Sustaining Hope Within Entangled Accompaniments: Toward an Otherwise Clinical Ethnography and Critical Social Medicine

Culture, Medicine, and Psychiatry https://doi.org/10.1007/s11013-025-09897-5 COMMENTARY Sustaining Hope Within Entangled Accompaniments: Toward an Otherwise Clinical Ethnography and Critical Social Medicine Matthew Hing1 · Salmaan Keshavjee2,3 Accepted: 17 January 2025 © The Author(s) 2025 Abstract The series of papers in this special issue, “Ethnography of and in Clinical Formation: Poetics and Politics of Dual Subjectivity,” touch on several themes that are at the core of social medicine: the web of social structures and power relations that organize the risk and prematurity of disease and death, who gets care when and where, and what that care looks like and does within situated social worlds. As Levenson and Samra (this issue) describe in their contribution, social medicine turns on extending the field of medical action “beyond the clinical encounter” in order to visibilize how such encounters are “organized by wider regimes of governance and expertise, and broader geographies of care, abandonment and violence.” Writing from the “fractured habitus” as reported by Schlesinger (Doing and seeing: Cultivating a “fractured habitus” through reflexive clinician ethnography, Somatosphere, 2021) of clinician-ethnographers, the authors here witness and interrogate the nascent possibilities for more liberatory and autonomous forms of care within these otherwise determining regimes. They also expose the limits of traditional clinical ethnographic positioning through authors’ diverse participations within spaces of organized violence – indicating the need for a “new conceit” (Aboiil, this issue) of the clinical ethnographer/social medicine practitioner who is open to sitting in the trouble of a “complicity consciousness” (Sufrin, this issue) and the expanded fields of theorizing, action, and accompaniment that it makes possible. Keywords Clinical ethnography · Social medicine · Accompaniment · Liberatory solidarity * Matthew Hing 1 Department of Anthropology, University of California, Los Angeles, CA 90095, USA 2 Department of Global Health and Social Medicine, Harvard Medical School, Cambridge, MA 02138, USA 3 Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA 02130, USA Vol.:(0123456789) Culture, Medicine, and Psychiatry Introduction The series of papers in this special issue, “Ethnography of and in Clinical Formation: Poetics and Politics of Dual Subjectivity,” touch on several themes that are at the core of social medicine: the web of social structures and power relations that organize the risk and prematurity of disease and death, who gets care when and where, and what that care looks like and does within situated social worlds. As Levenson and Samra (this issue) describe in their contribution, social medicine turns on extending the field of medical action “beyond the clinical encounter” in order to visibilize how such encounters are “organized by wider regimes of governance and expertise, and broader geographies of care, abandonment and violence.” Writing from the “fractured habitus” as reported by Schlesinger (Doing and seeing: Cultivating a “fractured habitus” through reflexive clinician ethnography, Somatosphere, 2021) of clinician-ethnographers, the authors here witness and interrogate the nascent possibilities for more liberatory and autonomous forms of care within these otherwise determining regimes. They also expose the limits of traditional clinical ethnographic positioning through authors’ diverse participations within spaces of organized violence – indicating the need for a “new conceit” (Aboiil, this issue) of the clinical ethnographer/social medicine practitioner who is open to sitting in the trouble of a “complicity consciousness” (Sufrin, this issue) and the expanded fields of theorizing, action, and accompaniment that it makes possible. The roots of social medicine are multiple and diverse (Allende, 1939; Du Bois, 1899; Engels, 1845; Fanon, 1959; Tristan, 1843; Virchow, 1848), but these branches converge around a shared sociogenic approach to illness (Kalofonos, this issue): recognition of how social forces manifest in power gradients, political-economic structures, and practices of (un)freedom that produce or limit health and shape clinical practice. Similarly, all propose various solutions aimed at restructuring power relations – reframing social relations otherwise – as a means of improving collective health. Clinical ethnography, as a key methodology of social medicine, remains an essential instrument for charting and critiquing the social dynamics and power relations that affect health. The manuscripts in this series enrich this genealogy of engaged clinical ethnography through continued problematization of these same gradients and the structural milieus within which they function. Social medicine is also about critical recognition of where would-be health professionals themselves are located within these fields and relations of power; as the articles here demonstrate, the “insider-outsider status” (Karlin & Hodge, this issue) of clinician-ethnographers provides a generative position for situating oneself to feel the weight of modern medicine’s neoliberal and carceral entanglements as well as to glimpse emergent and unknown “otherwise” possibilities for care and praxis. These manuscripts revolve around several important themes. The first is careful “observant-participation” (Sufrin, 2015) of the ways that healthcare and clinicians have increasingly become appendages of carcerality and capitalism. The coterminous nature of the medical industrial complex and prison industrial complex has long been interrogated by social scientists, clinicians, and community activists (Ben-Moshe, 2020; Clayton-Johnson, et al., 2021; Roberts, 2022), and Culture, Medicine, and Psychiatry the pieces here contribute to this urgent scholarship by describing viscerally and painfully how multiple spheres of medicine – psychiatry, addiction care, reproductive care – are deeply imbricated with neoliberal thinking and carceral logics. These relationships also shape “the material circumstances of [medical] training” described in Holmes’s piece and their implications for trainee’s truncated capacity for empathy and solidarity, socializing clinicians early on into subjectivities productive for the “carceral therapeutic state” (Sue, 2019). Medicine becomes part of a transplanting mechanism for changing social relations and creating a specific type of social order that is linked to punishment, liability, and different forms of state and social surveillance. Direct clinical practice in penal institutions (so-called “correctional health”) is the starkest example of this process, where clinicians cannot cure or stop the state-sanctioned violence of incarceration, and even the intimately documented micro-subversions and harm reduction efforts by structurally attuned jail clinicians like Sufrin, Buchbinder, and Sue come to feel like stabilizing effor (...truncated)