Thesis (Ph. D.)--University of Chicago, Dept. of Anthropology, March 2003. / Includes bibliographical references. Also available on the Internet.

Thesis (Ph. D.)--University of Oregon, 2005. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 339-377). Also available for download via the World Wide Web; free to University of Oregon users.

Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (p. 511-533).

Female sterilisation or tubal ligation remains the most promoted and prevalent method of contraception in India today, especially among the rural and urban poor. This thesis provides an ethnographic account of poor women’s experiences of the sterilisation procedure in order to investigate the intricate relationship between the state, biomedicine and poor women in rural North India. The thesis draws on 18 months of ethnographic fieldwork in a mixed-caste village in Southern Rajasthan. Besides engaging with women in their daily lives in the village, participant observation was also carried out in regularly organised sterilisation camps, which were run by Marie Stopes India in two nearby towns. The thesis aims to explore how women experience the female sterilisation procedure, how this procedure relates to concerns beyond the sterilisation camp and how various forms and sources of authority influence reproductive decisions. The female sterilisation procedure encapsulates not only people’s engagements and negotiations with the power, practices and discourses of the state, but also with other forms of authority, such as biomedicine, and intersecting structures of gender, caste and class. The thesis approaches the main research theme – the relationship between the state, biomedicine and poor women in rural North India – by examining various relationships and power struggles within these domains as much as between them. The chapters focussing on the history of family planning in India, on local articulations of the state in the village and on local health workers who are an integral part of “motivating” women for the female sterilisation procedure reflect an effort to problematise “the state” and to investigate how local embodiments and discourses of the state contribute to women’s decisions to stop childbearing by undergoing the tubal ligation procedure. The ethnography of a sterilisation camp provides a look into processes of biomedical examinations conducted in the camp before the procedure, and shows how biomedical tools of knowing, seeing and acting are negotiated and contested by various biomedical personnel, bureaucrats, as well as by women seeking the procedure. In such a way, I problematise the category of “biomedicine” and highlight its contested nature. Finally, chapters on reproductive agency and operable bodies examine how women themselves make sense of tubal ligation, how they negotiate conditions under which to undergo the procedure, and how female sterilisation becomes a site to negotiate one’s social status. An ethnographic investigation of the state, biomedicine and poor women as categories which are not homogenous but rather are constituted through multiple internal and external contestations allows a deeper and more complex understanding of how increasing medicalisation of women’s lives in rural North India is experienced in various different ways. Furthermore, acknowledging the multiplicity of agendas, discourses and experiences within the categories of “the state”, “biomedicine” and “poor women” provides an insight into how power is contested and articulated on multiple levels and by multiple actors, resulting in theoretical contributions to the existing theories on power, governmentality and biopolitics.

Autoimmunity is a modern age medical dilemma which is inextricably linked with emotional stress. Based on semi-structured interviews and participant Adverse Childhood Experiences (ACE) survey results, this study confirms that the autoimmune process may be initiated via psychosocial factors like emotional stress and childhood trauma. Ninety-three percent of participants experienced adversity or trauma in childhood, and 50% of participants talked about a period of prolonged stress that preceded the onset of their condition. This study also confirms the intimate and satisfactory relationship developed between patients and complementary and alternative (CAM) practitioners, who invite patients to be co-producers of health and holistically address patients' minds, bodies, and souls. Finally, this study demonstrates the incredible resiliency of people diagnosed with autoimmune conditions and how they find healing and meaning post-diagnosis.

The opioid epidemic is an issue that has ravaged much of the United States, and specifically Appalachia. Many different academic disciplines have attempted to provide a solution to no avail. This ethnographic study investigates the social nature of addiction & recovery related to problematic opiate use. Through semi-structured interviews and participant observation with clients at a drop-in mental health and addiction services center, the study explores the social conditions which facilitate problematic substance use in addition to vetted strategies to reach and maintain active recovery from opiate misuse. The conclusion focuses on how addiction and recovery are inherently social exercises that are heavily influenced by one's social network and the social contexts they live or have lived in. Using an anthropological perspective, this study shows the value that social science and an anthropological perspective in particular, can provide on such a pervasive and unsettling issue.

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.

Public health experts have developed education campaigns based on nutritional messaging to alleviate illnesses related to unhealthy 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=10) and participant observations conducted in an Integrative Medicine clinic at an urban hospital.

In opposition to theories of power which focus on the domination of one group by another, Michel Foucault coined the term "biopower" to refer to the ways in which power manifests itself in the form of daily practices and routines through which individuals engage in self-surveillance and self-discipline, and thereby subjugate themselves. Biopower is a useful concept for medical anthropology because it focuses on the body as the site of subjugation, and because it highlights how individuals are implicated in their own oppression as they participate in habitual daily practices such as the self-regulation of hygiene, health, and sexuality. Yet few medical anthropologists have taken advantage of Foucault's framework to illuminate how both the individual and society are involved in perpetuating such practices. This paper brings together Foucault's theory and three concrete examples of bodily practice in Western culture, demonstrating how behaviors associated with physical fitness, femininity, and obstetrical practices all contribute to the creation of "docile bodies". The article ends by considering why some scholars have found Foucault's conception of power to be problematic.

This dissertation documents my active involvement in anthropological research on elder well-being in Comitan, Chiapas, Mexico, and how my research was a springboard for local dialogue on the need for primary health care for the elderly, an issue with global significance. I describe my work as part of a larger process, still unfolding, that I helped initiate and continue to trace as an ethnographer engaged in participant observation. My long-term residence and applied health research in Chiapas, graduate training in medical anthropology, and institutional backing from the Comitan Center for Health Research (an NGO where I have worked since 1994) equipped me to catalyze engagement around elder health in Comitan. To do so, I drew on formative research, a multi-stage participatory process that is iterative and draws upon multiple methods and actors to identify and define a problem, then develop, monitor, and assess locally-congruent interventions. Specifically, I conducted: 1) ethnographic research on middle and lower class elders living alone and with family; 2) an elder health needs and resources survey of 300 households; 3) interviews with elders, home-based caregivers, and formal care providers; 4) an interinstitutional elder health conference and 5) a strategic planning meeting, which spawned 6) an independent working group that is currently exploring potential elder care strategies, with 7) my ongoing facilitation. In detailing elders' lives, problems, and care, I at once address the specific issue of elder well-being in Chiapas as seen by elders, caregivers, and providers, and describe the social relations of community action to provide basic elder care. I take stock of historical factors that have altered family relations and elder care dynamics in Chiapas, including structural adjustment, epidemiological and demographic transitions, globalization, and migration, as well as resultant local and regional socio-political struggles. I give special consideration to the household production of health, gendered differences in elder health and care resources, and the social relations of health care-seeking and therapy management. My findings challenge popular misconceptions regarding elder entitlement and access to economic, cultural, and social capital, and indicate potential solutions. This dissertation, then, illuminates how anthropological research can facilitate community-based problem solving.