective likelihood. Meanwhile, they understand “ambiguity” as the existence of “alternative ways of knowing” a situation and the ensuing disagreements over possible outcomes (205). They discovered such ambiguity over infant vaccination in both Burkina Faso and CAR—with parents and health workers holding ontologically different understandings of personhood and wellbeing—but this did not prevent vaccination as parents were keen to “hedge their bets” by utilizing multiple forms of health protection (211). In CAR, however, ambiguity was compounded by uncertainties over vaccine urgency, as well as constraints in time and money, such that parents opted not to vaccinate their infants when “impediments to vaccination were more storied than the vaccination itself” (216). Giles-Vernick et al. draw upon Tim Ingold’s (2011) concept of “storied knowledge” to capture how information that is not storied—not experientially known—leads to uncertainty over its truth value. Their article thus refutes the notion that vaccine hesitancy is driven by “ignorance,” or a lack of knowledge, while also demanding a rethinking of knowledge itself as processual and enacted. Telling stories about infant wellbeing is a way of knowing-as-doing, much as Dossa (2002) wrote about. Understanding storytelling as a knowledge practice is also a valuable reminder of the importance of our own storytelling, pointing to why ethnographic narrative has remained the cornerstone of medical anthropology scholarship across MAQ’s long and storied archive.
Knowing Better? Articles from the MAQ Archive
Is Science Catching Up with Magic? A Look at the Content of Belief Systems | Marlene Dobkin De Rios (1975)
Belief as Pathogen, Belief as Medicine: “Voodoo Death” and the “Placebo Phenomenon” in Anthropological Perspective | Robert A. Hahn and Arthur Kleinman (1983)
Traditional Chinese Medical Theory and Real Nosological Units: The Case of Hansen’s Disease | Paul Unschuld (1985)
Suffering and the Social Construction of Illness: The Delegitimation of Illness Experience in Chronic Fatigue Syndrome | Norma C. Ware (1992)
Sterilizing Vaccines or the Politics of the Womb: Retrospective Study of a Rumor in Cameroon | Pamela Feldman-Savelsberg, Flavien T. Ndonko, and Bergis Schmidt-Ehry (2000)
Narrative Mediation of Conventional and New “Mental Health” Paradigms: Reading the Stories of Immigrant Iranian Women | Parin Dossa (2002)
The Vanishing Mother: Cesarean Section and “Evidence-Based Obstetrics” | Claire L. Wendland (2007)
“The Same Thing in a Different Box”: Similarity and Difference in Pharmaceutical Sex Hormone Consumption and Marketing | Emily Sanabria (2014)
Incertitude, Hepatitis B, and Infant Vaccination in West and Central Africa | Tamara Giles-Vernick, Abdoulaye Traoré, and Louis Bainilago (2016)
Corporate Mortality Files and Late Industrial Necropolitics | Peter C. Little (2017)
Living with/out Dementia in Contemporary South Korea | Jieun Lee (2019)
“Making Moves” in a Cardiac ICU: An Epistemology of Rhythm, Data Richness and Process Certainty | Scott D. Stonington (2020)
Experimental Entanglements: Surveillance Science, Sex Worker Activism, and Evidentiary Politics in Kenya | Robert Lorway (2020)
Prepared by Laura A. Meek
Knowing and/as Doing
Experiential Learning Assignment #1: Embodied Knowledge Project
For this assignment, students should select a health or wellness practice that they are interested in learning about and that they would like to put into practice in their own lives. This should be an activity that they do not already do regularly. Some examples include: vegetarianism/veganism, acupuncture, yoga, prayer, sleeping routines, weight lifting, cooking, meditation, aerobics, guided breathing, massage, fitness tracking, scheduling breaks or naps, swimming, giving up alcohol/sweets/coffee/etc., going for walks, limiting blue light in the evening, spending time in green spaces, journaling, stretching, or healthy eating. It is prudent to ask students to propose a topic early in the semester and to check that none of their practices might be harmful, dangerous, or illegal.
The assignment comprises three parts: A research paper about the selected health practice; regularly engaging in the practice (with or without journaling); and a reflective paper contrasting one’s experience of the practice with one’s research about it.
Research Paper: Students will write a research paper on their chosen topic, summarizing different forms of literature about it and its health benefits. They could review scholarly medical, psychological, and social science publications, as well as other media, such as newspaper articles, blog posts, magazine stories, or even fiction. This first paper can be as short or elaborate as teachers wish, serving as a short weekly assignment or a midterm paper, depending on course design. In the latter case, instructors may also ask students to contrast the different kinds of knowledge they were (and were not) able to learn from their various forms of source materials.
Engaging in the Health Practice: After this first essay, students will begin doing their wellness practice, making sure to engage in it regularly (for instance, every day or every other day for at least a month). During this time, I encourage students to keep a journal detailing what changes they notice in their bodies, routines, sensations, feelings, relations, and daily lives. (This journal can be kept private and/or just graded for completion.)
Contrasting Paper: Finally, for the last part of this assignment, students will write a second paper contrasting their embodied learning with what they learned previously in their research assignment. The purpose of this second essay is to help students better understand the concept of knowing-as-doing. They may be asked to make connections to two or three course readings on this topic. Some guiding questions to use for this assignment are:
- What did engaging in this practice teach you about it that you couldn’t learn by just reading about it?
- What surprised or frustrated you, differing from your expectations when you started?
- Was there anything you wanted to know more about that you wouldn’t have thought to look into before trying this practice yourself?
- How did the practice change your perceptions of your own body, wellbeing, identity, and/or everyday life?
- Based on your own experience, how would you describe the difference between knowing-as-doing versus knowing via second-hand information?
- Are there things you learned in practice that you would struggle to explain to others?
- Which forms of knowing do you find most: powerful, trustworthy, memorable, reliable, impactful, generalizable, believable, or important?
Note: This assignment is loosely based on a Body Practices Blogging Project that Priscilla Song and I developed for our course Bodily Politics: Local Worlds, Global Processes at the University of Hong Kong. Details about our body blogging assignment are available on our course website here. This project was inspired by a similar one Joe Dumit used in his graduate seminar, aBody++, which I took with him at the University of California, Davis, in 2010.
Discussion Questions for “Knowing and/as Doing” Readings
- What is Cartesian dualism? Where do you see this binary operating in the world around you? Does it shape our own university’s health centers? What might a more holistic approach to health and healing look like?
- Do you agree with Hahn and Kleinman that belief has the power to kill and to heal? Do you think the notions of the placebo and nocebo effects capture any of your own experiences with using medicine?
- What does it mean to say that medical efficacy isn’t just about the medicines, but also about the interpersonal/relational act of providing treatment? Do you ever feel better if someone special is caring for you? Or worse after a particularly negative medical encounter?
- Thinking with Sanabria’s article about brands, generics, and similares, do you also prefer certain kinds or brands of medicines over others? What factors shape the confidence you place in the products you use?
- What does it mean to say that the “body knows”? Is there anything you know bodily that you would struggle to explain in words?
- Were you surprised by Stonnington’s ethnographic material showing that ICU doctors have to “make moves” without being certain what is wrong with their patients? How does this challenge commonsense ways of thinking about biomedical treatment?
- Do you agree with Dossa’s argument that storytelling is a form of knowing-as-doing? Can you think of any stories you tell—or were told as a child—that contribute to making the world a certain way?
- Think of the history courses you took in middle and high school. If those history textbooks told different stories, from the perspectives of more diverse actors, how might this impact our society and the world?
- Following Lorway’s analysis, do you think that patient activism should play a role in the production of medical research? Do you see it as a positive or negative development that research, treatment, and activism have become so deeply entwinned?
- Lorway and Dossa’s articles foreground power and social inequality in a number of ways, including with regards to gender, sexuality, class, race, religion, nationality, and language. Such forms of inequalities were not discussed in Hahn and Kleinman’s article nor in Stonnington’s. Do you think that power and social inequalities matter in these domains (like patient-doctor interactions and ICU care)? Would foregrounding this have affected the authors’ arguments?
Knowledge and/as Ignorance
Experiential Learning Assignment #2: Ignorance Mapping Project
This assignment comes directly from Joe Dumit’s Implosion Project (2014)—a project he learned while a teaching assistant for Donna Haraway at the University of California, Santa Cruz, and that I learned while his teaching assistant at the University of California, Davis. The full project (linked above) has several steps to guide students in tracing connections as they follow facts, processes, stories, things, histories, people, and other material-semiotic actors that make up objects. The overarching purpose of this assignment is to “implode” an object by tracing these connections in detail, learning how objects are in the world and the world in them. At the same time, it also reveals how we come to know—or not—about certain aspects of our world. The “Ignorance Map” helps students to recognize the lacunas, omissions, and dead zones in their knowledge about ordinary objects that they encounter often and might presume to know well.
This assignment has four steps: Selecting an object; creating a knowledge map about it; researching one’s gaps in knowledge while attending to patterns in the gaps (e.g. making an ignorance map); and coming up with theories of ignorance to account for any remaining gaps in knowledge that cannot be filled in after further research.
Select an Object: This may be a thing, a fact, or a process. In a medical anthropology course, students might select a drug, a diagnostic category, or an epidemic, for instance. The key is that each object needs to be very specific—“not just fluoxetine, but one of those colored, branded Prozac pills that is in your medicine cabinet” (Dumit 2014, 350).
Knowledge Map: For the “Knowledge Map” (354), students record what they already know about their object’s various dimensions without doing any additional research. Dimensions to consider include an object’s materiality, political context, symbolic associations, bodily effects, history, technological apparatuses, economic production, and more. Dumit (2014, 351-354) provides a longer list of dimensions along with definitions and prompts for each of them, which I recommend providing to students as a helpful resource. This first activity is often eye-opening for how it reveals what knowledge we attend to and what we neglect—that which we didn’t even know we didn’t know. I like to ask some students to share their Knowledge Maps with the class as a group exercise to think together about what is at stake in our collectively cultivated knowledge and its gaps.
Ignorance Map: Next, students research their object, attempting to fill in their knowledge gaps. For instance, perhaps a student knows a great deal about the political and bodily aspects of that Prozac pill, but very little about its history or the labor that goes into its production. As they fill in their “Ignorance Map,” they should also consider why they don’t know certain things. This exercise can also be conceptualized, in conversation with Giles-Vernick et al. (2016), as identifying information that is “unstoried” and has thus not captured their attention. The goal is to “pay attention to patterns of ignorance” and to recognize how one’s “knowledge and attention and caring have been shaped” (Dumit 2014, 355-356).
Theories of Ignorance: Finally, students note which information they are unable to locate and develop an argument about why this might be so. For instance, maybe there are some statistics, data, or facts that “were never collected because no one was interested, or they were specifically not interested” (Dumit 2014, 356, original emphasis).
This exercise emphasizes how ignorance is socially constructed, with socio-political-economic forces interacting to story some knowledge and silence others. The assignment can be adapted for graduate students to deepen their dissertation research, used as the backbone of an undergraduate STS course, or condensed into short in-class brainstorming activities to prompt discussion (see Dumit 2014, 358-359).
Discussion Questions for “Knowledge and/as Ignorance” Readings
- Does every method for producing knowledge necessarily also exclude some questions from consideration? Do we always produce ignorance whenever we produce knowledge?
- Reading Wendland’s piece on cesarean sections, we saw how mothers’ own experiences of giving birth were discounted in clinical trials. Could we design clinical trials differently so that this wasn’t the case? How?
- Is any kind of knowledge purely objective and unbiased? How might one’s answer to this question change how they do their own research?
- What does “situated knowledge” mean? Do differently situated actors have access to different knowledge about the world? If so, what does this mean for how we produce knowledge in fields like science and medicine?
- Reading Little’s article what was your reaction to the fact that after all those years of research, the occupational health study—which did show links between IBM’s waste products and diseases, like cancer—wasn’t useful in court? What causes corporate science and our legal system to function like this?
- Do you think that more data leads to more knowledge and/or improvements in social justice? Is it possible to record more than ever before and yet not “know better”? If so, why?
- Why did the family members in Lee’s article choose not to reveal dementia diagnoses to their loved ones? Do you think this was an ethical decision? Why or why not?
- Is there anything that you would prefer to remain ignorant about? Is knowledge always empowering or can it also be harmful? (Think about what we tell children, for instance: why do we keep certain information from them, and should we?)
- In which of these articles is ignorance intentional versus unintentional? In Wendland’s example, ignorance operates as invisibilization (of mother’s experience), whereas in Little’s case, everyone seems to “know” the truth but not how to “prove” it. In Lee’s piece, sometimes patients did know about their dementia, but chose to go along with the pretense that they didn’t. Would you call all of these “ignorance”? Why or why not?
- Giles-Vernick et al. argue that “ignorance” is only one kind of “incertitude,” with the others being ambiguity and uncertainty. What exactly are the differences between these terms and do you find this differentiation helpful?
Knowing and/as Disqualifying
Experiential Learning Assignment #3: Medical Delegitimation Interview Project
For this assignment, students will interview someone about an occasion (or perhaps multiple ones) in which their healthcare provider did not trust, believe, or take seriously their embodied experience. This is a variation of a typical illness narrative assignment, with a focus on experiences of delegitimation and disqualification within medical treatment. The range of possible examples can be broad, including experiences with acute or chronic conditions, bodily alterity or disability, mental health or wellbeing, nonbiomedical afflictions, drug side-effects, or even insurance coverage. It is wise to advise students to render their interviewee anonymous and to avoid interviewing anyone who is under eighteen years old, not able to consent, seriously ill or emotionally overwrought in response to their experience. However, I do encourage students to interview friends and family members, with the caveat that they will need to listen in a different way, carefully recording their interviewee’s words, metaphors, feelings, reactions, body language, reflections, worldview, and associations in a way that they would not normally. This assignment is therefore also an opportunity to teach about interview methods, how to design open-ended questions, ask follow-up questions, identify themes, and develop rapport.
This assignment has two parts: The illness interview/s (I recommend one plus a follow up); and an analytical paper based on the interviews. Alternatively, the assignment can be further scaffolded into multiple smaller parts (detailed below).
The Interviews: Time permitting, I recommend two rounds of interviews (of thirty minutes to one hour each), with notes submitted afterwards (and graded for completion). Between the first and second interview, students may be broken into groups during class to discuss their interview material with one another, providing ideas about connections to course themes, readings, and concepts. I also encourage students to raise issues, concerns, or challenges in class so that these examples can be discussed and brainstormed together. They may also be asked to submit a preliminary thesis statement for feedback before the final assignment is due. Depending on course design, this assignment can be a shorter, self-contained midterm or final, or it can be scaffolded in several components to serve as an experiential learning project that develops over the entire semester. Potential components include: preliminary reports after each interview, a short ethnographic vignette, a thesis statement, group feedback, an in-class presentation, and the final paper.
Analytical Paper: For the final paper, students should analyze their material in relation to two or three course readings, drawing upon concepts as they compare and contrast their interviewee’s experience with others’ accounts. I emphasize that students should try to learn about their interviewee’s experience in the context of their life, using their own stories, metaphors, memories, categories, values, and associations. Length can vary depending on how advanced the course is, but for an advanced undergraduate course I suggest around six pages double-spaced (or 1,800 words). Papers can be evaluated on having a nuanced, sophisticated, creative argument; supporting this argument with evidence from the interview; developing concepts and ideas drawn from the interview; and making excellent use of course materials and readings to support interpretations.
Note: This project is inspired by other illness narrative interview projects that Cristiana Giordano assigns in her undergraduate courses on Introduction to Medical Anthropology and Psychological Anthropology at the University of California, Davis, for which I served as a teaching assistant.
Discussion Questions for “Knowing and/as Disqualifying” Readings
- Have you ever had an experience in which a doctor (or other medical practitioner) didn’t believe you about something? If so, how did this affect you?
- Ware writes about how individuals with chronic fatigue syndrome were told that their symptoms were either fake or psychological. How might a non-Cartesian understanding of well-being help healthcare providers to understand illness experience differently?
- What is the difference between “beliefs” and “knowledge”? When anthropologists refer to other people’s notions of the world as “beliefs,” are they necessarily implying that these ideas are untrue?
- Let’s think of some synonyms authors use to refer to “belief” and “knowledge,” and write these on the board (e.g. rumors, gossip, conspiracy theories, understandings, idioms, myths, perspectives, theories). Which of these would you be okay with someone else using to refer to your ideas about the world? Which would offend you, and why?
- Were there any examples of “magic” in Marlene Dobkin De Rios’ piece that you think might be “ahead of” what we can know scientifically (e.g. plant perception, which is increasingly an area of scientific inquiry today)?
- Alternatively, are there aspects of our lives that science does not have the tools to perceive at all? Might other practices, like shamanistic healing, be able to access other realms of experience? Who should decide if this knowledge is credible and legitimate or not?
- Feldman-Savelsberg et al. write that while gossip and rumors may be literally untrue, they can still capture and congeal other kinds of truths. What do you think they mean by this? Have you ever heard any rumors or “conspiracy theories” that you think speak to a kind of truth in this way? What makes such rumors and gossip so powerful?
- What were the similarities and differences in the two articles on vaccine hesitancy in Africa (by Feldman-Savelsberg et al. and Giles-Vernick et al.)? The former refers to rumors and gossip as “beliefs” while the latter discusses incertitude and “storied knowledge.” Which approach did you find more compelling, and why?
- Did the two articles on vaccine hesitancy remind you of issues around Covid-19 vaccination, in the U.S. or elsewhere? How would we apply Feldman-Savelsberg et al. and Giles-Vernick et al.’s approaches to thinking about why some people don’t want to get vaccinated for Covid-19?
- Many of these readings point towards inequalities over whose knowledge counts as knowledge and who gets to produce knowledge that is recognized as real and legitimate. Some scholars call this inequality “epistemic injustice” or “epistemological violence.” Do you agree that this is a kind of injustice and/or violence? Why or why not?
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