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Since the introduction of the Improving Access to Psychological Therapies (IAPT) programme in NHS England, psychological therapy has gained traction as 'evidence-based' and 'effective' in both clinical and economic terms. In the process, psychotherapeutic care has been reconstituted as highly manualised, standardised, and quantifiable. Drawing on anthropological fieldwork with mental health practitioners, this paper examines some common tensions that practitioners experience in their daily work where psychotherapy is sought within the framework of evidence-based medicine (EBM). For therapists working within IAPT, extensive monitoring and practices of accountability have come to undermine psychotherapeutic efforts to care for patients as 'people'. As a result, many practitioners now feel that they are working in a 'factory of therapy' whereby psychological treatment is recast in the service of outcome measures, and by which critique of the IAPT service, as well as caring relations within it, have been precluded. [ABSTRACT FROM AUTHOR]

Organ donation is constructed in the UK as a public responsibility, but more particularly as an obligation for members of minority ethnic communities. This paper draws attention to the ways in which ‘ethnicity’ has been made problematic by the allocation practices of transplant medicine, health promotion discourses and policy developments. Taken together, they have served to culturalise and racialise the procurement of organs. As the problem of organ donation is as much made inside medicine as outside it, this paper argues greater attention ought to be paid to these institutional practices and processes. Drawing on ethnographic work in the north of England, and with a specific focus on the organ consent encounter, this paper shows how categories of ethnicity in organ transplantation are an outcome of biopolitical and institutional practices. It argues that organ donation is best thought of, less as a discrete temporally-bounded act of decision-making, and more as a set of variegated situated practices that, in all manner of ways, problematically produce the publics that transplant medicine has come to rely upon so profoundly. [ABSTRACT FROM PUBLISHER]

This paper draws from two years of fieldwork investigating the social course of illness among Pakistani Muslims in East London, exploring how chronic illness is communicated and negotiated in local worlds disrupted by migrancy. It examines episodic short stories about dreams, premonitions and uncanny coincidences that were prominent within the illness narratives of migrant Pakistani Muslims, recalling and throwing light on complex questions concerning subjective constructions of misfortune, the personal and social meanings of illness and the relationships between narrative and selfhood. The ethnography identifies a strong normative context of communication about ill health and bad news, within which revelation through the mode of the supernatural takes on added significance. Recurrent motifs in the dreams emphasize the connectedness between family members scattered across migratory contexts, and the reawakening of moral obligations in families. Whilst medical anthropology has understood descriptions of dreams and other uncanny experiences as 'subjunctivising tactics' serving to maintain alternative plots about the source and outcome of illness, in the Islamic context the narrating of supernatural encounters can have transformative effects, re-organising praxis and conferring legitimacy to certain forms of moral selfhood. The paper therefore argues that the notion of the 'subjunctive mode' imposes the analysts' own system of logic and that there is a need to understand the interpretive frameworks present in the illness narratives in their own terms. [ABSTRACT FROM AUTHOR]

The Bangladeshi diaspora in East London exists in a rapidly changing social geography. Drawing on fieldwork conducted with Bangladeshi mothers in East London over a period of 18 months (2003-2004), this paper explores the different ways in which becoming a mother is conceptualised, and examines the cultural claims that mothers make through their narratives of motherhood. The research focuses on health and motherhood because they are important points where personal experience, social institutions and notions of 'culture' all intersect. Through examination of the different sources of information these women used to build their narratives, debates around ethnicity and class are brought into sharper focus, as are the potential challenges in providing services to mothers that successfully deal with both with diversity and social inequality. In investigating the complexity and possible contradictions within personal narrative, this paper also highlights some of the practical challenges involved in providing services for diverse populations in a manner that recognises difference at both a community and an individual level. Finally, by utilising biographical research more fully, this paper argues that it is possible to investigate critically the role of ethnicity in the provision of services more generally. [ABSTRACT FROM AUTHOR]

Hoarding has become increasingly prominent in clinical practice and popular culture in recent years, giving rise to extensive research and commentary. Critical responses in the social sciences have criticised the cultural assumptions built in to the construct of 'hoarding disorder' and expressed fears that it may generate stigma outweighing its benefits; however, few of these studies have engaged directly with 'hoarders' themselves. This paper reports on in-depth, semi-structured interviews with 10 individuals living in England, who received assessment and intervention for hoarding from Social Services. Their narratives drew on the cultural repertoire of values and discourses around waste and worth, the mediation of sociality and relationships through material objects, physical constraints on keeping order and the role played by mental health. Analysing these perspectives anthropologically shows how dominant models of hoarding, such as the DSM-5 paradigm, potentially lend themselves to reductionist understandings that efface the meaning 'hoarding' may have and thereby deny agency to the person labelled as 'hoarder'. More culturally informed analysis, by contrast, affords insights into the complex landscape of value, waste, social critique, emotion, interpersonal relationships and practical difficulties that may underlie hoarding cases, and points the way to more person-centred practice and analysis. [ABSTRACT FROM AUTHOR]

This paper focuses on the diversity in patients' experience of biomedicine and contrasts it with the normative view characteristic of health professionals. Ethnographic fieldwork among Polish migrant women in London, Barcelona and Berlin included interviews about their experiences with local healthcare and health professionals. Themes drawn from the narratives are differences between the cities in terms of communication between patients and health professionals, respect for patients' choices and dignity, attitudes to pregnancy and birth (different levels of medicalization), and paediatric care. It is argued that patients continuously negotiate among their own views and expectations based on previous experiences and knowledge from personal communication; internet forums and publications; and the offer of medical services in the countries of their settlement. Patients experience pluralism of therapeutic traditions within and outside bio-medicine. In turn, representatives of bio-medicine are rarely aware of other medical practices and beliefs and this leads to various misunderstandings. By highlighting the pluralism of medical practices in European countries and the increasing mobility of patients, this case study has useful implications for medical anthropologists and health professionals in a broader Western context, such as raising sensitivity to different communication strategies and a diversity of curing traditions and expectations. [ABSTRACT FROM AUTHOR]

Ethnography is increasingly being used in the evaluation of quality improvement and change initiatives in healthcare settings, particularly in the form of 'focused' and 'rapid' ethnographies. This new ethnographic genre is tailored to suit narrower enquiries within clinical pathways. However, the application of ethnography to the evaluation of quality improvement is not straightforward or free from reductionist bias, particularly in hospital settings where interventions take place during a limited period of time and instigate change in busy and sensitive settings. This paper discusses problems and emergent solutions involved in conducting an ethnographic process evaluation of co-design projects in lung cancer and intensive care unit services in two hospitals in England. The mixed-methods ethnographic evaluation consisted of observations of the co-design process and triangulation of findings with interviews, questionnaires, participant reflective diaries and service improvement logs. Limitations of observational time and distance from 'the field' were overcome by making most of the pre- and post-event observational periods, situating quality improvement within the wider context of clinical practice, achieving attunement with local clinical cultures and engaging participants in collaboratively guiding observational and interview design. This approach led to a focused ethnographic evaluation that accommodated ethnographic principles to obtain rich insights into quality improvement processes despite the limitations of short-timeframes and the hospital setting. [ABSTRACT FROM AUTHOR]

This paper describes the appearance and subsequent disappearance of ‘Barrow Man’ and uses anthropological and social psychological theory to examine the socio-cultural, psychological and economic conditions for the existence of the phenomenon. It argues that these conditions were the result of both specific local labour market circumstances and of the effects of global political changes, and argues that to talk about ‘Barrow Man’ as if it was a psychiatric diagnosis was to identify a moral construct as a mental disorder. It also argues that at the same time the phenomenon was expressive of certain core values that were not readily acknowledged in everyday clinical practice and that it might therefore best be understood as an institutional category. [ABSTRACT FROM PUBLISHER]

In England, health inequalities policy shifted during the Labour term (1997–2010) from initially strong commitments to tackling the ‘upstream’ social determinants of health to a technically-driven emphasis on lifestyle risk factors and healthcare access. This multi-sited study, based in and around Westminster (2006–2007), extends our understanding of how political context influences policy-making by drawing from anthropological studies of policy. Qualitative material from central government is put into conversation with theory concerning policy as zones of practices. The paper explores the bristly process through which public health, healthcare and corporate interests vied to shape the political agenda for health inequalities; the selective use of evidence by civil servants in accordance with their perceptions of what politicians conceive to be electorally palatable; the silencing of critique of the dominant narrative about evidence-based policy; and how technical aids developed a life of their own – as a result of which, health inequalities policy ended up being depoliticised. [ABSTRACT FROM PUBLISHER]

This paper looks at the role of Bangladeshi families in the provision of care and help seeking: the burden on family members but also their presumed role in the causation of illness. It deploys data deriving from an interview study examining understandings and health-related practices among British Bangladeshis with mental and physical illness and their carers. While families generally support the mentally ill, the emotional and physical burden on them can be extensive. Conflicts between individuals may result in accusations of sorcery, especially when envy is suspected. Regular travel betweendeshandbideshattempts to maintain family unity and continues traditional understandings of serious sickness and disability. [ABSTRACT FROM AUTHOR]

An interview study of 44 Bangladeshi patients and relatives in eastern London demonstrated frequent appeals to God and deprecation of personal agency. This paper offers an interpretation of this apparent ‘fatalism’, which argues for the logical downplaying of human agency and ambition in archaic Arabia, contemporary rural Sylhet and among first generation Sylheti migrants in London. [ABSTRACT FROM PUBLISHER]

By often taking as its focus the experience of illness in itself, medical anthropology has sometimes neglected the meanings that patients may assign to the diagnostic procedures that they are expected to undergo. This paper puts into anthropological perspective the author's experiences working as an assistant psychologist in two British memory clinics for the detection and treatment of dementia, using comments by patients to illustrate the significance that one aspect of these procedures - cognitive testing - had for them. These comments suggest that the meanings that patients construct with regard to such testing are complex and cannot be understood if one persists in seeing it as a neutral diagnostic tool without broader implications. It is argued that a strong association made by many patients between the cognitive tests and their childhood school experiences informs their reactions for better or worse. It is important to acknowledge the implications of this active interpretation of medical procedures if the memory clinic experience is not to become an alienating and infantilising one. [ABSTRACT FROM AUTHOR]

This paper is a study of blind people's 'body image'. Starting with the hypothesis that-without mirrors for visual surveillance-blind people's sense of their bodies and selves are 'embodied' (focused on corporeal experience rather than on appearance), this article examines what blind people know about their bodies, how they imagine their bodies, how their identities relate to their blindness, and how they experience their bodies. From interviews with 13 blind people in England (one adult woman, nine female adolescents, and three male adolescents), several conclusions are drawn about each of the above areas of enquiry (knowledge, self-image, identity, and experience). The most significant result to emerge is a refutation of the initial hypothesis: blind people are by and large quite concerned with their appearance (they are extremely self-conscious) and place very little emphasis on their corporeal experiences. [ABSTRACT FROM AUTHOR]

This paper examines the supernatural beliefs of najar (evil eye) and bhut (ghost) and their roles in illness causation in Gujarati families in Britain today. The data arose unexpectedly in an ethnography of child rearing patterns carried out in Harrow, North West London and a short period of observation in Ahmedabad, India. I used anthropological methods of participant observation and unstructured interviews, which were transcribed using pseudonyms. The study group involved 70 Hindu and Jain Gujarati households with children and the fieldwork was conducted over a period of four years. Many of the individuals studied had migrated from India to East Africa before coming to the UK in the 1970s, but maintain links with both countries through kinship ties, marriage and rituals. I set out to study the continuity of women's roles in the transmission of religious and moral values, the rituals of childhood, views about infant feeding, and parenting relationships within joint families. The beliefs of najar and bhut in poor, rural settings in India have been described, but these Gujarati beliefs in Britain have not been well documented. This study indicates that najar and bhut continue to be a concern of women in most Gujarati families in Britain today and across all socio-economic groups, not confined to those on the 'bread-line', as have been previously suggested. These beliefs align themselves with Hindu ideas of the soul and reincarnation: powerful forces residing outside the body. An understanding of these beliefs could be informative to health professionals working with Gujarati communities in the UK. [ABSTRACT FROM AUTHOR]

The article provides information on the medical course, which is the Master of Science in Intercultural Therapy, offered at the University College London in England. This three-year part-time degree has been run since 1990 in association with the Nafsiyat Intercultural Therapy Center. Lectures in medical anthropology, ethnic relations, social policy and psychodynamic psychotherapy are complemented by tutorials, a once-weekly experiential group and individual psychotherapy supervision.

An interview study of 44 Bangladeshi patients and relatives in London demonstrated simultaneous trust in psychiatrists as well as in the widespread use of healing amulets. At the same time, local Islamic clerics and traditional healers were seen by many with some degree of suspicion. The authors offer an interpretation in which local healers and their methods are regarded ambivalently: the more distant biomedical framework fits with the newer modernising ‘High’ Islam (literate, scripturalist, puritanical, unitarian, urban, clerical, perhaps masculinist), as opposed to Hindu-inflected traditional Sufi Islam in Bangladesh (peasant, popular, syncretic, saintly, magical, ecstatic and possibly more sympathetic to women's experience). [ABSTRACT FROM PUBLISHER]

It has been argued that norms of occupational health have weakened with diversification in the sex industry. We explore this issue in walk-in flats in London, focusing on relationships between managers (maids) and sex workers. Today, most maids are local and most sex workers are ‘migrants’. We collected data on 117 maids and sex workers, and carried out intensive fieldwork with seven maids and 17 sex workers. Managers take prime responsibility for educating and inducting new workers. Authoritarian management has been considered bad for health both in these walk-in flats and in the ‘100 per cent condom use programme’ criticized by sex workers’ projects. Yet, we found that maids acted as friends and managers, which helped settle new sex workers. Over time, however, migrants were more affected by issues of isolation and exploitation than local workers. Alternative models of health promotion such as peer education must be seen in a wider legal context where the lack of rights makes it difficult to appeal against exploitation, or to become mobile. [ABSTRACT FROM AUTHOR]

Informants’ accounts of what they did with ashes they had chosen to remove from UK crematoria described disposal and memorialization strategies that have implications for anthropological understanding of issues of well-being, and the generation of new ritual practices. Here we aim to explore informants’ conceptions of how well-being might be restored after a bereavement and how these were being put into practice. Data were gathered as part of an Economic and Social Research Council (ESRC) funded project, which used qualitative interviewing and focus groups among professionals involved with independent ash disposal; and individuals who had removed the ashes of relative or friend from a crematorium. Barking and Dagenham, Nottingham, Sunderland and Glasgow were our field sites. Analysis involved recognizing these data as ‘motivated narratives’ (Bury 2001) that, for example, extended informants’ relationships with the dead, as well as reflecting tensions between professionals’ imperatives to complete work with a client and their commitment to offering individual choice and support during their ongoing relationship with the dead. Such findings highlight the contested nature of contemporary conceptions of restorative ritual, with tensions existing between the meta-narratives of individual choice and professional expertise; between different individuals’ ‘choices’; and between the event of a death ritual and the process of ritualization. These findings contribute a nuanced account of the diversity of discursive practices through which the individuals, both ‘lay’ and professional, involved in a particular death, might understand how well-being can be restored. [ABSTRACT FROM AUTHOR]

Cultural pluralism that characterises many major urban centres, especially London, underscores needs for research in cultural psychiatry to identify distinctive needs for mental health services and clinical treatment. Such questions motivated development of this study of the cultural experience and meaning of depression amongst white Britons in London, involving development of a British EMIC interview for depression by adapting an earlier version of the EMIC used in Bangalore, India. Steps in the process involved historical and ethnographic study of depression, and extensive pilot testing. This report focuses on the experience of depression with reference to patterns of distress and its meaning with reference to perceived causes. A wide range of contradictory, overlapping and linked explanations, consistent with reports from previous studies of Indian and other non-Western cultures, were notable among white Britons, whose illness concepts are likely to appear as diverse and inconsistent to an outside observer as findings from research in South Asia may be for a Western medical anthropologist. Furthermore, somatic idioms of depression, although not spontaneously reported, were frequently reported when specifically probed, raising questions about the distinctiveness of depressive and somatoform disorders as discrete diagnostic headings. The range of perceived causes are reviewed, considering the relationship between coded categories and narrative accounts that specify the interrelationship of categories in a causal web. The discussion considers the utility of the EMIC for cultural study and reflections on methodological issues arising in its adaptation and use that may help other researchers wishing to apply the framework and use the tools of cultural epidemiology. [ABSTRACT FROM AUTHOR]

The article reports on the medical anthropology courses offered at University College London (UCL) in London, England. The courses taught as a regular component of undergraduate and postgraduate program. The masters in science students in medical anthropology at UCL have their own tutorials and workshop and a special weekly public seminar.