The notion that nature and nurture interact to produce the phenotype of an individual is a very old one. Modern techniques of molecular biology and the mapping of the human genome have led to multiple studies approaching gene-environment interaction as more than a metaphor. A part of that revolution was led by Caspi and associates in their studies of depression. They examined a gene linked to the serotonin transporter mechanism, which influences how long the neurotransmitter serotonin remains in the synapse between nerve cells. Many anti-depressant medications inhibit the re-uptake of serotonin by the transmitting cell. In some way, this helps to alleviate depressive symptoms. Caspi and associates found that risk of depression was enhanced under the condition of individuals possessing a specific polymorphism or gene variant for the serotonin transporter gene and having experienced recent stressful life events. For individuals with other variants, risk of depression associated with the experience of stressful life events was reduced.
This was indeed revolutionary work, inspiring an explosion of papers examining gene-environment interaction (or “GxE” as it is abbreviated). It also generated its own controversy and lively debates. One of these involves whether or not GxE effects have been detected at all, based on two issues. First, replication of results in GxE research is highly variable. Second, the “candidate gene” approach, where one gene (or sometimes a multiple polymorphism index) is examined, has been severely criticized by researchers in favor of an approach involving genome-wide scans, a method in which, for example, respondents are divided into groups who are depressed and not depressed, and then the entire genome for each individual in each group is scanned to see if there is some collection of genes that differ between them. The argument for this approach is that any complex phenotype, like depression, is likely to be the result of multiple—literally dozens—of interacting genes. It is then argued that candidate gene researchers are finding spurious results because they are capitalizing on a chance outcome, given the hundreds of possible combinations of genes that could be detected.
While the candidate gene versus genome-wide scan arguments are interesting, what seems more relevant to me is the question forming the title of this essay: what is the “environment” in gene-environment interaction research? As I noted, there has been an explosion of papers in GxE research, and with only a few exceptions, the ”environment” examined has consisted solely of the occurrence of stressful life events. These have been assessed both during childhood (referred to as “childhood adversity”) and as standard concurrent stressful events (e.g., unemployment, death of a close family member); but typically, that’s the “environment.”
There are very few anthropologists involved in GxE research, at least in the study of mental health outcomes. It would, nevertheless, seem an area of research ripe for our attention, because if anthropologists know about anything, it is context. And if the environment in GxE research refers to anything, it must refer to context. We know that the cultural context within which individuals function can be configured in a myriad of ways. Therefore, it is entirely plausible that the variable replication of results in GxE research is a result of the ways in which the environment changes from one study to the next, in subtle and nuanced ways.
Why have GxE researchers stuck to an impoverished view of the human environment? I think because most of them have been more interested in the genes than in the environment (and that is, of course, an important way to proceed). Since a number of researchers have found interesting results employing a measure of experience in the social environment as easy and straightforward as stressful life events, it simplified research design to stick to that. It does, however, leave the environment in GxE work under-specified.
My colleagues and I ventured into this area some years ago when we found, in a small subsample from a larger study in Brazil, an interaction between cultural consonance in family life and a polymorphism in the 2A receptor for serotonin. Those individuals with a single variant of the gene, if they had low cultural consonance, reported exceptionally high depressive symptoms; those individuals with that same variant, if they had high cultural consonance, reported exceptionally low depressive symptoms. Persons with other gene variants exhibited the same inverse association of cultural consonance and depressive symptoms, but not as strong.
When later we tried to replicate the results on a larger and more representative sample, as is some common in this literature, we could not. We did, however, find an interaction between childhood adversity and the 2A receptor polymorphism. This in turn was mediated by cultural consonance in family life, and the interaction and mediating effects were most pronounced among lower social class respondents.
This results in a model that looks like this:
This is a far cry from a simple interaction between life events and a gene. And, given that there is a cultural mediation of a gene-environment interaction, which in turn is moderated by social class, the sociocultural context looms large in the overall biocultural process. This approach does not lend itself well to the genome-wide scan, either, since instead of comparing two groups, you would end up having a complex, multiple group comparison.
I won’t argue that more complex models of GxE, specified within a sociocultural context, is the only way to proceed. I only want to emphasize is that this is an important way to proceed, and that biocultural anthropology is uniquely situated to contribute to it.
On my graduate school journey in medical anthropology at the University of Alabama, I became curious about HIV risk while conducting fieldwork in Mobile, Alabama. There, I worked on my thesis on intergenerational body image beliefs of working class African American mothers and daughters. Mothers in my study revealed that they could tell someone had HIV by looking at them. These insights solidified my interests in determining what African American adolescent girls in Alabama knew about HIV and how social ecological factors influence both knowledge and sexual health behaviors. Alabama is an abstinence only sex education state (Minimum Contents to be Included in Sex Education Program or Curriculum, Alabama State Code Section 16-40A-2). Sexual health education is focused on abstinence until marriage, and prevention of sexually transmitted infections, including HIV/AIDS, and teen pregnancy.
The Youth Risk Behavior Surveillance reports that while risky sexual activity is decreasing among adolescents, condom use among African American high school teens during last sexual intercourse declined from 70 percent in 1999 to 65 percent in 2011. Alabama is ranked lowest in rates of condom use among high school students (Eaton et al. 2012). African Americans represent 26 percent of the state’s population, but 64 percent of reported HIV infections are from this group. Adolescents in Alabama aged 13-24 comprise 5 percent of existing HIV infections, and 32 percent of new cases reported in 2014 (Alabama Department of Public Health, 2015).
When I embarked on my journey toward this project, I was driven by anthropological theory as a way to address a public health concern. Although I did not consider a strengths-based approach to lead my inquiry regarding sexual health, I understood and respected the importance of addressing community needs as a participant observer and researcher. I recognize that dismissing assets used to address sexual health concerns is problematic. However, given the taboo nature of what I wanted to explore, I believe acknowledging these assets pose additional challenges and would not have changed the peaks and valleys experienced in my community engagement and research. Following is a brief, partial list of lessons learned through my experiences working with an anonymous African American community in Alabama. It is my hope that the suggestions put forth will prove valuable to those committed to community engagement and scholarship.
Find community members supportive about what you want to learn.
Two years prior to beginning my research, I met with many community members. Among them was a school board member who worked for many years as a nurse. She developed and implemented a health initiative program where I happened to volunteer one summer prior to meeting her. Because of this established rapport through familiarity of her program, she provided me with beneficial information about health issues, community life and how to effectively engage with other members. She recommended members and organizations, as she ended many of our conversations saying, “Tell them I sent you.” This type of advocacy was essential to discovering where my skills could be used in the community while simultaneously researching sexual health issues among teen girls.
Understand that what scholars, governmental institutions, and non-profit organizations view as important, community members may not judge similarly.
When establishing rapport in the early stages of my research, a professor suggested I meet a pastor amenable to research. This pastor was extremely welcoming, although, early on in our conversation, he stated that his church members do not really talk about HIV or believe it is a major problem in the community. In addition, I attended a high school parent meeting provided by a local health organization discussing sexual health and sexually transmitted infections. Notably, only two school administrators and myself attended this meeting, even though parents were given advanced notice of the seminar.
I discovered early on that difficulty in trying to research a stigmatizing topic is the strong desire for community members to separate themselves from the issue through attempting to achieve mainstream social norms, values, and conduct. This also creates difficulty in using a strengths-based approach, since assets may not be used for the purpose of addressing a proscribed issue that community members approach in denial.
Find a place where you fit in and build community relationships.
After explaining my project to numerous community members, I had a difficult time having people take me seriously, return my calls, or acknowledge me in public. Initially, I spoke with middle class community members to gain entrée into the community, establish where I could assist with community needs, and determine the best way to learn what young teenage girls knew about HIV risk. For example, I approached another pastor who was willing to assist, but was ultimately too busy to accommodate me in his church. This early acceptance and eventual rejection happened frequently. While this pastor was too occupied to assist me, he introduced me to the director of a neighborhood center centrally located in a working class community, and this introduction proved to be extremely valuable.
The neighborhood center resulted in collaboration with the director where I fulfilled both community engagement and research roles. The center provides residents with numerous services including computer classes, GED classes, a Chess Club, and after-school and summer programs for youth. Upon my introduction to the community, the director asked if I would be interested in teaching GED. classes. I jumped at the chance to serve this community that was welcoming to my presence and could utilize my academic skills. I taught math GED classes weekly for a fall and spring semester to men and women in the community.
The women I taught were extremely helpful to my understanding of community dynamics. Understanding community interactions was useful given that I took a social ecological perspective to HIV risk in my research. Women shared that conflict centered on arguing over men who were unfaithful in not only the local community where the center was centrally located, but also in an adjacent governmental housing area. Remarkably, one of the women revealed that higher sexual risk was associated with a woman’s male partner having a concurrent relationship with someone outside of the immediate neighborhood. If their boyfriend had a sexual relationship with a woman in the governmental housing neighborhood or beyond the immediate community, it was believed that sexual health risk increased greatly because the sexual partners that their boyfriend was concurrently dating was unfamiliar. Given that the women were aware of gossip regarding illnesses that other women in the local community held, it was viewed as a higher risk situation when information about the health of potential sex partners outside of the community was not readily available, whether this information is true or not.
After spending some time in the community, I interviewed younger girls in the neighborhood who shared various characteristics and behaviors associated with HIV risk which highlighted socio-ecological factors important to this topic. High risk was associated with lack of parental investment, hanging out in the neighborhood, running away from home, and transactional sex. In contrast, low risk was associated with parental investment, staying at home, interest in academic pursuits and future goals, and involvement in church.
Do not take it personally when you run into a person or people who are unsupportive. Avoid flattery and move on to someone willing to assist.
A school administrator that worked closely with the students shared some of the experiences of the girls that attended the community high school where I observed. At the outset, she was forthcoming about issues faced by female students including domestic violence, sexual abuse, teenage pregnancy and abortions. Through this first conversation, this administrator mentioned that she mentored and advised two in-school programs for girls that experienced these concerns. I looked forward to observing these programs, hoping to get a sense of how these students understood sexual health through their lived experiences. Afterwards, the administrator noted that she would have to ask permission to allow me to gain access to these programs and observe students.
After a great deal of effort to contact her in the days and weeks following our conversation, I emailed her to see if I would be more successful in contacting her in that manner. This approach worked, with a brief email returned almost immediately. Unfortunately, the administrator noted that aside from the Principal of the school, she also answered to another supervisor at the department of education. Her supervisor advised that she was not under any responsibility to assist me in understanding issues related to sexual health, and wished me the best in my endeavors.
I was not surprised by the eventual demise of our communication, although the situation was extremely discouraging. After the dust settled, I asked some colleagues in anthropology and the school board member (see lesson #1 above) for advice on the situation. My colleagues thought I should try to establish rapport with her by finding out what she liked and buying it for her. This was not bad advice from anthropologists since we are trained that participant observation “involves getting close to people and making them feel comfortable enough with your presence so that you can observe and record information about their lives. […] Only by confronting the truth about participant observation—that it involves deception and impression management—can we hope to conduct ourselves ethically in fieldwork“ (Bernard 2006:342). With this training, it makes sense that fellow anthropologists would advise me to build rapport using this method.
In contrast, when I met with the school board member over lunch one afternoon, she stated that there would always be someone who does not approve of the work being done in the community, and that people would stand in the way. She advised that I should simply go around the school administrator and find someone able to help with what I need—a suggestion that really spoke to who I am personally. I could not imagine having a disingenuous relationship with this woman who is extremely busy with her own responsibilities. Eventually, I became grateful for the little time where we sat together and she shared valuable information about the girls that she serves through her employment at the school. Fortunately, I did bypass this school administrator and found allies with amazing teachers and other administrators who supported my observation in the school.
To conclude, this journey to understand sexual health concerns and risks among African-American teenagers taught me a great deal. I learned the value of community engagement on a level of incorporating my skills to meet the needs of those who valued my presence, even though they may have thought I was strange for asking about community dynamics or why some girls were viewed as high or low risk of HIV. One of the most valuable things I learned is that if there is sincerity in your desire to assist in what the community deems important, community members will value that goodwill and add to your scholarship by revealing more about their lives than initially hoped.
Tina Thomas (PhD, University at Alabama, 2016) is a Postdoctoral Fellow in Anthropology at Juniata College. She studies the intersection of culture, social ecology, and health in the U.S.
At the 115th Annual Meeting of the American Anthropological Association this year in Minneapolis, MN, I was recruiting a graduate student whose former adviser was denied a promotion and who then told the student she should leave academia because she would never get hired or tenure at an R1 institution. There are several layers of things wrong with this scenario, but my pitch in gaining her interest in our program (as she has no intention of leaving academia) was that I absolutely refuse to send students into the field alone unless they essentially demand it, have already set up the field site, and have a proven track record of mature and independent work. There are several reasons for this. One, fieldworkers learn more from each other as part of a team. Two, there is emotional support when working with trained collaborators. Three, fieldwork teams conduct better science and collect more thorough data. Four, in theory, team fieldwork should be safer, provided the team makes safety a conscious priority and is ethically vetted. And, five, team fieldwork is a joyous, fun experience.
As we were preparing the AAP article and I was teaching with Bourgois and Schonberg’s book in my Anthropology of Drug Use course, I was invited by my friend and fellow biocultural anthropologist Michaela Howells (UNCW) to tag along as her research assistant for a trip to American Samoa to assess the influence of the Zika outbreak there on prenatal care access and utilization. Michaela and I have collaborated for the past several years on our Family and the Field Study, but we had never worked together in the field. This trip to American Samoa gave us an opportunity to test out this collaborative fieldwork model firsthand. I was recruited because, as a male with relatively high rank in the U.S. (as a tenured associate professor), I would be able to interview males in this traditional, hierarchical cultural system, where it is not appropriate for females to interview males, especially high status males, and vice versa.
American Samoa is a small group of islands in the South Pacific and the southernmost territory of the U.S. It is characterized as the most traditional of the Pacific cultures, with village-based authority dominated by mostly male chiefs (Shore 1982). It is also strongly evangelical Christian and influenced by neoliberal identity politics. Women have been the primary resources for studies of prenatal care utilization, but in the American Samoan cultural system, resources are redistributed in the villages, with preferences given to elite members or relatives of chiefs (Howells 2013). Michaela and I spent several weeks making arrangements to interview males in the village of Fagasa, even buying ritual goods to give for the planned sua, a ceremonial gift-giving ceremony when interacting with matai or chiefs. However, the arrangements ultimately fell through; we collected survey data from 172 participants in the Department of Health clinics, but we failed to conduct any firsthand interviews. This situation could have been really frustrating, given the resources Michaela used to get me to American Samoa. Instead, it was the best, most productive field season I have ever experienced, primarily because we established and developed our team.
One of the best parts of this experience was watching each other work and learning how to communicate nonverbally with a good team member. One of the things I learned from Michaela is how easy it is to give a compliment to someone and how far that can go toward forging a relationship. Like many cultures of the world, one of the most important ethnographic skills to develop in Samoa is learning to hang out and shoot the shit. When you’re meeting someone, bring food to share, sit down with them (i.e., don’t hover over them, suggesting you’re in a rush and preparing to leave), and look for something to compliment. Michaela admired a lot of puletasi (traditional Samoan two-piece formal garment, worn by Samoan women to church or other formal events) while we were there. In turn, I learned to comment on the tatau (tattoos) I was noticing. I have brought this new skill home with me—I love good facial bling, colored contacts, tattoos, hairstyles, and clothes. People go to the trouble to deck themselves out, and it turns out they enjoy it when people do them the courtesy of noticing. The necessity of making small talk before getting down to business is common cross-culturally, but it’s not a norm in the U.S. and requires learning, especially for academic types, who are not necessarily known for their skills in verbal social grooming.
To figure out how to talk with people in Samoa, I watched Michaela and quickly learned how to show deference and when and how to reinforce what she was saying. But she also pointed out things I wouldn’t have noticed, such as that I am a resonant talker and tend to dominate a room. Ordinarily, and as a teacher, this works to my benefit; but in working with Samoans, I needed to tone it down, speak quieter, and literally lower my body so my head would be below that of the person I was speaking with. This behavior shows respect in a status-conscious, traditional society. This type of context is where our non-verbal communication came into play. As a feminist male, I defer to Michaela’s ethnographic expertise in American Samoa but am conscious to explicitly give her credit where it is due because others may assume that, as a male, I am in charge and that she is my student (or something else). I pointed out, for instance, that she developed the project and field site and that I was there as her research assistant.
I learned a lot about myself as well. I have never been observed by a colleague or superior in the field, though anthropology is not my first career or where I learned to teach or interview. However, aside from being hired for teaching jobs after demonstrating my approach, reading my teaching evaluations, or listening to my interviews and reading the transcripts, this was the first time I have ever received feedback on the job I was doing while doing it. For instance, I always try to maintain eye contact and to talk with people, not at them. Michaela noted that my eye contact seems to bring my interlocutors to life, like they are being seen, and my skill at turn-taking opens them up so that they feel like they are being heard. This was extremely validating and something I had developed on purpose but without realizing its effect. Our feedback to each other, thereby, reinforces our strengths and tweaks our skills while they are in use in the field.
One of the misnomers of fieldwork is that it is always a dream come true while it is happening. In fact, most anecdotal evidence and a significant accumulation of literature supports a different model. Conducting fieldwork alone, especially as an inexperienced student, is scary and can even be traumatizing. I often tell students about the first time I went into a Pentecostal church service, when I was beginning my dissertation fieldwork. I was in New Paltz, which I affectionately term “Portlandia East” (or the liberal vortex of the east coast). Despite feeling very comfortable in this, my hometown at the time, I was so nervous about walking into the “other” that I sat in my car until the service was half over. The result was that the only seat left was right up front, and I drew more attention to myself by arriving late than if I’d gone straight in. Most of us are nervous about fieldwork and lack anyone to talk to about these experiences. My wife does clinical work, part of which includes processing emotions and “transference” with a clinical supervisor or adviser. Anthropologists only get this if they have empathetic advisers and colleagues, which is certainly not guaranteed and, in my discussions with colleagues, may be relatively rare. Even as a professional, when I began setting up a second field site in Costa Rica, a veritable tropical paradise, I often felt alone and exposed and did not particularly enjoy it. By contrast, setting up a new field site in American Samoa (mind you, one that had really been set up in advance by Michaela) was truly pleasurable. I enjoyed every moment of it specifically because we gave each other emotional support while problems were occurring. Because Michaela and I share similar training, the support we could gave was qualified and credible. For instance, when we could not get the interviews in the short time we were there, we were able to remind each other that we were learning actual realistic things about navigating culture and that our process was as or more important for the long term project as was the survey data we were collecting for the short term project. Our sympathetic support of each other meant that we rolled with the frustrations of the field and took things in stride, without reacting in potentially negative ways.
Team research is better research, whether for scientific or humanistic data collection and interpretation. We do both in Samoa. For instance, together Michaela and I constructed a better (though always imperfect nevertheless) survey in a rapid amount of time, complete with translations into Samoan and back-translations to ensure accuracy. It is always difficult to find a balance in survey questions when one is also soliciting native input, as emic and etic biases pull you in different directions. Michaela and I were able to continually confer with each other to ensure that the questions we asked addressed our research questions first and foremost, while remaining sensitive to cultural perspectives. This was particularly important and difficult when asking about condom use, the discussion of which is basically verboten in the Samoas. Furthermore, we were able to discuss the greater vision of our project. Is this 10-year plan that we envision practical? Can we do this? What are our resources? What should we include? Are we on the right track? Regardless of the expertise of one trained individual, two or more trained team members can observe more, have greater vision, and plan better. And, frankly, while we share training, Michaela and I have complementary but slightly different temperaments that enhance our abilities to connect with a variety of people. Finally, it is no coincidence that we follow in the footsteps of Margaret Mead in American Samoa. Mead realized immediately after her first field experience in Ta’o, the island we plan to return to, that fieldwork in the Pacific—and probably everywhere—is better conducted by a team of trained researchers that includes females and males (Shankman 2009).
As I said, Michaela and I planned to interview men and get their perspectives. We went so far as to buy goods for ritual gift-giving for the sua and Samoan business attire for the occasion. (Michaela had puletasi already, but I needed Hawaiian shirts, which I borrowed from David Herdrich, an ie faitaga [male sewn lavalava in neutral colors, with pockets], and a kukui nut necklace.) However, our trip coincided with the planning and celebration of the American Samoa Nurses Association Centennial, which took place over the last several days we were there and dominated everyone’s time and attention, including ours. Since there were two of us, Michaela focused on refining our social networks to develop leads for later or the next field season, as well as collecting data for a project with Nicky Hawley and Micah van der Ryn on gestational diabetes, while I collected survey data from visitors to the Department of Health Physical Exam, Prenatal Care, and Well Baby Clinics.
In that short time, we made two significant observations. The first is that public health initiatives need medical anthropologists on their teams from the design stage through implementation. This is by no means a novel finding, but it is the first observation specifically with regard to the Zika outbreak. We have written a short commentary on this that is currently in review, but journalist Jessica Carew Kraft recently published an NBC News piece about our work on Zika and the role of culture in American Samoa. Second, according to our data, there is a general consensus among Samoans that prenatal care is more urgent for married mothers than for unmarried mothers, despite believing that all pregnant women should get prenatal care and be screened for Zika. Such attitudes place an additional burden on lower status women and their babies, reinforce social inequities, and play a role in the “biosocial inheritance” of health disparities trans-generationally (see Schell 1992 and 1997 for how risk is focused across multiple generations like this and Hoke and McDade 2014 for a thorough integration of risk-focusing and related models under the theoretical paradigm of “biosocial inheritance”).
Conducting fieldwork with partners with the same professional status does not guarantee safety, but I would like to think it reduces the chances of sexual harassment. There are few ways to guarantee that sexual harassment and assault won’t happen, but there are ways to minimize their potential and it is important to be explicit in addressing them with students. Safety in the field is discussed in most graduate programs but generally with respect to human subject protections and the stability of the site. Less discussed until recent publications by the SAFE team (e.g., Clancy et al 2014) and others is safety with regard to sexual harassment by peers, supervisors, and advisers in the field. While I hoped we were entering a new era of increasing scrutiny within our disciplines of microaggressions that lead to sexual harassment, the U.S. public’s willingness to be represented by President Pussy-Grabber leads me to believe that people really do think there is a problem with so-called “political correctness.” In reality, the backlash against being politically correct is a frustration by those in positions of privilege at the inconvenience of having to consider the feelings of those previously invisible to them. Such microaggressions start with professors or supervisors feeling they can put their arms around undergraduate student shoulders without permission and get worse from there. And it’s not restricted to aggressions by males toward females. When I was an undergrad on a study abroad program in Ecuador, a male professor plied me with whisky and began kissing me. The difference is that I felt brave and protected enough as a white male to tell the program administrators, and they were probably homophobic enough that they fired him immediately with absolutely no process to confirm or check my story (maybe he’d been reported before—I don’t know—but I still feel guilty about this 15 years later).
Fieldwork environments and experiences like the one Michaela and I created become, as a consequence, downright joyous and fun. Working this past summer in American Samoa with a friend and partner with the same training was more exciting than any field experience I’ve had before. Therefore, the work we did was enormously satisfying WHILE we were doing it. This was the type of experience that we tell our students about that inspires them to become anthropologists and the kind we have that validates our own career choice and keep us going. My goal going forward is to purposively create such experiences for my students by being explicit and concrete about how to design research, where to conduct it, how to get support, and how it should feel while doing it. There are no theoretical or methodological reasons to send out any more lone strangers.
Christopher Lynn (PhD, University at Albany) is an Associate Professor in the Biocultural Medical program and director of the Evolutionary Studies program. He studies the cognitive science of religion, human behavioral ecology, and health in the U.S., Costa Rica, and American Samoa.
Mississippi is the U.S.’s poorest state and has the lowest rates of insurance coverage. Mississippi also has very poor health outcomes including the highest or second highest rates of cardiovascular disease, diabetes, and age-adjusted death rate due to cancer (Mississippi State Department of Health 2014). These rates are nothing new and Mississippi has a history of health disparities that stretch back to the Depression and beyond. In spite of this, the Affordable Care Act has had little impact on the nation’s poorest, sickest state. Mississippi opted out of the Medicaid expansion, which left 138,000 Mississippians, most of whom are African American, without any insurance options (Kaiser Health News 2014). Refusing the federal subsidies has increased the burden on rural hospitals, forcing some to close entire departments and lay off staff.
During the course of my thesis research on health seeking behaviors of the working poor, I defined a cultural model that primarily included the usage of safety net providers, delaying treatment, or “making a bill,” which I will discuss more in a moment. Participants were particularly open about the competing demands for resources that have to be weighed before they decide to seek health care, like whether to pay for groceries or a doctor bill. Some participants were very frank about having to go without in order to go a doctor. One participant talked about sacrificing food so they could go see a dentist, in her words, “One thing has to take the place of the other.” When seeking health care requires making such sacrifices… it’s not really fair to characterize it as a choice, but, for lack of a better word, I will now discuss the “choice” between delaying treatment or making a bill, something that the working poor frequently brought up during interviews.
Delaying treatment or “Making a Bill”
With few good options for affordable health care the working poor openly discussed delaying treatment so they could avoid “making a bill.” By making a bill, what participants were literally referring to was the creation of a new monthly bill. For the working poor, seeking health care outside of the free clinics is almost synonymous with the creation of a new long-term payment commitment. Participants discussed waiting until it was unavoidable to go to the doctor’s office or the ER/ED and “make a bill.” While they were speaking literally, this language also indexes to others their place in society and the tough decisions that the poor are faced with every day including those concerning their health and those of their family members. “Making a bill” indexes a position in society that is deemed unworthy of access to affordable health care. During the entire course of fieldwork and interviewing, not one participant said that a doctor’s visit would mean emptying their savings or bank account. A few participants mentioned borrowing money from family or friends, but “making a bill” was the more likely outcome. When asked if some people without insurance don’t seek health care when they are sick, one participant said:
Yeah, cause they can’t afford it. Sometimes before you can be seen they need money and you don’t have it cause you need it for groceries or to pay a bill. They pray to get well. They try to do a home remedy, try to get better on they own. Get on their knees and pray to God to get better.
This was not an uncommon response. When another participant was asked what he did for health care, he said:
If I ain’t got no money, if it’s an emergency, then I just have to charge up a bill and make a payment. […] I do anything to not get sick. That’s one thing about being a small business owner, no insurance. […] I primarily use the free clinic. I have medical bills right now. I try to pay them off. I’m a small business owner. I want a good credit rating.
This participant ran a small food cart and needed a good credit rating so he might expand his business in the future. He was one of a handful of participants who brought up credit ratings. The very real possibility of not being able to make consistent payments was yet another consideration for the working poor when deciding whether to seek medical care. Treating even relatively minor acute illness episodes could turn into years of monthly payments making it increasingly difficult for the working poor to make ends meet and to afford future health care costs.
This intersection of culture and biology finds the working poor making decisions based on financial needs in the moment that have repercussions for their long term health. The participants and providers I worked with indicated that outside of the free clinics, health care for the working poor came at cost they were ill able to afford out of pocket. When delaying treatment became unavoidable, they reported that “making a bill” was the only option. A circumstance which has become so normalized in this community that there is an effective shorthand for simultaneously conveying the situation they found themselves in and the outcome of seeking care.
It is important to note that the link between delaying treatment and poor health outcomes was not lost on patients or providers, but no one knew how to break the cycle within the current health care system. Medical and non-medical participants alike discussed changing the system. They were frustrated with a system that seems to be working against the working poor at every level of health care. One doctor told me that the hardest part of his job was getting people the care they need but can’t afford. Affordable health care for the poor seems to be continually out of reach.
As a psychological anthropologist interested in alternative healing options, I recently traveled to Peru to experience ayahuasca with a shaman I had been corresponding with for some time. Ayahuasca is being used to help treat war veterans and others suffering from PTSD and depression. Its use as a treatment option for addicts has also become widespread. For thrill seeking millennials ayahuasca tourism has become a trendy activity.
Ayahuasca was first described outside of indigenous communities in the early 1950s by Harvard ethnobotanist Richard Evans Schultes. When sending his advisee, Wade Davis, to the Amazon he told him not to come back without trying it. The word “ayahuasca” comes from the Quechua who have used it for thousands of years. Ayahuasca is made by combining Banisteriopsis caapi, a liana, with Psychotria viridis, a perennial shrub. P. viridis contains about 0.10-0.66% alkaloids, approximately 99% of that is dimethyltryptamine (DMT), a psychedelic compound of the tryptamine family. It is a structural analog of serotonin and melatonin and a functional analog of psilocybin. DMT is not activated when ingested unless a MAOI is added. B. caapi contains harmine, harmaline, and tetrahydroharmine, all of which are both MAOIs and beta-carboline harmala alkaloids. People who have consumed ayahuasca report having spiritual revelations regarding their purpose on earth, the true nature of the universe, and gaining insights into their lives. Individuals also report connection to “spiritual” dimensions and contacting spiritual or extra-dimensional guides and healers.
Feeling the need for a break from a year of fieldwork in the Costa Rican jungle, I decided it was time to satisfy my academic curiosity and experience ayahuasca. I traveled to Peru where it is legal and where shaman Antonio Bracero and his teacher, a Shipibo woman named Virginia Vasquez Alavuelo, were to meet me. There was also a local woman, Carmela, who cooked for me. That night we continued the discussions we had started through email about my interests and desires concerning the ayahuasca ceremony. We decided I would participate in three ceremonies over a one week period, beginning the following evening.
The ceremonies began with cleansings and prayers before the ayahuasca was administered. Each time I was a little scared- as Tim Plowman told Wade Davis “(it) is many things, but pleasant isn’t one of them.” However, for me, after the initial uneasiness passed I found the experiences not only enjoyable, but blissful. I experienced profound altered states of consciousness and gained novel insights concerning my life goals and existence. Each ceremony was unique- my mind focusing on different domains of my life each time.
From my journal following the first ceremony:
I soon began to see black and white geometric patterns. Antonio began singing an icaro. Then Virginia sang- her icaro sounded Japanese; I had the impression it was very ancient, like from the dawn of human consciousness.Soon my sense of self began to dissolve and all I could do was breathe and listen to the icaros- which they alternately sang, accompanied by various shakers and rattles- at one point Antonio played the guitar. I could see and feel the music. I had the sense that other people were there with us, as the sounds seemed to be coming from all around me. Sometimes I felt people standing over me- all with positive and healing intent.
The ceremony lasted from 7:00 pm to 1:00 in the morning. Some of the few thoughts I remember are “wonder” and “wonderment” and later “gratitude.” When I came down from the high I felt a little melancholy (if that is the right word- it was more like the Japanese term “mono no aware”) and I still feel a little like that today- but at peace. Last night I told Antonio how intense, but how ecstatic, joyful, and caring the medicine was. He said, “The medicine is just a reflection of yourself, it was a real good first ceremony.”
Research suggests ceremonial use of ayahuasca can provide mental health benefits. Da Silveria and colleagues conducted a comparative study of adolescents subscribing to an indigenous Amazonian belief system that sacramentally used ayahuasca and their urban Brazilian counterparts. They measured frequencies of substance abuse disorders, anxiety, depression, body image disorders, and attention deficit hyperactivity disorder. As compared to the control group, ayahuasca-using adolescents scored on average seven times less likely to experience these problems. Harris and Gurel surveyed individuals who had used ayahuasca at least once in North America. They found similar spiritual experiences amongst the ayahuasca users and a comparison group of worshipers who had attended a Catholic spiritual retreat. They also found that the ayahuasca users had made life changes after their experience with ayahuasca- they had reduced their alcohol intake, ate healthier diets, experienced greater self-acceptance and improved mood as well as reporting an increase in the experience of love and compassion in their relationships. They also stated that they received ongoing guidance and support from the spirit of the ayahuasca.
There are, however, problems concerning the booming ayahuasca tourism business. With the influx of money, there are now people providing it who have poor training or bad intent. There have been reports of molestation, rape, and negligence at the hands of predatory and/or inept shamans. In the past few years alone, a young woman was allegedly raped and beaten by two men who had administered ayahuasca to her and two people died while staying at ayahuasca lodges. Stories persist about unwanted sexual advances and people experiencing difficulties after being given overly potent doses.
As anthropologists know, the set and setting of healing rituals involving altered states of consciousness are of vital importance. My experience took place in an aesthetically pleasing location with shamans who were attentive and nurturing. To protect people who seek out this ancient medicine as a healing modality, regulation may be necessary. Anthropological, psychological, and botanical research can aid in defining how best to regulate the booming ayahuasca business, creating a safe option for those desiring alternative mental health treatment.
Greg Batchelder studied counseling psychology at Colorado Mesa University, psychological anthropology at Colorado State University, and is currently conducting doctoral research among the indigenous Bribrí in the Costa Rican rain forest of Talamanca.
The anthropologist is frequently construed as an ideally detached observer who doesn’t let his or her own ideals or visions for society interfere with or steer her research. But sometimes it’s hard not to care. As Sally Merry has described, pressing issues of social justice challenge the border between scientific disengagement and ethical activism and “open up important possibilities for rethinking what anthropology is and does, and what contributions it can make to global activism concerning social justice.“
This past summer I was in Poland, conducting preliminary ethnographic field research for my dissertation project about attitudes toward and experiences of people with disabilities in Poland. While I was in the field as a researcher, I didn’t feel personally affected by the things I was observing or hearing. I was (and still am) very thankful that my informants didn’t treat me with kid gloves. They spoke candidly to me about their and their society’s attitude toward people with disabilities and ‘the issue’ of disability and accessibility. But now that my goals my have been reached, it’s time for some personal processing. I guess it’s undeniable that I have a disability too, and I’ve experienced firsthand the huge difference that a few simple accommodations and an accessible environment can make. It’s the difference between inclusion and exclusion, participation and marginalization, recognition and invisibility. That is why I can’t simply be a detached observer.
Jennie Fenton’s TedX Talk begins with an illustration of the caste system in India, where a segment of society, by virtue of birth, is excluded from certain public spaces and events. In the talk, she asks the audience to imagine if this kind of marginalization were happening in their own society, wouldn’t they be outraged? Well, Jennie points out, it is happening in our societies, and this segregated group are people with disabilities, who, by virtue of the body they were born into (or developed through no fault of their own), do not have equal access to many parts of their society. And yet we turn a blind eye or make up excuses like ‘there isn’t enough money to change this’ or ‘the disabled people themselves prefer to stay in their homes and be lazy and let other people care for them’ or the idea that ‘disability is something that doesn’t concern me’ or only affects a small segment of society. ‘Why go through the trouble of making the world more “comfortable” for a few [unfortunate misfits] who are too blind, or too lame, or too deaf, to function in the ‘normal’ world?’ (these quotes reflect some of the statements and sentiments I heard in Poland). But why should those who can walk always be privileged over those who can’t? Why should those who can see and hear be privileged over those who can’t? It doesn’t hurt anyone to make it possible for blind people to cross the street safely, or for wheelchair users to have access to buildings and make use of public transportation too.
Sometimes I feel like I’m shouting this to a stone wall though. Sometimes I feel like I ought to acknowledge that, well, this is just one of the many ‘issues’ in the world. And of course, everyone thinks their cause is the most important. Sadly, it makes sense to me that “mine” isn’t seen as the most important or the most popular cause out there. At times I found myself beginning to adopt the emic perspective and almost agreeing with the statements of some of my informants in the field, such as:
“Creating a secure economy is most important here. After that, you can start dealing with the comfort of the people.”
This statement equates accessibility with comfort, ease, or even privilege, rather than an issue of equality and inclusion.
“Everyone struggles in this society. The majority needs to be served/content first, before people can start to think of such first world issues as ‘minority rights.”
This comment suggests that disabled people are some kind of second rung citizens who need to wait their turn patiently, to be ‘served’ and have their needs met, rather than full members who could already play an active role in building and shaping society.
Such sentiments make sense to me, but also left me feeling discouraged at times–why do I bother? Maybe this is just a ‘first world’ luxury issue, and I shouldn’t be bothering or annoying these people with it. On the other hand, creating accessible spaces really doesn’t have to be an issue of having the right amount of money (and believe me, even when all the money and resources are there, people could, and do, still neglect it), it’s about having the right amount of motivation for it. I’ve also heard encouraging stories, of neighbors getting together to build a ramp for one of their neighbors who uses a wheelchair, for example. Even though there was just one man in the apartment that needed this accommodation, the neighbors cared, and they built a ramp for him. Nothing fancy, and it probably doesn’t meet ADA requirements in terms of safety and durability, but it works, and now he can get in and out of his house. Poles are very creative and, if they care, they’ll always come up with clever solutions and help one another. Stories like this give me hope.
In activist anthropology, the researcher utilizes personal convictions as a strength, rather than avoiding them as though they were a trap. It challenges the notion that the anthropologist is a detached observer who simply has an academic and impersonal curiosity about the habits, customs and believes of the ‘natives,’ rather than one who holds a shared commitment to improving their situation.
Mirjam Holleman is a graduate student in the Biocultural Medical Anthropology Program at the University of Alabama. For her dissertation project, she will be investigating attitudes toward and the experiences of people with disabilities, in terms of their social integration and participation, in Polish society.
Every so often a piece of research comes along that is a real game-changer—it literally shakes the earth under your feet. I had that experience about a year ago when Anne Case and Angus Deaton, two economists, published an analysis of recent mortality trends in the United States. If you electronically search “mortality trends” for the U.S., you will see that, overall, mortality rates are declining, as they are for Canada and Western Europe. What Case and Deaton did was to separate out mortality rates for non-Hispanic Whites. Starting about the year 2000, rather than continuing to decline like everyone else’s, mortality for this group bucked the trend and started to climb. When causes of mortality were examined, deaths from lung cancer were declining, from diabetes were stable, and for three causes were climbing, dramatically. These were chronic liver disease, suicide, and what Case and Deaton refer to, by default since that’s what the feds say, “poisonings” (read: unintentional drug overdose).
I’ve taught epidemiology off-and-on for a long time, and mortality rates just don’t jump around like this, unless, that is, something catastrophic is happening. An example of a catastrophic event leading to high mortality rates was the fall of the former Soviet Union. In the decade following that political upheaval mortality—especially male mortality—climbed, fueled by a potent combination of vodka and cigarette smoke.
A further component to their findings was that the changes in mortality rates were highest among non-Hispanic Whites who had a high-school education or less. In 1999, rates of death from “poisonings” were 4 times higher for people with a high-school education or less than they were for people with a college degree. In 2013 those death rates were 7.2 times higher for the less-well educated versus the well-educated.
I felt so compelled by this evidence that I dropped what I was doing in my classes—one on cognitive anthropology and one on the history of anthropological theory—and taught the Case and Deaton paper. Even though it caught a lot of attention in the national press, at least for awhile, I was afraid that it would escape the notice of many of my students and, furthermore, that they might not really appreciate the magnitude of the results.
The pattern of results suggests that non-college educated Whites are experiencing some kind of profound stress and that in response they are self-medicating with alcohol (hence chronic liver disease) or with prescription opioid pain medication (with its attendant risks of overdosing), and that they are responding with major depression and the associated risk of suicide. In their interpretation, Case and Deaton emphasized the stress of economic insecurity for working class Whites, noting that widening inequality might account for the trend. This would seem to me to affect other population groups—like African Americans—even more than non-college educated Whites, yet the trend toward higher mortality from these causes is not observed in other population groups. Case and Deaton also suggest that it might be specifically the transition in retirement programs from guaranteed benefit plans to defined-contribution plans, with their associated stock market risk. In this interpretation, looking forward to an uncertain and possibly impoverished future is the source of stress.
For obvious reasons—and I’m talking about the election season in which we find ourselves—I have continued to think about this research, given the prominent place that Whites with a high school or lower education seem to be playing in support of one of the major candidates. Is it, to quote a political strategist from a past campaign associated with the other major candidate, “the economy, stupid!” Or, is it that, and something more?
As I considered the findings, I was reminded of an old paper by James P. Henry and John C. Cassel from the American Journal of Epidemiology in 1969. They examined cross-cultural data on age and blood pressure, noting that, while many physicians believed the rise of blood pressure with age to be “natural,” it was in fact “cultural.” In many communities around the world, especially those that had yet to be drawn very closely into capitalist, market economies, there was little evidence of an increase of blood pressure with age. In what were called (back in the day) “modern” communities, blood pressure rose with age.
To explain these results, they drew on a process that Cassel had been thinking about for some time, namely, the inconsistencies and incongruities that can accompany profound culture change. Cassel’s preferred research strategy had been to follow migrants into a new setting, where he predicted that the incongruity between the culture they arrived with, and the culture of their majority host community, created a period of stressful and taxing adaptation, as the migrants tried to adjust to their new setting. The end result of this stressful adjustment, especially if it was not especially successful, was an increased risk of disease. Henry and Cassel suggested that the same process could be occurring across the life-span of an individual, arguing that in the modern world, with the ever increasing pace of social change, an individual is born into and socialized in one culture, yet ends up living in another, as the world changes around him or her.
This strikes me as an eminently plausible interpretation for the Case and Deaton findings. Non-college educated Whites are indeed facing economic stresses, but the broader cultural changes they are experiencing are even more profound. And what can more effectively and graphically communicate to them that the world around them has changed than the fact that they will shortly trade their first African American president for their first female president? (I trust Sam Wang and his Princeton Election Consortium.)
Cassel drew heavily on culture theory for his insightful interpretation of epidemiologic data. Case and Deaton’s findings suggest that those insights are still relevant.
More so than almost ever before, these two trips brought to the forefront the challenges of maintaining an active international research program as a young faculty member, and I want to talk about that in this post.
First of all, here’s an obvious truth that nobody ever told me: fieldwork changes once you’re out of graduate school. In the department where I studied, a year of fieldwork was the unstated minimum for anyone doing research with ethnographic components, and almost all of this work was international; those who stayed longer got extra hard-core points. Because this was simply the way things were done, it never occurred to me that this was the exception–rather than the rule–to most fieldwork experiences for anthropologists in academic positions. Faculty simply don’t get that time very often: most sabbaticals are only a semester, and a full year only comes about if you receive an external fellowship, are willing to go with half-pay, or something similar. Also, sabbaticals are increasingly few and far between; in my current department, I will get my first sabbatical after receiving tenure. That’s six years, typically. During my doctoral fieldwork, I was fortunate to have few other major life responsibilities, and no other professional ones. By contrast, faculty anthropologists doing fieldwork are often expected to supervise online courses, prep syllabi, write the book or paper about the last major fieldwork project…the list goes on. I didn’t know any of this as a graduate student, however.
In so many ways that I only now realize, fieldwork in graduate school is a golden period. Not “golden” in the sense that it is always happy and wonderful, but golden in the sense that it was a one-time deal.
So, changes have come about, and many of these I believe are relevant for anthropologists at any stage. The obvious first change I’ve made in my approach to fieldwork is to stop judging an anthropologist’s mettle based solely on the length of time they have spent in the field. Ethnographers fetishize extended time periods. Just think of Malinowski, out there stuck in the Trobriands, a political exile for years on end–his experience is the model on which we’ve judged the acceptability of our fieldwork for a century. Now, this is not without reason; immersion is indispensible for good ethnographic fieldwork and must be done at some point, but generally academic employment isn’t set up for that. Increasingly, neither are the funding structures on which we rely to pay for this research.
I’ve come to realize, rather, how incredibly much can get done in six weeks, or even three weeks, if you know the right questions to ask. So much of fieldwork is figuring out what to ask, to whom, and when. If you are returning for a short time to a place you already know, it goes much faster. Thank goodness for that.
This depends, of course, on having already spent extended time in a place so that one has the necessary familiarity. “Parachute ethnography,” as it is sometimes rather pejoratively called, can be highly problematic, and this is not what I am advocating. Yet at the same time, I find myself pulled to make more happen in shorter periods of time, and figuring how to do that without losing authenticity is an ongoing challenge. So perhaps my point is that returning to a former field site as a junior faculty member can be highly rewarding and extremely productive, even if time allows for only a few weeks of work. If one were to go to a brand new field site for only a few weeks of work, things might look very different, but many anthropologists make this work. I’m not sure how yet, to be honest. Stay tuned.
A second change I’ve made is to prioritize regular contact with friends and acquaintances in my research sites during the 9 months when I am teaching in the US. This is true both for older field sites and for the brand-new ones I just began developing in India. Social media has been great for this. Now, I can get on Facebook and tell Arlete that I will be coming back to Brazil for 3 weeks in June, and can she work with me again as a research assistant? This smoothes the entry, too. I remember spending weeks–perhaps months–setting up this stuff as a graduate student. Now, it is much easier for me to hit the ground running when I arrive in India or Brazil. And again, this is true even for newer field sites, and exploiting that to its full potential is, I think, key to getting the most out of short fieldwork periods.
A third change I’ve made is to develop research projects that proceed in discrete phases and span multiple years. A good example is my current project in Brazil, Food Insecurity and Mental Health in Global Perspective, a 3-year, 3-site study I am conducting with colleagues Craig Hadley and Bonnie Kaiser (Craig works in Ethiopia, and Bonnie in Haiti). Phase 1 was dedicated to freelisting and ethnography only. Phase 2 is for ranking and rating exercises on freelist items plus participant-observation surrounding food buying and preparation, and Phase 3 will consist of questionnaires using instruments developed in the first two phases, biomarkers, and anthropometrics. Each of these can be done in a summer, especially with the help of graduate students. (Speaking of, I am currently seeking a new Master’s or Doctoral student to assist with this project in summer 2017. Read more about this here.)
And this brings me to the fourth change: increased collaboration. I wanted to do a cross-cultural comparative study with multiple phases of instrument development and mixed methods. Don’t have time to spend a full year in each of 3 countries? No problem! Team up with colleagues who can each work in one country, then split the work into short phases. This way, each person ends up with a manageable chunk of work in a single country to do each summer. Fortunately for me, biocultural work is especially well suited to this phase-based work because it often involves methods that build on one another.
Fifth and finally, I have learned tricks that help me capture more data from shorter periods of time. Good, deep ethnography takes time and investment, no question, and you have to give that time at some point. But there is so much that goes on in the everyday interactions of fieldwork that rarely made it into my fieldnotes when I was a graduate student because I was so singularly focused on what I imagined to be Ethnographic Experiences. At some point in my early research, however, I started voice-recording interviews where I was doing anthropometrics, blood tests, and questionnaires. So much valuable material has come out of those recordings. I didn’t expect this; these seemed to me like the most cut-and-dried structured interviews one could have, not those real Ethnographic Experiences. Yet, when I began transcribing them, people’s side comments about the questions I was asking added up to rich qualitative material. Now I always voice record interviews, no matter whether they are “ethnographic” (i.e. unstructured or semi-structured), or whether they are structured interviews organized around pilesorts, freelists, questionnaires, or other exercises. It creates a lot of work after the return from the field, but these recordings allow me to pick up on extra data that I would otherwise miss. They help me get the most out of those short fieldwork periods.
Despite the constraints of short fieldwork periods, I think I am a happier fieldworker now than I was in graduate school. It is not an easy thing to pick up and leave one’s life for a year (or more). Increasingly, work by anthropologists about anthropologists is documenting that fieldwork can be particularly hard on mental health (see, for instance, Rebecca Lester’s and Eileen Anderson-Fye’s presentations at 2015’s AAA meeting). For me, the hardest part about long-term fieldwork was missing the people and the rhythms of my everyday life. Short periods of fieldwork like those I now have to do are in some ways positive because they allow me to maintain that balance more effectively. It’s more feasible to bring my children on shorter trips. I won’t have to be out of contact for as long with my aging parents when I am away on shorter trips. I can–and indeed am expected to–keep working on other projects during fieldwork. All of this adds up to fieldwork becoming a part of everyday life, part of the yearly rhythm of my and my family’s existence. This to me is what being a career anthropologist is all about.
Lesley Jo Weaver (PhD/MPH, Emory) is an Assistant Professor in the Biocultural Medical program and an affiliated faculty member in UA’s Asian Studies program. She studies health and illness in India and rural northern Brazil.
“Juana,” a Mexican immigrant who lives in Birmingham, Alabama, is a native of a small ranching village in Jalisco. Fifteen years ago, her husband lost his job in Mexico. They had no money saved, and she was scared for the safety of her children because of drug-related crime in their community there. Her husband convinced her that they needed to move to the U.S. where he could find work, they could get their kids in good schools, and they could have better lives. He went first, and, a little while later, Juana paid a “coyote” to take her across the border. After a month-long, treacherous journey, during which she was arrested and sent back, attacked by wild animals, left behind in the desert without food or water, and was constantly scared, she finally made it across the border and eventually to Alabama where her husband was living. He found steady work, and they sent for their three kids, who are now participants in the Deferred Action for Childhood Arrivals program. Juana and her family have achieved all the things they set out to achieve in moving to the U.S. Yet her health has suffered considerably, both physically and mentally. Unfortunately, this is not an uncommon experience for people like Juana.
The typical framework used to study what happens to individuals who developed in one sociocultural context when they attempt to live in another is called “acculturation.” In my work with Mexican immigrant women in Alabama, I’m trying to figure out what the acculturative process looks like and why typical measures of acculturation are associated with a dramatic decline in health outcomes, particularly diabetes and depressive symptoms. To understand how cultural meaning systems change and the effects of such meaning on human lives, we need to have a clear concept of what culture is, how it works, and ways to measure it. A cognitive definition of culture is a good place to start because it moves culture out of the realm of abstraction and allows for it to be measured in concrete terms. As Dressler point out in a previous post, culture is the information needed to think and behave appropriately in certain situations and to interpret the behavior of others correctly. This knowledge is encoded in overarching cultural models, which we draw on to structure our understanding of how we ought to live. Once we have an idea of what a cultural model looks like in a certain context, we can measure individuals against it and see how well they stack up. That stacking up is termed “cultural consonance“—the ability to live up to the shared cultural expectations of the group—and it affects health.
So, what’s going on with women like Juana? We know they tend to be in better health upon arrival than their U.S.-born counterparts, despite tremendous suffering before and during immigration. However, as they carry out their lives in the U.S.—even as their standard of living improves and they gain access to better health care—their health often gets worse. Researchers haven’t been able to explain the underlying cultural mechanism responsible for this. I’m interested in using cultural consonance as an intervening variable between measures of acculturation and health outcomes to determine if the pathway by which acculturation leads to declining health is, at least in part, in its effect on the ability to achieve a culturally valued lifestyle.
I focus on four cultural domains—lifestyle, family life, Mexican immigrant identity, and life goals. Using a technique called free listing, I asked my informants to list as many items as they could in response to these four questions:
What kinds of things are important or necessary to have a good life?
How would you describe a loving family?
What are the qualities or characteristics of Mexican immigrant women?
What are your goals in life? This gives me a glimpse into how cultural realities are changing in a new context
The next step is to understand what kinds of things go together and why as well as which items are most highly valued and sought after. This is analyzed using cultural consensus analysis, which measures the extent to which cultural knowledge is shared among informants and provides the best representation of how the collective thinks about a particular domain.
In general, people act in ways that correspond to cultural influences and expectations. I believe that, as Mexican immigrant women carry out their lives in the U.S., they internalize a new cultural model for how one ought to live, and, as they do this, their positions in the cultural landscape change. The further away they find themselves from living a collectively valued lifestyle in their new U.S. cultural context, the greater risk their risk for declining health. For Juana, adapting to a new culture has been difficult. For example, speaking Spanish in the home and celebrating Mexican traditions is very important to her, but she struggles to get her children to do this, which is a source of family discord. Another thing is that she is scared to drive, so she can’t get around easily and has lost her sense of independence.
Reasons for cultural dissonance among immigrants may range from economic constraints, structural or interpersonal violence and abuse, or lack of interest in engaging with a new culture. I hope to improve understanding what role culture plays in immigrant health outcomes as well as what social and institutional factors may limit the achievement of a culturally valued lifestyle. Such limitations may simply produce new stress that contributes to poor health outcomes.
Biocultural anthropology offers an inherently interdisciplinary, cross-subfield approach to anthropological research. As such, it draws heavily upon various biological, cognitive, and sociocultural theories, among others, to point researchers towards certain methodologies and variables for inclusion in their research design. The outcome of such an approach yields a growing genre of work that articulates the ways in which the human body, at every level, both shapes and is shaped by cultural practices. As one of the four major subfields of the discipline, linguistic anthropology also engages questions regarding bidirectional connections between culture and body. Such work emphasizes the ways in which embodied experience is constantly mediated by interactions that involve words, gestures, and prosodic features such as rhythm and emphasis.
Despite a shared interest in demonstrating links between culture and body, theoretical and methodological approaches within biocultural and linguistic anthropology have only rarely been actively combined. Besides a few outlying studies by, for example, Erica Cartmill, bioculturally oriented research has rarely engaged seriously with language as a multi-modal process shaped by and shaping embodiment. Researchers in linguistic anthropology have likewise, for the most part, chosen not to focus on the biological implications of complex, culturally mediated interactions.
From my current vantage point as a linguistic and psychocultural medical anthropologist working in a department with a strong biocultural program, I am beginning to question what researchers in each area might be missing out on when they choose not to include either linguistic or biocultural perspectives when they design their research. While I fully acknowledge that it is not always possible to do everything in every study, I would like to propose that the two fields are at a point where they could fruitfully be joined together more explicitly and consciously. This is both a methodological and theoretical endeavor.
Methodologically, for example, biocultural work draws upon methods such as cultural domain analysis (including cultural consensus analysis), and inclusion of biological outcomes, in addition to traditional long-term ethnography and interviews. From my perspective, there is ample room in such studies for incorporating additional methods from linguistic anthropology, such as audio and/or video recording and the use of conversation analysis to transcribe and interpret data. For biocultural anthropologists, such an approach can arguably increase the ‘grain’ of research, enabling scholars to track how difficult-to-operationalize concepts, such as “stress” or “belief,” emerge over time in interaction. Likewise, the inclusion of biocultural methods offers linguistic anthropologists an opportunity to study how conversations literally get under the skin.
The incorporation of additional methods alone, however, does not automatically lead to such enhanced results. Research seeking to combine biocultural and linguistic methods must thus be held together, at every level from research question to data analysis, by theory. Here, biocultural theories that recognize bidirectional links between large-scale sociocultural and economic processes and individual human biologies (e.g., Goodman and Leatherman 1998) are a good starting point. Even more relevant, perhaps, for scholars seeking to incorporate a linguistic anthropological perspective is the specific theoretical construct of cultural consonance, described here by Bill Dressler. As Dressler describes, cultural consonance theory pushes past generalized theories of “culture as context” to develop nuanced connections between cultural meanings and individual meanings, further linking such connections to individual biology. Although admittedly I am not yet an expert in this theory, it strikes me as an excellent opportunity to incorporate theories from linguistic anthropology that focus on the emergence of culture as an uneven process that occurs in specific interactions (see, for example, Duranti and Goodwin 1992 or Tedlock and Mannheim 1995). Some specific examples of areas where both the theories and methods of biocultural and linguistic anthropology might be productively combined include, then:
Research on illness and healing: Biocultural anthropologists have made significant contributions in demonstrating the link between cultural processes and health outcomes A lot of work is being done in this realm across anthropology. Some examples from our department include Oths 1999, Lynn 2014, Weaver et al 2015, Dressler et al 2016. At the same time, many linguistic anthropologists, often in collaboration with medical anthropologists, have drawn upon recordings of doctor-patient interactions, and the fine-grained analysis of conversations between suffering individuals and their families to demonstrate the role of micro-interaction in the experience of illness and healing. Future work combining approaches might examine how, for example, conversations with physicians or family members work to mediate stress and other biological outcomes.
Research on child development: Several biocultural anthropologists, including Carol Worthman and Jason DeCaro, have made great strides in demonstrating the ways in which cultural and social circumstances affecting children translate into lasting physiological characteristics. In linguistic anthropology, the field of language socialization observes the role of interaction between caregivers, children, and peers in shaping children as participants in culture, as well as speakers of language. Future research combining approaches offers the possibility of measuring the ways in which different kinds of interactions, over time, form the basis for how children become embodied participants in culture.
Research on emotion: Most subfields of anthropology have considered emotion in some way. Biocultural approaches to the emotions have challenged traditional divides between nature and nurture when it comes to emotional experience. Studies of emotion in linguistic anthropology, on the other hand, have shown that emotion, rather than being a product of individual or a simple reflection of culture upon individual, is a jointly produced phenomenon. Again, future collaborative research might demonstrate how the biology of emotion is similarly mediated by interactions with others.
I have listed just a few examples here. The list could go on. Whatever the specific research topic, however, it is important to reiterate that the combination of biocultural and linguistic anthropology is both a methodological and theoretical endeavor that has certain practical implications. While it would certainly be possible for individual biocultural researchers, for example, to stretch their work to incorporate video or audio recording and analytic theory from linguistic anthropology, this could easily become unwieldy without the participation of a researcher trained in linguistic anthropology. The reverse is also true. From this vantage point, it becomes incredibly important to think about managing the logistics of creating multidisciplinary research teams working with mixed methods. Tom Weisner has, in fact, written that “the future of our field and the social sciences is far more likely to be characterized by interdisciplinary methodological pluralism.” This blog post is obviously in agreement with this. As a linguistic anthropologist, I would just like to note that, at a practical level, this kind of work demands efforts at understanding one another’s language, and developing communicative strategies that serve the project. From my perspective, such strategies can serve to enrich rapport among colleagues, but also form the basis of an enhanced ability to conduct research that addresses pressing social issues in ways that can have a lasting and beneficial impact on human lives.