In Excess of Medicine: Pleasure and Politics in Venezuelan Health Care
Leading Latin America’s democratic turn to the left since the early 2000s, Venezuela has instituted social welfare programs that promise to end poverty and encourage democratic participation. Government programs offering free medical services have flourished, transforming access to health care for poor Venezuelans. For the past nine years, I have used ethnographic methods to study these changes from the perspective of the urban poor in Caracas.
Venezuelan public health programs are politically polarizing and fraught with controversy, yet participants express an excitement in accessing health care that exceeds the satisfaction we might expect from having one’s medical needs met. In my book, I answer a question that has puzzled me since the first day of fieldwork: Why do people express so much pleasure in going to the doctor? What do public health programs offer Venezuelans, in excess of medicine?
In Excess of Medicine: Pleasure and Politics in Venezuelan Health Care examines key sites in central Caracas where people sought “health” during a bonanza of government medical reforms. The book describes intimate doctor-patient consultations, dance parties for aging adults, earnest training sessions for clinic volunteers, and frustrated homeless outreach efforts. In this detailed ethnographic account, In Excess of Medicine documents the emergence of an emphatically pro-poor medical system that, responding to local desires for a caring form of biomedicine, framed health care as a technology of dignity and social justice. Participants expected public health programs to do more than cure disease — they saw participation as empowering them by offering valued forms of sociopolitical recognition. In spite of their problems, government health projects elicited excitement and pleasure because they identified marginalized Venezuelans as bodies who mattered. This research shows that health is not a value-neutral measure of bodily function, but a political and aesthetic experience of belonging in the world.
As the first in-depth analysis of health reform in Chávez’s Venezuela, this book offers a uniquely personalized account of people’s struggles for social justice via health care. It intervenes in the field of global health by arguing that medicine represents much more than a technical fix for physical ills. Health care systems are value-laden cultural productions that people evaluate in terms of historically informed expectations and desires. These findings have important implications for assessing the achievements of health interventions across cultural and political contexts. In Excess of Medicine also signals a paradigmatic shift within the field of medical anthropology by establishing the value of studying pleasure with the same seriousness of purpose as we study suffering.
Chapter 1. Moving medicine “inside the barrio”
Chapter 2. The doctor’s political body
Chapter 3. Navigating the health landscape
Chapter 4. Pleasures of participation
Chapter 5. The limits of citizenship
ADHD and Stimulant Use
ADHD is one of the most commonly diagnosed mental health problems in North America, affecting both children and adults, yet much remains unknown about how an ADHD diagnosis and symptoms of the disorder shape people’s lives across the life course. Furthermore, although diagnostic practices and personal experiences of ADHD are strongly shaped by social and cultural forces, relatively few studies have considered ADHD and stimulant use from an ethnographic perspective. In Fall 2014, I began a collaborative ethnographic research project that includes anthropology undergraduate student researchers to conduct participant observation and interviews with young adults on topics related to ADHD and stimulant medications. Our goal is to better understand how young adults understand and experience ADHD and stimulant use in their daily lives. The study will focus on cultural constructions of the disorder among the campus community, everyday life with ADHD, illness-related stigma, notions of disability and enhancement, and the ways in which students use and conceptualize stimulant medication. This collaborative research project will allow undergraduates to contribute to all stages of the research process, including applying research findings in educational and other interventions related to mental health on campus.
An article based on this research has been accepted for publication in the journal Ethos.
Homelessness and Mental Health
Between 2004 and 2006, I conducted ethnographic research on experiences of homelessness and mental illness in Chicago, as part of an NIH-funded research team led by anthropologist Tanya Luhrmann (Stanford). For this group ethnography, team members learned about psychiatric interviewing (using the SCID, Structured Clinical Interview for DSM-IV) and participated in ongoing collaborative ethnographic analysis. During this period, I conducted participant observation and interviews in a drop-in center for homeless women in the Chicago neighborhood of Uptown. Based on this research, I published an article in the journal Culture, Medicine, and Psychiatry that analyzes the importance of institutional time schedules in women’s experiences of homelessness. I continue to explore the unintended effects of social services on unhoused persons in my ongoing research on health care in Venezuela, where part of my research focused on a new government program to rehabilitate indigentes (“indigent people”).
Psychiatry and the Stigma of Mental Illness
Between 2001 and 2005, I worked with various mental health research groups to better understand psychiatric services and stigma in North America, focusing on institutions, patients, and psychiatrists in the Midwest. Projects included an NIMH-funded study of ADHD symptoms in children, psychiatric services program evaluations for the State of Illinois, and survey research on the relationship between stigmatizing persons with mental illness and care-seeking behaviors. This research has been published in The Journal of Nervous and Mental Disease and Psychiatric Services. My current teaching and research draws on this diversity of research experiences in mental health, which includes two years of coursework in clinical psychology and work as a diagnostic interview intern for the psychiatry outpatient clinic in Cook County Hospital (Stroger) in Chicago. I am particularly invested in incorporating anthropological methods and perspectives into research on psychiatric practices and experiences of mental health and illness.