Analysis #3 - Put Your Money Where Your Brain Is

The human brain has always managed to fascinate us through its complex functions, mechanisms of communications, and storage of mass amounts of information. Compared to other animals, humans have the largest brain to body size ratio, making the human brain one of great interest to scientists and researchers alike. Advances in technology as well as biomedicine have provided us with new tools that have helped to expand our knowledge and understanding of the human brain and how it works. Studies on the human brain, like any other scientific study, tend to focus on viewing the human brain through an objective lens. This may be ideal in studies dealing with measurable or quantifiable components of the brain's functions (i.e. the damaging effects of alcohol on irreplaceable brain cells), but it may not be the most appropriate to apply in studies involving mental or psychiatric illness as the latter is based on the subjective experiences of the patient and is thus harder to physically detect by strictly objective biomedical standards. Objectifying human experiences with mental illness, which may be problematic as it tends to oversimplify the various sociocultural factors involved in its creation, is the controversial talk among scholars today and is the focus of this analysis.

The above image, from the Bioinformatics team at Becker Medical Library (http://beckerinfo.net/bioinformatics/?p=675), is a cartoon that depicts two frames illustrating how we see ourselves and how our professors see us. (I have extended the term "professors" to encompass a broader category of professionals including professors, medical professionals, researchers, scientists, etc.) The left cartoon frame portrays us as being "complex human beings" with "hopes, dreams, and aspirations". The right cartoon frame, however, portrays us as being seen simply as a brain on a stick whose sole purpose is to contribute to science (through research, for example). The way this cartoon portrays humans as merely "brains on a stick" may seem like a crude joke to some, yet I find a great deal of truth hidden amidst the sardonic humor behind this cartoon. It seems that in recent times, with the onset of technological and medical advances, scientists and researchers have been dangerously eager to place a blanket of objectivity over humans and the experiences we face as complex human beings. Simon Cohn discusses this emphasis on objectivity in his piece on "Picturing the Brain Inside, Revealing the Illness Outside: A Comparison of the Different Meanings Attributed to Brain Scans by Scientists and Patients". In examining the effects of brain scan images to both scientists and patients, Cohn states that "for the neuroscientists, making images is ostensibly about doing science - gaining objectivity through the identification of definitive material things without having to resort to the messy external subjectivity of a behaviour-based classification of disease" (Cohn, 66). The term "messy" used in this context carries with it a negative connotation, suggesting that any subjective factors involved in mental or psychiatric illness are bothersome, overly complicated, and in the need of organization or even complete removal.

Patients who voluntarily participate in the research study outlined in Cohn's article receive "a copy of the scan to take home as a kind of thank you gift" (Cohn, 74). The copy of the brain scan has profoundly different meanings for the scientists and the patient. While "the researchers perceive the value of the scans only in terms of the work in the lab, and view giving the patients a copy merely a contractual duty with no other consequence or significance" (Cohn, 67), the patients view the scans as a way to "legitimize their conditions in a new way and make them 'real'" (Cohn, 67). Again, the scientists' attitudes of indifference towards the copies of the brain scans demonstrate how they value the organ only for the objective information it can provide to their research and not to the subjective or personal experiences of the patients. Cohn continues on to state that we live in an era in which "new biological knowledge is being used as the grounds for individual identities and forms of sociality" (Cohn, 68), forcing people to develop and organize relationships with others "through technologies that divide and categorize" (Cohn, 68). This process of separation and categorization is partly responsible for the behavior of the patients who take home copies of their brain scans to show others in an effort to "redefine the whole well self from the diseased part" (Cohn, 75). This need to "re-conceptualize their suffering" (Cohn, 74) rests on the patients' desire to objectively "demarcate mental from physical illness" (Cohn, 75) by locating the physical source of the illness on the brain scan. Patients would do this in the hopes of authenticating their conditions and labeling them as "a social object" that is separate from the person behind the mental illness. The use of the processes of brain scans to diagnose mental illnesses such as schizophrenia "have shifted from the realm of human subjectivity and interaction to one of apparent objectivity via the hardware and the vastly complex mathematical algorithms used to identify brain abnormality" (Cohn, 76). In this sense, we have grown to ignore the importance of sociocultural determinants of health and have instead shifted to a much more narrow, objective view of illness.

Much like scientific objectivity has affected studies on brain functions and their relations to mental illness, cultural ideology has also shaped our views on various psychiatric disorders. In his piece titled "A Description of How Ideology Shapes Knowledge of a Mental Disorder (Posttraumatic Stress Disorder)", Allan Young discusses the role of ideology in the production of knowledge. The Institute for the Treatment of Posttraumatic Stress Disorder emphasizes on "its division of mental labor" (Young, 117) and the need for the therapists and staff "to behave as if they believe the ideology's propositions are true" (Young, 126). Like the patients in Cohn's article, who hope for a cure to their now physically and objectively defined mental illnesses, the veterans who suffer from PTSD in Young's article hope to "[exculpate] themselves of moral responsibility for their present state", which they can now classify as exhibiting "sickness without psychosis - an attractive idea to someone who fears he is going crazy or who was once diagnosed as psychotic" (Young, 127). Both articles demonstrate how patients, despite being aware that objectifying their experiences downplays the importance of their subjective experiences, strive to use objectively conceptualized definitions of their mental illness in order to separate themselves from their psychiatric conditions. The patients may feel this need to "prove" themselves to others within various social spheres since "in the end it required the recognition and affirmation of others as much as the [patients] themselves" (Cohn, 79). Science's emphasis on pure objectivity without the influence of subjective experiences and society's focus on social acceptance both play crucial roles in shaping discourses on health and illness. This in turn may have a huge impact on the ways we view humans as both people and as pure subjects of study. Such views can present implications of how and where biomedicine may lead us in the future.

 Works Cited:

Cohn, Simon. 2010. “Picturing the Brain Inside, Revealing the Illness Outside: A Comparison of the Different Meanings Attributed to Brain Scans by Scientists and Patients”. Pp. 65-84. Technologized Images Technologized Bodies. Edited by Jeanette Edwards, Penny Harvey, and Peter Wade. New York: Berghahn Books.

Young, Allan. 1993. “A Description of How Ideology Shapes Knowledge of a Mental Disorder (Postraumatic Stress Disorder)”. Pp. 108-128. Knowledge, Power, and Practice: The Anthropology of Medicine and Everyday Life. Edited by Shirley Lindenbaum and Margaret Lock. Berkeley: University of California Press.

Analysis #2 - How can "health" be measured?

Numbers can provide an efficient way to organize and classify people in various situations. We walk into a restaurant and we see above the doors “Capacity 168”. We open up the morning’s newspaper and read the headings titled “52 Residents Saved in Local Fire”. We watch on television the latest breaking news that claim scientists have “successfully treated 174 out of 250 lung cancer patients in a research study”. These are but a few nonfictional and fictional examples of how people are organized and addressed as numbers. Organizing people into numbers is not in itself harmful, as long as the numbers are not being used to place numerical values on people. Under such circumstances, people become recognized only by the numbers they represent and the relative value behind these numbers. Although this appears to happen rather frequently in today’s society (i.e. a businessman’s “worth” to a company as being measured by how much sales he can rake in monthly, the number of winning cases a lawyer carries as a measurement of his/her level of competence and value to prospective clients, etc.), it is disturbingly frightening to imagine a world in which health becomes a target of such numerical categorization.

The above image, found on a business coach’s personal blog (http://www.tanveernaseer.com/more-than-just-a-number), shows three individuals with numbered white tags on their foreheads. Above this image are the words: “I’m More Than Just a Number”. The blog uses this image to help its readers understand that a successful business mindset is to look not just at the numbers, but “the person behind those numbers…who they are, what their interests are, and what they enjoy/dislike about your product or service” (http://www.tanveernaseer.com/more-than-just-a-number). I believe this same mindset should be applied when providing health care to people on a local, national, international, and global scale. In Vincanne Adams’ chapter titled “Against Global Health? Arbitrating Science, Non-science, and Nonsense through Health”, she describes the shift in the role of science in defining the meaning of health. She states that “the foundational grounds for its inquires was always health as seen in real patients with real diseases, [which] could be contrasted with later efforts to pursue “science” as an end in and of itself through colonial or postcolonial medicine” (Adams, 43). These later efforts, which emphasized the need to focus on empirical evidence, led to a “shift from health to “science”” (Adams, 43). This shift would eventually lead to the representation of patients as merely people with numbers attached to them, much like the image provided above. Each patient would be labeled as either a success or a failure in a research study. The socio-cultural, political, or economic backgrounds of patients are ignored unless their “relevance can be justified by [their] ability to advance real, scientifically based interventions” aimed at improving health (Adams, 46). Such a statement demonstrates that people are increasingly becoming evaluated by their scientific worth – that is, whether or not they can provide empirical numbers to strengthen a scientific claim. Adams discusses the emphasis pharmaceutical sciences place on statistical evidence and suggests that “it is the prioritizing of pharmaceutical consumption and its research agenda over the prioritizing of health that leads to” problems of racial and social inequalities on study populations that have no other way to obtain health except to enroll in clinical trials (Adams, 48).

The rise of global health sciences, as explained by Adams, has changed the way we measure health. A patient may die, yet a treatment is deemed “successful” if it fulfills its original objective – that is, if the treatment reduces the malady (i.e. tumor size), it is considered a success even if it comes at the expense of the patient’s life. Such way of thinking “requires embracing the notion that health itself could be located in a specific organ rather than in a whole person. In this logic, death itself was absorbed within the notion of health” (Adams, 49). Health becomes subject to technological and statistical calculations of “profit and loss” (Adams, 50), which may be dangerous as it justifies the action of sacrificing the few “for the sake of obtaining more robust numbers that could tell us that more…could be saved in the future if we furthered our knowledge of the scientific “evidence base”” (Adams, 50).

Changing notions of health have forced health to do “more than just eliminating disease. It is made to do the work of generating scientific studies and producing evidence-based outcomes that don’t always mesh well with the goals of patient care” (Adams, 55). This brings into mind Good and Good’s chapter on “Learning Medicine: The Constructing of Medical Knowledge at Harvard Medical School”, in which they describe how an emphasis on “competence” has led medical students to focus more on medicine as a science rather than the patient as a person. When asked to “reflect on the meaning of being a good physician, two juxtaposed themes quickly emerged – “competence” and “caring”” (Good & Good, 91). Being competent meant understanding the “language of the basic sciences, with “value-free facts and knowledge, skills, techniques, and “doing” or action” (Good & Good, 91). Being caring meant understanding the “language of values, of relationships, attitudes, compassion, and empathy” (Good & Good, 91). This juxtaposition between “competence” and “caring” seems very similar to the dichotomy between “science” and “non-science” as described in Adam’s chapter on global health sciences. It is the challenge between being able to see people as numbers (representing science) and being able to see the people behind the numbers (representing non-science/social science). This challenge is “built into American medicine as a cultural institution and the struggle between technology and humanism, between science and culture” (Good & Good, 93). The real question is then, is it possible for us to find a healthy balance between the two worlds? Can we see beyond the numbers stamped onto the bodies of each and every individual?

WORKS CITED

Adams, Vincanne. 2010. “Against Global Health? Arbitrating Science, Non-Science, and Nonsense through Health”. In Against Health: How Health Became the New Morality”. Edited byJonathan M. Metzl and Anna Kirkland. Pp. 40-58. New York: New York. University Press,

Good, Byron J. and Good, Mary-Jo DelVecchio. 1993. “Learning Medicine: The Constructing of Medical Knowledge at Harvard Medical School”. Pp. 81-107. In Knowledge, Power, and Practice: The Anthropology of Medicine and Everyday Life. Edited by Shirley Lindenbaum and Margaret Lock. Berkeley: University of California Press.

Analysis #1 - Naturalizing Social & Cultural Constructions of Gender Roles

Perhaps what sets humans apart from any other animal species is our ability to learn and acquire cultural and social understandings of our interactions with our world and with each other. But what happens when we become too consumed by culture, granting it permission to take over our lives and to blind us from what we truly need to see? Such seems to be the case in the scientific portrayal of the male and female reproductive systems, in which objective scientific facts get shoved aside to make room for culturally imposed ideas of gender roles.

Above is an image found on the Community and Public Sector Union (CPSU) website (http://www.cpsu.org.au/issues/news/19431.html). The poster states rather bluntly that “women [are] like men, only cheaper” and depicts two businesswomen smiling and giving each other high-fives. I found this image to be very powerful because it utilizes irony to send a message to its audience that these women are being paid lower wages for the same jobs held by men. The enthusiastic smiles of the two women undermine the seriousness of the issue of gender discrimination, while simultaneously suggesting the idea that perhaps women are being paid less because they “happily” accept the low wages (not knowing that they are being held at a great disadvantage or knowing that they are yet choosing not to react). Such gender discrimination in the workforce is not uncommon today, since we live in a society that continues to impose on us culturally established “traditional” gender roles, in which the male is seen as the strong, active, knowledgeable being and the female as the passive, obedient, dependent counterpart. These same gender roles are being used by scholars in medical texts to describe the roles of the reproductive systems of males and females. In Emily Martin’s article “The Egg and the Sperm: How Science Has Constructed a Romance Based on Stereotypical Male-Female Roles”, she discusses the cultural implications placed on the roles of these gametes. Many, if not all, of medical texts described the sperm as “the one that makes it all happen” (Martin, 496). We would expect scientific journals to present information as objectively as possible, yet we see medical texts favoring and emphasizing the various ways in which “sperm, despite their small size, can be made to loom in importance over the egg” (Martin, 491). Scientific papers classify menstruation as “the death of tissue…a chaotic disintegration of form…a failure” (Martin, 487) and the female as “unproductive” and “degenerating” (Martin, 488) since she ceases to produce eggs after birth. The male body, on the other hand, is celebrated since it continues to produce sperm from puberty throughout life.

The image above, unlike depictions of the egg in medical texts, does not necessarily portray the women as being the passive “Damsel in Distress” awaiting rescue. If this were the case, I believe the image would have shown two housewives or helpless women tied onto some rusty railroad tracks. Instead, the women are portrayed as businesswomen – that is, women who have been given more active roles (in a traditional sense. The same has happened with the onset of new research and evidence showing the egg as being more active and the sperm as more of a “receptor” (Martin, 496).  Although such evidence has forced scientists to give “the egg an active role, that role is drawn in stereotypically feminine terms” (Martin, 496-497). This situation is reflected in the image above, which bluntly states that “women [are] like men, only cheaper”. Such a statement contains a deliberate choice of words to send the message across that women are like men, that they can attempt to be like men but will never be accepted as their equals. Just like the egg is being given a larger, more active role, women are given the chance to pursue careers that were once deemed to be strictly for males. However, this new active role given associated with the egg comes with its own disadvantages, much in the same way that these women pursuing these “male” careers are being given much lower wages.  

The image that I have included in this analysis illustrates the harsh reality that we may be unable to see past our cultural lens when viewing the objective facts that science has to offer. Rayna Rapp, in her piece called “Accounting for Amniocentesis”, also states that “bounded representations of biological and social bodies are deeply linked to nature/culture oppositions in the history of Western thought” (Rapp, 60). We accept science as being objective, yet “science itself can be viewed as constructed by social and cultural processes” (Rapp, 63). Is this perhaps the reason why we find it so difficult to separate cultural imagery with biological science?

Towards the very bottom of the image are the words: “If you don’t like it, help us right it”. Such a statement indicates that there are people and organizations working fighting for the end of gender discrimination. In a similar sense, we have scholars like Emily Martin, who suggest that “waking up [sleeping metaphors in science], by becoming aware of when we are projecting cultural imagery onto what we study, will improve our ability to investigate and understand nature…will rob them of their power to naturalize our social conventions about gender” (Martin, 501). Both the articles of Martin and Rapp as well as the image provided in this analysis are proof that we are in need of change. If we are to learn more and better understand ourselves, we must first be aware of the various lenses through which we view our world and be careful in merging matters of nature with social and cultural constructions.