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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]

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]

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]