Simon Cohn (Medical Anthropologist, Senior Lecturer, University of Cambridge)
Borders, boundaries and thresholds: in pursuit of the living body
(This presentation will serve as an introduction to the workshop)
For years, people with Type II diabetes have been encouraged by the medical profession to monitor their own blood, under the assumption that it promotes a sense of ownership and ensures greater control of their chronic condition. A drop of blood, extracted habitually from a fingertip with a special pricking device, is squeezed out onto the pad of a small electronic device that almost instantaneously gives a highly accurate digital display of current sugar levels. The simple logic is that this provides a general indication of the homeostatic system within and unambiguously reveals the state of the illness to the patient so that diet, exercise and sometimes medication can all be adjusted to achieve a normal range. However, recent clinical studies have questioned the long-term physiological value of self-monitoring. Longitudinal evaluations, measuring how much glucose has bonded to haemoglobin over the last 2-3 months, seem to suggest blood testing might actually not provide any improvement to overall blood sugar control. Against much consternation and debate from other medical professionals, these commentators have consequently suggested that the promotion of such monitoring might only constitute an unnecessary burden for patients and a misuse of limited health service resources.
This paper will draw on the experiences and views of a sample of patients and doctors talking about blood monitoring in order to explore the various ways in which the illness is conceived, how and where exactly it is imagined to be located, and the times when it cross over from one conceptualisation to another. Taking thresholds to always suggest zones of ambiguity between unsettled states, it will explore how boundaries that constitute a diverse range of domains are evoked and sometimes collapsed by the apparently simple act of testing the blood, and so offer an alternative perspective on the reported failure of Type II self-monitoring. More generally, it will exploit intersecting ideas relating to the terms ‘borders’, ‘boundaries’ and ‘thresholds’ to invite ways of thinking about the body that, by their very nature, traverse different ways it is conceived and it is lived.
Simon Cohn is a medical anthropologist employed by the General Practice & Primary Care Research Unit of the Department of Public Health, Cambridge, to strengthen applied research initiatives that draw on social science perspectives. He is involved in a wide range of collaborative projects, including ones addressing physical activity and health, diabetes, blood donation, stroke, diet, and patient-doctor encounters. In the past he has investigated ideas of health amongst patients and medically professionals – particularly in relation to chronic conditions. He has published work on diabetes, ME/chronic fatigue, gulf war syndrome, and the impact of neuroscience in psychiatry.
This paper will draw on the experiences and views of a sample of patients and doctors talking about blood monitoring in order to explore the various ways in which the illness is conceived, how and where exactly it is imagined to be located, and the times when it cross over from one conceptualisation to another. Taking thresholds to always suggest zones of ambiguity between unsettled states, it will explore how boundaries that constitute a diverse range of domains are evoked and sometimes collapsed by the apparently simple act of testing the blood, and so offer an alternative perspective on the reported failure of Type II self-monitoring. More generally, it will exploit intersecting ideas relating to the terms ‘borders’, ‘boundaries’ and ‘thresholds’ to invite ways of thinking about the body that, by their very nature, traverse different ways it is conceived and it is lived.
Simon Cohn is a medical anthropologist employed by the General Practice & Primary Care Research Unit of the Department of Public Health, Cambridge, to strengthen applied research initiatives that draw on social science perspectives. He is involved in a wide range of collaborative projects, including ones addressing physical activity and health, diabetes, blood donation, stroke, diet, and patient-doctor encounters. In the past he has investigated ideas of health amongst patients and medically professionals – particularly in relation to chronic conditions. He has published work on diabetes, ME/chronic fatigue, gulf war syndrome, and the impact of neuroscience in psychiatry.
