Reader in Medical Anthropology, London School of Hygiene and Tropical Medicine
Cohn’s research to date has focused on issues related to diagnosis, contested conditions and chronic illness in the UK and other high-income societies. With a strong commitment to contemporary social theory, he is interested in how innovative social science might provide both critical insight and influence in aspects of contemporary biomedical practice.
A more recent research interest is the role of fluids, both inside and outside the body: how they relate to health, their general absence in medical anthropology and sociology accounts, and the extent to which their constant movement and flow might demand a new way to think about old problems. Work on blood & blood donation, the withdrawing of fluids at the end of life, and a new project on urinary incontinence are serving as introductory cases to think with.
Capturing disease and the politics of discriminating
This talk will propose that diagnostic practices are as much about ‘containing’ as they are about ‘identifying’. The practices of diagnosis do not simply uncover disease, but actively make them present. By this, I am not simply referring to the social and cultural meanings that may be ascribed, but the very material ways in which ill health is delineated and acted upon to bring it in to the world as a discrete entity. But diagnostic practices are straining to preserve clear distinctions and territories; the idea that specific diseases have their own unique aetiology, distinctive pattern of symptoms and differential procedures increasingly feels at odds with a world of complexity, flux and instability.
To highlight this tension, and suggest it is likely to be an increasing feature of biomedical practice, I will draw on the apparently mundane example of multimorbidity, which is said to be when two or more long-term disorders are present in parallel. Associated with an aging population, the growing prevalence of multimorbidity is often presented as an emerging challenge to the appropriate provision of services and a major burden for healthcare in the future. In some instances, various conditions are thought to be causally intertwined, leading experts to suggest that in combination they should be thought of as constituting an umbrella syndrome. But on other occasions, although the conditions appear to have some kind of affinity for each other, there appears to be no biological rationale why they occur in combination at all.
This paper will highlight the kinds of biomedical work done to maintain the discrete nature of individual conditions in such situations, how diagnostic capture restricts as much as it reveals, and how tenable it is to maintain this logic in our contemporary world. Complementing the imperative that anthropologists should document local variation and the multiplicity of individual conditions, I will highlight the centripetal forces that have the potential to blur disease boundaries and perhaps even undermine the single-disease paradigm of biomedicine that has been so crucial to its history.
Professor of Victoria University of Wellington, New Zealand
Annemarie Jutel has written widely about diagnosis, including contested diagnoses, diagnostic roles, self-diagnosis and more. A professor at Victoria University of Wellington, her current interest is in how trans-disciplinary understandings of diagnosis provide critical distance for understanding how classification in general, and diagnosis in particular, serve to shape contemporary understandings of health, illness and disease. Her book, “Putting a Name to It: Diagnosis in Contemporary Society” was published by Johns Hopkins University Press and provided the first ccomprehensive framework for this emerging sub-discipline of sociology of diagnosis. She has also co-edited a textbook on diagnosis geared towards introducing cultural and sociology concepts to students and professionals in clinical practice entitled “Social Issues in Diagnosis” (also by JHUP).
Diagnosis, culture and society
Putting a name to a disease has an impact often more powerful than the ailment itself. Despite its important role in medicine--diagnosis explains symptoms, determines what treatment should be implemented, and gives a sense of what the future holds--learning about a serious diagnosis can also be profoundly disruptive. Simply receiving the name of a disease can turn things upside-down, dividing life into "before" and "after", and calling into question everything one previously took for granted. This disruption is often attributed to psychology, yet the social and cultural contexts of both the patient and the clinician play a possibly even greater role. Both popular culture and medicine recognise the life-altering potential of the diagnostic moment. Not only is it the topic of medical articles, it features in novels, poetry and movies; it leads to bucket lists, religious conversions and even greeting cards. In this presentation I will show popular representations of the diagnostic moment in view of developing a deeper understanding of the social context of diagnosis. By showing how this has been portrayed in historical, literary, and popular sources, I will reveal how diagnostic disclosure constructs and promotes the medical profession as a source of authority, but also of tension. Further, I will demonstrate how a transdisciplinary and transhistorical approach to studying the diagnostic moment brings social patterns and practices into stark relief.