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Clinical Ethnography: Ethnographic Approaches to Health Experiences Research. This chapter introduces ethnographic (participant observation) approaches to study of health experiences. Ethnographers studying health experiences immerse themselves in sociocultural contexts of illness and treatment for prolonged fieldwork periods to collect descriptive data and form an understanding of local culture and embodied experience. They pay close attention to insiders’ views in natural contexts and go for a depth of understanding rather than large sample sizes. This chapter discusses the origins of ethnography in the anthropological study of small scale societies and the subsequent application of the approach in hospitals and other medical settings. The chapter will discuss strengths of the approach (e.g. that it takes into account what people do as well as what they say and allows us to discover new information) as well as limitations (e.g. that it is time consuming and requires a special personal commitment by the researcher).

The early 21st century has seen a resurgence in the performance of exorcism in the Catholic Church.  Exorcism is a solemn rite that must be performed by a priest with the express consent of the bishop with jurisdiction in the area where the exorcism takes place.  Both a form of healing for afflicted individuals and a discourse on evil at large in the contemporary world, exorcism lies at the intersection of therapy and cosmology in the world's largest religious institution.  Its social and cultural significance is therefore worthy of analysis. This chapter takes a step in that direction through consideration of ethnographic material from exorcists, mental health professionals who assist and consult with them, and the afflicted people who seek their help.

Turning to practices of persuasion as techniques of governance, Chapter 4, Mistaken by Design: Biopolitics in Practice, examines how RHI addresses rural publics in the Upper East region. Through an ethnography of public health educational film screenings, I try to understand how RHI’s work is persuasive even though it eschews translation and mobilizes misrepresentations. Rather than interpreting these as indicators of a lack of knowledge or tying them to failure, I suggest that they constitute deliberate, tactical refusals of translation. Medical anthropologists tend to emphasize and critique what is said in public health and development interventions, and how it is said, but I want suggest that what is done and how power is materialized matters much more. My analysis of the place of knowledge in NGO interventions shows that NGOs like RHI know how to make knowledge matter, but also recognize that more than knowledge is needed for the production of authority. Claims about the harms of cutting become “true” when presented in visual spectacles that materialize governmental power and set the conditions and constraints on which knowledge about reproduction, health, and society is socially productive.

The introduction lays out what we know about the social context of schizophrenia from the epidemiological literature: that risk of schizophrenia is particularly high for immigrants from predominantly dark-skinned countries to Europe; that risk increases with lower socioeconomic status at birth and even at parent’s birth; that risk increases with urban dwelling and seems to increase the longer time is spent in cities; that risk increases as ethnic density in the neighborhood declines. The chapter presents a history of the way schizophrenia has been understood in the United States, and the diagnostic complexities of serious psychotic disorder. It then discusses what ethnographers have observed so far about the social conditions which may shape the experience of psychosis: the local cultural interpretation of mental illness; the role and presence of the family; the structure of work; and the basic social environment. This becomes the ground for our case studies.

This paper examines key institutional and economic forces driving the rapid extension of the use of Western models of diagnosing and treating mental illness into all corners of the developing world. It examines the ways that problems in the American psychiatric research system, notably, ethnocentric biases and untoward economic influences, appear to be mirrored in the emerging international system, and how these may undercut the promised benefits of expanded mental health care to communities across the globe. It approaches these issues by examining the changing treatment of socio-cultural issues in the Diagnostic and Statistical Manual of Mental Disorders [DSM] and the International Classification of Diseases [ICD]. While identifying persisting problems in the main body of the DSM-V, the paper notes the significant progress in thinking about the socio-cultural dimensions of mental health represented in the Cultural Formulation Interview included in the appendix of the work. Drawing on research from cultural and multi-cultural psychology, cultural psychiatry, and medical anthropology, the paper maps several out possible steps for establishing more responsive and well-grounded mental health practices to serve diverse communities within the United States and across the world.

Dominant conceptions of sleep have changed over time, and so have American understandings of the normal, the ideal, the disorderly, and pathological. These changes are the result of scientific, medical, and popular forces: the identification of circadian rhythms that govern feelings of alertness and sleepiness, the nosological definition of various pathological forms of sleep, and commercial and media representations of sleep have all collaborated in altering how sleep is conceived. These are all changes that have occurred since the 1880s and been dependent upon social formations and cultural expectations from early colonial America through the Industrial Revolution. How Americans sleep now is tied to these historical forces and human physiology.

Ernesto de Martino (1908–65) could be described as one of the founding figures of Italian ethnology. Until his work was translated into English, he was fairly unknown to English-speaking anthropologists. Since then, however, the importance of his contributions to the field has received wider recognition. In the book Terra del Rimorso: Contributo a una storia religiosa del Sud (The Land of Remorse: A Study of Southern Italian Tarantism), de Martino unravels how alterity may be found “at home,” through a study in the southern peninsula of Salento of rural people seasonally affected by tarantismo, a form of possession attributed to the bite of the tarantola spider.¹ The affliction is cured by the performance of “choreutic” dances followed by pilgrimages and offerings made to Saint Paul. For de Martino, tarantismo is the living presence of an other-than-Catholic history—an echo of earlier pagan, erotic ritual forms. Tarantism can be understood only when placed within the context of Catholicism’s regional history, its broader social and economic conflicts, and tensions around gender, kinship, and sexuality within the home. The cult is one that the Catholic Church has “purged” but also resignified and appropriated in an effort to contain its vitality. As de Martino shows, however, the church’s engagement with the cult in the first half of the twentieth century colludes with scientific and medical—particularly psychiatric—discourses. The relevance of this work for a modern anthropology of Catholicism is plain in its historical breadth and the richness and detail of de Martino’s ethnographic research. But it is also interesting for the way it highlights how questions of science, magic, and enchantment have posed challenges of different types for the modernizing, bureaucratic church.

I begin by describing the contemporary situation of sleep medicine – its rise since the 1970s and the forces behind it. I also describe the sleep clinic where I conducted my fieldwork. I argue that the basis for sleep medicine – and American medicine generally – is not knowledge, but doubt.

Based on the contemporary sleep clinic, I focus on the roles of doubt and certainty in medical practice, particularly in a series of cases presented by physicians to other physicians and the discussions that ensue, as well as media focused on the promotion of sleep as an explanatory device for understanding individual and social disorder.

This chapter discusses how narcolepsy has become the model for contemporary American sleep, and examines two narcolepsy drugs – Xyrem and Provigil – to show how, increasingly, Americans are being driven to use chemicals to promote alertness and induce sleepiness.

Counter to many expectations that we would adopt a 24 hour society, I discuss herein the ways that the American work day has remained steadfastly diurnal and the various global and local coordinations that have occurred to allow this – including workplace napping.

This chapter focuses on the experiences of disordered sleepers and their families, and I present a series of cases of individuals and families who identify as specific kinds of disordered sleepers – narcoleptics, insomniacs, sleep apnics, and so on, to discuss the emergence of new desires for sleep.

What compels us to want to not sleep? I introduce cases of perpetual sleeplessness to challenge this imagined posthuman future of sleep, attempts to break records to stay awake, science fictional representations of experiments to eradicate sleep, and scientific attempts to reduce or dramatically alter our sleep.

This chapter focuses on contemporary politics around time and its use in American society; I focus primarily on the Take Back Your Time movement and the rearrangement of school start times to allow students to get more sleep throughout the school week.

This chapter traces the history of the use of the sleepwalking defense in the U.S. and its roots in conceptions of desire and nature. I follow this discussion by focusing on the invention of drowsy driving laws at the turn of the 21st century, laws that explicitly recognize the effects associated with ongoing sleep deprivation.

This chapter takes the concerns of how sleep makes us human into stranger realms – extreme sports, military research, and adventurous science. At once, the very basis of sleep is being tested in these situations, while sleep’s potentialities are being isolated.

I trace discussions of sleep from early colonial America through the scientific efforts in the first half of the 20th century, focused on American idioms of sleep – which highlight concerns with efficiency and productivity. That sleep is known through its metaphors compounds the doubts that motivate clinical practice.