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Journal: Medical anthropology quarterly

28

U.S. media reports suggest that vastly disproportionate numbers of un- and under-vaccinated children attend Waldorf (private alternative) schools. After confirming this statistically, I analyzed qualitative and quantitative vaccination-related data provided by parents from a well-established U.S. Waldorf school. In Europe, Waldorf-related non-vaccination is associated with anthroposophy (a worldview foundational to Waldorf education)-but that was not the case here. Nor was simple ignorance to blame: Parents were highly educated and dedicated to self-education regarding child health. They saw vaccination as variously unnecessary, toxic, developmentally inappropriate, and profit driven. Some vaccine caution likely predated matriculation, but notable post-enrollment refusal increases provided evidence of the socially cultivated nature of vaccine refusal in the Waldorf school setting. Vaccine caution was nourished and intensified by an institutionalized emphasis on alternative information and by school community norms lauding vaccine refusal and masking uptake. Implications for intervention are explored. This article is protected by copyright. All rights reserved.

Concepts: Education, Sociology, Qualitative research, Copyright, Alternative education, Anthroposophy, Rudolf Steiner, Waldorf education

3

The Arabic miswak (Somali, adayge) is a tooth-cleaning stick from the Salvadora persica plant. In this article, we trace the social life of a “thing,” examining meanings inscribed in the stick brush, drawing on interviews with 82 Somali refugees in Massachusetts and an analysis of local and transnational science and marketing. The miswak toothbrush symbolizes relationships to nature, homeland culture, global Islam, globalizing dental medicine, and the divine as it intersects with the lives of producers, marketers, distributors, and users, creating hybrid cultural forms in new contexts. [ethnodentistry, Islam, Somali diaspora, commodifiction, miswak] This article is protected by copyright. All rights reserved.

Concepts: Culture, All rights reserved, Globalization, Oral hygiene, Copyright, Somalia, Salvadora persica, Miswak

2

Living with extreme weight in the U.S. is associated with discrimination and self-stigma, creating structural exclusions, embodied stress, and undermining health and wellbeing. Here we combine ethnographic interviews (N = 35) and surveys (N = 296) from those with experiences of living with extreme weight to better explain how this vulnerability is created and reinforced by public cues, both physical (e.g., seatbelts) and social (the reactions of strangers). “Misfitting” is a major theme in interviews, as is the need to plan and scan constantly while navigating too-small public spaces. The most distressing events combine physical misfitting with unsympathetic reactions from strangers. Sensitivity to stigmatizing public cues reduces with weight loss, but does not disappear. This study explains one basic mechanism that underlies the creation of felt stigma related to weight even after weight loss: the lack of accommodation for size and the lack of empathy from others that characterize modern urban spaces. This article is protected by copyright. All rights reserved.

Concepts: Explanation, All rights reserved, Reinforcement, Copyright, Ethnography, Public, Public library, Urban design

2

Based on ethnographic fieldwork in a U.S. men’s prison, I investigate how this social and cultural context structures relations between correctional officers and inmates with severe mental illness. Utilizing interpretivist perspectives, I explore how these relations are structured by trust, respect, and meanings associated with mental illness. Officers' discretionary responses to mentally ill inmates included observations to ensure psychiatric stability and flexibility in rule enforcement and were embedded within their role to ensure staff and inmate safety. Officers identified housing, employment, and social support as important for inmates' psychiatric stability as medications. Inmates identified officers' observation and responsiveness to help seeking as assisting in institutional functioning. These findings demonstrate that this prison’s structures and values enable officers' discretion with mentally ill inmates, rather than solely fostering custodial responses to these inmates' behaviors. These officers' responses to inmates with mental illness concurrently support custodial control and the prison’s order.

Concepts: Psychology, Mental health, Sociology, Mental disorder, Psychiatry, Mental illness, Psychiatric medication, Cross-cultural psychiatry

1

African American males diagnosed with a psychotic disorder are overrepresented among “chronic users” of inpatient mental health care. We engaged in nine months of clinic-based ethnographic research in a high-poverty, urban area to explore the experience of psychosis and recovery for African American men. What emerged as most salient for our participants was the paralyzing autobiographical incoherence surrounding their collective experiences of psychotic disorders. We identify three important points when autobiographical incoherence was not addressed: during the initial psychotic break, while the young person was being reintegrated into their home communities after a period of treatment, and also when a person begins to feel “stuck” in their illness while being cycled through institutions of “care” that remained blind to their needs. Addressing inadequate public mental health care that erases the existential needs of young black men may help promote their mental health recovery. This article is protected by copyright. All rights reserved.

Concepts: Black people, Mental disorder, Race, Psychosis, Psychiatry, African American, Barack Obama, Karl Jaspers

1

Many of medical anthropology’s most pressing research questions require an understanding how infections, money, and ideas move around the globe. The Global Polio Eradication Initiative (GPEI) is a $9 billion project that has delivered 20 billion doses of oral polio vaccine in campaigns across the world. With its array of global activities, it cannot be comprehensively explored by the traditional anthropological method of research at one field site. This article describes an ethnographic study of the GPEI, a collaborative effort between researchers at eight sites in seven countries. We developed a methodology grounded in nuanced understandings of local context but structured to allow analysis of global trends. Here, we examine polio vaccine acceptance and refusal to understand how global phenomena-in this case, policy decisions by donors and global health organizations to support vaccination campaigns rather than building health systems-shape local behavior.

Concepts: Medicine, Vaccine, Polio vaccine, Sociology, Anthropology, Cultural anthropology, Poliomyelitis eradication, Ethnography

1

The nation’s fight against fat has not reduced obesity, but it has had other worrying effects. Mental health researchers have raised the possibility that the intense pressures to lose weight have heightened the risks of developing eating disorders, especially among the young. Medical anthropology can help connect the dots between the war on fat and disordered eating, identifying specific mechanisms, pathways, and contextual forces that may lie beyond the scope of biomedical and psychiatric research. This article develops a biocitizenship approach that focuses on the pathologization of heaviness, the necessity of having a thin, fit body to belonging to the category of worthy citizen, and the work of pervasive fat-talk in defining who can belong. Ethnographic narratives from California illuminate the dynamics in individual lives, while lending powerful support to the idea that the battle against fat is worsening disordered eating and eating disorders among vulnerable young people.

Concepts: Medicine, Nutrition, Eating disorders, Mental disorder, Anthropology, Dieting, Psychiatry, Cultural anthropology

1

This article examines appetite loss among married women living in a Delhi slum. Research has shown that through feeding, women in South Asia gain domestic authority and become part of the families into which they marry. I use observations and interviews collected over 14 months in one poor urban community to explore the social dimensions of feeding and abstaining from eating in a context of marital and food insecurity. Results show that women report appetite loss in response to domestic violence, the stress of marital fights, and fears about the dissolution of their marriages. In other instances, women report that they forget to eat because of dedication to caregiving or refuse to eat because of their husbands' failure to attend to their needs. In the context of this research, I show that food insecurity research would benefit from considering the kinship and gender politics involved in feeding and eating behaviors.

Concepts: Family, Marriage, Eating, Food, Husband, Appetite, Family therapy, Wife

1

Cancer graphic narratives, I argue, are part of a medical imaginary that includes representations of difference and biomedical technology that engage Fassin’s (2009) concept of biolegitimacy. Framed in three parts, the argument first draws on discourses about cancer graphic narratives from graphic medicine scholars and authors to demonstrate a construction of universal suffering. Second, I examine tropes of hope and difference as a biotechnical embrace. Finally, I consider biosociality within the context of this imaginary and the construction of a meaningful life. Autobiographical graphic narrative as a creative genre that seeks to give voice to individual illness experiences in the context of biomedicine raises anthropological questions about the interplay between the ordinary and biolegitmate. Cancer graphic narratives deconstruct the big events to demonstrate the ordinary ways that a life constructed as different becomes valued through access to medical technologies. [graphic narratives, cancer, health inequalities, biolegitimacy, medical imaginary] This article is protected by copyright. All rights reserved.

Concepts: Health care, Medicine, Oncology, Philosophy of language, Anthropology, Social sciences, All rights reserved, Copyright

1

Pink t-shirts that proclaim “My horse is my therapist” are for sale in a wide variety of horse-sport catalogues. Literature on the healing power of human-nonhuman animal encounters and the practice of a variety of animal-assisted therapy programs, such as hippotherapy and equine-facilitated therapy, show dramatic growth over the last 30 years. Less attention is paid to the role that horse-human interactions may play in more popular accountings of well-being and impairment among a sample of everyday riders. Analysis of 50 lifecycle narratives, collected from accomplished but nonprofessional equestriennes, demonstrates the complex and ambiguous ways in which women draw from their experience of human-horse relationships as they challenge and transgress the borderlands between pleasure and impairment. Combining the perspectives of multispecies ethnography and medical anthropology that engages the complexities of well-being, analysis is informed by and contributes to recent controversies concerning the medicalization of normality and pleasure in DSM 5. This article is protected by copyright. All rights reserved.

Concepts: Medicine, Therapy, Fiction, Complexity, Anthropology, All rights reserved, Cultural anthropology, Copyright