Stefan Ecks
University of Edinburgh, School of Social and Political Science, Faculty Member
- Anthropology, Culture, Critical Theory, Mental Health, Neoliberalism, Depression, and 27 moreIndia, Psychiatry, Medical Anthropology, Indian studies, Philosophy, Medicine, Phenomenology of the body, Anthropology of the Body, History Of Madness And Psychiatry, Transcultural Psychiatry, Diagnostics, Anxiety Disorders, Sociology of Children and Childhood, Anthropology of Children and Childhood, History of Capitalism, DSM-IV-TR, Social Sciences, Cultural Theory, Ethnography, Biopolitics, Psychological Anthropology, Social and Cultural Anthropology, Anthropology of Pharmaceuticals, Science and Technology Studies, Computer Networks, Databases, and Softwareedit
- Stefan Ecks is co-founder of the Medical Anthropology Programme and a Senior Lecturer in Social Anthropology at Edinb... moreStefan Ecks is co-founder of the Medical Anthropology Programme and a Senior Lecturer in Social Anthropology at Edinburgh University. He studied anthropology, sociology, and philosophy and graduated with a PhD from the London School of Economics. He has carried out fieldwork on health and medicine in South Asia since 1999. He held visiting fellowships at the University of California at Berkeley, the Karl Jaspers Centre for Advanced Transcultural Studies at Heidelberg, and the Brocher Foundation at Geneva. He serves on the Editorial Boards of Medical Anthropology and Anthropology & Medicine, and as Area Editor for Anthropology, Archaeology, Health, and Ethics of Research for the International Encyclopedia of the Social and Behavioral Sciences, 2nd Edition. Recent publications include a monograph, Eating Drugs: Psychopharmaceutical Pluralism in India (New York, 2013), and a Special Issue of Culture, Medicine and Psychiatry on "Anthropological Engagements with Modern Psychotropy" (co-edited with M. Oldani).edit
Shilpi Rajpal’s Curing Madness? gives a grand tour of psychiatric institutions in pre-Independence India. The book is aligned to the existing scholarship on the history of psychiatry in colonial In...
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... Ethnographic Insights on Marketing Strategies Stefan Ecks* Social Anthropology, School of Social & Political Science, University of Edinburgh ... And it applies particularly to fluoxetine: Eli Lilly's branded... more
... Ethnographic Insights on Marketing Strategies Stefan Ecks* Social Anthropology, School of Social & Political Science, University of Edinburgh ... And it applies particularly to fluoxetine: Eli Lilly's branded Prozac was never even introduced in India. ...
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The ethnography of health, illness, and healing in South Asia started around the middle of the twentieth century. A specialized field of "medical anthropology of South Asia" began to take shape in the 1970s. Key themes... more
The ethnography of health, illness, and healing in South Asia started around the middle of the twentieth century. A specialized field of "medical anthropology of South Asia" began to take shape in the 1970s. Key themes ofcross-cultural medical anthropology, especially medical pluralism and religious modes of healing, also dominate medical anthropology research on South Asia. A particular feature of the South Asian context is the strong presence of long-standing scholarly healing systems, especially the "Great Traditions" of Ayurveda, Yoga, Unani, Siddha, or Tibetan Medicine. The authority of text-based healing traditions has long overshadowed a genuinely ethnographic approach to South Asian medical practices. The aim of this article is to give an overview of medical anthropology research on South Asia based in Germany, especially of current research carried out by members of the AG Medical Anthropology.
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Biomedicine tends to treat "mental" illnesses as if they could be isolated from multiple social and somatic problems. Yet mental suffering is inseparable from complex somatosocial relations. Clinical fieldwork in a deprived area... more
Biomedicine tends to treat "mental" illnesses as if they could be isolated from multiple social and somatic problems. Yet mental suffering is inseparable from complex somatosocial relations. Clinical fieldwork in a deprived area of the UK shows that nearly all the people treated for "depression" are chronically multimorbid, both in their bodies and in their social relations. Mental suffering is co-produced by poverty, trauma, and excessive medication use. Patients' guts are as imbalanced as their moods. Single vertical treatments make them worse rather than better. In the UK, patients in poorer neighbourhoods do not "lack access" to healthcare. If anything, they suffer from taking too many medications with too little integration. I conceptualize the bad effects of excessive interventions in patients with multiple chronic problems as polyiatrogenesis.
How do child psychiatrists in Kolkata reflect on the links between scholastic pressure and rising rates of mental illness? As is known from many ethnographic studies, giving one's child a "top" education is a central concern... more
How do child psychiatrists in Kolkata reflect on the links between scholastic pressure and rising rates of mental illness? As is known from many ethnographic studies, giving one's child a "top" education is a central concern of Indian parents today, especially among the middle classes. Sending one's child to preschools and making them take several hours of private tuitions every day has become markers of "good parenting." To start children as early as possible and to reduce "useless" free time to a minimum puts enormous scholastic pressure on children. Even cross-country comparisons flag up that Indian children are made to study harder and earlier than in most other countries. This paper analyzes how child psychiatrists in Kolkata experience the consequences of parents' high expectations for scholastic success onto children's mental health. Attention deficit hyperactivity disorder (ADHD), "school refusal," depression, and suici...
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Abstract To date, the strongest predictor for dying with COVID‐19 is suffering from several chronic disorders prior to the viral infection. Pre‐existing multimorbidity is highly correlated with socioeconomic inequality. In turn, having... more
Abstract To date, the strongest predictor for dying with COVID‐19 is suffering from several chronic disorders prior to the viral infection. Pre‐existing multimorbidity is highly correlated with socioeconomic inequality. In turn, having several chronic conditions is closely linked to multiple medication intake, especially in richer countries with good access to biomedical care. Owing to its vertical structure, biomedicine often risks giving multiple treatments in an uncoordinated way. Such lack of integrated care can create complex forms of iatrogenic harm. Multimorbidity is often exacerbated by a pharmaceuticalization of social deprivation in place of integrated care. In this article, I explore the possibility that clusters of over‐medication are a contributing factor to higher death rates from COVID‐19, especially in poorer areas within richer countries. Anthropological perspectives on the social embeddedness of multimorbidity and multiple medication use can expand our understanding of who is most vulnerable to SARS‐CoV‐2.
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This chapter explores how public–private collaborations can be successful in India. Public–private mixes (PPMs) are an important part of the Stop TB campaign globally, but they are especially vital in India. One reason for this is the... more
This chapter explores how public–private collaborations can be successful in India. Public–private mixes (PPMs) are an important part of the Stop TB campaign globally, but they are especially vital in India. One reason for this is the sheer number of TB patients. India has more people suffering from TB than any other country. Another critical reason is that an overwhelming number of these patients are being treated in the private sector and are often receiving a low quality of care. The chapter follows the pharmaceutical industry's efforts to shape the diagnosis and treatment of TB, homing in on interactions between medical representatives and doctors, and showing how the very materiality of global health interventions (drugs, protocols, policies, recordkeeping) provides the context for the expansion of a private therapeutic market.
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ABSTRACT This article reflects on the meanings of money in the lives of two very different people from Kolkata. Mr Mukharji, a 60 year-old Bengali man, was a branch manager of a state bank who devoted his life to Tantrik Yoga. Mr.... more
ABSTRACT This article reflects on the meanings of money in the lives of two very different people from Kolkata. Mr Mukharji, a 60 year-old Bengali man, was a branch manager of a state bank who devoted his life to Tantrik Yoga. Mr. Kathotia, a Marwari man, was a wholesale paper dealer, with an interest in stamp and coin collecting. After first developing a theoretical framework on the sociology of money, the authors go on to describe their encounters with these two people, their different ethnic belongings, their social and working lives and what matters to them in life.
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We argue that predictions of a ‘tsunami’ of mental health problems as a consequence of the pandemic of coronavirus disease 2019 (COVID-19) and the lockdown are overstated; feelings of anxiety and sadness are entirely normal reactions to... more
We argue that predictions of a ‘tsunami’ of mental health problems as a consequence of the pandemic of coronavirus disease 2019 (COVID-19) and the lockdown are overstated; feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health. Some people will need specialised mental health support, especially those already leading tough lives; we need immediate reversal of years of underfunding of community mental health services. However, the disproportionate effects of COVID-19 on the most disadvantaged, especially BAME people placed at risk by their social and economic conditions, were entirely predictable. Mental health is best ensured by urgently rebuilding the social and economic supports stripped away over the last decade. Governments must pump funds into local authorities to rebuild community services, peer support, mutual aid and local community and voluntary sector organisations. Health care organisations must tackl...
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Since the mid-2000s, government initiatives in India have been gripped by the idea that biometric identification is more efficient than any form of paper-based documentation. In this article, I explore how new health care schemes in India... more
Since the mid-2000s, government initiatives in India have been gripped by the idea that biometric identification is more efficient than any form of paper-based documentation. In this article, I explore how new health care schemes in India have adopted this technocratic promise. On the basis of ethnographic research in Karnataka, I describe how enrolments for biometric smartcards for RSBY insurance proceeds. These enrolments are meant to turn the rural poor into consumer citizens, yet the RSBY cards elicit unexpected responses from the beneficiaries. Instead of reproducing state authority, the new ID cards become a fulcrum for questioning the stability of government.
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Experiences of autism-spectrum disorder are now increasingly studied by social scientists. Human-animal relations have also become a major focus of social inquiry in recent years. Examining horse-assisted therapy for autistic spectrum... more
Experiences of autism-spectrum disorder are now increasingly studied by social scientists. Human-animal relations have also become a major focus of social inquiry in recent years. Examining horse-assisted therapy for autistic spectrum disorders, this is the first paper that brings these fields together. Drawing on participant observation and interviews at a UK horse therapy Centre, this article examines how staff and the parents of riders account for the successes and limitations of equine therapy. To the respondents, horses 'open up' autistic children and make possible interactions that seemed impossible before. Horses were regarded as facilitating the emergence of apparently social behaviours, which included eye contact, pointing, and speech. Three key explanations emerged for therapeutic success: the sensorial, embodied experience of riding the horse; the specific movements and rhythms of the horse; and, the 'personality' of the horse. Equine therapy can be regard...
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Experiences of autism-spectrum disorder are now increasingly studied by social scientists. Human–animal relations have also become a major focus of social inquiry in recent years. Examining horse-assisted therapy for autistic spectrum... more
Experiences of autism-spectrum disorder are now increasingly studied by social scientists. Human–animal relations have also become a major focus of social inquiry in recent years. Examining horse-assisted therapy for autistic spectrum disorders, this is the first paper that brings these fields together. Drawing on participant observation and interviews at a UK horse therapy Centre, this article examines how staff and the parents of riders account for the successes and limitations of equine therapy. To the respondents, horses ‘open up’ autistic children and make possible interactions that seemed impossible before. Horses were regarded as facilitating the emergence of apparently social behaviours, which included eye contact, pointing, and speech. Three key explanations emerged for therapeutic success: the sensorial, embodied experience of riding the horse; the specific movements and rhythms of the horse; and, the ‘personality’ of the horse. Equine therapy can be regarded as enabling a...
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Global Mental Health (GMH) is a young field of research and policy, no older than 25 years. The current meaning of ‘‘global mental health’’ is even younger: it was only in the early 2000s that global mental health ceased to mean a... more
Global Mental Health (GMH) is a young field of research and policy, no older than 25 years. The current meaning of ‘‘global mental health’’ is even younger: it was only in the early 2000s that global mental health ceased to mean a population’s overall (‘‘global’’) stress level, but a programme of ideas and interventions for mental health for all (Cohen, Patel, & Minas, 2014). The label ‘‘global mental health’’ was slow to gain traction, even in the key publications that signpost the development of the movement. Neither the World Development Report (World Bank, 1993), the book on World Mental Health (Desjarlais, Eisenberg, Good, & Kleinman, 1995), nor the World Health Report 2001 (World Health Organization [WHO], 2001) contain the phrase ‘‘global mental health.’’ Only from 2001 onwards does ‘‘world’’ mental health turn into ‘‘global’’ mental health (e.g., in the WHO Mental Health Gap Action Programme [2008]). It helps to distinguish Global Mental Health—in capital letters and with the abbreviation ‘‘GMH’’—from broader issues in transcultural psychiatry and the globalization of Western psychiatry. GMH is one moment in a long series of globalization processes in psychiatry: an important moment, but one among many moments. GMH was formed when a set of disparate fields and concerns were assembled in a new way. Psychiatric epidemiology rests on the symptoms-based approach pioneered by the DSM-III in the 1970s. Calculations of the impacts of mental disorders on national economies go back to the introduction of disability-adjusted life years (DALYs) in the 1990s, when the ‘‘global burden’’ of mental disorders such as depression got specific price tags. The analysis of health infrastructures and of the availability of competent doctors and nurses has been a staple of public health research since its beginnings. The spectrum of therapies deemed to be based on ‘‘best evidence’’ by advocates of GMH had all been established before the 1990s, especially psychopharmaceutical treatments. Another pillar of GMH, the drive to educate the public and to minimize the stigmatization of mental
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The chapter focuses on the global spread of psychopharmaceuticals, discussing how in 1990s psychopharmaceuticals were cast as heralding a new era of treating mental ills. Yet this hope, or hype, started to wane in the 2000s, and even... more
The chapter focuses on the global spread of psychopharmaceuticals, discussing how in 1990s psychopharmaceuticals were cast as heralding a new era of treating mental ills. Yet this hope, or hype, started to wane in the 2000s, and even large pharmaceutical companies are now withdrawing from this segment. Doubt about psychopharmaceuticals has even gained ground in the more recent policies of the World Health Organisation, which has moved from advocating drugs as the best first-line treatment to a greater emphasis on non-pharmacological therapies.The “public lives” of drugs that are captured by WHO treatment gap calculations are shown to be cut off from the “private lives” of psychopharmaceuticals in the prescriptions of nonspecialists in the private market. Drugs are circulating far more widely than is known, and the influence of manufacturers onto prescription patterns is far stronger than is assumed.
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The ethnography of health, illness, and healing in South Asia started around the middle of the twentieth century. A specialized field of "medical anthropology of South Asia" began to take shape in the 1970s. Key themes... more
The ethnography of health, illness, and healing in South Asia started around the middle of the twentieth century. A specialized field of "medical anthropology of South Asia" began to take shape in the 1970s. Key themes ofcross-cultural medical anthropology, especially medical pluralism and religious modes of healing, also dominate medical anthropology research on South Asia. A particular feature of the South Asian context is the strong presence of long-standing scholarly healing systems, especially the "Great Traditions" of Ayurveda, Yoga, Unani, Siddha, or Tibetan Medicine. The authority of text-based healing traditions has long overshadowed a genuinely ethnographic approach to South Asian medical practices. The aim of this article is to give an overview of medical anthropology research on South Asia based in Germany, especially of current research carried out by members of the AG Medical Anthropology.
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Two southern provinces of Rwanda, Butare and Gikongoro. To identify beliefs and popular perceptions on cough and tuberculosis (TB) in rural Rwanda and determine how they shape health-seeking behaviour. Eight focus group discussions, 21... more
Two southern provinces of Rwanda, Butare and Gikongoro. To identify beliefs and popular perceptions on cough and tuberculosis (TB) in rural Rwanda and determine how they shape health-seeking behaviour. Eight focus group discussions, 21 key informant interviews and 12 illness narratives were conducted between May and June 2004. TB patients, community members, traditional healers and health workers. There is wide use of herbal treatment for chronic cough in Rwanda. Patients seek conventional care when alternative treatment options fail or when severe symptoms such as shortness of breath, bloody sputum and weight loss appear. There are several local illnesses associated with chronic cough, with different alternative treatments. TB symptoms are often mistaken for the acquired immune-deficiency syndrome (AIDS). Identified causes for cough-related illnesses can be classified as biomedical (germs, internal body dysfunction and worms), environmental (seasonal changes and dust), cultural (in...
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This paper explores the potentials of applying Michel Foucault's notion of 'self-care' to issues in medical anthropology. While Foucault's... more
This paper explores the potentials of applying Michel Foucault's notion of 'self-care' to issues in medical anthropology. While Foucault's writings on regimes of power/knowledge have had an enormous influence on medical anthropologists, his late works on the ethics of the self have not yet received much attention. This paper discusses Foucault's notion of self-care in relation to Ayurvedic interpretations of digestion in Kolkata (formerly Calcutta, India). In Kolkata, it is a widely held belief that attentive care of the self, and especially for the stomach, can set a person free from dependencies. Yet at the same time, 'modern' people are seen as unable to live up to the ethics of self-care. The parallel between bodily sovereignty and cultural/political sovereignty produces a discourse on 'lack of self-control' as one of the main reasons for continuing dependency in all spheres of life. How does Foucault's late work help to conceptualize these findings?
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book review of Kaufman's Ordinary Medicine for JRAI