Sociology 168: Sociology of Biomedicine and Global Health

Mary-Jo DelVecchio Good (Harvard Medical School) Tuesdays, 1:00-3:00, WJH

450
maryjo_good@hms.harvard.edu Spring
2016
Office hours: Tuesdays, 3:00-4:00 and by appointment, WJH 402 Exam Group: 1
TA: Mira Vale, mira_vale@hms.harvard.edu Harvard College/GSAS:
156053

This seminar on the sociology of biomedicine and global health examines the culture of
medicine in comparative perspective in diverse environments of risk and trust, in the US
and globally, and explores the transformative influence of the medical imagination on
contemporary worlds of biomedicine, medical humanitarianism, and mental health.

The seminar is designed for students who wish to explore in depth the culture and political
economy of biomedicine and health care institutions from a comparative perspective, drawing on
recently published empirical studies and case materials from around the globe as well as from the
United States. The seminar addresses questions generated by current movements in global health,
with a particular focus on studies of medical humanitarianism and recent policy endeavors in
global mental health. In addition, the seminar will explore how policy debates and debates about
how culture counts affect our understanding of inequalities and disparities in health care, and
how mental health care in North America has influenced health policies internationally. Topics
are framed in a comparative international perspective to explore the culture of medicine in
diverse environments of risk and trust.

The seminar will also explore the subjective experiences of clinicians and their patients through
clinical narratives, the biotechnical embrace, the medical imaginary, and the political economy
of hope. We will also explore subjective experiences of clinicians in the context of medicine's
responses to individuals harmed through natural disasters and civil strife, war and conflict; as
well as medicine's responses to everyday activities of "just doctoring" in caring for the gravely
ill, the chronically ill, the acutely ill, and those afflicted with ever evolving disease plagues.
Analyses of readings, films, and new data will illustrate a variety of ways cultures of
biomedicine and psychiatry are locally and globally produced, legitimized, and authorized; how
health policies are influenced and implemented; and how a range of "just doctoring" (or not-so-
just) for patients and populations around the globe comes under an ongoing scrutiny from the
public and from professional global bodies (such as the WHO).

The course will be divided into six broad sections, which intersect:

 Seeing the World via the Culture of Medicine and the Global Medical/ Psychiatry
Commons: concepts, theoretical frames, classic studies, new studies, new models
  The Humanitarian Impulse and Medicine as Mission
 Controversies in Psychiatry and Global Mental Health in Comparative
Perspectives
 Transformations: The Biotechnical Embrace, the Medical Imaginary, The Clinical
Narrative, the Aesthetics of Statistics and the Political Economy of Hope
 "Shattering Culture" and Crisis in the Clinic
 Just Doctoring and Compassion

Additional details on readings and schedule will be placed on the website, including listings of
books we can order for purchase. Books will be divided into reference books, optional books,
and books we will read together as a class. Most readings will be articles or new PDF essays and
will be available through the website links. Full length films will be shown at a time chosen by
the class. Short film clips will be shown in class when relevant. The whole syllabus is subject to
modification per student interest.

I. Requirements
Students are expected to attend and participate in seminar and to keep up with assigned reading.
Students will give short presentations on their own research projects; these presentations will be
scheduled throughout the semester. Students may use their own field and/or research experiences
for these projects or may use literature, create multimedia projects, or carry out secondary
analyses on data sets. We will discuss options in seminar. Students are expected to meet with
Professor Good early in the semester to discuss project proposals for the course. Requirements
are broken down as follows:
 Weekly attendance at seminar, brief presentations on readings and research, and 5 précis
on readings (1-2 pages) (50%).
 Due March 11. Comparative analysis of two books on medical humanitarianism (8-10
pages; 1500-2000 words) (25%).
 Due April 5. Abstract and outline for final seminar paper based on empirical research,
literature review or multimedia project (you may do a group multimedia project or group
research project) (5%).
 Due May 4. Final paper/project (20% final paper, 5% abstract, detailed above). Seminar
papers and projects must be grounded in scientific literature and empirical data, and may
include your own ethnographic fieldwork, new analysis of existing data sets, or creative
uses of media to present relevant health data or scenarios. For example, you may wish to
use film or video images created by clinicians or ill persons as part of your "paper." Or
you may want to create graphic depictions or photographic stories of clinical work, or
work with GIS models, etc. Students may also work on older media and bring this
material into contemporary use (i.e. interviews between clinicians and patients) In
addition, interdisciplinary projects may be appropriate (working with bioscientists and
mixing the social and biological and psychological sciences).
Variations: If you are working on a thesis or project and wish to expand it, discuss with Professor
Good for acceptable options. The seminar paper or project may be used as prelude to or
preparation for your undergraduate thesis.
II. Books We Will Read in Full Buy a copy or request from BorrowDirect in
advance

Adia Benton. HIV Exceptionalism: Development through Disease in Sierra Leone. University of
Minnesota Press, 2015.

Janis H. Jenkins, ed. Pharmaceutical Self: The Global Shaping of Experience in an Age of
Psychopharmacology. SAR Press, 2011.

Lesley A. Sharp. The Transplant Imaginary: Mechanical Hearts, Animal Parts, and Moral
Thinking in Highly Experimental Science. University of California Press, 2013.

Students will read one of the following:

Didier Fassin. Humanitarian Reason: A Moral History of the Present. University of
California Press, 2011.
Renée Fox. Doctors Without Borders: Humanitarian Quests, Impossible Dreams of
Médecins Sans Frontières. Johns Hopkins UP, 2014.
Peter Redfield. Life in Crisis: The Ethical Journey of Doctors Without Borders.
University of California Press, 2013.

Students will read one of the following:

Angela Garcia. The Pastoral Clinic. Addiction and Dispossession along the Rio Grande.
University of California Press, 2010.
Neely Myers. Recovery’s Edge. Moral Agency and Mental Health Care in the US.
Vanderbilt University Press, 2015.
Lisa Stevenson. Life Beside Itself: Imagining Care in the Canadian Arctic. University of
California Press, 2014.

III. Books We Will Read in Part Photocopied selections available on the course
website

Sharon Abramowitz and Catherine Panter-Brick, eds. Medical Humanitarianism: Ethnographies

of Practice. University of Pennsylvania Press, 2015.

Joao Biehl and Adriana Petryna, eds. When People Come First: Critical Studies in Global
Health. Princeton University Press, 2013.

Didier Fassin and Mariella Pandolfi, eds. Contemporary States of Emergency: The Politics of
Military and Humanitarian Interventions.. Zone Books, 2010.
Mary-Jo DelVecchio Good. American Medicine: The Quest for Competence. University of
California Press, 1998.

Mary-Jo DelVecchio Good, et al., editors and authors. Shattering Culture: American Medicine
Responds to Cultural Diversity. Russell Sage Foundation, 2011.

Devon Hinton and Byron J. Good, eds. Culture and PTSD: Trauma in Global and Historical
Perspective. University of Pennsylvania Press, 2015.

Devon Hinton and Alexander Hinton, eds. Genocide and Mass Violence: Memory, Symptom,
and Recovery. Cambridge University Press, 2015.

Janis H. Jenkins. Extraordinary Conditions: Culture and Experience in Mental Health.

University of California Press, 2015. 

Elizabeth Pisani. The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS. W.W.
Norton & Company, 2009.

IV. Schedule of Readings

Week 1, January 26: Seeing the World via the Culture of Medicine and Global Health
Read the following carefully:
1. Mary-Jo DelVecchio Good, Cara James, Byron Good, and Anne Becker, “The Culture of
Medicine and Racial, Ethnic, and Class Disparities in Healthcare,” Ch. 17 in Unequal
Treatment: Confronting Racial and Ethnic Disparities in Health Care, National
Academies Press, 2003.
2. Mary-Jo DelVecchio Good. American Medicine: The Quest for Competence. Ch. 6 and 7.
University of California Press, 1998.
3. Byron Good. Medicine, Rationality, and Experience. Ch 3. Cambridge University Press,
1994.
4. Theodore Brown, Marcos Cueto, and Elizabeth Fee. “The World Health Organization and
the Transition From "International" to "Global" Public Health.” American Journal of
Public Health, 2006, 96(1): 62-72.

Skim the following:

1. Jim Yong Kim and Paul Farmer. “Global Issues in Medicine,” Ch. 2 in Harrison's
Principles of Internal Medicine, McGraw Hill, 2011.
2. Dean T Jamison, Lawrence H Summers, et al. “Global health 2035: a world converging
within a generation.” The Lancet, 2013, 382: 1898–1955.
3. Mary-Jo DelVecchio Good. “Cultural Studies of Biomedicine: An Agenda for
Research.” Social Science & Medicine, 1995, 41(4): 461-473. 
Optional:
1. Robert M. Wachter. “How Measurement Fails Doctors and Teachers.” The New York
Times. January 16, 2016.

Week 2, February 2: Doctoring as Mission: Humanitarian Interventions

1. Peter Redfield. “Doctors, Borders, and Life in Crisis.” Cultural Anthropology, 2005,
20(3): 328-361.
2. Renée Fox. “Medical Humanitarianism and Human Rights: Reflections on Doctors
Without Borders and Doctors of the World.” Social Science & Medicine, 1995, 41(12):
1607-1616.
3. Didier Fassin. “Humanitarianism as a Politics of Life.” Public Culture, 2007, 19(3): 499-
520.
4. And read one of the following:
a. Renée Fox. Doctors Without Borders: Humanitarian Quests, Impossible Dreams
of Médecins Sans Frontières. Johns Hopkins UP, 2014.
b. Peter Redfield. Life in Crisis: The Ethical Journey of Doctors Without Borders.
University of California Press, 2013.
c. Didier Fassin. Humanitarian Reason: A Moral History of the Present. University
of California Press, 2011.

Week 3, February 9: States of Emergency and Complex Engagements

1. Selections from Contemporary States of Emergency: The Politics of Military and
Humanitarian Interventions. Didier Fassin and Mariella Pandolfi, eds. Zone Books, 2010.
a. Didier Fassin and Mariella Pandolfi. “Introduction: Military and Humanitarian
Government in the Age of Intervention.”
b. Mary-Jo DelVecchio Good, Byron Good, Jesse Grayman. “Complex
Engagements: Responding to Violence in Postconflict Aceh.”
c. Didier Fassin. “Heart of Humaneness: The Moral Economy of Humanitarian
Intervention.”
d. George Marcus. “Experts, Reporters, Witnesses: The Making of Anthropologists
in States of Emergency.”

2. Byron J. Good, Mary-Jo DelVecchio Good, Sharon Abramowitz, Catherine Panter-Brick

et al. “Medical Humanitarianism: Research insights in a changing field of practice.”
Social Science and Medicine, 120 (2014) 311-316.
3. Jesse Hession Grayman. “Rapid Response: Email, immediacy, and medical
humanitarianism in Aceh Indonesia.” Social Science and Medicine 120, (2014), 334-343.

Week 4, February 16: Global Health & Global Mental Health

1. Byron Good, Mary-Jo DelVecchio Good, and Jesse Grayman. “Is PTSD a ‘Good
Enough’ Concept for Post-Conflict Mental Health Work? Reflections on Work in Aceh,
 Indonesia.” In Devon Hinton and Byron Good, eds. Culture and PTSD: Trauma in
Global and Historical Perspective. University of Pennsylvania Press, 2015.
2. Selections from Genocide and Mass Violence: Memory, Symptom, and Recovery. Devon
Hinton and Alexander Hinton, eds. Cambridge University Press, 2015.
a. Introduction Devon Hinton and Alexander Hinton. “An Anthropology of the
Effects of Genocide and Mass Violence: Memory, Symptom, and Recovery.”
b. Ch. 12 Mary-Jo DelVecchio Good. “Acehnese Women’s Narratives of Traumatic
Experience, Resilience, and Recovery.”
c. Ch. 13 Christopher Taylor. “Rwanda’s Gacaca Trials: Toward a New Nationalism
or Business as Usual?”
d. Ch. 14 Kimberly Theidon. “Past Imperfect: Talking about Justice with Former
Combatants in Colombia.”
3. Erica James. “The Political Economy of ‘Trauma’ in Haiti in the Democratic Era of
Insecurity.” Culture, Medicine & Psychiatry 2004. 28(2): 127-149.

Week 5, February 23: Global Mental Health Part I

1. Selections from Pharmaceutical Self: The Global Shaping of Experience in an Age of
Psychopharmacology. Janis Jenkins, ed. SAR Press, 2011.
a. Introduction, Janis Jenkins.
b. Ch. 2 Janis Jenkins. “Psychopharmaceutical Self and Imaginary in the Social
Field of Psychiatric Treatment.”
c. Ch. 3 Mary-Jo DelVecchio Good. “Trauma in Postconflict Aceh and
Psychopharmaceuticals as a Medium of Exchange.”
d. Ch. 5 Stefan Ecks, “Polyspherical Pharmaceuticals: Global Psychiatry,
Capitalism, and Space.”
e. Ch. 6 Byron Good, “The Complexities of Psychopharmaceutical Hegemonies.”

Week 6, March 1: Global Health Part II: Comparative Perspectives and Sociological
Understandings of What Drives Global Health Movements
1. Selected chapters from When People Come First: Critical Studies in Global Health, eds.
Joao Biehl and Adriana Petryna. Princeton UP, 2013.
2. Mary-Jo DelVecchio Good. “Clinical Realities and Moral Dilemmas in Bioethics and
Beyond.” Daedalus 128 (4): 167-196. 1999.
3. Giuseppe Raviola and Mary-Jo DelVecchio Good. “HIV, Disease Plague,
Demoralization, and Burnout.” Culture, Medicine and Psychiatry 26: 55.

Week 7, March 8: The Politics of Numbers and Narratives in Global Health Policies and
Programs
Guest Speaker Adia Benton, Assistant Professor of Anthropology, Northwestern University
1. Adia Benton. HIV Exceptionalism: Development through Disease in Sierra Leone.
University of Minnesota Press, 2015.
 2. Adia Benton. “But what’s the prevalence?” Innumerable subjects and the social
production of thinness in gender-based violence survey research. Draft, not for
circulation, citation copyright to Adia Benton.
3. Adia Benton. “Exceptional suffering? Numbers and Narrative as modifiers of the HIV+
experience in Sierra Leone.” Medical Anthropology 2012. 31(4): 310-28.
4. Selections from Elizabeth Pisani. The Wisdom of Whores: Bureaucrats, Brothels and the
Business of AIDS. W.W. Norton & Company, 2009.

Due March 11: Comparative analysis of two monographs or two sets of readings

March 12-20: Spring Break

Week 8, March 22: Mental Illness and Psychosis in the US: New Research
1. Read one of the following:
a. Angela Garcia. The Pastoral Clinic: Addiction and Dispossession along the Rio
Grande. University of California Press, 2010.
b. Neely Myers. Recovery’s Edge: Moral Agency and Mental Health Care in the
US. Vanderbilt University Press, 2015.
c. Lisa Stevenson. Life Beside Itself: Imagining Care in the Canadian Arctic.
University of California Press, 2014.
2. Janis Jenkins. Extraordinary Conditions: Mental Illness as Experience. University of
California Press. 2015. (Chapter to be circulated.)
3. Kimberly Sue. Wicked Bad Habits. Governing Women on Heroin in the Carceral-
Therapeutic State. (under review at U California Press, prepublication chapter to be
circulated).

Week 9, March 29: American Psychiatry and Culture, Race and Ethnicity: Patient and Clinician
Perspectives
1. Selections from Mary-Jo DelVecchio Good, et al. editors and authors. Shattering
Culture: American Medicine Responds to Cultural Diversity. Russell Sage Foundation,
2011.
a. Ch. 1, Mary-Jo DelVecchio Good et al. “Shattering Culture: An Introduction.”
b. Ch. 10, Antonio Bullon et al. “The Paper Life of Minority and Low-Income
Patient Care.”
2. Mary-Jo DelVecchio Good and Seth Donal Hannah. “‘Shattering culture’: perspectives
on cultural competence and evidence-based practice in mental health services.”
Transcultural Psychiatry 2015 52(2): 198–221.
3. Selections from Janis Jenkins ed. Pharmaceutical Self: The Global Shaping of
Experience in an Age of Psychopharmacology. SAR Press, 2011.
a. Review Ch. 2, Janis Jenkins. “Psychopharmaceutical Self and Imaginary in the
Social Field of Psychiatric Treatment.”
 b. Ch. 7, Jonathan Metzl. “Gender Stereotypes in the Diagnosis of Depression: A
Systematic Content Analysis of Medical Records.”
c. Ch. 8, Tanya Luhrmann. “Medication on the Street: Homeless Women in Uptown
Chicago.”
d. Ch. 9, Emily Martin. “Sleepless in America.”
e. Ch. 10, A. Jamie Saris. “The Addicted Self and the Pharmaceutical Self:
Ecologies of Will, Information, and Power in Junkies, Addicts, and Patients.”
4. Special Issue of Culture, Medicine and Psychiatry, 2013. Guest Eds. Elizabeth
Carpenter-Song and Sarah Willen. (See all essays and select).

Due April 5: Abstract and outline for final seminar paper

Week 10, April 5: The Biotechnical Embrace, the Medical Imaginary, Clinical Narratives and
the Political Economy of Hope
Guest Speaker Lesley Sharp, Ann Whitney Olin Professor of Anthropology, Barnard College
1. Lesley Sharp. The Transplant Imaginary: Mechanical Hearts, Animal Parts, and Moral
Thinking in Highly Experimental Science. University of California Press, 2013. Selected
chapters.
2. Mary-Jo DelVecchio Good. “Clinical Narratives in Oncology.” Ch. 8 in American
Medicine: The Quest for Competence. University of California Press, 1998.
3. Selections from A Reader in Medical Anthropology: Theoretical Trajectories, Emergent
Realities. 3rd edition. Wiley-Blackwell, 2010.
a. Ch. 21, Mary-Jo DelVecchio Good. “The Medical Imaginary and the Biotechnical
Embrace: Subjective Experiences of Clinical Scientists and Patients.”
b. Ch. 22, Lawrence Cohen. “Where It Hurts: Indian Material for an Ethics of Organ
Transplantation.”
c. Ch. 23, Aslihan Sanal. “‘Robin Hood’ of Techno-Turkey or Organ Trafficking in
the State of Ethical Beings.”
d. Ch. 24, Marcia C. Inhorn. “Quest for Conception: Gender, Infertility, and
Egyptian Medical Traditions.”

Week 11, April 12: The Culture of Clinical Medicine in the Contemporary Era: Global Health,
Local Medicine
1. Select articles from Holmes SM, Jenks A, and Stonington S, eds. “Theme Issue:
Anthropologies of Contemporary Clinical Training.” Culture, Medicine and Psychiatry.
2011; 35(2).

Week 12, April 19: The Medical Imaginary in Global Health and Biomedicine: Concluding
Considerations and Just Doctoring
1. Mary-Jo DelVecchio Good et al. “Narrative Nuances on Good and Bad Death: Internists’
Tales from High-Technology Work Places.” Social Science and Medicine, 2004 58(5):
939-953.
 2. Mary-Jo DelVecchio Good and Amalia Muhaimin. “Communication Barriers among
Physicians in Care at the End of Life: Experience from a Postgraduate Residency
Training in Java, Indonesia.” Asian Bioethics Review 2012, 4(2): 102–114.
3. Patricia Ruopp, Mary-Jo DelVecchio Good, et al. “Questioning Care at the End of Life.”
Journal of Palliative Medicine 2005, 8(3): 510-20.
4. Atul Gawande. “When Doctors Make Mistakes.” The New Yorker, February 1, 1999.
5. Atul Gawande. “Slow Ideas.” The New Yorker, July 29, 2013.

Week 13, April 26: Compassion and Charisma in Global Medicine: Just Doctoring and the
Medical Imaginary
1. Atul Gawande. Being Mortal: Medicine and What Matters in the End. Metropolitan
Books, 2014.

2. Select chapters from Troyen Brennan. Just Doctoring: Medical Ethics in the Liberal
State. University of California Press, 1991.

Due May 4: Final paper/project