Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 321-333). Also available on the Internet.

This thesis examines from a medical anthropological viewpoint how the practice of the newly imported complementary and alternative medicine (CAM) has been transplanted, received and transformed in Japan. More specifically, I focus on homeopathy, which was introduced into Japan in the late 1990s. To address the research question, I focus on the practice of homeopathy from the anthropological viewpoint. The adoption of any new form of medicine is influenced by the prevailing medical, social and cultural context. So, how and why was homeopathy introduced into Japan the late 1990s? I explore this question by focusing on three aspects of the reception of homeopathy in Japan: (1) the institutionalisation of the homeopathy, including the formation of associations of practitioners and homeopathic colleges; (2) the translation of the theory and practice of homeopathy by the practitioners into a culturally acceptable form; (3) the utilisation and consumption of homeopathy by the patients, their families and self-prescribers. Over eighteen months of fieldwork in Japan led me to focus on these three elements of homeopathic practice. Regarding the theoretical framework, this mainly explores medical pluralism and the health care system in Japan from an anthropological perspective, and the globalisation and transmission of medicine. I argue that the success of homeopathy in Japan was largely thanks to the transmission strategies set by the founders of the colleges for lay homeopaths. Mothers in particular, concerned by worries over family health care, were drawn by this approach. Furthermore I also argue that this group not only be' self-help groups, creating thereby a strong tie with the lay homeopaths. I argue that mothers gained a sense of the empowerment through homeopathy. Within the Japanese health care system it was the popular sector that received and developed homeopathy.

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.

The objective of this thesis is to critically examine the diagnostic divisions of eating disorders as proposed within the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). I focus on Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Other Specified Feeding or Eating Disorder (OSFED), although there were several new categories issued in 2013. Using person-centered ethnographic interviews, focus groups, participant observation, and autoethnography, I collected qualitative data to highlight how disordered eaters perceive themselves and their behaviors in relation to their diagnoses. I recruited participants in Boston, MA from Eating Disorders Anonymous (EDA), a decentralized network of support groups for disordered eaters. Subjects in my study, as well as from EDA at large, have a wide variety of diagnoses. Building off anthropologies of the pathological body, embodiment, medicalization and neuroanthropology, I highlight how predominant scripts of mental illness in both popular media and science shape the ways that disordered eaters understand their pathological behaviors. I also examine the historical and contemporary evolution of eating disorder theory within the psychological literature, offering a reflexive approach to the theoretical foundations within the field. Interweaving psychological literature reviews with ethnographic data, I demonstrate that disordered eaters do not fit as straightforwardly into diagnostic categories as presumed. Instead, findings indicate that individuals express different combinations of symptoms that range across diagnostic divisions.

Access to healthcare is an important topic within medical anthropology, in part because access is denied or complicated through structural forces for many populations in the United States. Anthropological research explores the impact of lack of access to healthcare on the lives of at-risk populations, as well as the differing and unexpected ways that access is denied or limited (Adler and Newman 2002; Becker 2004; Becker 2007; Horton 2004; Horton, McCloskey, Todd, and Henricksen 2001; O'Daniel 2008). For low-income, rural and minority populations, research shows that access to healthcare is further complicated by a higher propensity to break appointments (Bean and Talaga 1992; Bean and Talaga 1995). The act of appointment breaking is an essential aspect of this discussion: it is through appointment breaking and other similar activities that it is possible to understand how people access care when it is “available” to them and what everyday barriers prevent them from having true and full access. In this project, I define appointment breaking as the act of missing a scheduled appointment without prior cancellation. Through this research, I explore how people understand their access to healthcare resources and what factors impact their use by focusing on appointment breaking at a Florida community health center. This research uses a critical medical anthropology approach and is grounded within the anthropological theories of access to healthcare, health disparities, structural violence, and the political economy of health; through this theoretical perspective, the issue of appointment breaking can be studied as a complex and integral aspect of access to healthcare, and rooted in the long history of medical anthropology studies on health disparities. Using qualitative research methods, specifically interviews and participant observation, as well as an analysis of the demographics of those patients that have missed appointments at this community health center, this study investigates the broader implications of a lack of access to care characterized by appointment breaking. This research connects the act of appointment breaking to cultural influences which shape access to healthcare. I found that barriers such as finances, mental health needs, personal issues, and lack of child care prevents patients from accessing healthcare, even through the safety net programs that are in place to serve at-risk populations, such as low income, rural, and minority populations. This research contributes to the existing literature on gaps in access to healthcare that is provided for at-risk populations and develops the anthropological research on the overlooked topic of appointment breaking. By exposing the issue of appointment breaking as a factor in the larger issues of access to care and health disparities, this research highlights the larger structural forces that impact access to care beyond access to insurance and the availability of affordable and accessible healthcare resources.

This autoethnographic account explores my experiences of healing with my daughter and two sons after childhood cancer. My goal was to understand the disconnect between my experiences of persisting fear, grief and trauma and the contradictory messages we encountered during treatment that urged us to resume our ‘normal lives’ at the end of treatment. In analyzing my story, juxtaposed with other anthropologists’ narratives of their journey through cancer and beyond, I realized that my experiences were mediated by prevalent war metaphors in illness; the pervasive social and medical messages and expectations of restitution; as well as narrow biomedical un- derstandings of illness and healing. I offer up my story with the intention of bridging the divide between patients, their family, and medical professionals.

No description available.

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 hyper-diverse 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.

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.

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.