Hey fancy folks, I’m presenting at three conferences/symposia in the next few months. One is tomorrow! Ahh.
MEDUSA Anthropology Graduate Student Symposium, March 20, 2014
CSHPS (Brock University), May 24-26, 2014
Understanding Epistemic Injustice (Bristol, UK), June 26-27
Haven’t posted music in a while, but here’s a lil draft of what I’ve been working on with my genius producer pal.
I submitted an abstract today to the CSHPS annual meeting in May. (It’s pronounced “sea ships” which is the best.) If I get in, here’s what I’ll be presenting on:
The Risky Business of Empathic Care: Epistemological Foundations of Secondary Trauma in Healthcare Providers
What are the consequences of caring for traumatized individuals? While post-traumatic stress disorder (PTSD) — the pathological reaction to direct trauma — is a well-defined construct in the psychiatric literature, the effects of exposure to indirect trauma are less well-documented. Secondary trauma is a condition described since 1990, primarily within populations of healthcare providers, in which listening to the traumatic narratives of patients can elicit a pathological response. This response includes intrusive thoughts, avoidance, and hyperarousal, thus mirroring the symptoms of PTSD. While neither an officially recognized disease, nor a well-defined or stable condition, the term “secondary trauma” nevertheless describes a well-known response to listening to traumatic narratives. In this paper, I address three epistemological issues facing secondary trauma as a medical category. First, it has been described using several similar but non-interchangeable terms; these include “secondary traumatic stress,” “compassion fatigue,” and “vicarious trauma.” While these terms describe similar constellations of symptoms, their theoretical bases remain distinct. Second, the existing scales for measuring this phenomenon lack congruity, and demonstrate divergent conceptualizations of the condition and its symptoms. Third, the degree to which secondary trauma can be considered a “disease” remains unclear and subject to debate, particularly within a medical literature that wishes to avoid labeling empathic care as potentially pathological. In taking stock of these epistemological issues, I ask how these different conceptualizations of the condition affect its status as a medical phenomenon, and its social ramifications for clinical care.
I like to collect medical pamphlets. This week I picked up a pamphlet on mood stabilizers from the outpatient mental health clinic where I volunteer. I’m hoping to incorporate these into my research — in other words, how do these brief but almost-canonical texts figure in the patient’s experience of the clinic and her own illness? Some observations on the mood stabilizer pamphlet:
1. The language of risk
There is a ton of great literature in science & technology studies on risk and anticipation (one of my favourite pieces is here). Part of the pamphlet that struck me most was the section called Is it safe to take mood stabilizers while pregnant or breastfeeding? The answer it offered:
"For any pregnant woman with a history of bipolar disorder, the question of taking mood stabilizers during pregnancy usually comes down to a risk-benefit analysis. All mood stabilizers carry some risk — some more than others; however, episodes of depression or mania can affect prenatal care and a mother’s ability to parent her newborn child.” (emphasis mine)
This kind of balancing act of risks is in no way uncommon in medicine. But the language of risk itself has a sterilizing effect. It lacks all of the emotional weight of the decision in question. Consider the patient’s position, in which the choice to maintain or go off medication means weighing the options of endangering your own mental health, your sense of stability, the chemical well-being of your embryo, and your ability to act and identify as a good mother. All the uncertainty surrounding this decision (will the drug harm the fetus? will my mental health decline if I don’t take it? will I be healthy for my newborn?) can be traumatic in itself. Reducing it to an economic-sounding, and presumably rational decision-making process masks the painful process this decision actually represents, and can implicitly hold patients to a standard of emotionless, rational decision-making they could never fulfill.
2. Drugs sound like magic.
There is a weird sense of mystery whenever it comes to psychopharm. That’s not surprising, especially considering how little we know about how mood stabilizers actually work. The main message here is trust the drug, it works in mysterious ways. The pamphlet reads, “It’s important to give them time to work.” Are we talking about shoe-making elves? It’s as if these drugs take on an agency of their own, and patients must stay passive and waiting (they can take four to six weeks to reach their full effect) to witness the results in their own body.
3. Matching life with drug-life
There is a section in the pamphlet on cutting down on (or completely stopping) mood stabilizers. It reads:
"The first step is to ask yourself is this the right time. Are you feeling well? Is the level of stress in your life manageable? Do you feel supported by your family and friends?
Here is where the importance of narrative comes in. The pamphlet frames these questions as something the patient should ask herself before considering cutting down on meds. But in the clinician-patient encounter, whenever it comes to changing a dose or switching medications, these are things a doctor should also be aware of — and which often get ignored. I’ve seen patients have their medications changed days before important and stressful events (tests, talks, etc). Maybe the doctor forgot to ask. Maybe the patient felt nervous speaking up and contradicting the doc’s authority. Either way, these are subjects that really need to become part of the conversation in any kind of drug management.
4. Managing the chronic
I’m particularly interested in the chronic management of illnesses, especially where symptoms or side-effects are, by that point, minimal. That’s where questions of drug maintenance or life changes (like pregnancy) come in, because the focus is no longer on critical illness and acute care, but on managing a more-or-less stable state. It’s a liminal zone of not-exactly-healthy, and not-quite-ill. It’s a state in which, apart from a daily dose of medication, patients can often lead a normal life, and some can even ignore their illness altogether. It’s as if we assume that life is compartmentalized into normal-life (outside the clinic) and medical-life (in the clinic). We inhabit two worlds that don’t intersect. Maybe that’s a strategy for making illness less painful and less intrusive in our daily lives and identities. But it’s the encounters and decisions — do I go off my meds to get pregnant? Am I stable enough to lower my dose? — that make these worlds finally intersect, and that in itself can be traumatic. Suddenly you are forced to face uncertainty about your health again — and more than anything, uncertainty about the future.
Tweeting Cancer, by Meghan O’Rourke
The New Yorker, January 13, 2014
"… What Adams is doing is not new—it is not even new in our time. But it is less filtered and more immediate than ever, and surely this is part of what’s at stake here: a lingering concern that dying perhaps deserves contemplation rather than immersion.
I can understand, in a certain sense, how each Keller was jolted into contemplation of Adams’s public persona. I am Facebook friends with Adams—she must have sent me a request a while ago—and before the Guardian column appeared, in late December, I had been similarly struck when I opened my Facebook feed (usually an assortment of puppies, babies, and complaints about signing up for Obamacare) and found posts by Adams detailing what it’s like to be in the hospital unable to control her pain, or the indignity of having visitors drop by without notice. I didn’t know her personally, and these posts felt highly personal, and different in kind from the buoyant mundanity of the rest of my feed. But there is something useful about the disjunctiveness of posts like hers, which pop the bubble of the social-media surfaces that we slide along, as if our time here were a never-ending river rather than a journey that has a distinct end. I also welcome debates about what the ends of our lives might look like…”
A really excellent read. (You should read it too.) Will be thinking about all this for a long time. Also thinking of writing something about this when I get the chance.
Books I am reading / have read in the last couple of months. (clockwise from top left)
- S. Lochlann Jain (2013) Malignant: How Cancer Becomes Us
- Cindy Patton (ed.) (2010) Rebirth of the Clinic
- Joseph Dumit (2012) Drugs For Life: How Pharmaceutical Companies Define Our Health
- Eric Cazdyn (2012) The Already Dead: The New Time of Politics, Culture, and Illness
- Annemarie Mol (2002) The Body Multiple: Ontology in Medical Practice
Friends! I recently collabed with my pal Kristian Noel Pedersen on a song for his yearly Christmas album, Kristian Kinda Christmas. We covered Sufjan’s “Sister Winter” and used trap beats, so you’re welcome.
PS: a little music update — I’ve been working with MEESHA on music these days, and we’re putting together some sexy pop jams. He’s an amazing producer, so get ready for new tunes in 2014.
its treatment is that, at the very moment when we are perhaps most
acutely aware of ourselves as an individual, medicine seeks to
restore health through viewing and reducing the individual to
classiﬁable membership of a category.