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Program: State, Society, Stigma: Rethinking Disease in a Global Age Thursday 26 June 9-9.45 Welcome: Executive Director LIMS, Professor Nicholas

Hoogenraad Introduction: Tarryn Phillips, Ingrid Sykes,

9.45-10.45 Keynote 1 Stigma and Disease, Medicalization and Disease, Sonia Ryang, T.T. and W.F. Chao Professor of Asian Studies Director, Chao Center for Asian Studies, Rice University. In the current climate of medico-psychological global industry, stigma and medicalization have entered a paradoxical pact of being co-constructors of illness on one hand and mutually exclusive players on the other. The discussion will extend beyond the area of medicine to an analysis of historical values, political values and global capitalism.

10.45-11 Coffee

11-1pm Session 1 Stigma and Disease: Chair Ingrid Sykes Dilip Das (EFL University, Hyderabad): Disease: Stigma and the Body of Law Kalinga Tudor Silva (University of Peradeniya): Stigmatization of Chronic Kidney Disease of Unknown Etiology in Sri Lanka Mercian Daniel (Jawaharal Nehru University): Narrative of Users’ Families Living with Serious Mental Illness: Emerging Structural Stigma and Resistance to Biomedical Authority

1-2 Lunch

2-3 Keynote 2 Distress, Danger and Disorder, Keynote: Malathi de Alwis, Socio-Cultural Anthropologist How do notions of distress and disorder interact? How might minority groups be caught up in in this interchange? How do men, frequently positioned as ‘dangerous individuals’ articulate their grief? What is the nature of their activity in the context of natural disaster as opposed to war?

3-3.30 Coffee

3.30-5pm Session 2 Nations and the Body Politic: Chair: Tarryn Phillips Damir Mitric (Swinburne University of Technology): Masculinity, Trauma and Loss in Post-War Bosnia: Reconstructing Categories of Gender Ben Silverstein (University of New South Wales): Race and Health in the African City: Colonizing Articulations of Difference Ross Jones (University of Sydney): Rethinking the Colombo

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Plan: the role of Australian Universities in the creation of medical schools in Indonesia and Malaysia from the 1950s.

Friday 27 June 9-10 Keynote 3 Global Disease and Meaning, Harish Naraindas,

Associate Professor, School of Social Sciences, Jawaharal Nehru University We will examine how ‘disease’ is a contested category that maintains a variety of meanings across cultures. How does Western medicine interact with other cultural identifiers of disease in specific local contexts and can we draw any conclusions that can be used to ameliorate cultural misunderstandings about disease within the clinical environment?

10-10.30 Coffee

10.30-12 Session 3 Disease and Meaning. Culture and Healing: Chair: Ingrid Sykes Guy Attewell (French Institute of Pondicherry): Whose Pathology, Whose Therapeutics? Navigating Fracture-Traffic, Credibility and Iatrogenesis through Bone-setting and Orthopaedic practices in Hyderabad Kamminthang Mantuong (Jawaharal Nehru University): Avian Influenza: Public Health Discourse, Vernacular Healing and Santals’ Response to Culling Divya Padmanabhan (Jawaharal Nehru University): From Distress to Disease: A Critique of the Medicalization of Possession

12-1 Keynote 4 Waste, Landscapes and Economies of Medical Practice, Sarah Hodges, Associate Professor, Department of History, University of Warwick, UK Scholars have long pondered healthcare’s ‘outcomes’. What happens when we expand our view of ‘outcomes’ to look beyond cures and treatment, and consider the material afterlives of everyday clinical medicine? How does medicine’s waste manifest itself and how does the human self negotiate its presence?

1-2 Lunch

2-3.30

Session 4 Disease and Meaning, Categories and Vocabulary: Chair Tarryn Phillips Matthew Allen (University of New England): Disorder and Disease: the Risks of Consuming Alcohol Paul Mason (Woolcock Institute of Medical Research): 19th and 20th-Century Consumption: the Growth of Structural Violence against Diversity Paulina Billett (La Trobe University): Infertility, Disease, Condition or Something Else?

3.30-4 Coffee

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4-5pm Session 5 Panel led by Australian Research Centre for Sex, Health and Society, Disease, Disorder, Normativity and Treatment Practices: Ontologically Entangled, Rethinking Causality: Chair Steven Angelides (La Trobe University/Macquarie University)

5-5.45pm Closing Keynote The Promise of Providence: Politics, Leprosy and the Postcolonial Condition in New Caledonia

5.45-6pm

Closing Remarks: Convenors

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Keynote 1 Stigma and Disease, Medicalization and Disease

Sonia Ryang, T.T. and W.F. Chao Professor of Asian Studies Director, Chao Center for Asian Studies, Rice University

In the current climate of medico-psychological global industry, stigma and medicalization have entered paradoxical pact of being co-constructors of illness on one hand and mutually exclusive players on the other. For example, in the US pharmaceutical industry, the argument went that more direct TV ad of mental illness drugs such as anti-depressant would help lessen stigma against the disease; after ten years of such ruling, we discover that the stigma attached to mental illness has not changed, while consumer awareness of drugs as commodity have been elevated. Thus, medicalization of mental illness, in this case, has not served to reduce or alter stigma. In the opposite of this spectrum, currently, we see what I call a governmental effort to psychologize defectors from North Korea in South Korea. When defectors first arrive, they are institutionalized in the government-run rehabilitation facility, where they are given basic education about South Korean society and also intensively assessed in terms of psychological evaluation. The assumption behind this practice is that those that come from the other side of the Cold War ideology have psychological problem. Here, what used to be seen as ideological question is turned into psychological or medical question, while the existence of mental illness among defectors is presupposed. The current societal treatment (in an ironic double speak) that North Korean defectors in South Korea receive thus mixes stigma and medicalization, with the two reinforcing each other. Then, there are Southeast Asian (former) refugees who have been relocated and settled in Iowa, US. Among them, the term mental illness still has not found the way to be accepted, not so much because of stigma, but because of what we may call un-medicalization. For many former Southeast Asian refugees living in Iowa who I worked with, there is a clear distance exists between sadness, sense of loss, or feeling empty, i.e. symptoms that the practice of medicalization would name depression, and the depression as a clinical symptom. The former are accepted as part of life’s consequences involving global relocation and dispersion of families and having to start their life anew in a foreign land, while the latter is seen as a pathology invented by the American capitalism, the benefit from which they continue to be excluded. Thus, typically, they do not seek medical assistance in the area of mental health. Here, we see that the lack of medicalization is actually deterring the rise of stigma. Based on these instances, I’d like to address the way stigma and medicalization of illness sometimes reinforce each other and sometimes behave in mutually exclusive ways. In order to explore these instances, I’d like to extend my inquiry beyond the area of medicine and see how historical factors (such as war and diaspora), political values (Cold War ideological construction), and global capitalism (over-medicalization by the pharmaceutical industry) get embedded in medico-psycholgical practice in different settings.

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Disease, Stigma and the Body of Law

Dilip K. Das, EFL University

The body is not just biological substance but a crucial site of socialization, and as such becomes a target for power relationships. Stigma, which literally means marks on the body, is one of the ways in which societies control individuals deemed to be deviant. As Mary Douglas has argued in Risk and Blame, the stigmatisation of individuals and groups on the charge of harbouring infectious disease serves to entrench social boundaries and to justify social exclusions. This is true not merely of pre-modern societies, where ‘superstition’ is presumed to rule: it is equally true of modern societies that govern themselves through rational systems of knowledge like medical science and universal principles of law. One of Foucault’s key insights into modernity is the way medico-legal institutions in states committed to the preservation of life, especially through mechanisms of disease prevention and control, function as an apparatus of social hygiene. This leads to a crucial paradox: in ensuring the ‘public good’, it excludes from the obligation to protect those who are diseased. Law holds the diseased body in an aporia: diseased individuals, while being recognized as citizens, are subject to the suspension of citizenship rights on grounds solely of disease. My paper explores this paradox and its implications for medico-legal rationality, through a critical reading of recent court decisions in India. In my view, court decisions provide important indications of how a society governs itself – who and what are considered to be of value – and in interpreting the law decide what the law can permit and what it can place in an exception. My reading of these decisions brings out contradictions underlying law’s claim to universality, and thereby opens up the question of whether law, as an instrument of social order, can render justice to those subjected to its authority.

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Stigmatization of Chronic Kidney Disease of Unknown Etiology in Sri Lanka

Kalinga Tudor Silva, University of Peradeniya

An epidemic of Chronic Kidney Disease of Unknown Etiology (CKDue) has broken out in rural farming populations in selected Dry Zone areas in Sri Lanka with effect from 2003. The patients and their families experience a great deal of stigma in view of the near certainty of death and the risk and misery associated with progressive renal failure and the high cost of and lack of access to dialysis and renal transplantation therapy. Using a series of case studies from two affected areas undertaken as part of an ongoing study of the social and economic impact of CKDue in Sri Lanka, this paper examines the social processes through which stigmatization occurs, its emotional, social and health effects on the affected families, and how patients and their families cope with stigmatization. The stigmatization of CKDue begins with labelling of the disease within the health care system and in local communities, how disease is presented in mass media and the moral panic surrounding contaminated food, contaminated drinking water and heavy use of agrochemicals understood as possible risk factors for the disease. The emotional impact of stigmatization of CKDue has in some patients making suicidal attempts following their diagnosis. The social impact includes rejection of the members of the affected families in the marriage market due to the possible fear that members of such families may have a genetic predisposition for the disease. Due to fear of stigmatization some persons do not go for CKDue testing and others who are diagnosed keep it as a secret from their friends, neighbours and even close family members in some instances. Finally the paper examines possible legal, health care, health education and patient rights measures for countering stigmatization of CKDue.

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Narratives of Users’ Families Living with Serious Mental Illness: Emerging Structural Stigma and Resistance to Biomedical Authority

Daniel Mercian, Jawaharlal Nehru University

Health as a given right and entitlement for its citizens is supposed to be a prime responsibility of any state that largely subscribes to a socialist welfare ideology. Moreso, this should not be in any way different for problems that concern mental health. In the light of such an argument, this paper attempts to understand intended and unintended forms of structural stigma [These are policies restricting rights and diminishing life opportunities of users with severe mental health problems (Corrigan, Markowitz & Watson, 2004; Link & Phelan, 2001; Pincus, 1996)]arising out of the narratives of families living with users having a Severe Mental Illness (SMI). As theorising stigma in such a manner finds no mention whatsoever in Indian literature, in addition to primarily exploring issues related to the above, emerging accounts of how family members counter biomedical power is further looked into. Therefore, only specific aspects of family narratives gathered during the author’s doctoral qualitative work is used here to substantiate these arguments by firstly contextualising the differing, yet similar, situations that four families are confronted with while caring for their affected relative. Secondly, certain aspects of long-term systemic level discrimination these families experience largely perpetuated by the state, while in conclusion the possible reasons why such powerful narratives critiquing existing biomedical care and treatment paradigm would be discussed. This paper strongly argues for revisiting the subject and the subjectivities of both users and their family members living with SMI constantly engaging with (a supposedly welfare) state, and contend that these may provide alternative insights into transforming mental health policies in India as opposed to the dominant and ongoing power of psychiatry.

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Keynote 2 Danger Distress, Disorder

Mourning and Masculinity in Eastern Sri Lanka

Malathi de Alwis, Socio-Cultural Anthropologist

This paper seeks to disrupt and de-centre a particular formulation of Tamil masculinity that has been produced through humanitarian and development aid discourses in Sri Lanka, in the wake of the December 2004 tsunami. It has been well documented that alcoholism and domestic violence did increase in Sri Lanka, in the aftermath of the tsunami, especially in the camps for those displaced by the tsunami. What I wish to disrupt here is the assumption that this was a predominant form of masculinity, along with that of the ruthless yet heroic militant, in Sri Lankan Tamil society. I wish to argue that there were other, less negative masculinities and masculinized practices that also came to the forefront during this period but were rendered invisible through these discourses.

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Masculinity, Trauma and Loss in Post-War Bosnia: Reconstructing Categories of Gender

Damir Mitric, Swinburne University of Technology

This paper is based on interviews I held with a couple that were imprisoned in a concentration camp in Bosnia together with their two children for 17 months in the 1990s. I interviewed them individually, but I also recorded a conversation between the three of us, which turned into a very open dialogue between my interviewees about the influence of the war on the husband’s masculinity: “I have lost everything. Everything. I have lost everything. I am no longer the husband that I used to be. I am no longer the father that I used to be. I am not the Senad (his pseudonym) I used to be…” I argue that the current literature on gender specific coping strategies of Bosnian exiles misinterprets statements such as these. In these discourses men are constructed as emasculated and unable to recover from it. I argue that these men know that their ability to fit into the social definition of hegemonic masculinity has changed. Indeed, they question what kind of men can exist after war and violence. To label this as ‘misplaced masculinity’ (to use one of the common descriptions) misses the point, because it presumes that only the one hegemonic type can ever exist and that once lost it is irrecoverable. People like Senad speak about a different kind of masculinity, one of trauma and loss, but nevertheless active, dynamic and strategic.

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Race and Health in the African City: Colonising Articulations of Difference

Ben Silverstein, UNSW Race intensifies as a distinct classificatory practice of colonial rule, scholars have argued, when social space becomes shared. Bodies of difference mixing together in the same or similar spaces provoked colonial ideologues to (re-)assert physical difference as immutable determinism, concerning themselves with the consequences of mixing. The ‘problem’ of urban spatial coexistence exercised the members of the International Institute of African Languages and Cultures, founded in 1926 and comprising some of the leading theorists of British colonialism. Frederick Lugard worried about the problem of governing the “Europeanised African” who lived in cities and who had received an Anglicised education. Such men, he wrote, became unhealthy: “Doctors and dentists tell us that he has become less fertile, more susceptible to lung-trouble and to other diseases, and to defective dentition”. Bronislaw Malinowski was similarly worried about “phenomena of change such as the educated African, the converted African”, which he compared to “skokian, the famous concoction brewed, retailed and consumed in the notorious slum yards of native South African locations”. This regularly consumed and poisonous brew was, Malinowski wrote, “symptomatic and symbolic” of the “new things” generated by the “clash and interplay of the two cultures”. Urban coexistence was dangerous, they argued, because it produced not only disorder and deviance, but also problematic and unhealthy bodies. In this paper I explore the production of knowledge about colonial contact in British Africa through the prism of disease. Conceptualising urban proximity as producing diseased black bodies medicalised the social field, prompting a renewed logic of racialization which inscribed urban spaces as white and whiteness as urban, and incited a concern for the health of African bodies out of place. This paper explores the way a governmental concern for disease came to be conducive to the articulation of racialised difference in British colonial thought.

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The Australian Prime Minister; the reluctant Dean and a ‘subject of national significance’: the Colombo Plan and the role of Australian Universities in the creation of Medical Schools in Indonesia and Malaysia post World War Two.

Ross L Jones, University of Sydney

In 1956 Frank Fenner, Professor of Microbiology at the John Curtain School of Medical Research, Australian National University, Canberra, wrote to Sydney Sunderland, Dean of Medicine at the University of Melbourne, asking him to be part of a delegation to Indonesia to assess the possibility of Australia assisting Indonesia in the setting up of Medical Schools under the Colombo Plan. This was the beginning of a decade long project carried out by Sunderland, and actively encouraged the Prime Minister of Australia, Robert Menzies. Hampered by inadequate funds and staff, revolution in Indonesia and opposition in Australia, Sunderland failed at the last moment to successfully launch a medical school in Bukittingi. Rather than withdraw, however, Sunderland, transferred his attention to Malaysia and successfully supported the foundation of the Medical School in Kuala Lumpur in the early 1960s. This paper will examine the processes, personalities and motivations involved in these two projects and discuss the role of post-colonial medicine in the development of elites in emerging nations in South-East Asia. Furthermore, it will ask whether this is an episode of medical “colonialism” in the post-colonial world, as well as exploring the results of the introduction of an Australian version of the European biomedical tradition, which, when intersecting and combining with indigenous notions of disease and healing, potentially produced a new medical model.

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Keynote 3 Global Disease and Meaning

Of Sacraments, Sacramentals and the Anthropologist: The Cultural and the Clinical Mis/understandings of Disease

Harish Naraindas, Associate Professor, School of Social Sciences, Jawaharal

Nehru University We will examine how ‘disease’ is a contested category that maintains a variety of meanings across cultures. How does Western medicine interact with other cultural identifiers of disease in specific local contexts and can we draw any conclusions that can be used to ameliorate cultural misunderstandings about disease within the clinical environment?  

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Whose pathology, whose therapeutics? Navigating fracture-traffic, credibility and

iatrogenesis through ‘bone-setting’ and orthopaedic practices in Hyderabad (India)

Guy Attewell, French Institute of Pondicherry

This paper draws on ethnographic research in three clinics which specialize in non-surgical fracture reduction and the management of pain and injury to the bodily frame (‘traditional orthopaedic practice’, ‘bone-setting’), in order to think through epistemological, ontological and ethical dimensions of these styles of practice in relation to their establishment orthopaedic counterparts. Formally, ‘bone-setters’ are outside the orthopaedic mainstream, and yet they participate in a fracture / pain economy in which practitioners of various kinds, the sufferers and their familial/social networks are brought into sustained, though partial, connections. The paper will point to contestation over appropriate ways of knowing the injured body (e.g. haptics and medical imaging technologies), as well as over methods of managing and treating injury (e.g. plastering, surgery and binding). It shows how practitioners have navigated credibility in relation to their clientele and to other practitioners, and in the process have reconfigured their practices. The paper considers the labelling of an iatrogenic category Traditional Bone-Setters Gangrene in orthopaedic public health discourse in the context of failed cases that circulate between establishment orthopaedic and bone-setting practices. Further, the prospect of iatrogenic impoverishment (Meessen et al. 2003) appears as an important dimension in the decisions people make about who to approach for treatment in urban and peri-urban contexts.

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Avian Influenza: Public Health Discourse, Vernacular Healing and Santals’

Response to Culling

Kamminthang Mantuong, Jawaharlal Nehru University In mid January 2008, avian influenza (‘bird flu’) broke out in West Bengal, India. Nearly 4 million birds were killed in the culling operation in West Bengal to prevent the possible outbreak of a pandemic. In the culling drama that followed, the discourse of public health on ‘bird flu’ (of viruses and scientific rationality) was pitted against the discourse of lay people against culling, which may in part be based on a sentient and sacred cosmology. Public health officials met pockets of resistance among the locals, partly because chickens were seen by the lay people not only as food or as a source of livelihood but also as manat – a propitiatory sacrifice. The contestation, conflict and protest that ensued between the state and the subjects in the course of the culling and mopping operations were not only epistemic but ontological as well. It is against this backdrop that the author examined Santal cosmology and the dominant public health discourse. The author did this by examining how the ‘outbreak’ of avian influenza was framed and rationalized by the discourse of public health, and attempts to understand the kind of symbolism attached to the ‘chicken’ in particular and animals in general by studying the ‘vernacular healing’ of the Santal ‘tribal’ community. In this respect, the author would be looking at vernacular healing and biomedicine as two different contrasting set of epistemes and practices rather than seeing the local from the vantage point of biomedicine.

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From 'Distress’ to ‘Disease’: A critique of the medicalization of possession

Divya Padmanabhan Jawaharal Nehru University

This paper is an attempt to critique the global category of disease by examining the case of possession practices in a temple in Kerala, India. It articulates that the category of disease/disorder outlined in standardized manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), is premised on a static, Eurocentric view of the mind, body and self which not only negates other theories of disease and healing, but also renders other knowledges as obsolete, primitive or at best ‘unscientific’. In doing so, it theoretically creates a distinction between the normal and the abnormal. By examining the case of possession in a temple in Kerala, India, this paper argues that a standard universal understanding of disease reduces the multiplicity of meanings, forms, and purposes of possession that extends beyond restoring mental or physical functionality. Through the process of labeling an individual as being mentally ill, the global category of possession as dissociative identity disorder turns an afflicted individual into a patient and distress into disease. Such an approach limits the scope for examining the efficacy of healing through possession. For this, it is essential that non western practices, in this case possession be examined and tested in its own terms and theories, rather than superimposing a psychiatric/biomedical lens. This paper argues that neither possession nor its manifestation is considered as a disease of the ‘mind’. It challenges the common understanding that ‘indigenous’ ways of healing thrive largely due to absence of medical facilities, as most of the sufferers of affliction had first visited a medical facility (biomedicine) and were informed that there was no evidence of disease and hence not provided any treatment. It emerges thus that the temple is not as generally suggested a ‘culturally appropriate equivalent’ for a psychiatric ward, but rather visiting a temple for healing is a search for relief from other forms of distress, which are outside the purview of the medical model. Given these aspects, this paper suggests a reading of possession as distress, thereby giving legitimacy to other ways of understanding distress and relief, rather than reading it only within the framework of disease and cure.

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Keynote 4 Waste, Landscapes and Economies of Medical Practice

Throwaway Medicine: Medical Garbage and the Problem of Stigma

Sarah Hodges, Associate Professor, Department of History, University of Warwick

 What does medicine feel like? Today, much medicine feels of plastic. What happens when you go into the clinic for a procedure? It happens in plastic. Plastic tools, plastic tubes, plastic plates, plastic gloves, plastic-coated tablets. Nearly everything is plastic in a hospital or clinic today because, in today¹s clean medicine, everything is disposable. This talk explores how this came to be and why it matters. In particular, I ask: In getting cleaner, does everyday medicine now produce proliferating mountains of plastic waste? This explores what happens to all this plastic once it has been used. Where does it all go? The first part of this talk tells the story of everyday medical garbage's afterlives in the south Indian city of Chennai. Based on over a year of fieldwork there, I track the material afterlives of used, discarded medical plastics across the city‹from hospital, to disposal facility and beyond. The second part of the talk asks more explicitly: what animates the movement of this trash across the city? I argue that a range of competing rationalities ­ clinical hygiene, environmental protectionism and markets and entrepreneurialism‹and their competing constitutions of what constitutes Œstigma¹ propel these used, discarded plastic objects across the city. In other words, the stigma of used plastic on a hospital ward is different from that of plastic in an environmental facility and different again in from the constitution of stigma in a plastic scrapshed.

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Disorder and disease – the risks of consuming alcohol

Matthew Allen, University of New England.

From the late nineteenth-century, habitual, problematic drunkenness has been increasingly interpreted as a disease – in Mariana Valverde’s telling phrase, “a disease of the will”. This project of medicalization is in part an effort to reduce the stigma surrounding problematic drinking: inspired by the AA model, the disease of alcoholism inspires sympathy and is cured through forgiveness of self and by others. Since the Second World War, there has also been a growing push to understand drinking as a causal factor in a much broader range of diseases and injuries to the point where the WHO now estimates that 4% of all deaths worldwide are attributable to the consumption of alcohol. The implications of this project are quite different. Drinking is stigmatised as unhealthy, risky and costly, a burden on society that should be severely taxed and strictly regulated. But uniting these two very different forms of medicalization is a new concept of alcohol as a cause of problems, a notion with its origins in the nineteenth-century temperance movement. Earlier criticism of drinking had largely blamed sinful, criminal and deviant drinkers, but the failed political campaign of the temperance movement inspired a new focus on the drink itself. Thus alcohol can serve as a case-study for the broader implications of medicalization and its implicit shifting of the burden of responsibility for social problems. My paper will trace this history and examine the social implications of the new understanding of alcohol as a cause of disease. Focusing on Australia, I will argue that the global project of medicalization, regardless of its undoubted benefits for public health, has contributed to a transformation of personal responsibility in our society and to the modern obsession with metrics and costs as a means of understanding social problems.

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19th and 21st Century Consumption: the growth of structural violence against

diversity

Paul H. Mason, Woolcock Institute of Medical Research Tuberculosis has been characterised as a ‘disease of capitalism’, a ‘disease of incomplete civilisation’, and a ‘disease of incomplete industrialisation’. However, before it gained any of these titles, tuberculosis was known as consumption, ‘a disease of wasting’. Consumption was a major cause of death that afflicted people during their early life and productive years. The growth of the disease to epidemic proportions accompanied the overcrowding of urban centres following the industrial and agricultural revolution. A severe impediment to productivity, consumption was to be avoided at all costs. Any condition that prevented a person’s ability to contribute to the productivity of an industrious society was considered ‘degenerate’—a value-laden misappropriation of the Latin word degeneratus that originally meant simply a change either positive or negative from the general or standard type. In productivist civilisations, standardisation, not diversity, was highly valued. Degeneracy became a consequential label to refer to negative deviation from the norm. Where vaccines and antibiotics were lacking, practices of physical, social and mental hygiene became a moral imperative to maintain worth and avoid degeneracy. Notions of normality were increasingly tied to social values of productivity and medical values of health. Physical, social, and mental hygiene became commodified through mass-produced personal and household cleaning products as well as elite standards of professional mental health care. While consumption was a highly stigmatised disease, it was also a romanticised condition. Perversely, consumption came to shape ideals of feminine beauty, with the emaciated pallor, vulnerable complexion, and morbid fragility of the consumptive persisting in many fashion centres today as the height of feminine glamour. With a consideration of medicalization and hygienic citizenship, this paper discusses tuberculosis, degeneracy, and the irony that consumption, once considered a disease of wasting, is now one of the central drivers of a capitalist assault on biodiversity.

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Infertility, Disease, Condition or Something Else?

Paulina Billett, La Trobe University While peak bodies such as The World Health Organisation consider infertility to be a disease, in Australia, infertility occupies a sometimes complicated and ambiguous classification; simultaneously positioned as disease and condition. Some would argue that the difference between these two classifications is so slight as to render it inconsequential. I maintain, to the contrary, that this difference produces a significant challenge for those ‘diagnosed’ under this category. This is particularly true for couples who have ‘unexplained’ infertility. Infertility is a multidimensional experience with social, economic and cultural implications. Often infertile couples are faced with a lack of empathy and support by family members and the larger community of their situation. This can lead to anxiety, frustration and the withdrawal from previously fulfilling networks. Furthermore, the lack of understanding, prompted by lax in definition of infertility, has meant that while cost for medical treatment such as Assisted Reproductive Technologies continues to escalate, government aid for these patients is diminishing and increasingly monitored. In this presentation I explore the meanings of disease and condition in order to place their importance within the larger social, economic and cultural dimension. I aim to examine how terminology can affect the capacities of individuals to access social and economic resources. This presentation makes use of data collected during a wider study on infertility undertaken in 2012 - 2014.

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Panel Ontologically Entangled: Rethinking Causality

Chair: Steven Angelides (La Trobe University, Macquarie University)

Speakers: Kate Seear (Curtin University): ‘The makings of a modern epidemic: Endometriosis, gender and politics’ Kiran Pienaar (Curtin University:) ‘HIV/AIDS, poverty and the making of disease’ J.R. Latham (La Trobe University): ‘Making (trans) sense: Enacting maleness through sexual practices’ Emerich Daroya La Trobe University: ‘The emergence of Pre-Exposure Prophylaxis (PrEP) in online cultures of barebacking’ Jacinthe Flore (La Trobe University): ‘Traces and amounts: A medical historiography of sexual appetite’ The papers in this panel each rethink and reconceptualises the relationship between disease, disorder, normativity and treatment practices. We ask: How are problems (and patients) being produced through the systems designed to treat them? How have our concepts of disease and disorder predetermined the outcomes of treatment, health promotion techniques and strategies of protection? We take as our objects of analysis: endometriosis, poverty, HIV/AIDS, transsexuality, Pre-Exposure Prophylaxis (PrEP) and the Diagnostic and Statistical Manual of Mental Disorders (DSM), among others. In particular, each paper challenges the commonplace view that these are separately determinate entities, which interact in linear, causal ways. Embracing Karen Barad’s theory of agential realism and intra-activity, we propose that each of our examples is constituted through the very practices that are said to be consequential. In this way, poverty and disease, transsexuality and diagnosis, endometriosis and treatment, PrEP and online forums, object choice and sexual appetite are more usefully understood as ontologically entangled. On the basis of these alternative accounts, we propose that there are more effective, nuanced interventions that can be developed.

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Closing Keynote State, Society, Stigma

The Promise of Providence: Politics, Leprosy and the Postcolonial Condition in New Caledonia

Ingrid Sykes, La Trobe University

In this closing keynote I explore the connection between residual colonial anxieties surrounding leprosy within the French overseas territory of New Caledonia and the message of the the most recent plan for New Caledonia’s future, the Noumea Accord (1998). Leprosy remains an important part of the New Caledonian landscape not only because it is incurable. It provides a powerful reminder for both Europeans and Kanaks of the impact of colonisation. The enduring message of leprosy in New Caledonia is much more complex, however, than one might think. The disabled, colonized patient is constructed through the lens of Divine Providence demanding that his/her suffering forms part of a broader Divine plan for the social good. Such a framework not only compounds the stigma already associated with the condition, it perpetuates a political ideology based on the continued dependence of Kanak peoples on their French colonial ‘caretakers.’ I draw attention to the complex way in which state, society and stigma reflect and refract each other within this Pacific postcolonial landscape.