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Chronic Homework in Emerging Borderlands of Healthcare

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Abstract

The task of caring for those with chronic illnesses has gained a new centrality in health care at a global level. We introduce the concept of “chronic homework” to offer a critical reflection on the treatment of chronic illnesses in three quite different national and local contexts: Uganda, Denmark, and the United States. A major challenge for clinicians, patients, and family caregivers is how to navigate the task of moving health care from clinic to home. By “chronic homework,” we refer to the work patients and families are expected to carry out in their home contexts as part of the treatment of chronic conditions. Families and patients spend time receiving training by clinical experts in the various tasks they are to do at home. While this “colonization” of the popular domain could easily be understood from a Foucauldian perspective as yet another emerging mode of governmentality, this a conceptualization can oversimplify the way specific practices of homework are re-imagined and redirected by patients and significant others in their home surroundings. In light of this re-invention of homework in local home contexts, we foreground another conceptual trope, describing chronic homework as a borderland practice.

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Notes

  1. Among other developments, the growth in the discipline of medical anthropology is directly related to the exploration of the popular sector of health. See, for example, Gaines (1992), for pertinent discussions of this.

  2. This kind of health work in homes continues to exist, though, alongside and intersecting with the chronic homework guided and supervised by health professionals.

  3. One of the authors, Mattingly, explores this trope elsewhere. See, for example, Mattingly ( 2010).

  4. Since 2002, Meinert has been involved in a study with a group of Ugandan and Danish researchers (under the TORCH project) looking into social aspects of ARV medicine use (see Meinert et al. 2009; Whyte et al. 2006; Whyte et al., forthcoming). Anna was not part of this study, but many of the insights into her case have been developed with this research group, which Meinert would like to acknowledge.

  5. (http://clinicaltrials.gov/ct/show/NCT00119093).

  6. The case is taken from fieldwork conducted among the staff and patients at the patient school and patients in their homes from 2001 to 2003 as part of a PhD. Project (Grøn 2005a, b).

  7. An extended discussion of this case is presented in a recent book by Mattingly (2010), The Paradox of Hope, chapters four and eight.

  8. Some scholars have considered this from a narrative perspective. From this vantage point, one can speak of the way that hope is couched in what are often implicit and unstated future narratives that link the task of care to a future marked by some level of rehabilitation and recovery (A. Frank 1995; Mattingly 1998a, b, 2010). From a clinical perspective, these implicit narratives project a future time that proper clinical care will help realize. Even for those with chronic conditions, the structure of clinical care is based on a presumption that there is some kind of hopeful “future story” that appropriate treatment can further make them feel better. At the very least, this hoped-for- future story is meant to ameliorate the worst effects of the clinical condition; even where patients suffer from very grim prognoses, most clinicians work to envision some kind of a hopeful-future story until the point where, as they say, “nothing more can be done.” (M.J. Good et al. 1990).

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Acknowledgments

The authors would like to thank the reviewers for their very helpful comments. One of the authors, Mattingly, would also like to acknowledge the support in the form of generous grant from the National Institutes of Health, National Institute of Child Health and Development, (NCMRR), (RO1HDO38878), and from the Maternal and Child Health (MCJ-060745-01-0). Mattingly would also like to thank Mary Lawlor, Lanita Jacobs, and the other members—past and current—of the Boundary Crossings research team.

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Authors and Affiliations

  1. Department of Anthropology, Division of Occupational Science and Therapy, University of Southern California, Grace Ford Salvatori Hall, 3601 Watt Way, Room 130, Los Angeles, CA, 90089, USA

    Cheryl Mattingly

  2. The Danish Institute for Health Services Research, Dampfærgevej 27-29, 2100, Copenhagen Ø, Denmark

    Lone Grøn

  3. Department of Anthropology and Ethnography, Aarhus University, Nobel Parken 1453, Chr. Skousvej 3, 8000, Aarhus C, Denmark

    Lotte Meinert

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  1. Cheryl Mattingly
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Correspondence to Cheryl Mattingly.

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Mattingly, C., Grøn, L. & Meinert, L. Chronic Homework in Emerging Borderlands of Healthcare. Cult Med Psychiatry 35, 347–375 (2011). https://doi.org/10.1007/s11013-011-9225-z

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