Psychobiographical reflections on Viktor von Weizsäcker within the cultural framework of salutogenesis and medical anthropology.

This article explores the life of Viktor von Weizsäcker (VvW, 1886-1957), a German medical doctor, philosopher and founder of the Heidelberg School of Anthropological Medicine, from a psychobiographical and salutogenic perspective. The authors use salutogenesis and sense of coherence (SOC), and take crucial cultural, historical, and socio-structural frameworks into account to explore the life during the 19th and 20th Centuries in Germany. They present the exploration of a strong SOC in the life of VvW and show how SOC is created within the tight family bonds of the family clan, which has produced many extraordinary theologists, philosophers, scientists and politicians over six generations. In a complex, interconnected and holistic way, SOC is evident in von VvW's individual life, and is also shown to be a family resource. This article contributes to psychobiography in three ways: it develops the salutogenetic perspective in psychobiography, explores the life of VvW within a specific sociocultural context, and investigates the life from a salutogenetic and socio-cultural perspective. Finally, conclusions are drawn, and recommendations for theory and practice are given.

Becoming a (Neuro)migrant: Haitian Migration, Translation and Subjectivation in Santiago, Chile.

Based on a multi-sited ethnography conducted over 14 months in northern Santiago, I examine how the introduction of a series of health policies and the global mental health agenda has interacted with and impacted Haitian migrants in the context of a postdictatorship neoliberal Chile (1990-2019). Specifically, I explore the interactions between health and social institutions, mental health practitioners, psy technologies, and Haitian migrants, highlighting migrants' subjectivation processes and everyday life. I argue that Haitian migrants engage with heterogeneous subjectivation processes in their interactions with health and social institutions, challenging normative values of integration into Chilean society. These processes are marked not only by the presence of, or exposure to, psy interventions and mental health discourses but also by the degree of compatibility between a psychiatric and neurological language and Haitians' ideals and moral frameworks.

Relational Harm: On the Divisive Effects of Global Health Volunteering at a Hospital in Rural Zambia.

Drawing on ethnographic research at a hospital in rural Zambia, I show how the presence of white Christian medical volunteers from the United States damaged relations between local health workers and patients. Working from a position of economic and racial privilege, medical volunteers received praise from many patients and residents. However, these positive attitudes incited resentment among many Zambian health workers who felt that their own efforts and expertise were being undervalued or ignored. Focusing on these disrupted relationships, I argue that it is crucial to understand how global health volunteering can produce enduring forms of "relational harm".

Expanding Medical Semiotics.

This special issue explores the evolving landscape of medical semiotics of conventional biomedicine. With expansion we refer to the range of phenomena considered signs or symptoms of underlying disease, but also the growing anthropological attention to the medical sign system in ways which reach beyond classic semiotic analysis. The articles testify to the expansion in terms of empirical foci and theoretical contributions. As part of the introduction, we discuss three modes of reading symptoms within medical anthropology: the hermeneutic, material, and critical readings, all highlighting the crucial role of medical anthropology in understanding the biosocial and cultural dimensions of medical semiotics.

Tackling the Unknown: Medical Semiotics of Inflammation and their Legal-Epistemological Boundaries in Brazil.

Do different medico-scientific understandings of autoimmune inflammation, whose carriers disobediently promote the therapeutic use of immunostimulants, have the potential to destabilize the hegemony of the standard palliative treatment based on immunosuppression? Here I explore whether and how medical paradigms in Brazil develop and expand around immunopathologies through practices of exclusion and inclusion in the context of global circulation of knowledges, therapies, and regulatory frameworks. While focusing on concurrent immunotherapeutic models within biomedicine, I discuss aspects of legal-epistemological frictions that animate controversies in which distinct ways of co-producing medical evidence affect and are affected by the biomedical establishment.

Testing Care and Morality: Everyday Testing During COVID-19 in Denmark.

COVID-testing was central to control the spread of infection in Denmark. Drawing on ethnographic fieldwork, we show that testing was not just a diagnostic sign; it was also a biosocial practice that enacted a public health morality, centered on responsibility, care, and belonging. We argue that testing led to a public healthicization of everyday life, as it moralized individual and collective behavior and created a moral divide between the tested and the untested. By attending to COVID-19 testing as a material-semiotic sign, we show how testing is embedded within a particular cultural and moral framework of the Danish welfare state.

Crafting Ethnographic Relationships During the COVID-19 Pandemic in Germany Using Voice-Based Technologies.

Drawing on a two-year ethnography of care practices during the COVID-19 pandemic in Germany, we discuss the affordances of voice-based technologies (smartphones, basic mobile phones, and landline telephones) in collecting ethnographic data and crafting relationships with participants. We illustrate how such technologies allowed us to move with participants, eased data collection through the social expectations around their use, and reoriented our attention to the multiple qualities of sound. Adapting research on the performativity of technology, we argue that voice-based technologies integrated us into participants' everyday lives while also maintaining physical distance in times of infectious sociality.

Challenging NHS Corporate Mentality: Hospital-Management and Bureaucracy in London's Pandemic.

Whilst NHS Health Service management is usually characterized by hierarchized bureaucracy and profit-driven competitiveness, the COVID-19 pandemic drastically disrupted these ways of working and allowed London-based non-clinical management to experience their roles otherwise. This paper is based on 35 interviews with senior non-clinical management at a London-based NHS Trust during 'Alpha phase' of Britain's pandemic response (May-August 2020), an oft-overlooked group in the literature. I will draw upon Graeber's theory of "total bureaucratization" to argue that though the increasing neo-liberalization of the health-services has hitherto contributed toward a corporate mentality, the pandemic gave managers a chance to experience more collaboration and freedom than usual, which ultimately led to more effective realization of decision-making and change. The pandemic has shown NHS managers that there are alternatives to neoliberal logics of competition and hierarchy, and that those alternatives actually result in happier and effectively, more capable staff.

Uncertainty Work: Dealing with a Psychiatric Crisis in Two European Community Mental Health Teams.

The quest for how to deal with a crisis in a community setting, with the aim of deinstitutionalizing mental health care, and reducing hospitalization and coercion, is important. In this article, we argue that to understand how this can be done, we need to shift the attention from acute moments to daily uncertainty work conducted in community mental health teams. By drawing on an empirical ethics approach, we contrast the modes of caring of two teams in Utrecht and Trieste. Our analysis shows how temporality structures, such as watchful waiting, are important in dealing with the uncertainty of a crisis.

Making It Count - Tracing Signs of Consciousness and Potentiality in Severe Brain Injury in Denmark.

Healthcare professionals use various technologies to evaluate and support patients who have suffered severe brain injuries. They integrate monitoring and sensory assessments into their clinical practice, and these assessments can have an impact on treatment decisions and prognostication. Responses from patients during different interactions are interpreted as "signs of consciousness" when considered contextually relevant. This study is based on anthropological fieldwork conducted in specialized Danish intensive care units, where we explore how signs of consciousness are made to count through practices of enactment. We ethnographically trace how the clinical concept of potential influences the interpretation of signs of consciousness as a complex biosocial practice based on the biomedical assumption that consciousness is a vital indicator of what makes a life. The article provides insights into the potential for recovery as an emergent biosocial practice and contributes to a broader discussion within medical anthropology of the moral landscapes of clinical and experimental borderlands.

"Beautiful Registrations": Metrics and Prenatal Care in Rural Bahia, Brazil.

In Brazil, lack of quality in the delivery of prenatal care is a persistent concern. In this study, I analyze the dynamics taking place in the prenatal clinical encounter, and illuminate how the requirement to produce metrics through registration and monitoring endorses a form of bureaucratic care. This form of care develops in a context characterized by scarcity and a lack of medical resources, where healthcare professionals attempt to contain uncertainty. Ruled by notions of risk, centered in measuring practices, and saturated by an overvaluation of technology, bureaucratic care reinforces the disenfranchizement and stigmatization of Black rural women.

The Multispecies Sociality of Digestion and the Microbiopolitics of the Belly Among Somalis in Ethiopia.

Management of what Somalis call "dacar" - translated as digestive bile, bitterness, aloe, and masses of tiny beings in the gut - is key to popular health cultures and ethnophysiologies in eastern Ethiopia. Managing bodily dacar requires cultivating multispecies sociality and flows of life between humans, vegetation that nourishes livestock, and animals that produce milk consumed for therapeutic and nutritional properties. Transcending Western scientific conceptualizations of the "gut microbiome" and the instrumentalization of microbes to improve human health, Somalis' gut epistemologies and concept of dacar provide an ecological perspective on the co-constructed, mutable, and multispecies nature of digestion and life itself.

Ineffective responses to unlikely outbreaks: Hypothesis building in newly-emerging infectious disease outbreaks.

Over the last 30 years, there has been significant investment in research and infrastructure aimed at mitigating the threat of newly emerging infectious diseases (NEID). Core epidemiological processes, such as outbreak investigations, however, have received little attention and have proceeded largely unchecked and unimproved. Using ethnographic material from an investigation into a cryptic encephalitis outbreak in the Brong-Ahafo Region of Ghana in 2010-2013, in this paper we trace processes of hypothesis building and their relationship to the organizational structures of the response. We demonstrate how commonly recurring features of NEID investigations produce selective pressures in hypothesis building that favor iterations of pre-existing "exciting" hypotheses and inhibit the pursuit of alternative hypotheses, regardless of relative likelihood. These findings contribute to the growing anthropological and science and technology studies (STS) literature on the epistemic communities that coalesce around suspected NEID outbreaks and highlight an urgent need for greater scrutiny of core epidemiological processes.

Signs of Nothing: Negotiations Over Semiotic Indeterminacy in Danish Lung Cancer Diagnostics.

In Denmark, injunctions of "early" cancer diagnosis increasingly imply surveillance of small tissue changes, which may or may not develop into cancer. Based on fieldwork at diagnostic lung cancer clinics and with people in CT surveillance for tissue changes, I explore how detected tissue changes are ascribed meaning as signs of "nothing" or "something." Inspired by Peircean semiotics, I suggest that the semiotic indeterminacy of tissue changes points to how diagnostic socialities both expand medical semiotics and enable this expansion. The article, thereby, contributes to understandings of signs as diagnostic infrastructures.

Understanding Gut Sensations: Irritable Bowel Syndrome and Diagnostic Fluidity in Danish Clinical Practice.

Irritable bowel syndrome (IBS) is a prevalent health challenge in a Danish welfare context. Drawing on ethnographic fieldwork at two Danish gastroenterology clinics, and inspired by Charles E. Rosenberg's idea of styles of explaining widespread diseases, we outline three styles of understanding and treating gut trouble in daily clinical work: "The microbial gut," "the mindful gut," and "the lifestyled gut." Moreover, we suggest the concept of fluidity to characterize IBS as a diagnostic category that allows clinicians and patients to operate through complex understandings of permeable boundaries between body, mind, and environment to negotiate personalized solutions for embodied gut sensations.

Turning Towards the Affective: Medical Semiotics of Child Maltreatment in Denmark.

Signs of child maltreatment may be physical and detectable by clinical examination but may also arise as a feeling of strangeness that sparks uncertainty. Based on fieldwork in Danish general practice, and thinking along recent discussions around semiotics and affect, the article explores how feelings of "strangeness" arise in child consultations. It focuses on how subjective, embodied, and interpersonal reactions arise, how signs, however tactile and arbitrary, are felt and experienced, and how engaging with affective aspects when doing diagnosis, could expand the medical semiotics of child maltreatment.

Technologies of care and the engineering imaginary: Two approaches to assistive device design for the Global South.

Assistive devices serve as vectors for the ideals, judgments, and goals that their society of origin has towards people with disabilities. For some Ugandan inventors and prosthetists, familiarity with sociocultural norms and consistent feedback allow them to design prosthetic limbs as technologies of care that specifically meet the needs of Ugandans using these devices. In contrast, many biomedical engineers living in the United States rely on what I call the "engineering imaginary" to produce universalized forms of assistive technology intended for people living in an essentialized Global South. Drawing on research with engineers, prosthetists, and people living with limb loss in Uganda and the United States, I investigate the social and cultural aspects of prosthetic limb design and argue that there is a cross-cultural mismatch about what a prosthetic device does and what kinds of limbs it should fit. This mismatch becomes inscribed in the prosthetic device itself.

Failing kidneys: Hotspots, blind spots and biopolitics of indifference.

Chronic kidney disease of non-traditional cause (CKDnt) is commonly associated with monocropping agriculture, heat stress and impoverished working conditions, referred to as CKDnt "hotspots." The condition is also emerging in various sites of environmental contamination, raising questions as to whether multiple variants of the condition exist as a result of different ecologies and different human-environment interactions. This paper examines the emergence of CKDnt around Lake Chapala in Mexico, where we document local efforts to gain recognition and reparation for CKDnt. We follow the ways patients, families and activists have mobilized specific and interlocking infrastructural failures to enact complaint and confront state inaction and neglect of their bodies, communities, and environments. Though their labors have formally achieved little, we discuss how they make visible a biopolitics of indifference, one bound to the production of structural "blindspots."