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Drawing on a SARS-CoV-2 vaccine trial in a Latinx community in San Diego, we show how trial designs fail to redress structural racism and may introduce new harms. While important, trial diversity alone cannot redress entrenched inequities that affect Black, Indigenous, and People of Color (BIPOC) communities.

This project reveals how focusing on race in the formal medical school curriculum is inadequate because so much of medical school is informally thought outside of curriculum. These aspects of the hidden curriculum are not being addressed by proposed curricular changes through programs such as PRIME. Even when the medical curriculum does address race, it does so in ways that reinforce racist ideas (race as a biological determinant of health). The lack of understanding of how racism is embedded in existing institutional structures, the history of medicine and medical racism, are not at all addressed. Further, the microaggressions experienced by students of color both inside and outside the classroom require deeper cultural transformation. This project also calls for the need for antiracist and social justice work to be truly collective, to be the responsibility of each and every medical professional, rather than the burden of a few. Rather than a “choice” or “option,” all students and staff must learn how to integrate knowledge of racism and colonialism in their training. Currently, the structure--which emphasizes individual volunteers to take on this work--causes certain students who take on this work and who encounter difficulties and resistances to blame themselves, while white students (or students not in the PRIME program) are able to overlook structural violence and other health determinants.

Drawing on the work of Ivan Illich, our special issue reanimates iatrogenesis as a vital concept for the social sciences of medicine. It calls for medicine to expand its engagement of the injustices that unfold from clinical processes, practices, and protocols into patient lifeworlds and subjectivities beyond the clinic. The capacious view of iatrogenesis revealed by this special issue collection affords fuller and more heterogeneous insights on iatrogenesis that does not limit it to medical explanations alone, nor locate harm in singular points in time. These papers attend to iatrogenesis' immediate and lingering presences in socialities and structures within and beyond medicine, and the ways it reflects or reproduces the racism, sexism, and ableism built into medical logics.

Drawing on the work of Ivan Illich, our special issue reanimates iatrogenesis as a vital concept for the social sciences of medicine. It calls for medicine to expand its engagement of the injustices that unfold from clinical processes, practices, and protocols into patient lifeworlds and subjectivities beyond the clinic. The capacious view of iatrogenesis revealed by this special issue collection affords fuller and more heterogeneous insights on iatrogenesis that does not limit it to medical explanations alone, nor locate harm in singular points in time. These papers attend to iatrogenesis' immediate and lingering presences in socialities and structures within and beyond medicine, and the ways it reflects or reproduces the racism, sexism, and ableism built into medical logics.

This project reveals how focusing on race in the formal medical school curriculum is inadequate because so much of medical school is informally thought outside of curriculum. These aspects of the hidden curriculum are not being addressed by proposed curricular changes through programs such as PRIME. Even when the medical curriculum does address race, it does so in ways that reinforce racist ideas (race as a biological determinant of health). The lack of understanding of how racism is embedded in existing institutional structures, the history of medicine and medical racism, are not at all addressed. Further, the microaggressions experienced by students of color both inside and outside the classroom require deeper cultural transformation. This project also calls for the need for antiracist and social justice work to be truly collective, to be the responsibility of each and every medical professional, rather than the burden of a few. Rather than a “choice” or “option,” all students and staff must learn how to integrate knowledge of racism and colonialism in their training. Currently, the structure--which emphasizes individual volunteers to take on this work--causes certain students who take on this work and who encounter difficulties and resistances to blame themselves, while white students (or students not in the PRIME program) are able to overlook structural violence and other health determinants.

Drawing on the work of Ivan Illich, our special issue reanimates iatrogenesis as a vital concept for the social sciences of medicine. It calls for medicine to expand its engagement of the injustices that unfold from clinical processes, practices, and protocols into patient lifeworlds and subjectivities beyond the clinic. The capacious view of iatrogenesis revealed by this special issue collection affords fuller and more heterogeneous insights on iatrogenesis that does not limit it to medical explanations alone, nor locate harm in singular points in time. These papers attend to iatrogenesis' immediate and lingering presences in socialities and structures within and beyond medicine, and the ways it reflects or reproduces the racism, sexism, and ableism built into medical logics.

ObjectiveThe engagement of peers and service users is increasingly emphasized in mental health clinical, educational, and research activities. A core means of engagement is via the sharing of recovery narratives, through which service users present their personal history of moving from psychiatric disability to recovery. We critically examine the range of contexts and purposes for which recovery narratives are elicited in global mental health.MethodWe present 4 case studies that represent the variability in recovery narrative elicitation, purpose, and geography: a mental health Gap Action Programme clinician training program in Nepal, an inpatient clinical service in Indian-controlled Kashmir, a recovery-oriented care program in urban Australia, and an undergraduate education program in the rural United States. In each case study, we explore the context, purpose, process of elicitation, content, and implications of incorporating recovery narratives.ResultsWithin each context, organizations engaging service users had a specific intention of what "recovery" should constitute. This was influenced by the anticipated audience for the recovery stories. These expectations influenced the types of service users included, narrative content, and training provided for service users to prepare and share narratives. Our cases illustrate the benefit of these coconstructed narratives and potential negative impacts on service users in some contexts, especially when used as a prerequisite for accessing or being discharged from clinical care.Conclusions and implications for practiceRecovery narratives have the potential to be used productively across purposes and contexts when there is adequate identification of and responses to potential risks and challenges. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

In recent years, the Movement for Global Mental Health (MGMH) and the World Health Organization have worked closely with governments across the global South to redress major treatment gaps to improve access to mental health services. In India, recent reforms include transforming public psychiatric institutions from sites of treatment to research and training institutes, known as "Centres of Excellence," to combat acute manpower shortages and modernize psychiatry. Drawing on ethnographic fieldwork at a public psychiatric hospital in Srinagar, Kashmir, one of the institutions selected to be a future "Centre of Excellence," this article focuses on how these reforms have affected psychiatric institutions themselves. Efforts at modernizing and increasing access to mental health care-that is, emphasizing shortened stays, increasing outpatient treatment, and providing care in the "community"-depend on quarantining stigmatized, chronically ill, long-term patients who reside in custodial conditions with fewer resources and limited attention from providers. Psychiatrists have a radically different vision for redressing manpower shortages than the MGMH and Indian state, revealing contradictions in the reform process. This paper demonstrates how modernizing mental health care splits mental institutions spatially, ontologically, temporally, and epistemologically, so that the process of modernizing the institution is neither seamless nor complete.

In recent years, the Movement for Global Mental Health (MGMH) and the World Health Organization have worked closely with governments across the global South to redress major treatment gaps to improve access to mental health services. In India, recent reforms include transforming public psychiatric institutions from sites of treatment to research and training institutes, known as "Centres of Excellence," to combat acute manpower shortages and modernize psychiatry. Drawing on ethnographic fieldwork at a public psychiatric hospital in Srinagar, Kashmir, one of the institutions selected to be a future "Centre of Excellence," this article focuses on how these reforms have affected psychiatric institutions themselves. Efforts at modernizing and increasing access to mental health care-that is, emphasizing shortened stays, increasing outpatient treatment, and providing care in the "community"-depend on quarantining stigmatized, chronically ill, long-term patients who reside in custodial conditions with fewer resources and limited attention from providers. Psychiatrists have a radically different vision for redressing manpower shortages than the MGMH and Indian state, revealing contradictions in the reform process. This paper demonstrates how modernizing mental health care splits mental institutions spatially, ontologically, temporally, and epistemologically, so that the process of modernizing the institution is neither seamless nor complete.

In recent years, the Movement for Global Mental Health (MGMH) and the World Health Organization have worked closely with governments across the global South to redress major treatment gaps to improve access to mental health services. In India, recent reforms include transforming public psychiatric institutions from sites of treatment to research and training institutes, known as "Centres of Excellence," to combat acute manpower shortages and modernize psychiatry. Drawing on ethnographic fieldwork at a public psychiatric hospital in Srinagar, Kashmir, one of the institutions selected to be a future "Centre of Excellence," this article focuses on how these reforms have affected psychiatric institutions themselves. Efforts at modernizing and increasing access to mental health care-that is, emphasizing shortened stays, increasing outpatient treatment, and providing care in the "community"-depend on quarantining stigmatized, chronically ill, long-term patients who reside in custodial conditions with fewer resources and limited attention from providers. Psychiatrists have a radically different vision for redressing manpower shortages than the MGMH and Indian state, revealing contradictions in the reform process. This paper demonstrates how modernizing mental health care splits mental institutions spatially, ontologically, temporally, and epistemologically, so that the process of modernizing the institution is neither seamless nor complete.

In this article, we trace encounters between humans and phantasmic entities in hospitals in Indian-occupied and Pakistan-controlled Kashmir. In Pakistan, the presence of spectral beings (jinni) in hospitals is linked to state and sectarian violence, which precipitates ruptures between jinni and human worlds. Such breaches permit jinni to manifest in the medical present, where insecure actors harness them to ventriloquize unspoken anxieties. In Indian-occupied Kashmir, jinn-like, chronically mentally ill patients haunt psychiatric modernization projects. In embracing a jinneaological approach to medical crises, we theorize hospitals as multi-temporal and multi-dimensional spaces called "tesseracts," in which human-nonhuman encounters serve existential and political purposes.

In this article, we trace encounters between humans and phantasmic entities in hospitals in Indian-occupied and Pakistan-controlled Kashmir. In Pakistan, the presence of spectral beings (jinni) in hospitals is linked to state and sectarian violence, which precipitates ruptures between jinni and human worlds. Such breaches permit jinni to manifest in the medical present, where insecure actors harness them to ventriloquize unspoken anxieties. In Indian-occupied Kashmir, jinn-like, chronically mentally ill patients haunt psychiatric modernization projects. In embracing a jinneaological approach to medical crises, we theorize hospitals as multi-temporal and multi-dimensional spaces called "tesseracts," in which human-nonhuman encounters serve existential and political purposes.