Ayahuasca's entwined efficacy: An ethnographic study of ritual healing from 'addiction'.

BACKGROUND: A 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. METHODS: This 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. RESULTS: Ayahuasca'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. CONCLUSION: The 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.

[Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil]. / Entre saúde e aprimoramento: a engenharia do corpo por meio de cirurgias plásticas e terapias hormonais no Brasil.

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.

Entre saúde e aprimoramento: a engenharia do corpo por meio de cirurgias plásticas e terapias hormonais no Brasil / Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil

Resumo Este estudo explora as margens da medicina, em que práticas de saúde e aprimoramento se confundem. Ele é baseado no trabalho de campo desenvolvido no contexto de dois projetos de pesquisa distintos no Brasil sobre cirurgia plástica e terapias de hormônio sexual. Há uma significativa sobreposição clínica dessas duas terapias. Ambas estão disponíveis nos sistemas de saúde público e privado de tal forma que revelam a dinâmica de classes subjacente à medicina brasileira. Essas terapias também têm uma dimensão experimental enraizada no contexto normativo do Brasil e nas expectativas da sociedade em relação à medicina como forma de controlar a saúde reprodutiva e sexual da mulher. O uso medicinal experimental desses tratamentos está associado a um uso experimental “social”: as mulheres os adotam em resposta a pressões, ansiedades e aspirações no âmbito profissional e na vida pessoal. Argumenta-se aqui que essas técnicas experimentais estão se tornando moralmente autorizadas como um controle rotineiro da saúde da mulher, integradas aos tratamentos predominantes de obstetrícia e ginecologia, e sutilmente confundidas com práticas de cuidados pessoais que são vistas no Brasil como essenciais para atingir uma forma de feminilidade moderna.

Abstract 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.

Sensorial pedagogies, hungry fat cells and the limits of nutritional health education.

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.

Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil.

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.

"The same thing in a different box": similarity and difference in pharmaceutical sex hormone consumption and marketing.

The contraceptive pill has given way to a multitude of products, kinds of packaging, and modes of administration. This article draws on work on the pharmaceutical copy, extending the analysis to differentiating between forms of administration for contraceptive medicines as well as between brand-name drugs, generics, and similares, as they are known in Brazil. It explores how Brazilian prescribers and users-within the divergent structural constraints afforded by private and public health-apprehend and negotiate distinctions between the drugs available to them. This ethnographic account of hormone use reveals new fault lines through which the pharmakon exerts its influence. The attention that industry places on pharmacodynamics as it produces new products from similar compounds suggests that pharmaceutical effects are at once symbolic and real. The article concludes with a reflection on the future of the generic form in a field increasingly crowded by branded copies.