International audienc

BackgroundA range of studies has demonstrated the efficacy of the psychoactive Amazonian brew ayahuasca in addressing substance addiction. These have revealed that physiological and psychological mechanisms are deeply enmeshed. This article focuses on how interactive ritual contexts support the healing effort. The study of psychedelic-assisted treatments for addiction has much to gain from ethnographic analyses of healing experiences within the particular ecologies of use and care, where these interventions are rendered efficacious.MethodsThis is an ethnographically grounded, qualitative analysis of addiction-recovery experiences within ayahuasca rituals. It draws on long-term fieldwork and participant observation in ayahuasca communities, and in-depth, semi-structured interviews of participants with histories of substance misuse.ResultsAyahuasca’s efficacy in the treatment of addiction blends somatic, symbolic and collective dimensions. The layering of these effects, and the direction given to them through ritual, circumscribes the experience and provides tools to render it meaningful. Prevailing modes of evaluation are ill suited to account for the particular material and semiotic efficacy of complex interventions such as ayahuasca healing for addiction. The article argues that practices of care characteristic of the ritual spaces in which ayahuasca is collectively consumed, play a key therapeutic role.ConclusionThe ritual use of ayahuasca stands in strong contrast to hegemonic understandings of addiction, paving new ground between the overstated difference between community and pharmacological interventions. The article concludes that fluid, adaptable forms of caregiving play a key role in the success of addiction recovery and that feeling part of a community has an important therapeutic potential.

Sex hormones in Brazil are mobilised as modes of regulatory control and to discipline subjectivites. Their packaging effectively differentiates between two forms of citizenship. The first, available to those with private health, is founded on notions of personal autonomy, individual choice and self-enhancement, while the second frames decisions in terms of the individual's moral responsibility to the wider collectivity. Here, technical and biomedical interventions on middle-class bodies have personalising tendencies, while those effected on the bodies of the urban poor can be read as modes of inclusion through standardisation. Personalisation, in the Brazilian sense, concerns the attribution of privileges which place a person above the undifferentiated mass of individuals. The paper critically engages with approaches to bio-citizenships developed in contexts where biological inclusion is predicated on patient activism and shows how, in Brazil, complying with medical regimes is an integral part of constituting oneself as a citizen

This article examines what is said to be un/known about obesity and the ways in which attributions of knowledge or ignorance circulate in the field of public health nutrition. Risks caused by individual behaviors have been an overstated concern in public health. Obesity, like many of today's complex problems, is determined by myriad nested interactions spanning the political economies of market regulation, modes of agricultural production, the biochemistry of appetite regulation, and changing family structures. Yet public intervention—and the science produced to validate it—remains wedded to a mode of intervening that has limited purchase on the complexity with which it contends. This article draws on scholarship on the social construction of ignorance to argue that the field of evidence in obesity science is fashioned in a way that deflects attention (and responsibility) away from questions of food production and marketing and continues to frame the problem as one of individual responsibility. Rather than discrediting the veracity of evidence produced out of industry‐research partnerships that increasingly dominate public health research, this article examines how the field of evidence has been structured by these relations. It argues that the demonstration of causal relations between political and socioeconomic determinants of malnutrition and measurable health indexes is largely impossible, not simply because of the absence of good evidence but because the existing parameters of good science cannot straightforwardly reveal such relations. This, in turn, is due to the configuration of the knowable in terms of whether knowledge can be made operational.

International audienc

This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazil's regulatory context and societal expectations placed on medicine as a means for managing women's reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of women's health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.

This article focuses on blood donation as a form of bloodletting in a context where donation is commonly seen to alleviate the symptoms of `thick blood'. It deals with the gendered aspects of blood donation, and the parallels drawn between donating blood and menstruating. Women are seen not to need to donate blood as much as men, who, in the absence of menstruation, are more prone to thick blood and require a means to expunge the ensuing excess. While blood donation professionals strive to reconstruct donation as a selfless and ungendered act, counterposing the `facts' of arterial blood circulation to local blood-lore and beliefs, lay understandings challenge this construction in the use they make of blood donation centres or by reiterating the personalistic and gendered dimensions of donation. The article explores cases of patients who use hormonal contraceptives which suppress menstruation and express concerns over the resulting accumulation of blood in the body. It considers how blood donation is adopted by some women as a means of dispelling both the perceived inconveniences of menstrual bleeding and its swelling effects. Such literalized engagements with medical technologies reveal a conception of the body as a permeable, malleable and recipient-like enclosure. These views are often characterized as `ignorance' by medical practitioners, where ignorance is seen to derive not only from the absence of knowledge, but from the presence of the wrong kind of knowledge.

This article examines the way the category of 'the sensorial' is mobilised across obesity research and care practices for overweight persons in France. The 'natural' body is understood to have developed mechanisms that motivate eaters to seek out energy-dense foods, a hardwiring that is maladaptive in today's plethoric food environment. The article analyses the feedback models mobilised in scientific literature on the neuroendocrine processes regulating appetite. The analysis of how 'the sensorial' is studied and used to treat patients provides a vantage point onto the ways foods and bodies transform each other. Recent findings show that fat cells influence metabolism by secreting hormones, revealing that eaters are affected by the materiality of the foods they ingest. 'The sensorial' functions as a regulator in the feedback mechanisms where social norms regulating foodscapes become enfolded in the molecular processes that control appetite regulation. The article traces the work that the category of 'the sensorial' does as it flows through the loops and feedbacks between scientific evidence, policy and care. It examines the way pleasure and the sensations of eaters are increasingly foregrounded in French nutritional health promotion strategies in a context where informing eaters is increasingly deemed ineffective.