Care or Complicity? Medical Personnel in Prisons.

Imprisonment may sometimes be a justified form of punishment. Yet the U.S. carceral system suffers from appalling problems of justice-in who is put into prisons, in how imprisoned people are treated, and in downstream personal and community health impacts. Medical personnel working in prisons and jails take on risky work for highly vulnerable and underserved patients. They are to be lauded for their professional commitments. Yet at the same time, prison care undercuts the ability of medical personnel to uphold their own professional standards and sometimes fails in even basic health protection. Doctors in prisons are stuck between their commitment to vulnerable patients and complicity in a system that requires their participation to uphold its constitutionality. Medical ethics is frayed in prisons, and the problem deserves our attention.

The real cause of our complicity: The preoccupation with human weakness.

Chater & Loewenstein offer an incisive criticism of how behavioral sciences and public policy have become complicit with corporations in blaming public health and societal problems on individual weaknesses, thus deflecting support away from systemic reforms. However, their analysis stops short of holding the field to account in one important respect: its preoccupation with human irrationality and weakness.

[Immune mechanisms of complicity of somatic pathology in the pathogenesis of mental disorders]. / Immunnye mekhanizmy souchastiya somaticheskoi patologii v patogeneze psikhicheskikh rasstroistv.

Understanding the mechanisms of the relationship between the nervous and immune systems within the framework of the concept of the key role of inflammation, taking into account the involved genetic factors in the development of a wide range of combined forms of somatic and mental diseases, is of interest for research as well as for the development of new approaches to early diagnosis and more effective treatment of these diseases. This review analyzes the immune mechanisms of the development of mental disorders in patients with somatic diseases, in particular, the transmission of an inflammatory signal from the periphery to the CNS and the implementation of the influence of inflammatory factors on neurochemical systems that determine the characteristics of mental functioning. Particular attention is paid to the processes underlying the disruption of the blood-brain barrier caused by peripheral inflammation. Modulation of neurotransmission, changes in neuroplasticity, changes in regional activity of the brain in areas associated with the functions of threat recognition, cognitive processes and memory function, the effect of cytokines on the hypothalamic-pituitary-adrenal system are considered as mechanisms of action of inflammatory factors in the brain. The need to take into account variations in the genes of pro-inflammatory cytokines, which may be the cause of increased genetic vulnerability associated with the risk mental disorders in patients suffering from a certain somatic disease, is emphasized.

Epithelial and stromal co-evolution and complicity in pancreatic cancer.

Pancreatic ductal adenocarcinomas are distinguished by their robust desmoplasia, or fibroinflammatory response. Dominated by non-malignant cells, the mutated epithelium must therefore combat, cooperate with or co-opt the surrounding cells and signalling processes in its microenvironment. It is proposed that an invasive pancreatic ductal adenocarcinoma represents the coordinated evolution of malignant and non-malignant cells and mechanisms that subvert and repurpose normal tissue composition, architecture and physiology to foster tumorigenesis. The complex kinetics and stepwise development of pancreatic cancer suggests that it is governed by a discrete set of organizing rules and principles, and repeated attempts to target specific components within the microenvironment reveal self-regulating mechanisms of resistance. The histopathological and genetic progression models of the transforming ductal epithelium must therefore be considered together with a programme of stromal progression to create a comprehensive picture of pancreatic cancer evolution. Understanding the underlying organizational logic of the tumour to anticipate and pre-empt the almost inevitable compensatory mechanisms will be essential to eradicate the disease.

Intervenções psicológicas necessárias: a prática como residente no serviço de medicina fetal / Necessary psychological interventions: the practice as a resident in the fetal medicine service / Intervenciones psicológicas necesarias: la práctica como residente en el servicio de medicina fetal

Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)

Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)

Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)

Percepções de mulheres companheiras de homens presos acerca da conjugalidade / Perceptions on conjugality of female partners of imprisoned men / Percepciones de mujeres parejas de hombres encarcelados acerca de la conyugalidad

Este estudo objetivou compreender a experiência de mulheres companheiras de homens privados de liberdade acerca da conjugalidade. Para tanto, realizou-se uma pesquisa qualitativa, em que participaram 12 mulheres companheiras de homens presos. Como instrumentos, utilizou-se um questionário de dados sociodemográficos e uma entrevista semiestruturada, a qual foi analisada por meio da Análise Temática. Os resultados encontrados demonstraram que as mulheres lançavam mão de diferentes estratégias para se manterem próximas de seus companheiros, engajando-se no tratamento penal deles, o que repercutiu em uma percepção de incremento da coesão conjugal. O compromisso assumido com seus relacionamentos mostrou-se relacionado, além do amor sentido pelos parceiros, a um desejo de manutenção do casamento e da família nuclear, além de evidenciar experiências de ciúme por parte dos homens. Dificuldades na comunicação, conflitos relacionados à insatisfação com o contexto prisional, além da falta de privacidade na intimidade e sexualidade do casal foram referidos pelas participantes.(AU)

This study aimed to understand the experience of conjugality of female partners of imprisoned men. Therefore, 12 female partners of imprisoned men participated in a qualitative study. The participants answered to a sociodemographic questionnaire and a semi-structured interview, which was analyzed via Thematic Analysis. The results showed that women used different strategies to stay close to their partners, engaging in their criminal treatment, which reflected in a perception of increased marital cohesion. The commitment to the relationship was related to the love felt towards the partners, the desire to maintain the marriage and the nuclear family, in addition to the experience of men's jealousy. Moreover, it was identified difficulties in communication, conflicts related to dissatisfaction with prison context, and lack of privacy related to couple's intimacy and sexuality.(AU)

Este estudio tuvo como objetivo comprender la experiencia de las mujeres parejas de hombres encarcelados sobre la conyugalidad. Para ello, se realizó una investigación cualitativa, en la cual participaron doce mujeres parejas de hombres encarcelados. El instrumento utilizado fue un cuestionario de datos sociodemográficos y una entrevista semiestructurada, la cual se aplicó el análisis temático. Los resultados encontrados demostraron que las mujeres usaban diferentes estrategias para mantenerse cerca de sus parejas, comprometiéndose en el tratamiento delictivo de ellos, lo que repercutió en una percepción de mayor cohesión marital. El compromiso asumido con sus relaciones se mostró relacionado, además del amor a los cónyuges, a un deseo de mantenimiento del matrimonio y del núcleo familiar, y reveló experiencias de celos por parte de los hombres. Las dificultades en la comunicación, los conflictos relacionados a la insatisfacción con el contexto carcelario, y la ausencia de privacidad en la intimidad y sexualidad de la pareja fueron mencionadas por las participantes.(AU)

Complicity: Methodologies of power, politics and the ethics of knowledge production.

In this collection we develop the concept of "complicity" as a means to understand how medical sociologists might be allied in unexpected or uncomfortable ways with dominant structures of power. After giving examples of complicity from our own research, we introduce existing scholarship on complicity, describing it as a concept that comes coupled with a sense of responsibility and that is related to, yet distinct from, a range of other terms including reflexivity, collusion, guilt, and shame. We also discuss how complicity has been described to occur at the level of the institution, within theoretical frameworks, and during mundane moments that we face on a day-to-day basis. Building on this review, we hypothesise that medical sociology - where access to fieldsites is often hard won, where "researching up" in medical and scientific institutions is common, and where our own work frequently concerns matters central to medical institutions themselves - is a discipline wherein mundane complicity is likely. Following this gathering exercise, we introduce the interventions that comprise this collection: interventions from a diversity of sociologists of health and illness who, perhaps for the first time in written form, account for how complicities of various kinds came to shape their work and how, with varying levels of success, they have sought redress. We close by offering some insight into the process of developing this collection, celebrating its successes while also acknowledging that many gaps and complicities remain.

Confronting the Medical Community's Complicity in Marginalizing Abortion Care.

This Viewpoint discusses the exclusion of abortion care from many established medical sources (such as hospitals) and from coverage by many major payers and how the health care system should legitimize and ensure clinician training in safe abortion care.

The challenge of institutionalised complicity: Researching the pharmaceutical industry in the era of impact and engagement.

The pharmaceutical industry plays a central role in the production of the drugs we use to treat most illnesses. It is immensely powerful and has received sustained attention from sociologists of health and illness, who have provided a critique of its influence and sometimes unethical behaviour. However, in recent years, funders are increasingly expecting researchers to engage and collaborate with stakeholders, including industry. This raises important questions about the institutionalisation of complicity and the different forms this might take. This article asks: How can sociologists engage with the pharmaceutical industry in a positive and constructive manner, whilst remaining independent, principled and critical? It will draw on my experience of establishing a major project on high-priced drugs for rare diseases and the literature on collaboration, stakeholder engagement and responsible research to propose a methodological framework to address this challenge. This is based on six PRIMES: (normative) Principles, Reflection and Independence, (field) Mapping, (careful) Engagement and Strategic intervention that have broad applications to many other areas of contemporary social science research.

Between Resistance and Complicity, the Australian Healthcare Community and 30 Years of Immigration Detention.

This year marks 30 years since Australia introduced its policy of mandatory, indefinite immigration detention. We provide an overview of these policies with a focus on the involvement of healthcare workers, both within centres and externally, protesting these policies. We discuss several lessons that can be learnt from Australia?s approach, namely that traditional approaches to health and healthcare have done little to address the suffering of those who are detained. We call for the healthcare community to consider their role in activism and in calling for the abolition of detention. These lessons sadly have increasing global relevance with several countries now seeking to emulate Australia?s cruelty.

The practice of participatory action research: Complicity, power and prestige in dialogue with the 'racialised mad'.

Mental health service users in the UK have become increasingly involved in research over the last 2 decades partly as a consequence of research governance. Ethnic minority service users, however, point to power imbalances stemming from marginalisation and discrimination creating barriers to knowledge co-production (Kalathil, J. (2013). Hard to reach? Racialised groups and mental health service user involvement.). Heavily influenced by Freire's liberatory education, participatory action research (PAR) repoliticises participation where those most affected by injustice are central in both producing knowledge about injustice and implementing solutions. Ethnic minority people with lived experience of 'severe mental illness' ('the racialised mad') were appointed as coresearchers to work with academic researchers on a qualitative study exploring ethnic inequalities in 'severe mental illness'. Drawing on Foucault's notion of power as relational, we focus on three key aspects of productive power: (1) relational engagement and reciprocity, (2) positioning coresearchers as authentic researchers and (3) adopting an ethic of care, to explore complicity and resistance in reproducing hierarchies of knowledge and power when attempting to create and sustain a PAR process for collective analysis, action and solidarity. We utilise retrospective and recorded reflections over the course of the project. Finally, we discuss the ethical and methodological implications for contemporary sociological research into health and illness.

Physician complicity in human rights violations: Involuntary sterilization among women from Mexico and Central America seeking asylum in the United States.

Involuntary sterilization is a violation of human rights and grounds for asylum in the United States. Forensic medical evaluations can be useful in documenting this form of persecution and supporting asylees' claims for immigration relief. We conducted a retrospective case analysis of the personal and medical affidavits of 14 asylum-seeking women from four Latin America countries who all reported they had been involuntarily sterilized. Sixty-four percent said that "consent" was coerced; the remainder were unaware of having been sterilized at the time of the procedure. In all cases, findings on hysterosalpingogram were consistent with sterilization, revealing that all 14 had undergone a tubal ligation. Eighty-six percent of the women had been sterilized at the time of childbirth. The healthcare providers involved in the 14 cases failed to obtain informed consent, misled patients about sterilization, engaged in discriminatory behavior, and/or breached patient confidentiality regarding their HIV-status. All 14 asylum cases were defensive; of the 7 cases (50%) that have been decided to date, 100% have been granted asylum.

Dealing with complicity in fieldwork: Reflections on studying genetic research in Pakistan.

Health-related ethnography undertaken in a context marked by social inequalities and colonial legacies requires critical attention to power imbalances in the fieldwork. In this paper, I draw on my own experiences from studying genetic research in Pakistan. As a Danish-born female researcher with roots in Pakistan, I have followed genetic researchers and families dealing with genetic conditions in Pakistan. Through examples I unearth how encounters in the field were shaped by complicities of being in-between the Danish and the Pakistani, of studying and doing international research at the same time, and of my inaction towards suffering families. I base my analysis on the notion that complicity manifests in a generative, and unavoidable, engagement with both complex structures of inequality and interlocutors. We can never fully understand the specificities or consequences of complicity-whether moral or epistemic-when entering, engaging with or representing our fields. However, by staying constructively with the tensions, instead of attempting to move beyond the discomfort that they might create, we can learn how to deal with the consequences and in that, build further the value of ethnographic activity.

Complicity in sociology and community-based participatory research with Marshallese.

Complicity with colonialism can be reflected in a particular approach to research, whose interests it serves, and who has power or ownership over the research process. It can also be reflected in neglect, inaction or methodological erasure of groups historically subjected to domination by colonial empires. Social scientists have often failed to account for colonialism's role or the complicit role they have played. We provide a brief historical overview of colonialism in the Marshall Islands and the role social scientists-and their methodological and epistemological approaches-played in the US empire's expansion into the region. We discuss the tenets of Community Based Participatory Research (CBPR), setting the research agenda, co-direction of the research process, research team membership, collaboration challenges, and the action and outputs which have come from our team's health disparities research among the largest Marshallese population in the continental US. We argue CBPR is a promising but imperfect approach to guarding against complicity within medical sociology and situate our methodological approach within ongoing debates regarding objectivity and advocacy within sociology. We reflect on successes and shortcomings of our CBPR efforts to address health disparities among Marshallese, as well as how those successes and shortcomings overlap with questions of complicity.

The impossibility of engaged research: Complicity and accountability between researchers, 'publics' and institutions.

Over the past decade, U.K. universities have increasingly sought to involve publics in research as active participants in the construction of academic knowledge. Sociologists of health have largely welcomed this enthusiasm for engaged and participatory ways of working, including methodologies long in use in the field such as patient-led research and co-creation. Despite the strong interest in engaged research, however, we argue that funding patterns, bureaucratic structures and an overreliance on people employed on casual contracts make it extremely difficult, often impossible, to do engaged research in British universities. Drawing on our own experiences, we show how our attempts to practise and deepen accountability to variously situated publics were constrained by the way our institution imagined and materially supported engagement. We argue that it falls to individual researchers to mitigate or work around structural barriers to engagement, and that this process creates dilemmas of complicity. If engaged research is to fulfil its remit for inclusion and its radical potential, researchers need to think carefully about how the U.K. engagement agenda entwines with processes of casualisation, acceleration and projectification, and how institutional recuperations of engagement can undermine its political and epistemic objectives.

Researching the health and social inequalities experienced by European Roma populations: Complicity, oppression and resistance.

This paper draws on the experience of two Romani and three non-Romani scholars in knowledge production on the health and social inequalities experienced by European Roma populations. Together, we explore how we might better account for, and work against, the complex web of dynamic oppressions embedded within processes of academic knowledge production. Our aim is to encourage careful scrutiny through which sociologists of health and illness might better recognise our own complicity with oppression and identify concrete actions towards transforming our research practices. Drawing on a well-known domains of racism typology (Annual Review of Public Health, 40, 2019, 105), we use examples from our own work to illustrate three interconnected domains of oppression in which we have found ourselves entangled (structural, cultural and interpersonal). A new conceptual framework is proposed as an aid to understanding the spectrum of different "types" of complicity (voluntary-involuntary, conscious-unconscious) that one might reproduce across all three domains. We conclude by exploring how sociologists of health and illness might promote a more actively anti-racist research agenda, identifying and challenging subtle, hidden and embedded negative ideologies and practices as well as more obviously oppressive ones. We hope these reflections will help revitalise important conversations.