Thesis Grief, corporality and violence: An Anthropological critique of biopsychiatric approaches to Chronic Fatigue Syndrome, 2023, Becerra Castro

Via: Dr. Marc-Alexander Fluks

Source: Rovira i Virgili University Date: July 7, 2023 URL: https://www.tdx.cat/handle/10803/688850

https://www.tdx.cat/bitstream/handle/10803/688850/TESI Jenny Paola Becerra Castro.pdf

Grief, corporality and violence: An Anthropological critique of biopsychiatric approaches to Chronic Fatigue Syndrome [Spanish]
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Jenny Paola Becerra Castro - Departament d'Antropologia, Filosofia, Universitat Rovira i Virgili, Tarragona, Spain

Abstract

This doctoral thesis aimed to problematize the suitability of the dominant medical approach in chronic fatigue syndrome (CFS/ME).

It investigated the impact of its practices and violence-generating ideas through the analysis of medical discourse and the narratives of distress among patients.

It also delved into the narratives of distress and corporeality, detailing the types of violence, affected needs, and suffered harm.

Additionally, the role of alternative medicines in the case of CFS/ME was contextualized.

To achieve this, in-depth interviews and digital focus groups were conducted with diagnosed individuals or those who identified with this diagnosis.

Autoethnographic analyses were also employed, and informal holistic doctors and therapists were interviewed.

A framework of interpretative phenomenology set the entire process, and Galtung's theory of violence was used as a reference to understand the manifestations of violence.

Ultimately, the coding resulted in six macrocategories: types of experienced violence, experiences with healthcare professionals, somatic, mental, and spiritual effects, experiences with loved ones, experiences and expectations with alternative and complementary medicines, and manifestations of resistance.

It was demonstrated that all individual needs were affected by violence, expressed culturally, structurally, and directly through minimizations, epistemic violence, gaslighting, and other actions associated with the stigma and discrediting of the illness.

Regarding alternative medicines, it is concluded that they also emerge as a displacement resulting from institutional medical abandonment.

 

Nice cover picture: The Nightmare by Henry Fuseli - but which one is the patient ?

 

I like the way this thesis approaches the mistreatment of PWME as violence.

It meshes well with ethological concepts of aggression as a contest for control. The very topic Stephen Hawking advised us to understand better before his death, which I noted because it was also the subject I studied as a young zoologist with a deep fascination with animal behaviour, avidly reading the books of Lorenz and other ethologists including the aptly named "On Aggression".

The zoological perspective suggests that organisms compete for resources and have evolved to be aggressive where it is evolutionarily advantageous. This includes predator prey interactions but also intraspecific competition, which is another big problem humanity needs to face.

The archetype of two stags fighting in the rut, as studied in red deer by Clutton-Brock, epitomises the struggle between two individuals of the same species and gender for control of a resource, in this case opportunities to reproduce. The zoological theory is that aggression exacts a cost in terms of counter aggression and is not indulged in by social animals without a calculation of risks. This is why the stag who loses runs away to fight another day and is not chased by the victor, for fear of unnecessary injury and to reserve strength to face other contenders.

This kind of example is the tip of the iceberg in relation to competition between social animals and the beginning of a long pilgrimage to understand the nature of status in human society which involves complex status heirarchies, involving ongoing contests and microaggressions which people take for granted but which establish a basis for authority and keep a balance of power between healthy individuals who can fight to defend themselves, which prevents all out combat, most of the time. The civil detente which allows the rule of law is founded on a balance of equal but potentially opposing powers.

Consequently PWME who are weak because of their illness, cannot balance the contest for power the pax humanis is based on, as they cannot make social signals advertising strength, they dont have any, their immune system prohibits using stress hormones to prepare the body to fight, because stress hormones suppress the immune system, so they appear weak and to those who compete for their survival in habitually and unconsciously aggressive professions, this inspires aggression in the estimation that there can be no risk of repercussion, because their opponent cannot fight back.

I think "violence" is a very appropriate word and concept to study in relation to the treatment of ME patients.

 

I broadly agree with the idea, but not on the specifics of stress hormones and immune system.

We're more often the victims of aggression because we can't fight back. The PACE trial was a form of aggression because it attempted to tell a false narrative that would benefit professionals at the expense of patients. when patients were able to fight back, this must have caused confusion and triggered a sense of entitlement.

 

Not able to read Spanish I can't fairly comment on the thesis but I don't I warm to this type of approach and while no doubt it is legitimate within its academic boundary, to me its unhelpful in terms of advocacy. Structural Violence theory ends up making a victim of everybody except healthy, wealthy white men and in so doing falls into the morass that is intersectionality where people are valued by the multiplicity and grades of their oppression achieving a contradiction in that what is supposed to create commonality arrives at the exact opposite - futile for effective advocacy.

On the point re: Lorenz, ethnology and aggression - Lorenz has been critiqued perhaps to oblivion, not least by Richard Dawkins. Additionally there are issues of the aggression theory being based on very inadequate zoology, in the specific case of ungulate mate choice we have the image of two alpha/beta males contesting for unfettered breeding access a passive female 'harem'. There are a range of breeding strategies amongst ungulates but the passivity of females is likely in most cases to be falsely construed, for example: Mismatch between calf paternity and observed copulations between male and female reindeer: multiple mating in a polygynous ungulate?