Agrégateur de flux

Dates/Horaires de Diffusion:  21 Mai, 2013 - 14:00 - 14:57 Le professeur André Grimaldi et le docteur Hakim Bécheur auteurs tous deux de livres qui abordent l'organisation de la santé seront aujourd'hui avec nous pour aborder ce qui doit être, dans un futur proche, une révolution médicale en ce qui concerne l'accessibilité aux traitements efficaces à l'ensemble de la population. Nous aborderons les blocages propres à notre pays mais aussi les ...

L’AMOUR, cette tarte à la crème, est aussi une vache à lait. Autour de cet increvable sujet, les philosophes, de Platon a Nietzsche et au-delà ont accumulé quantité de mythes et analyses, concepts et gloses, vues opposées et théories contraires. A présent, tandis que l’horizon est morose et les repères en berne, voilà qu’on les ravive à tour de bras, histoire de rafistoler un semblant d’humanisme. Pourtant, à côte de ces grandes orgues, il semble bien qu’un domaine immense ait échappé à l’attention des penseurs.

Ce continent – presque muet, toujours modeste, évidemment fondamental, mais aussi paradoxal et prometteur- se nomme « I intime ». Au fil d’un travail vraiment étonnant et novateur, François Jullien l’arpente et la cartographie. II préfère écarter « l’intimité » – qui restreint les questions en jeu. II se soucie moins encore de ce qui est « intimiste » devenant ainsi exigu et mièvre, un monde sans pareil serait trahi. Alors, qu’est-ce donc ? Il faut repartir du mot, qui est curieux son double sens, en Europe, ne date pas d’hier. Déjà chez Cicéron, en effet, « l’intime » désigne ce qui est « le plus intérieur » a une personne ou a une chose. Mais le terme latin signifie en même temps la relation aux autres, au dehors, quand on parle d’amis intimes, de relations intimes, du fait d’être intime avec.

Voilà donc I ’étrangeté de départ un même mot dit à la fois le retrait et le partage, le dedans de soi et le lien a l’autre. Et si ces deux sens n’en faisaient qu’un ? Si le fait d’être « intime » supposait l’effacement des barrières, des distances, du quant-à-soi ? La réflexion de François Jullien montre pas à pas que l’autre se découvre dans le plus intérieur. Pour que s’établisse de l’intime, il faut que soit déjouée la clôture des sujets, défaite la frontière entre le « dedans » et le « dehors » de deux êtres humains. Toutefois, cette interconnexion particulière n’a pas été rendue possible par toutes les cultures les Grecs anciens ne la connaissent pas, les Chinois l’approchent, mais ne la thématisent pas.

Un journal de bord

L’invention de l’intime est d’abord une affaire chrétienne. Une nouvelle conception de l’humain s’ouvre avec Augustin dans ses Confessions, il découvre, au plus profond de son intériorité, l’infini de Dieu. Quelques siècles encore, et d’autres Confessions, celles de Rousseau, vont donner a I ’intime un sens rien qu’humain. Jullien en suit I ’évolution chez Stendhal comme chez Simenon.  Pourtant, qu’on ne s’y trompe pas,  ce livre n’est pas une histoire de l’intime, culturelle ou littéraire.

En fait, c’est un journal de bord de la «philosophie du vivre». L’invention continue du « vivre a deux » y est pensée comme intensification de I ’existence, pas comme son morne affadissement. Le plus souvent, en effet, on ne voit dans l’intime que les tristesses de l’habitude et la tiédeur des routines conjugales François Jullien, ici, fait tout l’inverse il y indique une terre d’aventure, l’ancrage d’une morale, un univers à explorer, « loin du bruyant Amour», et cent fois plus intéressant. A I ’évidence, ce livre en annonce plusieurs autres. C’est pourquoi on ne peut qu’admirer, tout simplement, qu’un philosophe reconnu ouvre ainsi, l’âge venant, un nouveau chantier. Son ampleur et sa nouveauté se révéleront sans doute pendant longtemps. En tout cas, le pan est facile à prendre.

Le désir de transparence et la soif de visibilité jusqu’à l’obscène ont rendu caducs la préservation de la vie privée et le sens du secret.

Le philosophe François Jullien leur redonne une seconde chance dans son nouveau livre : “De l’intime. Loin du bruyant Amour”.

L’intime est une idée veuve en Europe. Les sociétés traditionnelles, qui définissaient l’être humain par les relations qu’il pouvait entretenir avec les autres membres du groupe et avec le cosmos, n’ont pas connu cette dimension profonde de la subjectivité, et la Chine, elle, n’a pas eu de mot pour la dire. Ce sont les sociétés libérales modernes, héritières d’une longue histoire, qui avaient inventé, promu et exalté l’intime Or, il se pourrait que nous soyons en train d’assister à la disparition de ce bien fragile Le livre de Marcela lacub (I), laquelle réalise une sorte de synthèse idéale entre la prostitution et la pornographie, n’est qu’un symptôme parmi tant d’autres de cette porche né dans laquelle on voudrait nous foire entrer.

Le livre que François Jullien, philosophe connu pour ses ouvrages sur la culture chinoise, vient de publier (2) a entre autres le mente de nous rappeler que I intime se crée a deux De l’intime s’ouvre par une scène frappante d’un roman de Georges Simenon, le Train : durant I exode, en mai 1940, un homme que le hasard des aiguillages a séparé de sa femme et de sa fille fait I amour avec une inconnue, dans un coin de compartiment bonde. L’intime peut donc surgir partout.

L’espace de notre authenticité

Le contresens courant sur le « for » intérieur écrit avec un t comme s’il s agissait d un bastion ou d’une prison, ne manque pas de faire sens En anglais, I’intime (close) est presque ferme (closed). On ne peut en effet définir l’intimité sans son viol éventuel. Ne dit-on pas que l’on pénètre dans I’intimité de quelqu’un ? Mais l’intime pourrait tout aussi bien être défini comme notre part inviolable. La première protection de l’intimité est psychique dans un restaurant bruyant, un tête-à-tête peut être très intime. On peut simuler l’amour, rappelle François Jullien (qui a sous-titré son livre Loin du bruyant Amour), pas l’intime. L’intime est l’espace de notre authenticité, ce que Montaigne, dans son vigoureux langage, appelait f une arrière-boutique toute nôtre ».

La distinction et l’opposition vie publique/vie privée font partie des acquis de notre histoire récente. Elles se manifestent dans des lieux, des temps, et des activités spécifiques il y a la maison et le bureau, le temps de la vie familiale et le temps de la vie professionnelle, le repos et les loisirs d’un côté, le travail rémunère de l’autre. Ainsi différencie-t-on également une instruction publique et une éducation privée. Un homme politique fait des discours en public ou a des entretiens privés, etc.

Pendant longtemps, I existence d’une vie privée a été le luxe des classes privilégiées – que l’on songe seulement à la promiscuité à laquelle les « misérables » étaient voués. L’élévation du niveau de vie a beaucoup fait pour la promotion de la vie privée.

La valorisation de l’intime vient aussi de la crise du social. C’est ce que montre l’ouvrage du sociologue américain Richard Sennett les Tyrannies de l’intmité (1979). Les deux plus grandes affaires de l’existence humaine, le sexe et la mort, ont peu à peu perdu leur caractère public. Avec l’approfondissement de l’individu en personne le secret est devenu un véritable mode d’existence. La sexualité a été privatisée, et les obsèques sont désormais célébrées dans la plus stricte intimité.

Et pourtant, nous assistons bien à une crise de l’intime, ou les causes et les symptômes s’entremêlent. La personnalité est menacée. Ce n’est plus seulement la psychanalyse qui jette un froid sur les certitudes du soi. A présent, les pratiques pharmacologiques (l’usage massif des médicaments et des drogues) et les recherches biotechnologiques (la robotisation de l’organisme et le clonage à venir) s’apprêtent à bouleverser de fond en comble ce qui reste de I’identité du moi.

Dans son livre, François Jullien rappelle par ailleurs que I inventeur de l’intime, saint-Augustin, l’a constitué à partir d’une relation avec I autre – qui était Dieu. II est d’ailleurs possible que l’effondrement actuel de l’intime vienne de cette disparition de l’autre Dieu est mort, et les autres que moi qui pouvaient le remplacer ne sont que des autres moi pas spécialement intéressants Comment une société de défiance pourrait-elle sauvegarder l’intime ?

Dans un article intitule « La sphère enchantée de l’intime », écrit il y a une trentaine d’années, le sociologue Jean Baudrillard expliquait que ce qui menace l’intime dans nos sociétés, ce n’est pas tant la promiscuité que la transparence. Désormais, nombre de gens se racontent, se photographient, se filment avec jubilation pour être lus et vus sur le forum virtuel. Ainsi miment-ils les célèbres et les puissants qu’ils envient.

Notre époque, en fait, déteste le secret, car vouloir le connaître, c’est désirer le détruire L’exhibitionnisme suit I’intimisme comme son ombre. Dans un monde où tout est transformé en marchandise (définition basique du capitalisme), dans un monde ou l’emploi, quand il subsiste, a remplacé le métier, dans un monde de désœuvrement (d’absence d’œuvre), dans un monde ou les personnes singulières s’effacent au profit d’individus interchangeables les seules choses que les gens croient pouvoir vendre ou donner d’intéressant, et par où ils a croient exister, ce sont leurs apparences et leurs vécus. II s’agit non seulement d’ôter les voiles (la vente est nue) mais aussi de rendre apparent ce qui ne l’est pas.

Lorsque tout devient source de profit, la distinction entre vie privée et vie publique s’écroule. D’une pierre, deux coups en transformant la Maison Blanche en Bed & Breakfast, les époux Clinton avaient neutralisé à la fois ce que pouvait avoir de politique leur fonction et ce que pouvait avoir d’intime leur existence. La philosophe Hannah Arendt avait fait remarquer que le public et le prive ne sont pas seulement opposés mais corollaires. De fait c’est d’un même mouvement que, aujourd’hui, l’un et l’autre sont menaces. Car cette crise de I’intime ne bénéficie pas au monde commun, c’est le moins qu’on puisse dire. II y a cinquante ans, dans la Condition de l’homme moderne, Hannah Arendt écrivait aussi que le peu qu’il nous reste de strictement privé dans notre civilisation se rapporte au fait d’avoir un corps Si nous considérons l’état actuel de la société, et les tendances qui s’y dessinent, on peut se demander si ce « reste » n’est pas en train lui aussi de tomber dans la publicité. Le corps est désormais une marchandise, la maladie et le vice, des capitaux.

Cette tendance à l’abolition de l’intimité vient désormais moins de l’Etat que des associations et des personnes privées. Les Américains appellent outing I’action de débusquer – car on le débusque comme un gibier -1 homosexuel qui cachait jusqu’alors ses mœurs aux yeux des autres. Comme l’action est menée par des organisations d’homosexuels et que leur intention est la reconnaissance publique, elle est ou non justifiée par la bonne transparence -1 hypocrisie est censée y perdre, et la liberté y gagner. La philosophe féministe américaine Catharine MacKinnon n’a-t-elle pas condamne comme « puritaine » l’attitude de ceux qui veulent que la sexualité puisse demeurer en dehors de la sphère publique et du domaine d’intervention de la loi ?

Un mot, en vogue dans la langue écrite aujourd’hui exprime bien cette progressive et inéluctable disparition de l’intime au profil de l’étalement public la visibilité. Dans une société de spectacle, tout doit être visible pour exister, ce qui n’est pas visible n’est rien ou n’a aucun intérêt. D’où le règne de l’impudeur généralisée. II y avait la richesse ostentatoire du petit nombre, voici le corps ostentatoire pour tous. C’est pourquoi la pornographie est une métaphore assez juste de notre façon de regarder le monde. II y a un nom pour dire le dévoilement de l’intime pour le seul spectacle cela s’appelle l’obscène.

Soljénitsyne parlait d’un droit de ne pas savoir. Une existence libre a besoin de lieux et de temps de retrait et de réserve. C’est pourquoi nous devons nous efforcer de les recréer ou de les maintenir. Sinon, si nous n’y prenons garde, notre démocratie parviendra a réaliser ce qu’aucun régime totalitaire n’avait réussi à faire l’abolition complète de l’existence privée, la ruine de la subjectiv

Dates/Horaires de Diffusion:  21 Mai, 2013 - 14:00 - 14:58

Dates/Horaires de Diffusion:  14 Mai, 2013 - 14:00 - 14:57 Bientôt trente ans que le virus du sida a été découvert. Cette fantastique aventure à permis de voir la lumière au fond du tunnel. Avec l'avènement des trithérapies associées à une prévention à laquelle les associations de malades ont joué un rôle déterminant. Cependant, il reste 35 millions de patients infectés par le VIH à travers le monde et la révolution thérapeutique n'est pas ...

Dates/Horaires de Diffusion:  7 Mai, 2013 - 14:00 - 14:57 Qui n'a pas été victime de maux de tête de céphalées et qui ne s'est pas précipité sur les médicaments de son armoire à pharmacie que l'on croit efficaces et qui pourtant ne sont pas adaptés à ce type de phénomène qui frappe tant  de personnes. Céphalées de l'enfant et même du petit enfant, céphalées de la femme enceinte, céphalées de la personne âgée nous passerons en revue avec le ...

At the end of 2009, linguists around the world collected words to characterize the first decade of the new millennium.  “Aporkalypse” appeared at the top of their list, describing a swine-inspired end of days ushered in by the threat of bird flu. Though playful, this term points to a growing recognition that animals –and their diseases –have determining effects on human existence. Recent estimates suggest that over seventy percent of emerging and re-emerging infectious diseases are zoonotic –or have their origins in animals. As self-proclaimed “virus hunter” Nathan Wolfe warns, we are living at the dawn of a new pandemic age, where “human infection by an animal virus may wipe out millions, or hundreds of millions, of people throughout the planet – permanently changing the face of humanity.” Conjuring images of mass destruction at the hands (or wings) of animals, pandemic prophecies bring our entanglements with other species into threatening relief.

Pandemic flu threats have been particularly visible in Vietnam, where highly pathogenic avian influenza –bird flu –is decimating poultry populations and causing alarming human fatality rates. Here, bird flu outbreaks correspond to shifting contours of people-poultry interaction.  Economic growth and rising income levels resulting from Doi Moi economic renovation policies have expanded poultry production and consumption since the early 1990s.  Backyard farms once populated by a handful of free-range birds are now sites of overcrowded flocks confined to diminishing spaces.  From these farms, ducks and chickens travel on the bicycles, boats, and motorbikes of independent farmers and traders themselves, or in the trucks of transporters connected to wholesale distributors.  The heightened movement of poultry across Vietnamese landscapes has opened up new and dangerous disease ecologies –particularly in urban wet markets where live animals from across the country engage in all manner of biological exchange. These trends translate to increased opportunities for viral transfer and reassortment between species.

 

Poultry transport, central Vietnam.

Household duck farm, Mekong Delta, southern Vietnam.

Vietnam was among the first countries to report outbreaks of bird flu in 2003, and has since suffered some of the heaviest losses to the disease. The country tops the list of reported poultry outbreaks and ranks third worldwide in terms of human fatalities. Compounding these casualties, the status of poultry production as a chief industry in Vietnam means that avian flu also threatens national economic health. In the first year of outbreaks alone, Vietnam lost one percent of its GDP as a direct result of avian flu. The scale of human, animal, and economic losses has made the country a locus for multinational interventions against the disease. To date, Vietnam has received the highest per capita amount of foreign avian flu aid of any country. Further, in contrast with pandemic flu strategies in places like the US, which focus on developing vaccines, drugs, and surveillance mechanisms for humans, Vietnam’s bird flu strategies target humans and animals simultaneously. An early official statement declared, “The Joint Vietnam Government-UN program was established to support an integrated … well-coordinated response to … controlling avian influenza in animals and responding to the threat of a possible human pandemic.” Bringing animals into the fold of human health in unprecedented ways, the Vietnam provides an ideal site for investigating zoonotic governance beyond species distinctions.

My ethnographic study of bird flu management in Vietnam examines the intersections of humans and animals in contemporary global health. Between 2009-10, I traced a series of bird flu interventions from their development in policy arenas in the capital, Hanoi, through to their application among chicken farmers in a province in the northern Red River delta, and among duck farmers in a province in the southern Mekong delta. I looked specifically at strategies that took place at the “human-animal interface” –that is, strategies that altered existing relationships and interactions between people and poultry.

In my book manuscript, provisionally entitled, Bird Flu: The Circulation of Life and Death in a Postspecies World, I draw from this research to build a framework for analyzing health from a postspecies perspective. Bringing medical anthropology into conversation with a longstanding disciplinary interest in human-animal relationships, I foreground poultry in the processes through which human life is understood and safeguarded. This approach projects biopolitics across species to consider the role that poultry play in shaping human health and vitality in Vietnam: from the discipline of individual bodies, to the administration of populations, to the control of social relations. In doing so it illustrates animals’ essential role in the apprehension and regulation of human life and raises new questions about how to live with other species in contemporary pandemic contexts.

Providing the first long-term ethnographic study of avian flu management in the poultry sector, I examine how bird flu interventions manifest in both scientific arenas and poultry producing communities. Tracing interventions from policy to practice, I illustrate the various forms of expertise that intersect and collide as health workers engage with poultry producers. I situate this work in a consideration of the role of poultry in Vietnamese rural ideologies and cultural practices, adding historical and moral considerations to political economic analyses of disease emergence and spread. Taken together, this research seeks to offer a nuanced, ethnographically grounded discussion of the ways that species co-constitute one another in a variety of social and institutional settings over time. Not only do these interspecies relationships affect zoonotic management practices, but they also shape the ways in which species coexist in everyday life.

I trace the primary avian flu strategies in Vietnam to illustrate how these health efforts seek to prevent a human pandemic through calculated interventions at the interface of people, poultry, and pathogens. I suggest that inasmuch as these interventions operate on distinct forms of reasoning and practice, they posit heterogeneous, ambivalent, and conflicting species divisions. For instance, in targeting the influenza virus, mass poultry vaccinations molecularize people/poultry relations –inoculating poultry to prohibit viral transfer to humans. On the other hand, risk-mapping interventions spatialize interspecies relationships, surveilling and graphing contact zones among people and poultry. Going further, behavior change campaigns discipline interspecies relationships by cultivating responsibilities among people living with poultry. And finally, biosecurity interventions standardize interspecies relationships, establishing spatial and temporal divisions between people and poultry in farming communities.

Household chicken vaccination, northern Vietnam.

Duck weigh-in, southern Vietnam.

Yet, in tracing the implementation of these strategies in rural communities, my project reveals how avian flu control strategies encounter existing relationships between species, which express alternative ways of ordering and valuing human and nonhuman lives. In this national context, poultry figure into a variety of biological, social, cultural, ecological, and economic relationships with humans and other organisms. These relationships express multiple concerns, including, among others: personal profit, ritual performance, social advancement, agricultural production, and moral conduct. The dynamic role of poultry in Vietnamese society therefore confronts instrumental global health strategies that would relegate ducks and chickens to purely biological or economic interactions with humans and other creatures. In short, bird flu management confronts a complex environment where poultry play a dominant, yet changing, part in local lifeworlds.

Chicken slaughter, northern Vietnam.

Diverse ideas and practices circulate in Vietnamese bird flu management, which has important consequences for the definition of bird flu risks and their appropriate management. From a health perspective, hierarchies of knowledge and expertise between veterinary and human health sciences have posed challenges in determining whose lives merit protection and optimization, and whose lives require intervention and control. For instance, while human health officials may favor safeguarding human life by culling thousands of poultry during an outbreak, veterinary officials (and farmers) may point to a lack of disease symptoms in flocks, and the economic import of poultry, as reasons for avoiding mass slaughter. Moreover, from an agricultural perspective, disagreements about how to develop Vietnam’s livestock economy in light of zoonoses augment these debates. Namely, in questions over how to increase the productivity and safety of livestock production without marginalizing the small farmers who continue to dominate the industry. These small examples point to the fact that differential ideas about the place of poultry in human biosocial life engender ambivalence in influenza management strategies.

Cockfight festival, Hanoi

Moving from policymaking arenas to everyday practice compounds the complexity and ambiguity of bird flu management. Poultry farmers in contemporary Vietnam inherit a hard-won history of independence from outside intervention, particularly in the context of agricultural production. In poultry producing communities, practical experience and phenomenological knowledge outweigh what farmers consider to be the overly theoretical orientation of veterinary “experts.” Poultry health, then, seldom falls under the purview of state agents and global consultants, but rather remains the right and responsibility of farmers themselves. Further, inasmuch as multinational actors increasingly participate in these interventions, new modes of political subjectivities emerging in Vietnam, wherein farmers both incorporate and resist global health discourses and strategies in their everyday interactions with animals. In the daily implementation of bird flu interventions, then poultry play an important role in shaping knowledge hierarchies and relationships between authorities and citizens in the country.

Taken together, these local trends signal contingent modes of governing humans and animals in global health orders. The bird flu interventions I document encounter, entrench, and transform existing ideas about human’s biological links with, and moral responsibilities toward, other species. In contrast to recent work celebrating multispecies entanglements and flourishings, then, this research suggests that human exceptionalism still matters, particularly in zoonotic situations where people’s vulnerability to animals sparks intense panic and dread. Rather than eschew notions of human mastery over nature, I show instead how actors mobilize and reconsider these notions as a means to cope with pandemic threats. The tenuous, shifting human/animal distinctions in bird flu management thus demonstrate efforts to capture and control the increasingly uncontrollable, the chaos of agentive viruses, migrating fowl, unstable ecologies, and transgressive people-poultry interactions.

In sum, my research reveals how poultry’s multifaceted role in Vietnamese society comes to complicate global health strategies, which seek to secure health through rationalized and calculated interventions on interspecies relationships. Ethnographic attention to these relationships reveals an unavoidable interdependence of people and poultry for biological existence, economic wellbeing, social networking, and ethical self-fashioning. At times people and poultry threaten each other’s lives; at other times they sustain them; and still at other times they infuse them with meaning and value. These rich and multifaceted interspecies relationships call into question the utility of a “One World, One Health” order, which implies by its very name a singular way of apprehending health and vitality, and a singular way of living, or coexisting, across species.

 

Natalie Porter is a postdoctoral fellow in the BioProperty Program at the Institute for Science, Innovation and Society, University of Oxford.  Her work examines intersections of pandemics, biomedicine, and multispecies relations. Focusing on avian flu, Natalie’s research combines analyses of laboratory practice with observations of poultry farmers and global health workers in Vietnam, Europe, and the United States. She is currently conducting ethnographic fieldwork on the exchange of viruses and transgenic animals in global pandemic flu research.

"Book tower"

For the latest “Top of the heap” we have lists from A. Jamie Saris of the Department of Anthropology at the National University of Ireland, Maynooth and Elizabeth A. Wilson of Emory University’s Department of Women’s, Gender and Sexuality Studies.

 

A. Jamie Saris

C. Jason Throop, Suffering and Sentiment: Exploring the Vicissitudes of Experience and Pain in Yap (University of California Press, 2010).

Angela Garcia, The Pastoral Clinic: Addiction and Dispossession along the Rio Grande (University of California Press, 2010).

Natasha Dow Schüll. Addiction by Design: Machine Gambling in Las Vegas (Princeton University Press, 2012).

 I have been thinking a lot about addiction of late and the whys and wherefores of suffering and subjectivity.  Meanwhile, consumption and pleasure have also been on my mind. These three recent ethnographies read together spark off one another very well. They come from very different theoretical angles in quite different settings, but they come across quite similar issues — understandings of choice and will, of memory and pain, of morality, and an imaginative inquiry into what the subject of all those processes might be.  I would love to teach a class with just these three texts and some supporting articles as, it seems to me, in running the thick description of real people caught up in these (very often unhappy) webs of meaning against one another, there is some profound insight into how humans and human networks are produced and, of course, sometimes degraded.

 

A. Jamie Saris is Senior Lecturer in the Department of Anthropology, NUI Maynooth. He has been working for more than fifteen years in medical and psychological anthropology in Ireland, North America, and parts of Africa, where he has researched and published on such diverse issues as the social life of mental hospitals, the experience of major mental illness, colonialism and its aftermath, poverty and structural violence, drug use and abuse, and HIV risk and treatment.  He is also the Co-Chair of the Combat Diseases of Poverty Consortium (www.cdpc.ie) and he was formerly the Deputy Director of NIRSA (National Institute of Regional and Spatial Analysis), a multi-disciplinary research centre of excellence examining space and society.

 

 

Elizabeth A. Wilson

 R.D. Laing and Aaron Esterson, Sanity, madness and the family (Penguin, 1964).

I first read this as an undergraduate.  It remains a formative book for me intellectually and politically.  I have re-read it recently for class, and was delighted to find that it still feels powerful.  As a visual accompaniment try: Asylum (Director: Paul Robinson 1972).  It is a really excellent film of life in one of the houses set up in London in the early 1970s by practicing anti-psychiatrists. Crazy and brave.

 

Peter Kramer, Listening to Prozac (Penguin, 1993).

Still a sharp, thoughtful account of Prozac, even after all these years.  Essential reading for anyone interested in the contemporary psychocultural landscapes of the US.  And, in my opinion, this is a more feminist book than many of the other more obviously critical/political texts on antidepressants.

 

Ken Corbett, Boyhoods: Rethinking masculinities (Yale University Press, 2009).

Based on Corbett’s clinical experience with the analysis of boys, this is a book that makes me happy because it shows how academic theories of gender and sexuality can still be shaped, twisted, enlivened by contemporary psychoanalytic practice.

 

Sigmund Freud, Beyond the pleasure principle. In James Strachey, ed., trans., The standard edition of the complete psychological works of Sigmund Freud Vol. 18, 7–64. (Hogarth Press, 1920)

Because too much Freud is never enough.

 

Todd Meyers, The clinic and elsewhere: Addiction, adolescents, and the afterlife of therapy (University of Washington Press, 2013).

Meyers and I are stable-mates in the wonderful In Vivo series at the University of Washington Press (Editors: Robert Mitchel and Phillip Thurtle).  His book further confirms my view that I am in excellent company in this series: it is a beautifully written ethnography of adolescents in and out of drug rehab in Baltimore.

 

Adam Frank, Transferential poetics, from Poe to Warhol (Fordham University Press, forthcoming).

I’ve just read the first chapter of this manuscript, forthcoming from Fordham.  It is a virtuoso composition of Stein with Klein with Tomkins. I’m dying to read the whole book.

 

Yotam Ottolenghi and Sami Tamimi, Jerusalem: A cookbook (Ebury Press, 2012).

A cookbook; because I am finishing up a project on the gut.  These are amazingly good recipes from Ottolenghi and Tamimi’s home town.  Treat yourself.

 

Elizabeth A. Wilson is Professor of Women’s, Gender, and Sexuality Studies at Emory University. She is the author of Psychosomatic: Feminism and the Neurological Body (Duke University Press 2004); Affect and Artificial Intelligence (University of Washington Press 2010). She is finishing a project (Gut Feminism) on feminist theory, depression, the gut and psychopharmaceuticals.

This month’s Web Roundup is dedicated to the role that legislation and the courts have in promoting or restricting access to medical care. In particular, I will focus briefly on the passage of anti-abortion legislation in the US and a few recent court cases that are testing the limits pharmaceutical patents. While not overtly theoretical in nature, I have found these events to be particularly useful for discussing critical medical anthropology in undergraduate courses.

 

Abortion Rights

The abortion debate is an issue that never seems to totally go away. According to the Guttmacher Institute, a pro-abortion rights non-profit organization, 93 provisions addressing reproductive heath have passed at least one legislative body in the US since the beginning of the year. Of particular note is the Arkansas bill that limits abortion at twelve weeks and the North Dakota bill that bans most abortions as early as six weeks, both of which violate the Supreme Court standing that abortions can occur up to the point where the fetus is viable outside of the womb. In a second measure, North Dakota has also banned abortions sought for genetic abnormalities such as Down syndrome, making it the first state in the country to do so [KOAA].  The Center for Reproduction Rights has vowed to fight the legislation, however as of April 15, they were already in court fighting another law that bans medication to induce abortion [Jamestown Sun].

Anti-abortion advocates also scored a victory in Virginia with the Board of Health’s passage of new abortion clinic regulations. With these new regulations, abortion clinics now have to abide to the same building codes as surgical units and will be mandated to comply with standards related to specific hallway and door measurements, ventilation systems, and front entrance coverings.  According to the NARAL Pro-Choice Virginia Deputy Director, “the overall goal of these restrictions is to limit access to safe, legal abortions” [MSNBC].

 

Patent Laws

On a different front, there have been several legal challenges to pharmaceutical companies who tinker with the composition of their pharmaceuticals to make a new version of an older drug, a process called “evergreening”.  The practice has been contested both abroad and in the US. In India, the Cancer Patients Aid Association won a case in the Indian Supreme Court claiming that Novartis’s reformulation of its cancer drug Gleevec was not different enough to drastically improve its efficacy, a precondition for a new patent in India. The ruling paved the way for Indian generic companies to continue manufacturing the generic version of the drug that costs patients approximately 68,000 USD less per year [New York Times]. As one of the largest producers of generic medications, the ruling enables Indian pharmaceutical producers to sell the medication to developing nations around the world.

Within the US, the issue of generics has also been in the news with the recent Supreme Court case, Federal Trade Commission (FTC) v. Watson Pharmaceuticals et al. At the center of the issue is whether Solvay, the maker of AndroGel, a prescription testosterone gel, can pay generic manufactures 45 million per year not to make a generic version of their drug. The case came out a of a two year litigation battle between Solvay and generic manufactures who claimed that Solvay’s patent expired years ago and the changes made to the product were not enough to justify a new patent. A settlement was eventually reached in the case, where Solvay agreed to pay generic manufactures 45 million per year not to produce the product, successfully protecting their 400 million annual market. Consumer advocates, hospitals, and medical providers call this practice “pay to delay” and claim that it unfairly undermines competition and forces patients to pay more for pharmaceuticals. The FTC agreed and argued that the practice violates the nation’s anti-trust laws. A ruling is expected later in the year [NPR].

Finally, on April 15, the Supreme Court heard a case on whether human genes can be patented. The case centers around the company, Myriad Genetics, which has patents on two parts of the human genes that are used to detect breast cancer, BRCA 1 and BRCA 2. Through its patent the company has exclusive rights on the test that can be used to detect mutations in the genes that lead to ovarian and breast cancer. The American Civil Liberties Union claims that since the genes are part of nature, they cannot be patented and that Myriad Genetics’s monopoly over the test makes it too expensive for some women. On the other hand, the company claims that without the protection of patents, companies would be less likely to do this type of research. [NBCNEWS]

Each one of these events highlights the tension between patients, lawmakers, and corporations. Moreover, they illustrate the role courts may have in advocating for patients’ access to family planning (in whatever form it takes), affordable pharmaceuticals, and their own genetic material.

 

Further Readings:

In TIME Magazine last month Steven Brill wrote an amazing article about medical billing and the ever-growing cost of healthcare. Bitter Pill: Why Medical Bills Are Killing Us

A study by the National Voices Project found that there are disparities in mental health access for children. National Voices Project 

Mercredi 24 avril, 28h

The Association for Social Sciences and Humanities in HIV conference in Paris presents an ideal opportunity to establish an open assemblage of early career researchers and scholars connected through a shared engagement in HIV/AIDS. By coming together and forming this collective, we hope to institute a space in which to provoke and facilitate dialogue and collaboration amongst early career scholars across various disciplines and institutions worldwide. We aim to develop and nurture an inclusive space in which to share research experiences and knowledge emerging from our individual and collective projects to the benefit of all involved and, equally importantly, the multiple intellectual worlds we inhabit. Moreover, our network intends to engage with and encourage dialogue surrounding the various issues young scholars face in their transition from student to professional.

Two launch events for the proposed collective will take place at the ASSHH conference in Paris being held from the 7th to the 10th of July. We hope that you will join us for one or both of the events to join in the conversation and to offer your voice to this newly forming collective.

1. Sunday the 7th of July: There will be a roundtable event to introduce the networks, to share ideas and discuss emerging themes in our work and to begin to set an agenda for collective and international discussion.
2. Monday the 8th of July: There will be a cocktail party for early career scholars to meet informally, discuss ideas and forge connections. Attendance at the Sunday event is not a prerequisite for participation at the event, which will focus on building networks of support and knowledge sharing more broadly.

Please sign up below to express your interest in joining the network and participating in the Paris events. If you cannot attend the Paris conference, but are still interested in joining the collective, we would still appreciate a response from you to indicate your interest in joining our mailing list and participating in future network events.

The early careers scholars events at ASSHH are being jointly organised by the Interdisciplinary Network on HIV and Innovation (UK), the Network of Young Scholars on Social Sciences and HIV/AIDS (France), and the Transcriptions Forum.

• The Interdisciplinary Network on HIV and Innovation (United Kingdom) was established in 2008 as part of the HIV Project led by Marsha Rosengarten at Goldsmiths College, University of London.  As a collective we encourage interdisciplinarity and collaboration in order to open up debate across disciplines and engage the complex problematic of HIV/AIDS in its various guises using theory such as Science and Technology Studies (STS) and an imaginative approach to novel research methods.
• The Network of Young of Scholars on Social Sciences and HIV/AIDS (France) is an interdisciplinary network of approximately 80 members that was created in 2008 to advocate for collective activities and for the professionalization of young scholars. Its members organise seminars, conferences, thematic workshops and writing/publication workshops. The network is mainly supported by the French National Agency for AIDS research (ANRS) and the Young Scholars Network on Health & Society (Réseau Santé & Société), which also provides support for scientific activities.
• Transcriptions is a collaborative forum for critical enquiry on HIV/AIDS and global health: experiment, ethics, and practice. The site, hosted by Somatosphere, is designed as a space for scholars and activists, policy makers and practitioners working at the intersections of the biosciences, social sciences, public health, and the humanities to engage in critical conversation and to take each other up on important issues that cross disciplinary divides – methodological, conceptual, and programmatic.

Please sign up here to express your interest in joining the network and participating in our Paris events:

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Following up on Melanie’s In the Journals… (1/2),  here is a short sampling of other recently published articles.

On “Early View” from Sociology of Health & Illness:

In an article entitled, “Undoing gender? The Case of Complementary and Alternative Medicine,” Joslyn Brenton and Sinikka Elliott show how middle-class Americans who use complementary and alternative medicine reproduce traditional gendered identities, and neoliberal tenets like the cultivation of personal control. Fadhila Mazanderani, Louise Locock, and John Powell have investigated what motivates people to share their experiences on the internet or in memoirs. Using literature about the commodification of illness narratives and data from a large collection of illness narratives gathered in the UK, they show how patients point to the “biographical value” of sharing their stories. Sociologist Jessica Powers Koski uses social movement theory in an analysis of eating disorder support groups in the Midwestern United States to argue that “framing and collective identity promote participation in eating disorder support groups while simultaneously constructing a collective eating disorder illness identity.” There is also an article about healthcare utilization among Gypsies/Travellers in England, and another about identity work in people with speech dysfluency (stutter/stammering).

The most current print issue of Sociology of Health & Illness features articles that have been available online for a few months, but I’ll highlight some that may be of interest. Neil Stephens, Jamie Lewis, and Paul Atkinson write about uncertainty in the regulatory frameworks that govern stem cell research, drawing on ethnographic data from the UK Stem Cell Bank and another British laboratory. Catriona Rooke writes about the increasing use of harm reduction approaches in English tobacco control strategy. Renata Kokanovic, Gillian Bendelow, and Brigid Philip discuss dissonance in lay accounts of Australians diagnosed with depression that vacillate between medicalized discourse of depression and emphasis on the social context of distress.

There are also two articles in the same issue about “good death”: Erica Borgstrom, Stephen Barclay, and Simon Cohn show how denial appears as a disease-like, treatable object to UK medical students confronting dying patients, and Hannah Frith, Jayne Raisborough, and Orly Klein examine the cultural labor of constructing deaths as good or bad, with reference to media coverage of the death of UK reality television star Jade Goody.

In the April issue of Psychosomatic Medicine, there is an article evaluating the association between miscarriage and exposure to stress during pregnancy caused by rocket-attack alarm sirens in southern Israel.

Finally, the Journal of Ethnobiology and Ethnomedicine announced that it will run editorials in which ethnobiologists reflect on their first fieldwork experiences, though none have been published yet.  In March, that journal published a study that highlights the public health benefits of educating dairy farmers in Pakistan about the management of houseflies.

When Robert Lemelson, an anthropologist, filmmaker, and research professor at UCLA, recently visited the George Washington University to speak at a conference on how ethnographic films can help us understand torture, I had to request an interview. I confess—I have long been a fan of Lemelson’s films, which I have seen screened at meetings as large as those of the American Anthropological Association and the Society for Psychological Anthropology, and as small as the Culture, Life Course and Mental Health workshop at the University of Chicago.

Lemelson’s films have played at film festivals around the world. So, here are some tips for you.

Tip #1: Lemelson loves to screen his films to a wide variety of audiences, and if you invite him to screen his films for you, he may just agree to come and speak with your group.

Several of Lemelson’s films that I have seen are now part of a six-film series titled Afflictions: Culture and Mental Illness in Indonesia, which Lemelson produced and directed with Elemental Productions. This powerful series was nominated for Best Limited Documentary Series from the International Documentary Association Awards in 2010. The films have won numerous other awards, which can be viewed here.

Tip # 2: Rather than purchasing the film series yourself, it is ideal to request that it be purchased through your home institution’s library, which will make it available to your students (who will benefit from having access to the series), and faculty (who will enjoy using it as a teaching tool for various topics related to culture and global mental health). Or you can rent it on Amazon, etc.

The series consists of six, 20- to 45- minute ethnographic films on people diagnosed with severe mental illness in Indonesia. The series is based on material drawn from 12 years of person-centered research by Lemelson. In the spirit of psychological anthropology, the series follows six individuals of different ages and backgrounds across time to explore the relationship between culture, mental illness, and first-person experience. The films include (these titles hyperlink to trailers for each film): Memory of My Face, The Bird Dancer, Family Victim, Ritual Burdens, Shadows and Illuminations and Kites & Monsters.

As Lemelson and I settled in for his interview in the basement of the Red Cross building in Washington, DC, he told me that his commitments to the methods and theory of psychological anthropology, as well as his love for—and desire to experiment with—ethnographic film were the inspiration for this series. In general, Lemelson told me, he is committed to looking at anthropological concepts and their application to real-world problems. We must raise awareness of issues related to political economy, power, and gender, he claimed, because they are so important to solving global challenges.

Robert: I am trying to pioneer a kind of filmmaking that places people and their narratives at the forefront, or at least in an equal position with what is at stake theoretically for anthropology. As a psychological anthropologist, the subjects’ stories come first and telling those stories, informed by theory, is what the films are about. So stories are person-centered but they point to larger things.

Robert Lemelson and Nyoman Kereta and Family- the family highlighted in the film “Shadows and Illuminations”

What inspired the Afflictions Series?

These films tell the stories of the diagnosis, care and treatment of Indonesians suffering from mental “afflictions,” while analyzing the impact of cultural elements, such as kinship networks, symbol and ritual, stigma, gender, employment, politics, caregiving, and pharmaceutical and traditional treatments on the course of their illness.

The films were inspired by data presented in the DOSMED (Determinants of Outcome of Severe Mental Disorders) and IPSS (International Pilot Study of Schizophrenia) studies conducted by the World Health Organization. The IPSS was conducted in 1979 and investigated over 1200 young people with recent-onset functional psychosis in nine countries across the globe (China, Colombia, Czechoslovakia, Denmark, Nigeria, India, the USSR, the UK and the USA). The main finding of the IPSS was that people in the “developing countries” seemed to have better outcomes than people in the “developed countries.” Because the IPSS recruited people from psychiatric facilities, which may have been a confounding variable since help-seeking patterns can differ widely depending on social context, a second study (DOSMeD, 1992) was designed to correct this by recruiting people who were making their first contact with any helping agency and who had also received a diagnosis of schizophrenia.

This study recruited almost 1400 patients from 12 centers. At 2-year follow-up, the DOSMeD study confirmed the IPSS findings of a more favorable outcome in developing countries. Part of Lemelson’s dissertation research in the mid 1990’s was exploring the question of why people diagnosed with forms of severe mental illness in the developing world, in this case in Indonesia, had significantly better psychosocial outcomes than in the West. The Afflictions films have their origins in a number of his subjects from this research endeavor.

How did the findings of the DOSMeD and IPSS studies influence your own inquiry?

Robert: Well, these films – they all address issues related to better outcomes in the developing world for people with serious mental disorders. You can see it in the aggregate—all the films together. For example, what’s helpful for better outcome overall is social support. What’s disruptive is social isolation. People need valued roles—valued social roles. Labeling and attributions of illness also play important roles. For example, people can be psychotic but not viewed locally as mad. There is space for that in the Indonesian culture. You can see in the films how important non-stigmatizing labels may be and the important role of explanatory models. Take Gusti, for instance [a young woman from The Bird Dancer who experiences Tourette’s Syndrome]. Her family used local explanatory models that tend to stigmatize people like Gusti.

She is not really that ill, but because her family thinks she is bewitched and ancestrally cursed she has a terrible outcome- she is isolated, feared, scorned and rejected, all because of a negative, local explanatory model. You can see all of these things at work in the films—attribution, labeling, work routines, social support. Each film focuses on one or more of these critical factors integrally linked with differential outcome.

Pak Kereta, from “Shadows and Illuminations”

Lemelson’s attention to detail and his focus on issues pertaining to the outcomes data make these films a great tool for promoting student discussions pertaining to culture and global mental health. Topics they prompt for discussion, for example, include: how families’ attitudes and perceptions of afflicted family members shape the afflicted person’s sense of self in both positive and negative ways; the power of culture to protect and buffer people with psychiatric diagnoses, or exacerbate their condition; the nuanced stresses of everyday experiences of life with a serious psychiatric diagnosis (e.g., wanting to commit suicide to lessen the family burden of the costs of care); the importance of one’s cultural universe and for the explanation, expression and management of mental distress; and finally, the complex ways that pharmaceutical treatment can be effective or unsuccessful. These are issues at the heart of what it means to be human, as well as recent debates about the role of pharmaceuticals in global mental health, the role of religious institutions in care for people experiencing emotional distress, and the role of the family in sickness and in health.

Tip #3: The series also comes with a range of excellent supplemental study guides that my students and I have found to be very useful. They help me to flesh out my students’ understandings of the film with rich information about culture and context. These guides are available as free downloads from the same links that I used for the film trailers above.

But enough about me, what does Lemelson love about the films, and what advice does he have to offer those of us who are keen to make our own?

Robert: One thing I love about these films is that they were shot over an extended period—of years to over a decade. I have been filming in Indonesia for fifteen years, and we must have four to five thousand hours of raw film and video. I could do nothing else for the rest of my life besides edit what we have, which I have no plan of doing because there is a world out there waiting to be understood!

How did you get started?

Robert: It’s been a long road to get here and we shot for a long time. We have worked from 1997 (30 hours) and then I went back every year from 2000, except for the 2 years I was blacklisted [a notable hazard for ethnographers and filmmakers] for my political work on the film “40 Years of Silence” about the Indonesian mass killings of 1965. We sometimes did several shoots per year, but we waited till 2007 to do a complete output of a feature film. Well, we did put out a number of smaller films, but we saved a lot for this longitudinal perspective of people’s lives. A lot of times we didn’t even know how their story would become important until multiple visits had been made and we learned more of the details of people’s lives that you cannot really hide over time.

What is your advice to young anthropologists?

Robert: People shoot research footage for coding, logging, analyzing, and that’s fine. A lot of times, we don’t care what it looks like, but honestly for cinematic purposes it’s not valuable. So, I try to encourage people to film how I film when they are conducting their research, so that technically and artistically it’s of sufficiently decent quality to make a teaching film. A level above that is using your ethnographic video footage to produce an actual film, which will go out in the world beyond the class. In my ethnographic film classes, I want the students to understand film conventions—really basic fundamentals of cinema that enables them to transfer collected field data into teaching materials and beyond.

Do you think it’s possible to do that without, say, going to film school?

Robert: Well, film school helps, no doubt, but film school does not teach Anthropology! For simple projects, if you are smart enough, you can do it on your iPhone. They have HD cameras that 15 years ago would have been $100,000, and are now $100. This is the digital revolution—right now. But what is Youtube filled with? Videos of people with their cats, or whatever—sex. But if people approach film a little more methodically, we could have amazing teaching materials, like ten-minute pieces that you can screen in class. Ten years later the students may not remember what they read or the lecture you gave, but I bet they will remember that great film. The vast majority our students are not going to be anthropologists, so we want them to remember things of value that they can use to be better citizens. The digital revolution gives us this opportunity.

What is your perspective on bearing witness as a filmmaker?

Robert: Writing is the central part of our field. Margaret Mead called it “a discipline of words”. Writing is not going to go away. Words are valued. But a lot of journal articles are read by maybe 25 people in the entire world, all specialists—films get to be seen by many. For example, one of our films, “40 Years of Silence,” has been viewed by upwards of 40,000 people on our Facebook page. Some people are so grateful and others issue death threats, but the materials are out there for them to see and think about in their own lives when they are able.

So, bearing witness is a step of solidarity?

Robert: Right, trying to tell a story that has some impact in a domain. We have some ethnographic pieces that have a little bit of history. In Afflictions, we are making statements about stigma and the role of culture in mental illness. For example, Ritual Burdens and Memory of My Face, in very different ways, show how culture plays a role in differential outcome. A lot of theory went into how we constructed that.

Ni Ketut Kasih and her family from “Ritual Burdens”

In Ritual Burdens, we were trying to tell a story about developmental and cohort effects—how significant loss and trauma in childhood plays a role in a setting where life is very stressful for women. When the main character—an elderly women who survived the tumult of WW2, Indonesian independence struggles, and the mass killings of 1965—undergoes the gender-based stress of ritual preparation and ceremony, she remembers her difficult childhood and has a psychotic episode. The main character was psychiatrically hospitalized, like, 40 times. In the US, she would be on the street—she would not be at home, with a loving family, being cared for, massaged. This would be very unlikely to happen. So the film makes a comparative point also—about social support and the role social support plays in better outcome.

Bambang the main character from “Memory of my Face”

Memory of My Face is a piece on globalization. Globalization penetrates this subject’s life- in the metaphors he thinks with, the illness categories he labels himself with, the mechanized work routines of sweat shop work for multinationals, and—most interestingly—the content and shape of his psychotic delusions and hallucinations.

More positive, still globalized factors, pointed to the protective effect of a caring religious (in this case, Sunni Muslim) community. Also, a lot of the people in the films are married and have kids, unlikely for people with serious mental illnesses in America. These are all examples of how culture can be protective—meaningful social roles, protective families, meaningful work, but also harmful when stigma is strong or social expectations are too great.

How do you watch these things happen in your films and not want to just fix it right there?

R: Well, I do, sometimes. I have to get involved. Take the example of Lisa [a young woman Lemelson’s team first met when she was six years old and followed through her teenage years in a recent film on human trafficking, Standing on the Edge of a Thorn]. She wanted to be a doctor, but was recently herself was in danger of being trafficked into the globalized sex trade in Indonesia’s urban areas. So, we—my Indonesian collaborators and I—promised Lisa that if she kept up her grades, she could go to college if she still wanted to go, and we would find a way to pay for it. It was really not expensive. And listen, I feel like I contribute to the world through my philanthropy. I do my part to be a good contributing citizen to the world with my foundations, but my “subjects” in these films are in many cases also my friends. And you help your friends out in whatever way you can.

Do you let people watch the films you make about them?

Robert: Yes, I always, when I am able, screen my films to my subjects and get their feedback. That is an important part of the editing process. Sometimes they think we nailed it, sometimes there are criticisms, but this has to be a collaborative process.

What’s next for him?

Robert Lemelson has recently been filming in Burma (now Myanmar). He is also working more on short-format films, and he is excited about the portability and affordability of current technologies.

What’s next for anthropology?

Robert: Anthropologists have a real educational and research mission. The fact we are being consulted by international aid organizations shows that there is a fundamental orientation to development, and in an applied anthropology way we have a lot to offer. So much of the focus of anthropology on inductive, grassroots knowledge—these are concepts that if you think with and apply to a real-world problem, there is so much to learn.

Further Reading (from most recent)

The Bird Dancer, a film on Neurospychiatric Disorders, has all ready been extensively reviewed by Greg Downey, in a lovely piece available here, called Not allowed to have a small heart: Tourette’s Syndrome.

Myers, N. 2011. Update: Schizophrenia across Cultures. Current Psychiatry Reports.

Luhrmann, T.M. 2007. Social Defeat and the Culture of Chronicity: Or, why schizophrenia does so well over there and so badly here. Culture, Medicine and Psychiatry.

Hopper, Kim J. and Wanderling, J. (2000). Revisiting the Developed versus Developing Country Distinction in Course and Outcome in Schizophrenia: Results from ISoS, the WHO Collaborative Project.

Good, Byron J. 1997. Studying Mental Illness in Context: Local, Global or Universal?

François Jullien, philosophe et sinologue, a ouvert et développé, depuis une trentaine d’années, un chantier où il a élaboré, en passant par le dehors de la Chine, des concepts permettant de relancer la pensée européenne. Quand on veut présenter ou traduire en chinois une telle œuvre, on est confronté, sinon toujours du moins fréquemment, à ce problème : comment traduire en chinois les concepts de F. Jullien. Cette communication proposera une solution s’appuyant sur des expériences de traducteur. Ce n’est qu’en remontant aux sources de sa pensée et en tenant compte de son cheminement qu’on peut rendre en chinois une telle réflexion, sans la trahir.

 

Une œuvre pourrait connaître une seconde vie, voire une troisième vie ou plusieurs vies ailleurs, en étant traduite (j’ai failli dire « se réincarner ») en langues étrangères. De quelle nouvelle vie s’agit-il ? Dit autrement, qu’apporte la traduction ? Quel est son rapport au public de la langue d’arrivée ? Questions de base, questions que se posent tous les traducteurs consciencieux, et les auteurs traduits. En ce qui concerne le monde chinois, nous avons remarqué que, passés sous influence de la pensée occidentale, les philosophes chinois du XXe siècle ont emprunté peut-être trop directement pour traduire la pensée chinoise, les concepts européens comme « dialectique » ou « ontologie », afin d’établir le mérite et le rapport conceptuels à propos des grands couples de la pensée chinoise tels que « repos » et « mouvement », « modification » et « continuité », « de front » et « de biais », etc.[1] Mais nous voyons bien que, dans cette pensée, tout ce qui s’actualise comme opposé contient toujours aussi l’autre en soi, sur un mode latent, et que les contraires, en demeurant ainsi corrélés, sont conduits à alterner l’un avec l’autre ; d’où découle, à travers leur réversion, un dynamisme ininterrompu. Soyons prudent dans notre travail de « passeur », qu’il s’agisse de traduction, d’interprétation ou d’étude « comparatiste ». De l’Europe vers la Chine, de la Chine vers l’Europe, il faudrait prendre en compte le cheminement d’un concept ou d’une théorie. L’objet de cette intervention se concentra sur la traduction en chinois des concepts philosophiques, en donnant comme illustration ceux qu’a créés François Jullien, philosophe et sinologue (dont la bibliographie se trouve en fin de ce texte). En tant que sa traductrice, je fais très attention aux sources de sa pensée pour, d’une part, rendre ses concepts, sans les aplatir et, d’autre part, relancer le texte en exploitant son origine qu’on ne soupçonne pas.

 

 

 

 

 

Comment créer des concepts pour traduire la pensée chinoise ?

 

 

Au début, François Jullien a cherché à exprimer la pensée chinoise à partir des termes européens associés, les termes « monstrueux » tels que cosmo-anthropologigo-moral. En témoigne le début de sa thèse de doctorat d’Etat : La Valeur allusive, Des catégories originales de l’interprétation poétique dans la tradition chinoise, (EFE­O, 1985 ; rééd., PUF, 2003). Il a essayé de représenter une vision globale de la Chine en employant plusieurs termes européens séparés sur plusieurs plans. En effet, les outils philosophiques de l’Europe sont établis en plans différents, alors que la pensée chinoise se comprend dans une vision globale. Ensuite, l’une de ses préoccupations était comment créer des concepts pour traduire la pensée chinoise. Il a choisi, comme solution, des termes en marge des notions théoriques en usage en Europe, tels que la « fadeur », la « disponibilité », la « propension », les « transformations silencieuses », entre autres. Ces mots, moins chargés théoriquement, donc plus disponibles sémantiquement, sont transformés par lui en concepts philosophiques, et, ce faisant, il a resitué la pensée chinoise dans le champ philosophique. Une telle stratégie lui a permis de déplier les cohérences qu’il avait repérées, saisies et étudiées dans la pensée chinoise, et de ne pas les réduire aux catégories européennes.

 

Pour sortir du problème de « facsimiler » les concepts et théories européens passant en langue chinoise, il faudrait régler la possibilité de la catégorisation. Car, depuis l’introduction des concepts et des méthodes de l’Occident au XIXe siècle, la Chine a fini par s’emparer de ces emprunts conceptuels et méthodiques sans se soucier vraiment ni du sens originel des termes ni de leur évolution/application historique. Implantées dans le sol chinois, les catégories européennes se voient réappropriées par les Sinophones sans pour autant que ceux-ci fassent vraiment la distinction entre l’originel et le facsimilé. On en trouve nombreux exemples : le beau, l’ontologie, la métaphysique… Ce qui conduit à au moins deux phénomènes inquiétants. Premièrement, il y a une confusion sur le plan conceptuel : par exemple, des savants chinois croient que l’ontologie fait partie de la pensée chinoise,[2] alors qu’on sait que la question de l’Etre ne se pose même pas chez les penseurs chinois antérieurs à l’arrivée en Chine de la pensée européenne. Par exemple, dans son livre intitulé Etudes sur l’ontologie, Bentilun yanjiu (《本体论研究》), Yu Xuanmeng（俞宣孟, 1948-）tente de clarifier ce que’est l’ontologie européenne et d’examiner les termes chinois existants pour traduire le mot d’« ontologie ». Bien que sa proposition de « shi » (是) pour rendre l’« Etre » ne semble pas convaincante, on doit saluer ses efforts, au sujet de l’histoire de la « philosophie » chinoise (car pour Yu, il y a bien la philosophie chinoise depuis l’Antiquité, et il évite d’évoquer « la pensée chinoise »), pour dépasser les travaux de ses anciens tels que Hu Shi (胡适, 1891-1958), Feng Youlan（冯友兰, 1895-1990）ou Zhang Dainian（张岱年, 1909-）. Yu a aussi discuté longuement de l’origine grecque de l’ontologie (à partir de Platon mais il n’a pas parlé des notions de l’être avant Platon, comme « être et non-être » chez Parménide) et de l’évolution de la définition qu’on donne en Europe à l’ontologie. Il s’efforce de justifier ce que peut être l’ontologie en Chine depuis le Yijing ou Livre des mutations (《易经》), puisque la traduction chinoise de l’ontologie，形上学（xingshangxue）ou形而上学（xing’ershangxue）, provient de cet ouvrage fondamental de la pensée chinoise. Cela veut dire que, pour Yu, l’ontologie existe bel et bien dans la pensée chinoise (« philosophie chinoise » selon Yu), mais que celle-ci est différente de l’ontologie européenne. Yu a cité Chine et christianisme. Action et réaction de Jacques Gernet (Gallimard, 1982)[3] pour soutenir son idée que la philosophie chinoise ne sépare pas le Dao et la réalité (dao bu li qi道不离器), comme le fait le christianisme. Yu Xuanmeng se montre très réfléchi sur la problématique de l’ontologie ; cependant, s’il avait connu les travaux de François Jullien, (il ne connaît pas le français, et sa connaissance du livre de Gernet s’est acquise à travers d’une traduction en chinois), il aurait pu mieux cerner beaucoup de questions traitées dans son Etudes sur l’ontologie : tant du côté grecque, comme la définition du mot « philosophie », le général et le particulier, les parties et le tout, que du côté chinois tels que le Yijing, le Laozi, les Entretiens de Confucius, entre autres. Comme toutes personnes pensent en langue, Yu avait ses limites linguistiques, mais il ne semblait pas soupçonner. D’où l’importance de traduire, bien traduire, les œuvres de François Jullien, et de les faire connaître. Car ce que ce philosophe-sinologue a ouvert par son chantier comme des possibilités développées entre la Chine et l’Europe, invite à se réfléchir en retour d’un « dehors », celui de l’Europe. On ne se contente plus de passer par l’anglais ou le japonais ; on l’explore réellement dans les langues de la philosophie européenne.

 

Le second fait inquiétant est que, l’éducation moderne promue depuis l’ère républicaine (débutant en 1912), ayant adopté via le Japon les modèles occidentaux, les Chinois ainsi formés ont souvent négligé les anciens textes traitant par exemple de ce qu’on appelle en Occident la notion de l’esthétique ; ils connaissent les théories européennes quoique pour beaucoup d’entre eux, ils n’aient pas accédé aux sources premières, se contentant des traductions. Par conséquent, quand ils parlent de la perspective, ils ont souvent oublié les « trois lointains », « san yuan » (三远), dont Guo Xi (郭熙, environ 1023-1085) expose magnifiquement dans son Enseignements sur les montagnes et les eaux (Shanshui xun, 《山水训》) : il s’agit là du lointain par profondeur (shenyuan, 深远), du lointain par distance/étendue (pingyuan, 平远) et du lointain par hauteur (gaoyuan, 高远). On voit bien que, du côté chinois, le regard du peintre dans l’espace se conçoit sur trois plans (évitons d’établir immédiatement un équivalent avec 3D), ou précisément, le peintre « vit » au sein du paysage : l’étendue, la profondeur et la hauteur offertes par le paysage sont les vecteurs de la communication en esprit avec le peintre.

 

Un processus génétique : défaire pour refaire

 

 

D’où est nécessaire un travail de dé-catégorisation qui seule permettrait d’enlever les couches artificielles, de remonter à l’origine des concepts importés ; et en même temps de revisiter les textes chinois d’autrefois, de réfléchir sur les écarts ainsi ouverts et creusés entre les pensées chinoise et européenne. Il s’agit de sortir du cadre, ou casser le cadre philosophique, en vue d’examiner, un par un et cas par cas, les termes avec lesquels on se sent familier dans sa propre langue, tellement familier qu’on ne soupçonne même pas l’« impensé » de ce sur quoi l’on s’appuie dans ses réflexions et dans son discours.

 

Après avoir détruit le bulle confortable des théories dont on n’a jamais interrogé le fonds d’entente, on en vient ainsi à envisage une re-catégorisation des outils conceptuels, en tirant parti de ses propres réflexions sur le vis-à-vis entre Chine et Europe.

 

Le travail philosophique de François Jullien est issu d’un processus génétique : défaire pour refaire. Sa stratégie consiste à travailler au travers des termes en marge de la terminologie philosophique établie, des termes moins chargés théoriquement, donc plus disponibles sémantiquement : un tel mot serait plus maniable pour laisser passer ce qui est obscur, étrange ou illisible aux Européens. Très attentif aux cohérences de la pensée chinoise, F. Jullien les appréhende à travers tous les domaines (pensée première, politique, esthétique, littérature, stratégie militaire, etc.), sans les rabattre sur la pensée européenne afin de les conceptualiser. Il est à noter que les concepts qu’a créés François Jullien à partir des cohérences chinoises ne sont point des concepts en Chine. Prenons le concept de la « propension des choses » qu’il a promu à partir des cohérences chinoises. C’est pour défaire le grand clivage entre statique et dynamique, car ce terme, « la propension des choses », Shi（势）, inclut à la fois le mouvement des choses et la situation des choses, laissant apparaître l’inséparabilité des deux. D’où il ne répond en effet pas aux catégories européennes. Quand on remonte aux sources de ce concept de François Jullien, donc chez les Chinois, on comprend mieux le travail qu’il a opéré. De même pour les traducteurs de ses œuvres, c’est seulement en remontant à l’origine de ses concepts qu’on peut les rendre « correctement » dans une langue autre que le français. J’en donnerai quelques illustrations basées sur mon expérience de traducteur.

 

 

Allusivité : allusif, implicite, indirect, indiciel, par biais, le détour et l’accès

 

Le mot d’« allusif », nous dit le Petit Robert, signifie 1/ qui contient une allusion, 2/ qui parle par allusions. On remonte au terme d’« allusion » et on trouve comme définition dans le même dictionnaire : « manière d’éveiller l’idée d’une personne ou d’une chose sans en faire expressément mention ». Nous remarquons que dans le vocabulaire conceptuel de F. Jullien, c’est « allusivité », un mot qu’il a créé afin de promouvoir une cohérence chinoise des stratégies des expressions. Le mot « allusif » renvoie à une notion locale en français, alors que le terme d’« allusivité » passe à un niveau conceptuel, ajoutant une notion de capacité. Cette capacité s’applique dans toutes les circonstances, quels que soient le milieu culturel et l’époque.

 

Plusieurs ouvrages de F. Jullien se déploient, totalement ou en parie, autour de cette problématisation. La valeur allusive. Des catégories originales de l’interprétation poétique dans la tradition chinoise (1985), où il examine l’un des grands classiques chinois, le Livre des odes, le Shijing, et il y analyse comment la poésie exprime par allusions les mœurs, les éloges ou les critiques adressées aux princes. Éloge de la fadeur, A partir de la pensée et de l’esthétique de la Chine (1991), où l’auteur explique que la notion de la fadeur, positive en Chine, se prononce de manière allusive, indirecte. Ou encore, Le Détour et l’accès, Stratégies du sens en Chine, en Grèce (1995), où le philosophe-sinologue met en lumière la stratégie du sens en Chine, en s’appuyant sur l’exemple de Confucius (le Maître s’exprimant souvent par l’indiciel pour qu’on accède juste à ce qu’il veut dire, dont un célèbre épisode : il soulève un coin et c’est à son interlocuteur d’en trouver les trois autres coins). F. Jullien en parle encore dans ses autres livres (comme Cinq concepts proposés à la psychanalyse, 2012, p.51-82).

 

Notre question à nous, en tant que traducteur, consiste à rendre en chinois le terme d’« allusivité ». Resitué dans le cadre chinois, il peut dire « allusif » (hanxu含蓄, yingshe影射ou anshi暗示), implicite (yinyu隐喻), indirect (jianjie间接), indiciel ([bu mingshuo de] zhishi [不明说的]指示), par biais (chu qi出奇, cong pang ce ji从旁侧击ou guai wan mo jiao拐弯抹角), le détour et l’accès (qu er zhong曲而中ou  yuhui yu jinru迂迴与进入). D’après F. Jullien, c’est d’abord dans le sens de « hanxu » (含蓄 : contenant beaucoup de prégnances) qu’il entend ce terme d’« allusivité », un mot, rappelons-le, créé par lui. Ce n’est qu’en remontant aux sources du « terrain de quête et d’enquête » de F. Jullien, et qu’après avoir discuté avec lui que le mot hanxu a été choisi pour traduire « allusivité », et le titre de sa thèse de doctorat d’Etat. François Jullien veut faire passer, par l’« allusivité », une capacité globale de la pensée chinoise ; et en psychanalyse, une capacité générale. Ce qui explique que le mot anshi (暗示 : désignant en creux) conviendrait mieux pour rendre le chapitre d’« Allusivité » de Cinq concepts proposés à la psychanalyse, (car tout ce que dit le patient renvoie quelque part à son trauma).

 

Disponibilité : jian-kexing (兼可行) : com-possibles, ouvert à tous les possibles, sans privilégier l’un d’entre eux ; « xu wei yi dai » (虚位以待, « vide place pour attendre »)

 

Un mot courant dans la vie quotidienne, « disponible », selon le Petit Robert, dit 1/ (choses) ce « dont on peut disposer », 2/ (personnes) officiel, fonctionnaire disponible, qui n’est pas en activité, mais demeure toujours à la disposition de l’armée, de l’administration, 3/ dont l’action, le jugement, les sentiments peuvent se modifier librement, qui n’est lié ou engagé par rien. Quant au mot « disponibilité », il signifie « état de ce qui est disponible » ; 1/ (choses) la disponibilité des biens : la faculté d’en disposer, de les aliéner librement ; 2/ (personnes) situation administrative de certains fonctionnaires, écartés provisoirement de leurs fonctions, mais qui conservent leur grade, leur droit à la retraite, ou situation d’un militaire maintenu ou renvoyé dans ses foyers avant l’expiration de la durée légale, bien qu’il demeure apte au service actif ; 3/ état de ce qui est disponible, comme « disponibilité d’esprit ». On en vient à la troisième définition qui nous intéresse pour comprendre le travail de F. Jullien.

 

Dans Un Sage est sans idée, ou l’autre de la philosophie (1998), l’auteur remonte à l’Antiquité en Chine et en Grèce afin de distinguer le sage du philosophe (voir le tableau en annexe). La disponibilité est l’une des caractéristiques du sage chinois : celui-ci demeure ouvert à tous les possibles, se gardant de prononcer pour l’un d’entre eux, ne se braquant d’aucun côté, restant disponible à toute tendance. Confucius dit « Les quatre choses dont le Maître était exempt : il était sans idée (privilégiée), sans nécessité (prédéterminée), sans position (arrêtée) et sans moi (particulier) »[4] (Entretiens de Confucius, IX, 4). Différent du philosophe, le sage est disponible, ne manifestant de préférence d’aucune partie, d’aucun côté, ou d’aucun parti particulier. Pour François Jullien, un sage sait accéder à la disponibilité ; le Sage se maintient dans le compossible. L’auteur de Du « Temps ». Eléments d’une philosophie du vivre (2001) dit qu’« être de saison », c’est « être en phase » ; et parlant de la sagesse, il s’agit de « vivre à propos » (p.115) ; il y met en avant « opportunité et disponibilité » (p.118) et « opportunité du moment » (p.121). Etre disponible aux moments opportuns ; voilà ce qui relève d’une philosophie du vivre (davantage développée dans son Philosophie du vivre, 2011). On ne vit ni d’après un programme préconçu, ni n’importe comment, comme « à vau-l’eau », mais on accède au vivre au gré de, à la fois en épousant l’authenticité de son sentiment et de sa pensée, et en écoutant la tendance du monde. Lecteur attentif des œuvres de Freud, François Jullien invite ses propres lecteurs à réfléchir au concept de la disponibilité dans la pratique psychanalytique. Parmi les cinq concepts qu’il a proposés à la psychanalyse (« Disponibilité », « Allusivité », « Le biais, l’oblique, l’influence », « Dé-fixation » et « Une transformation silencieuse »), celui de la disponibilité apparaît en premier, car il va de soi qu’un professionnel de la discipline est disponible envers ses analysants. On sait que le premier « conseil » qu’adresse Freud au psychanalyste est de garder son attention diffuse et non focalisée, c’est-à-dire non régie par quelque « intentionnalité » (Cinq concepts proposés à la psychanalyse, 2012, p.28). Freud avance une formule d’« attention flottante » ou, traduisons plus précisément, dit François Jullien, « planant en égal suspens », gleichschwebende Aufinerksamkeit. En rappelant le chapitre « Qiwulun » de Zhuangzi, l’auteur nous dit que, pour être disponible, « La première exigence est, sans plus projeter de préférence ou de réticence, de tenir toutes les choses ‘à l’égalité’ » (ibid. p.42).

 

Rendre en chinois le concept de « disponibilité » est un défi, car la langue chinoise, familière avec cet état d’esprit, se dispose de plusieurs façons de l’exprimer, mais pas en tant que concept. En chinois, on dit « zizai » (自在, « soi-se trouver ») ; « xu wei yi dai » (虚位以待, « vide place pour attendre ») ; « xinxiong kaifang » (心胸开放, « cœur poitrine ouverts ») ; est souvent exprimé par négation cet état de disponibilité : « wu yi, wu bi, wu gu, wu wo » (毋意，毋必，毋固，毋我), comme le dit le précepte de Confucius ; « bu guzhi » (不固執, « ne pas s’obstiner, ne pas s’entêter »). F. Jullien, qui connaît parfaitement ces expressions anciennes ou modernes, se réfère plutôt à une notion parue dans un traité de la peinture de Guo Xi (郭熙), mentionné ci-dessus. « A considérer de près, il est ainsi ; à considérer de plus loin, il est différemment ainsi ; à considérer encore de plus loin, il est encore différemment ainsi. […] C’est ce qu’on appelle la forme de la montagne se modifiant à chaque pas. […] Ou, de face, il est ainsi ; de côté, il est un autre ainsi ; de dos, encore un autre ainsi : « c’est ce qu’on appelle la forme de la montagne telle qu’on la voit de tous côtés. […] Tel est l’aspect d’une montagne en même temps que de dizaine ou de centaine de montagnes »[5]. C’est pourquoi la montagne est « grande », ample, par sa compossibilité. François Jullien promeut la notion de « com-possible » qu’il a saisie dans Enseignements sur les montagnes et les eaux, et que je traduis par « Jian kexing » (兼可行). Cette notion de com-possible rejoint celui de la disponibilité. F. Jullien en a aussi fait un concept philosophique, un outil de penser, qu’on peut appliquer dans toutes les circonstances, quels que soient le milieu et l’époque. Etre disponible, c’est d’être en phase avec soi-même, avec tous les possibles du monde. J’ai rendu « disponibilité » en chinois par « kuanrong zizai » (宽容自在, « large-tolérant-soi-se trouver ») ou « xu wei yi dai » (虚位以待, « vide place pour attendre »).

 

Le « compossible » se trouve aussi dans Laozi comme il dit que « le grand carré n’a pas d’angle » (da fang wu yu, 大方无隅). Ce qui veut dire que « le grand carré » est délié ou libéré de sa forme stricte d’un carré, de sa « nature » comme un carré ; il n’est réduit  à aucune forme, à aucun carré. Il est « carré », mais sans se limiter à la détermination d’un carré. Car un carré conformément à la définition d’un carré n’est qu’un « carré », et ainsi restreint à « carrément carré » ; de ce fait, il se trouve « petit » (car restreint). Ce qui fait « grand » carré, c’est qu’il ne se laisse pas limiter à sa nature en tant que carré, ce qui veut dire qu’il n’a aucune nature caractéristique qui le détermine comme un carré. Le grand carré n’a pas de « forme » (eidos), pas d’essence constitutive.

 

 

Ecart : jianju (间距) ; le vis-à-vis, tension, réflexivité,

 

« Ecart » donne comme premier sens : « distance qui sépare deux choses qu’on écarte ou qui s’écartent l’une de l’autre » ; on y trouve une distance et un « vis-à-vis » ; l’écart crée ainsi une tension entre les deux parties qu’elle sépare ; celles-ci pourraient s’acquérir des réflexivités d’elle-même et aussi de l’autre. Le mot peut signifier « différence entre deux grandeurs ou deux valeurs » ; et, au sens figuré, il désigne « action de s’écarter des règles morales ou des conventions sociales ». On voit là que ce terme d’« écart » est dynamique, prêtant de la tension aux acteurs d’une situation.

 

Sur le chantier de la pensée de François Jullien, l’« écart » a fait sa parution dès sa thèse de doctorat d’Etat, La valeur allusive ; il est revenu dans presque toutes les œuvres qu’il y a édifiées. En décembre 2011, lors de sa leçon inaugurale (« L’écart et l’entre ») de la Chaire sur l’altérité, au Collège d’études mondiales au sein de la Fondation Maison des sciences de l’homme, à Paris, François Jullien a promu deux concepts – l’écart et l’entre – qu’il a inventés pour traiter de la problématique de l’altérité. Au lieu de souligner la « différence », très à la mode, notamment dans les domaines des cultural studies, de la sociologie et de l’anthropologie, il propose le concept de l’écart, expliquant en quoi cet outil philosophique serait fécond. Justement, l’écart ne range pas, ne compare pas, ne suppose en amont rien servant de fond à l’identité. Il suffit d’écarter deux choses pour créer un vis-à-vis entre elles, produire de la tension entre elles, une tension féconde en ce qu’elle met en valeur les spécificités perspectives des deux côtés, comme la tension entre le vert et le rouge fait ressortir davantage ces deux couleurs.

 

Entre : jian (间), zhijian (之间) ; l’entre,

 

Le second concept que François Jullien a créé et mis en avant est celui de l’entre, car l’écart produit de l’entre. La pensée européenne a eu du mal à penser l’entre parce que celui-ci n’a pas de détermination propre, pas d’essence, pas d’être. Par conséquent, les Européens n’ont pas eu de prise sur lui ; n’ayant pas de prise sur lui, on l’a laissé de côté. L’Etre, l’ontologie et la métaphysique des Grecs et des Européens ont certainement contribué à la fondation et le développement de l’Europe. Or, du fait qu’on ne saurait définir l’entre, il a échappé aux spéculations des philosophes et des théologiens occidentaux. Alors qu’en Chine, comme le montre François Jullien, l’entre est là où traverse la respiration, là où passe/se passe tout phénomène. Le boucher nommé Paoding (庖丁) du Zhuangzi (《庄子》) en donne une illustration par excellence : si, au bout de presque vingt ans d’application, le couteau du boucher ne s’use point, c’est parce qu’il sait parfaitement laisser son instrument traverser de l’« entre ». Rien ne lui fait obstacle, rien ne le contrarie, il ne s’use nullement. L’entre, c’est là où ça passe ; on circule et évolue sans se fatiguer. N’est-ce pas un bel concept vital ?

 

Comment rendre en chinois ces deux concepts philosophiques ? Il s’agit d’une compréhension totale de la pensée de François Jullien. D’apparence, les termes que j’ai proposés – jianju (间距) pour l’écart et zhijian (之间) pour l’entre – semblent faciles à trouver. On peut traduire l’écart par, outre jianju (间距), chaju (差距), juli (距离), xiangju (相距), etc. ; comme on dit : « Les maisons là-bas ont des écarts/espacements réguliers » (那儿的房屋彼此之间的间距很规律) ; « Les revenus des habitants du village sont d’un grand écart les uns des autres » (村里居民的收入差距很大) ; ou « un écart de cinq kilomètres » (距离5公里). Le mot de jianju est souvent employé pour traduire l’espacement ; il peut aussi rendre l’écart. Composé de deux caractères – jian (间: entre) et ju (距: distance) – le mot correspond parfaitement à l’idée de l’écart qu’entend François Jullien. Tant mieux qu’on puisse trouver ce terme pour traduire ce concept de l’écart. Mais il faudrait se garder contre l’aspect facile de ce résultat heureux et chanceux, car ce concept met en jeu tout le parcours philosophique de François Jullien, comme il l’a dit lui-même, de presque quarante années de travail mettant en vis-à-vis la Chine et l’Europe, afin de créer des concepts pour traduire la pensée chinoise et aussi pour relancer la philosophie européenne (voir par exemple Chemin faisant, connaître la Chine ou relancer la philosophie. Réplique à***).

 

Nous savons maintenant, grâce à la démonstration de François Jullien dans son L’écart et l’entre (Galilée, 2012), que les Grecs, n’ayant pas de prise sur l’entre, ont bien développé l’au-delà de la méta-physique, délaissant la metaxu (l’entre). Faisant partie des ressources de la pensée chinoise, la notion de l’entre est repérée et étudiée par le philosophe et sinologue pour en faire un concept, vital. Le mot chinois, jian (间ou閒) dont l’étymologie désigne que le clair de lune traverse entre deux battants d’une porte. L’« entre » est un mot subtilement imagé. En chinois moderne, « entre A et B » se dit « zai A he B zhijian » (在A 和B之间) ; d’où une autre possibilité de rendre « entre » en chinois par zhijian (之间). Pourquoi ai-je finalement choisi zhijian (之间) et non jian (间) pour traduire le concept de l’entre ? Essentiellement pour deux raisons. Comme le chinois emploie le parallélisme, les appariements, zhijian, bi-syllabique, rime avec jianju, lui aussi bi-syllabique. D’ailleurs, le caractère jian (间ou閒) avec une prononciation autre, xian, donne une autre signification : temps libre, inoccupé, à l’écart…  Ce qui constitue des ressources sémantiques de ce caractère. Par rapport à jian, zhijian évite des éventuelles confusions pour dire l’« entre ».

 

 

Transformation silencieuse : mohua (默化)

 

Il y a deux sensations dans l’expression de « transformation silencieuse » : la vue et l’ouïe. Le mot « transformation », au sens figuré, désigne un changement de toutes sortes : transformation physique, transformation d’une œuvre ou de l’écriture d’un auteur, transformation d’une société, etc. Quand un changement ne s’effectue pas brutalement, il passe souvent inaperçu jusqu’au moment où son état de mutation est très visible par rapport à celui d’il y a un certain temps. « Silencieux » évoque une autre sensation, auditive. Un endroit silencieux est calme, sans bruit ; une personne silencieuse ne parle ni ne fait de bruit ; les moments silencieux ressemblent à un arrêt ponctuel du temps : on semble se trouver dans un lieu hors du temps, où le temps paraît en suspens, mais les moments silencieux peuvent devenir oppressants quand on attend l’avènement de quelque chose ou de quelqu’un.

 

« Transformation silencieuse », un sinophone ordinaire dirait chenmode bianhua (沉默的変化), momode gaibian (默默的改変) ou qiaoqiaode zhuanbian (悄悄的转変), alors qu’un sinophone cultivé aurait tendance de l’évoquer par mohua (默化). François Jullien dit clairement l’origine de ce terme chinois, ou de cette notion chinoise : « [les] déplacements souterrain et [les] transformations silencieuses » (qianyi mohua 潛移默化) chez Wang Fuzhi (王夫之, aussi connu sous le nom de Wang Chuanshan, 王船山, 1619-1692). L’un des penseurs et auteurs préférés de François Jullien, Wang Fuzhi a bien proposé cet idiome en quatre caractères dans ses commentaires sur les grands classiques chinois et ses lectures critiques de la poésie chinoise. En chinois moderne, on lit ces quatre caractères en deux mots bi-syllabiques : qianyi et mohua, ce qui prouve que l’expression s’est bien intégrée dans le langage courant, et que font partie du fonds d’entente des Chinois l’idée des déplacements souterrains (en parlant du processus lent d’une modification s’effectuant par très petites touches comme si elle se déplaçait inaperçue), et celle des transformations silencieuses. Il s’agit là d’une pensée du « processus » : « une transformation silencieuse qu’on ne voit pas s’opérer. « Silencieux » est plus juste, en effet, qu’invisible, à cet égard, ou plutôt en dit plus. Car non seulement cette transformation en cours, on ne la perçoit pas, mais elle s’opère elle-même sans crier gare, sans alerter, « en silence » : sans se faire remarquer ; sans vouloir nous déranger, alors même que c’est en nous qu’elle fait son chemin jusqu’à nous détruire » (Les transformations silencieuses, p.11-12). François Jullien appelle « transformation silencieuse une transformation qui se passe sans bruit, donc dont on ne parle pas. Silencieuse dans ces deux sens : elle opère sans crier gare, on ne songe pas à en parler. Son imperceptibilité n’est pas celle de l’invisible, car elle se produit ostensiblement, sous nos yeux, mais ne se repère pas. » (Cinq concepts proposés à la psychanalyse, p. 147) Cette cohérence de transformation silencieuse, saisie dans la pensée chinoise, est exploitée par François Jullien en concept philosophique, un outil opératoire, permettant de repérer les changements qui se produisent sans crier gare.

Par opposition, nous dit François Jullien, se voit et s’entend un événement sonore qui n’est en fait que l’aboutissement des transformations silencieuses. A la différence des transformations silencieuses, un événement sonore peut être désigné, déterminé, avec un début et une fin, avec les éléments concrets susceptibles de donner un contour de ce qui s’est passé. C’est pourquoi l’on remarque fréquemment des événements survenus dans notre monde, mais dont les mutations peu inaperçues sont très souvent ignorées, tel qu’un procès connu du public : le média ne rapporte et ne montre que les moments et les images « forts ».

 

 

 

La prise en compte génétique dans mon travail du traducteur a deux sens, particulier et général. D’abord, concernant les concepts philosophiques que François Jullien a créés, ils sont promus en trois temps : 1/ l’association (une sorte de conglomérat) de plusieurs termes européens pour exprimer l’inséparabilité de la pensée chinoise ; 2/ la prise des cohérences de la pensée chinoise pour les faire passer en français ; 3/ la création de ses propres concepts en utilisant ces cohérences, dont on peut se servir pour toutes les expériences. La création de ces outils de penser est très significative puisqu’on peut les appliquer dans toutes les circonstances, tandis qu’en Chine, ils ne sont pas les concepts, leur pratique restant locale. Le sens général du mot « génétique » ici est de ne pas trahir le concept du départ ; il faut, au fond pour traduire, qu’un bon traducteur soit un généticien de la pensée. Il doit tenir compte de la diachronique des concepts et des théories : on ne peut pas se limiter à un moment de leur histoire.

[1] Voir, par exemple, l’Histoire chinoise de la dialectique (Zhongguo bianzhengfa shi, 《中国辩证法史》，田文军, 吴根友，郑州，河南出版社，2004) ; ou Contempory Chinese Philosophy, édité par Chung-ying Cheng et Nicolas Bunnin, Blackwell publishers,  2002.

[2] En témoigne par exemple l’ouvrage de Yu Xuanmeng, Bentilun yanjiu, Shanghai renmin chubanshe (俞宣孟,《本体论研究》, 上海人民出版社, 1999).

[3] Zhongguo he jidujiao , traduit par Geng Sheng, Shanghai guji chubanshe,《中国和基督教》, 耿昇译, 上海古籍出版社, 1991.

[4] “子绝四：毋意，毋必，毋固，毋我。”（《论语》<子罕第九>，四）

[5]郭熙论道：“山，近看如此，远数里看又如此，远十数里看又如此，每远每异，所谓‘山形步步移’也”。又说：“正面如此，侧面又如此，背面又如此，每看每异，所谓‘山形面面看’也”。“如此是一山兼数十百山之形状”。（《山水训》）

With daylight saving time come new articles this April!

The current issue of Medical Anthropology explores concepts of healing in diverse contexts. James B. Waldram opens the discussion with his investigation into the notion of efficacy within indigenous healing practices in Belize and Canada. He offers two approaches to define efficacy, each focussed on a different outcome: transformation and restoration.

Tsipy Ivry coins the term “kosher medicine” for the interaction between Israeli biomedicine and religion in the context of hormonal infertility treatment. She argues that collaboration in healing between medical doctors and rabbis only works as long as medical doctors do not display knowledge in rabbinic law nor challenge the rabbinic directives.

HIV/AIDS in displacement camps in Northern Uganda is associated with a diverse range of meanings, drawing from militarism, Christian missions, camp life to humanitarianism, argues Matthew Wilhelm Solomon. His fieldwork suggests that people with HIV/AIDS create new health identities at the intersections of being labeled and operating within biosocial and therapeutic spheres.

In Southern Ghana, healing is a pluralistic endeavour, write Kate R. Hampshire and Samuel Asiedu Owusu. The authors portray four healers, who “selectively adapt, adopt, and modify elements of biomedical, ‘local,’ and ‘exotic’ healing practices”. Thus, traditional healing is infused by modern technologies to increase reach and access to a growing healing market.

Finally, Tine Tjørnhøj-Thomsen and Helle Ploug Hansen describe a Danish cancer rehabilitation program through the study of ritualization.

Among the latest articles in Philosophy, Ethics and Humanities in Medicine is a commentary on physicians and the death penalty in the United States, by Joel B Zivot. The commentary is intriguing as Zivot describes physician involvement in the death penalty as a Catch-22: “If, according to the United States Supreme Court, the death penalty is not cruel per se, it needs no improvement. If the death penalty is cruel, then attempts to reduce cruelty by pharmacological adjustments are not necessarily humane, or worse, create an illusion of humanness as they are physician directed.”  I’d be interested in readers’ comments on this stance: the article itself does not have any comments yet.

Micol Ascoli and colleagues evaluate their Cultural Consultation Services project in mental healthcare in East London. The resulting narratives of cultures of care among health and social work professionals show that during the workday, professionals do not consider cultural influences on patient recovery and instead focus on organisational proficiency.

 

The April issue of the Journal of the History of Medicine and Allied Sciences includes four research articles discussing topics spanning from 1558 to the 1970s. In “Sex and the Capital City: The Political Framing of Syphilis and Prostitution in Early Republican Ankara,” Emine Ö. Evered and Kyle T. Evered argue that in the early Turkish Republic, public health professonials combined the fight against syphilis with policing of what they deemed inappropriate sexual practices and relations.

Andrew T. Simpson describes the establishment of modern paramedics and ambulance services in the United States in the 1960s and 1970s, and Stephen Woolworth examines the history of the Seattle school clinic (1914–21), a full-service medical program for poor and working class children.

I’d like to point out two open access articles in Social History of Medicine. The first one is by Roberta Bivins, arguing for a looking through a postcolonial lense at the investigation of post-war migration to Britain from (former) colonies.

The second open access article discusses the case of a disabled poor person starving in a workhouse in 1877 despite being “cared” for. Kim Price sees this man’s case as an example for systemic problems in the UK with workhouse care and contrasts it with community care during the Victorian period.

 

On the Social Science and Medicine website, you can already access articles in press or scheduled to be published up to June 2013. There you’ll find a plethora of articles. Some choices:

“ ‘We view that as contraceptive failure’: Containing the ‘multiplicity’ of contraception and abortion within Scottish reproductive healthcare ” by Siân M. Beynon-Jones.

“Metaphors and myths in pharmaceutical advertising” by Marjorie Delbaere.

“Addressing the unequal geographic distribution of specialist doctors in Indonesia: The role of the private sector and effectiveness of current regulations” by Andreasta Meliala et al.

“An impact evaluation of the Safe Motherhood Promotion Project in Bangladesh: Evidence from Japanese aid-funded technical cooperation” by Yusuke Kamiya and colleagues.

“Suicide in rural Haiti: Clinical and community perceptions of prevalence, etiology, and prevention” by Ashley K. Hagaman et al.

 

In the April issue of Social Studies of Science, Christopher J. Lawless discusses disputes around ‘low-template DNA’ methods, forms of forensic DNA profiling technologies; and Joanna Radin describes a case study of the International Biological Program in the United States in the 1960s and 1970s, arguing that “new access to technologies of cold storage, which would allow blood to be transported from the field to the lab and be stored for subsequent reanalysis, gave shape to this episode in Cold War human biology.”

When Robert Lemelson, an anthropologist, filmmaker, and research professor at UCLA, recently visited the George Washington University to speak at a conference on how ethnographic films can help us understand torture, I had to request an interview. I confess—I have long been a fan of Lemelson’s films, which I have seen screened at meetings as large as those of the American Anthropological Association and the Society for Psychological Anthropology, and as small as the Culture, Life Course and Mental Health workshop at the University of Chicago. Lemelson’s films have played at film festivals around the world.  So, here is a first tip for you.

 Tip #1: Lemelson loves to screen his films to a wide variety of audiences, and if you invite him to screen his films for you, he may just agree to come and speak with your group.

Several of Lemelson’s films that I have seen are now part of a six-film series titled Afflictions: Culture and Mental Illness in Indonesia, which Lemelson produced and directed with Elemental Productions.  This powerful series has recently won the Award of Excellence at the Accolades Film, Television, New Media and Videography Awards. The films have won numerous other awards, which can be viewed here.

Tip # 2:  Rather than purchasing the film series yourself, it is ideal to request that it be purchased through your home institution’s library, which will make it available to your students (who will benefit from having access to the series), and faculty (who will enjoy using it as a teaching tool for various topics related to culture and global mental health). Or you can rent it on Amazon, etc.

The series consists of six, 20- to 45- minute ethnographic films on people diagnosed with severe mental illness in Indonesia.  The series is based on material drawn from 12 years of person-centered research by Lemelson. In the spirit of psychological anthropology, the series follows six individuals of different ages and backgrounds across time to explore the relationship between culture, mental illness, and first-person experience. The films include (these titles hyperlink to trailers for each film): Memory of My Face, The Bird Dancer, Family Victim, Ritual Burdens, Shadows and Illuminations and Kites & Monsters.

As Lemelson and I settled in for his interview in the basement of the Red Cross building in Washington, DC, he told me that his commitments to the methods and theory of psychological anthropology, as well as his love for—and desire to experiment with—ethnographic film were the inspiration for this series. In general, Lemelson told me, he is committed to looking at anthropological concepts and their application to real-world problems.  We must raise awareness of issues related to political economy, power, and gender, he claimed, because they are so important to solving global challenges.

Robert: I am trying to pioneer a kind of filmmaking that places people and their narratives at the forefront, or at least in an equal position with what is at stake theoretically for anthropology.  As a psychological anthropologist, the subjects’ stories come first and telling those stories, informed by theory, is what the films are about.  So stories are person-centered but they point to larger things.

What Inspired the Afflictions Series?

 These films tell the stories of the diagnosis, care and treatment of Indonesians suffering from mental “afflictions,” while analyzing the impact of cultural elements, such as kinship networks, symbol and ritual, stigma, gender, employment, politics, caregiving, and pharmaceutical and traditional treatments on the course of their illness.

The films were inspired by data presented in the DOSMED (Determinants of Outcome of Severe Mental Disorders) and IPSS (International Pilot Study of Schizophrenia) studies conducted by the World Health Organization.  The IPSS was conducted in 1979 and investigated over 1200 young people with recent-onset functional psychosis in nine countries across the globe (China, Colombia, Czechoslovakia, Denmark, Nigeria, India, the USSR, the UK and the USA).  The main finding of the IPSS was that people in the “developing countries” seemed to have better outcomes than people in the “developed countries.”  Because the IPSS recruited people from psychiatric facilities, which may have been a confounding variable since help-seeking patterns can differ widely depending on social context, a second study (DOSMeD, 1992) was designed to correct this by recruiting people who were making their first contact with any helping agency and who had also received a diagnosis of schizophrenia. This study recruited almost 1400 patients from 12 centers.  At 2-year follow-up, the DOSMeD study confirmed the IPSS findings of a more favorable outcome in developing countries.  Part of Lemelson’s dissertation research in the mid 1990’s was exploring the question of why people diagnosed with forms of severe mental illness in the developing world, in this case in Indonesia, had significantly better psychosocial outcomes than in the West. The Afflictions films have their origins in a number of his subjects from this research endeavor.

How did the findings of the DOSMeD and IPSS studies influence your own inquiry?

Robert: Well, these films – they all address issues related to better outcomes in the developing world for people with serious mental disorders.  You can see it in the aggregate—all the films together. For example, what’s helpful for better outcome overall is social support. What’s disruptive is social isolation.  People need valued roles—valued social roles.  Labeling and attributions of illness also play important roles. For example, people can be psychotic but not viewed locally as mad.  There is space for that in the Indonesian culture.  You can see in the films how important non-stigmatizing labels may be and the important role of explanatory models. Take Gusti, for instance [a young woman from The Bird Dancer who experiences Tourette’s Syndrome].  Her family used local explanatory models that tend to stigmatize people like Gusti.  She is not really that ill, but because her family thinks she is bewitched and ancestrally cursed she has a terrible outcome- she is isolated, feared, scorned and rejected, all because of a negative, local explanatory model.  You can see all of these things at work in the films—attribution, labeling, work routines, social support.   Each film focuses on one or more of these critical factors integrally linked with differential outcome.

Lemelson’s attention to detail and his focus on issues pertaining to the outcomes data make these films a great tool for promoting student discussions pertaining to culture and global mental health.  Topics they prompt for discussion, for example, include: how families’ attitudes and perceptions of afflicted family members shape the afflicted person’s sense of self in both positive and negative ways; the power of culture to protect and buffer people with psychiatric diagnoses, or exacerbate their condition; the nuanced stresses of everyday experiences of life with a serious psychiatric diagnosis (e.g., wanting to commit suicide to lessen the family burden of the costs of care); the importance of one’s cultural universe and for the explanation, expression and management of mental distress; and finally, the complex ways that  pharmaceutical treatment can be effective or unsuccessful. These are issues at the heart of what it means to be human, as well as recent debates about the role of pharmaceuticals in global mental health, the role of religious institutions in care for people experiencing emotional distress, and the role of the family in sickness and in health.

Tip #3:  The series also comes with a range of excellent supplemental study guides that my students and I have found to be very useful. They help me to flesh out my students’ understandings of the film with rich information about culture and context.  These guides are available as free downloads from the same links that I used for the film trailers above.  

But enough about me, what does Lemelson love about the films, and what advice does he have to offer those of us who are keen to make our own? 

Robert:  One thing I love about these films is that they were shot over an extended period—of years to over a decade. I have been filming in Indonesia for fifteen years, and we must have four to five thousand hours of raw film and video. I could do nothing else for the rest of my life besides edit what we have, which I have no plan of doing because there is a world out there waiting to be understood!

How did you get started?

 

 Robert:  It’s been a long road to get here and we shot for a long time. We have worked from 1997 (30 hours) and then I went back every year from 2000, except for the 2 years I was blacklisted [a notable hazard for ethnographers and filmmakers] for my political work on the film “40 Years of Silence” about the Indonesian mass killings of 1965. We sometimes did several shoots per year, but we waited till 2007 to do a complete output of a feature film.  Well, we did put out a number of smaller films, but we saved a lot for this longitudinal perspective of people’s lives.  A lot of times we didn’t even know how their story would become important until multiple visits had been made and we learned more of the details of people’s lives that you cannot really hide over time.

What is your advice to young anthropologists?

R: People shoot research footage for coding, logging, analyzing, and that’s fine. A lot of times, we don’t care what it looks like, but honestly for cinematic purposes it’s not valuable. So, I try to encourage people to film how I film when they are conducting their research, so that technically and artistically it’s of sufficiently decent quality to make a teaching film. A level above that is using your ethnographic video footage to produce an actual film, which will go out in the world beyond the class. In my ethnographic film classes, I want the students to understand film conventions—really basic fundamentals of cinema that enables them to transfer collected field data into teaching materials and beyond.

Do you think it’s possible to do that without, say, going to film school?

R: Well, film school helps, no doubt, but film school does not teach Anthropology!  For simple projects, if you are smart enough, you can do it on your iPhone. They have HD cameras that 15 years ago would have been $100,000, and are now $100.  This is the digital revolution—right now.  But what is Youtube filled with?  Videos of people with their cats, or whatever—sex.  But if people approach film a little more methodically, we could have amazing teaching materials, like ten-minute pieces that you can screen in class. Ten years later the students may not remember what they read or the lecture you gave, but I bet they will remember that great film.  The vast majority our students are not going to be anthropologists, so we want them to remember things of value that they can use to be better citizens.   The digital revolution gives us this opportunity.

What is your perspective on bearing witness as a filmmaker?

R: Writing is the central part of our field.  Margaret Mead called it “a discipline of words”. Writing is not going to go away.  Words are valued. But a lot of journal articles are read by maybe 25 people in the entire world, all specialists—films get to be seen by many.  For example, one of our films, “40 Years of Silence,” has been viewed by upwards of 40,000 people on our Facebook page.  Some people are so grateful and others issue death threats, but the materials are out there for them to see and think about in their own lives when they are able.

So, bearing witness is a step of solidarity?

R: Right, trying to tell a story that has some impact in a domain. We have some ethnographic pieces that have a little bit of history.  In Afflictions, we are making statements about stigma and the role of culture in mental illness.  For example, Ritual Burdens and Memory of My Face, in very different ways, show how culture plays a role in differential outcome.  A lot of theory went into how we constructed that.

In Ritual Burdens, we were trying to tell a story about developmental and cohort effects—how significant loss and trauma in childhood plays a role in a setting where life is very stressful for women.  When the main character—an elderly women who survived the tumult of WW2, Indonesian independence struggles, and the mass killings of 1965—undergoes the gender-based stress of ritual preparation and ceremony, she remembers her difficult childhood and has a psychotic episode.  The main character was psychiatrically hospitalized, like, 40 times.  In the US, she would be on the street—she would not be at home, with a loving family, being cared for, massaged.  This would be very unlikely to happen.  So the film makes a comparative point also—about social support and the role social support plays in better outcome.

Memory of My Face is a piece on globalization. Globalization penetrates this subject’s life- in the metaphors he thinks with, the illness categories he labels himself with, the mechanized work routines of sweat shop work for multinationals, and—most interestingly—the content and shape of his psychotic delusions and hallucinations.  More positive, still globalized factors, pointed to the protective effect of a caring religious (in this case, Sunni Muslim) community. Also, a lot of the people in the films are married and have kids, unlikely for people with serious mental illnesses in America.  These are all examples of how culture can be protective—meaningful social roles, protective families, meaningful work, but also harmful when stigma is strong or social expectations are too great.

How do you watch these things happen in your films and not want to just fix it right there?

R: Well, I do, sometimes. I have to get involved.  Take the example of Lisa [a young woman Lemelson’s team first met when she was six years old and followed through her teenage years in a recent film on human trafficking, Standing on the Edge of a Thorn].  She wanted to be a doctor, but was recently herself was in danger of being trafficked into the globalized sex trade in Indonesia’s urban areas.  So, we—my Indonesian collaborators and I—promised Lisa that if she kept up her grades, she could go to college if she still wanted to go, and we would find a way to pay for it.  It was really not expensive.  And listen, I feel like I contribute to the world through my philanthropy.  I do my part to be a good contributing citizen to the world with my foundations, but my “subjects” in these films are in many cases also my friends.  And you help your friends out in whatever way you can.

Do you let people watch the films you make about them?

Robert:  Yes, I always, when I am able, screen my films to my subjects and get their feedback. That is an important part of the editing process.  Sometimes they think we nailed it, sometimes there are criticisms, but this has to be a collaborative process.

What’s next for him?

Robert Lemelson has recently been filming in Burma (now Myanmar).  He is also working more on short-format films, and he is excited about the portability and affordability of current technologies.

What’s next for anthropology?

Robert: Anthropologists have a real educational and research mission. The fact we are being consulted by international aid organizations shows that there is a fundamental orientation to development, and in an applied anthropology way we have a lot to offer. So much of the focus of anthropology on inductive, grassroots knowledge—these are concepts that if you think with and apply to a real-world problem, there is so much to learn.

 

Further Reading (from most recent)

The Bird Dancer, a film on Neurospychiatric Disorders, has all ready been extensively reviewed by Greg Downey, in a lovely piece available here, called Not allowed to have a small heart: Tourette’s Syndrome.

Myers, N. 2011. Update: Schizophrenia across Cultures. Current Psychiatry Reports.

Luhrmann, T.M. 2007. Social Defeat and the Culture of Chronicity: Or, why schizophrenia does so well over there and so badly here.  Culture, Medicine and Psychiatry.

Hopper, Kim J. and Wanderling, J. (2000).  Revisiting the Developed versus Developing Country Distinction in Course and Outcome in Schizophrenia: Results from ISoS, the WHO Collaborative Project.

Good, Byron J. 1997. Studying Mental Illness in Context: Local, Global or Universal?

 

An earlier version of this article appeared on Pharmalot.

The University of Minnesota has turned me into an activist against it. Let me confess right away that this is not a role for which I am naturally suited.  I have never staged a protest or addressed a rally.  Nor have I ever marched with a sign.  On the occasions when I am required to give public lectures, I sweat nervously and display an embarrassing tendency to pause in mid-sentence for uncomfortably long periods.   But even I can work up a pretty good head of anger when I see cruelty or injustice, and this is especially true when the injustice is deliberately inflicted and the victim cannot fight back.  As a white South Carolinian brought up in the 60s and 70s I have a pretty deep well of shame to draw on, but never in my life have I felt the kind of shame that I feel at the way my university has treated a woman named Mary Weiss.

The short version of the story goes like this.  In late 2003, a psychiatric researcher at the University of Minnesota used the threat of involuntary commitment to coerce Dan Markingson, a delusional, mentally ill young man experiencing a psychotic episode, into a highly profitable, AstraZeneca-funded clinical trial of antipsychotic drugs, despite the objections of his mother, Mary Weiss.  For months Mary tried desperately tried to get Dan out of the trial, warning that his condition was deteriorating and that he was in danger of committing suicide.  The psychiatrists ignored her, and five months into the trial, Dan killed himself in the most violent way imaginable.

In the field of medical ethics, some cases represent moral dilemmas so intractable that you could argue about them for a lifetime. This is not one of those cases.  The abuses of this vulnerable young man are so obvious, and the evidence for their occurrence so overwhelming, that it is virtually impossible to argue the other side in good faith.  Dan had been repeatedly judged incapable of giving informed consent.  He was under a commitment order that legally compelled him to abide by the treatment recommendations of his psychiatrist.  That psychiatrist and his co-investigator had enormous financial conflicts of interest, plus monetary incentives to keep subjects in the trial as long as possible.  I could go on much longer about exclusion criteria and study design, but it would probably be easier for you simply to read what I wrote about the case in Mother Jones magazine, or these blog posts by Matt Lamkin of Stanford Law School and Dr. Judy Stone.  (If you want to see the evidence for yourself, read this summary of the case with links to the relevant documents).  So obvious was the coercion in this case that in response, the Minnesota legislature passed legislation – “Dan’s Law” – prohibiting researchers from enrolling subjects under an involuntary commitment order in psychiatric clinical trials.

When I first decided to look into Dan’s death several years ago, after a report in the St. Paul Pioneer Press, I started by talking to university officials. One of the first officials I spoke to told me that Mary Weiss was crazy, and that if anyone was to blame for Dan’s suicide, it was Mary herself.  At the time, this casually delivered comment struck me as a stunningly callous way to speak about a mother who had lost her only child to suicide.  After I met Mary and began looking at the medical records, I concluded it was a smear aimed at discrediting her.  In fact, the university’s behavior towards Mary Weiss has been uniformly and consistently disgraceful.  University attorneys have bullied Mary and tried to block her efforts to get Dan’s medical records.  After her lawsuit against the university was dismissed on a technicality in 2008, the university threatened to make her pay $57,000 in legal costs, in order to intimidate her into giving up her right of appeal.  Mary’s efforts to reach the university president have not gone any better.  Her friend, Mike Howard, told me that when they tried to hand-deliver a copy of their 2009 complaint to the office of the president, Bob Bruininks, they were escorted out of the building by security guards.  The president’s staff would not even accept the envelope.  (“You’d have thought we were smuggling in anthrax,” Mike told me).

As the controversy over this study has grown louder, the university has tried to portray it as a dispute from the distant past.  Nothing could be farther from the truth.  We still do not know if Dan’s suicide was an isolated case.  It is possible that other psychiatric research subjects at the university have been seriously harmed or mistreated.  Last fall, the Minnesota Board of Social Work found that the study coordinator for the CAFÉ study (the AstraZeneca clinical trial in which Dan died) as well as the federally funded CATIE study had faked the initials of an investigator on study records, failed to inform Dan of new drug risks, failed to heed the warnings that Dan was in danger of killing himself, and had been given medical responsibilities far beyond her training.  If University of Minnesota officials were truly concerned about the welfare of research subjects, would they not at least want to investigate?

For the better part of the past three years I have unsuccessfully tried to convince an impartial oversight body look into the questions surrounding Dan’s death and other problems with research subject protection.  I’ve contacted just about every office imaginable, from the Office of Human Research Protection to the NIH Research Integrity Office to the HHS Office of the Inspector General.  (I have also complained about an incompetently performed 2005 FDA inspection report).  At the university itself, I’ve tried the Research Integrity Officer, the Research Subject Advocate, the Research Ethics Consultation Service, and even the Board of Regents.  I’ve had arguments with two successive deans, the General Counsel’s office, the Academic Freedom and Tenure Committee, and most disappointing of all, my colleagues in the Center for Bioethics.  The recently appointed president of the university refuses to meet with me, and has taken to cc-ing his replies to the Office of the General Counsel.  Even my friends and allies are tired of hearing me talk about this case. Mike Palmieri, who included Mary Weiss in the documentary film, Off Label, says, “You’re like the whistleblower who won’t stop blowing, even when the neighbors are yelling, ‘Dude, it’s 3 am!  Can’t we get a little sleep here?”

Last month, the time seemed right for a different strategy.  Mary Weiss and Mike Howard started an online petition to the governor of Minnesota, Mark Dayton, asking for an external investigation.  As an accidental activist I know very little about online petitions, but as Patton once said, “An imperfect plan executed immediately and violently will always succeed better than a perfect plan.”  So I have supported this imperfect plan, immediately and violently.   It seems to be succeeding.  Our early signatories include Susan Reverby, the historian who uncovered the US government-led syphilis experiments in Guatemala; Marcia Angell, Arnold Relman and Jerome Kassirer, all former editors-in-chief of the New England Journal of Medicine; Richard Horton, the editor of The Lancet; Richard Smith, the former editor of BMJ; Ben Goldacre, the author of Bad Pharma; and Ron Paterson, the former Health and Disability Commissioner for New Zealand.  MindFreedom International has endorsed the petition, and over 170 scholars in bioethics, medical humanities and social studies of medicine have signed on, including anthropologists such as Tanya Luhrmann, Lochlain Jainn, Karen-Sue Taussig, Michael Oldani and Paul Brodwin.

Of course, I am not asking anyone to sign the petition without looking at the evidence.  What I am saying is that if you look at the evidence, you will conclude that a serious injustice was inflicted on a vulnerable family at the worst possible moment.  This is not a hard case.  It is an easy case where ordinary people have looked the other way for too long.  We can never make things right for Mary Weiss, but by signing this petition, at least we can try to ensure that what happened to Dan does not happen to anyone else.

 

Carl Elliott MD PhD is Professor in the Center for Bioethics and affiliate faculty in the Department of Philosophy and School of Journalism and Mass Communications at the University of Minnesota.  His books include White Coat, Black Hat (Beacon) and Better than Well (Norton).  He blogs at Fear and Loathing in Bioethics.

A small-town high school in western New York became the focus of news media attention from late 2011 to early 2012. Nearly two dozen teens and one adult, all but one female, exhibited spasmodic movements and vocalizations with no easily detectable cause. The outbreak provoked a cascade of conflicts, leaving them largely unresolved even as the symptoms subsided and life returned to a semblance of normalcy for the afflicted and their neighbors.

This post trains an ethnographic eye on the reporting of this “mystery illness”. It relies heavily on web-archived news, mostly that which directly engaged with and was accessible to the principal actors–the afflicted and their families, local residents, medical practitioners and researchers, government and school officials, and the reporters themselves. The post sketches out the various narratives that these actors crafted to make sense of and grapple with the outbreak. It focuses in particular on two explanatory narratives:

a)    The first, proposed by medical professionals and supported by officials, was that the illness was psychosomatic in nature, arose from a nexus of social and psychic stresses, and was exacerbated by patients and community members (and journalists) questioning the diagnosis; and

b)    The second, proposed by activist counter-experts and accepted by a range of the afflicted and their families and neighbors, was that the illness was environmental in nature, came from a toxic or infectious agent, and was exacerbated by officials’ incompetent or conspiratorial dismissal of alternative explanations and treatments.

I intend to show how these narratives offer insights into the state of expert and lay conceptions of illness in the contemporary United States. First, the case highlights an intensified conflict between experts and non-experts, in part due to the proliferation of counter-experts and diverse epistemic communities, but also due to the proliferation of credible and complex environmental health threats. Second, the Le Roy outbreak brings to light an underlying agreement on, but persisting ambivalence toward, an implicit dualistic model of human nature among medical experts and laypeople. The agreement and ambivalence are especially apparent where the model connects mental health and illness to environmental factors. Following these two sections, I will briefly discuss the insights provided by an ethnographic approach to this case.

 

A Brief Chronology in Multiple Voices

A review of archived news articles and broadcasts reveals many attempts to understand the outbreak, not all of them consonant or forming a coherent whole. The dual origins of the outbreak seemed to lie in May 2011. In Le Roy, a town of 4,000 in the Genesee River watershed in western New York, it began with one “index case,” a high school student who had previously been diagnosed with Tourette’s syndrome (Owens 2012d). In Corinth, an equally small town near the state capital, Albany, two female students (who were also softball teammates) collapsed and became ill within days of each other (Edwards 2012; Fraser 2012; Roman 2012). Only later would their illnesses be linked, albeit tenuously, to those in Le Roy (Bleck 2012; Walker 2012).

By the beginning of the 2011-2012 school year in September, a succession of students (and one adult) in Le Roy began falling ill (Tan 2012c; Owens 2012f). Reports differed on who was first (cf. Owens 2012b; Stephanopoulos 2012), but all agreed that the afflicted students reported a sudden and dramatic onset, either waking from an otherwise uneventful nap (Asztalos 2011) or passing out unexpectedly (Dominus 2012). Then they began to manifest bodily tics (jerking arms, twitching necks) and wordless vocal outbursts, which were only temporarily suppressed and quickly grew tiresome and painful (see Video 1 below). While several of the early afflicted in Le Roy had previously diagnosed health problems (Melville 2012), these new symptoms caused consternation among their families and neighbors.

Vid.1: Jason Carroll interviews Melisa Phillips, Thera Sanchez, and Lydia Parker (AC360, CNN, 2012-01-18)

Once the total reached six students, the Le Roy Central School District under Superintendent Kim Cox quietly began to take action. They requested environmental testing of the school building from the Genesee Valley Educational Partnership in October (“Doctor: Mystery Illness Among Le Roy Girls Is Psychological” 2012, and then from Workfit Medical of Rochester in December. As the case became public, and reported, the GVEP also provided the District with the aid of the Rochester-area law firm of Harris Beach LLP, whose “senior manager of media and community relations,” William Albert, served as the school’s legal advisor and contact person. And they notified the parents of individual afflicted students as soon as they became symptomatic.

Throughout the fall the original afflicted girls and the adult female appeared one by one in the offices of neurologists, most of them going at least once to the Dent Neurologic Institute (Hopkins 2012; Tan 2012a; McFadden 2012) of suburban Buffalo (Mrozek 2012b). Some were taken out of school by their parents (Conte 2011; Trent 2012), while others attempted to attend class despite the tics. Rumors begin to circulate among neighbors and classmates about this growing cohort, attributing their symptoms to smoking synthetic marijuana at the same party (Gay 2012; cf. Mrozek 2012a), feigning illness to avoid school (or punishment for bullying the index case) (Moran 2011), and the human papillomavirus vaccine (Cooper 2012).

Vid. 2: Reporters interview Lori Brownell, Tosha Brownell, Alycia Nicholson, and Randy Nicholson (News 4 at 10:00, WIVB, 2012-01-24)

A letter acknowledging the “Tourette’s-like symptoms” (Klinck 2011) sent in early November 2011 to all parents did little to dispel these rumors. It did, however, lead to the first burst of news reporting, exclusively local and regional, and to the persistent journalistic framing of the outbreak as a “mystery illness” (“Update: LeRoy Students Exhibit Tourette-Like Symptoms” 2011; Gallivan 2011; “Tourette-Like Symptoms In LeRoy HS Still Not Understood” 2011), due in part to interviews of concerned but poorly informed parents (Brean 2011) and one pseudonymous afflicted girl (Conte 2011). Though few additional news stories appeared in the remainder of 2011, students continued to fall ill, and the District called on the Genesee County and New York State Departments of Health for help (“No “Infectious or Environmental Causes’ in Le Roy Tourette Investigation” 2011).

A community meeting in the second week of January 2012 (Owens 2012a)–arranged by the school district and featuring health officials–gave the only indication that the outbreak was becoming worse. At that meeting health officials reported twelve student cases (Fischer 2012), though they assured attendees that this did not constitute a public health emergency (McGowan 2012a), as no environmental or infectious had been identified in tests of the school or the students (King 2012). Furthermore, they said the students had been diagnosed and were being treated by their doctors, citing federal medical privacy rules (HIPAA) to explain why they could not share the diagnosis. Parents of some of the afflicted began at this meeting to express their displeasure with the District, health officials, and physicians for their handling of the outbreak. Some denied that doctors had even made a diagnosis (DeSmit 2012a; Brean 2012), while others–led by James DuPont, Jr., and Beth and Don Miller–flouted HIPAA by citing, and disparaging, the diagnosis of conversion disorder.

Vid. 3: Charlie Rose and Erica Hill interview Dr. Jennifer McVige (This Morning, CBS, 2012-01-30)

The day after the first community meeting, DuPont, the Millers, and several other parents met at DuPont’s TV shop (Brean 2012) in nearby Stafford to form a support group and plan an end-run around the authorities. The plan included taking to the regional and national news to publicize their suffering and thereby solicit assistance from experts not associated with the District, health departments, or the Dent Institute. Thera Sanchez and Katie Krautwurst were filmed at home and then in a studio interview with their mothers, Melisa Phillips and Beth Miller, respectively, for NBC’s national Today Show (Robach and Curry 2012). Brooke DuPont and her father followed on the Today Show several days later (Adams 2012a). Lydia Parker (Cooper 2012; Trent 2012), her mother Heather (Pinsky 2012c), and her younger brother Zachary (Gruenauer 2012) were quoted in newspaper and TV stories. Chelsea Dumars and her legal guardian Dave Watson gave interviews to regional and national TV stations (Robach 2012; Wooten 2012), as did Traci Leubner (McGowan 2012b; Stephanopoulos 2012), while Lauren Scalzo spoke exclusively to national media (Pinsky and Spellman 2012b; McFadden 2012). Nearly all of these appeared at least once (some more than once) on the HLN talk show, Dr. Drew, whose host, Drew Pinsky, enthusiastically positioned himself as their advocate, featuring the outbreak on a string of broadcasts in January and February (e.g., Pinsky 2012a; Pinsky 2012b; Pinsky and Spellman 2012c; Pinsky 2012e).

Vid. 4: Cynthia McFadden interviews residents, afflicted, families, and doctors (Nightline, ABC, 2012-02-07)

The parents’ activism was countered almost immediately by pediatric neurologist Jennifer McVige and neurological oncologist Laszlo Mechtler, the Dent Institute doctors treating most of the afflicted. Bolstered occasionally by colleagues in Buffalo, Rochester, and elsewhere, they defended their diagnoses of conversion disorder (e.g., Robach and Lauer 2012; Rose and Hill 2012), expanding it to mass psychogenic illness (MPI) once more than a handful of cases were involved. McVige and Mechtler also directed criticism towards sensationalist reporting, citing potential transmission of symptoms through the news media (e.g., Owens 2012i). For their part, news organizations continued to emphasize the mysteriousness of the illness even after it was officially labeled MPI, and they circulated dramatic videos on TV and the internet of the afflicted exhibiting tics. The lone adult among the afflicted, nurse practitioner Marge Fitzsimmons (McGowan 2012c; Pinsky 2012d; Putman 2012), made numerous media appearances on her own, against Mechtler’s advice, to counterbalance the activists’ claims and to call for compassion and understanding for all the afflicted.

The number of reported cases in Le Roy continued to increase through January, with news coverage noting two more in one week (Tan 2012b), three the next (DeGeorge-Pike 2012), and so on, up to a total of twenty (Adams 2012d; Owens 2012f). By late January, the activists’ outreach campaign had netted them some media allies and a set of counter-experts. Environmental activist Erin Brockovich had initially been contacted by the Millers in December (Pinsky 2012b; Pinsky 2012c; Pinsky and Spellman 2012c). Her colleague, water quality specialist Robert Bowcock, came in from California to follow up on a rising tide of phone calls and e-mails from Le Roy that pointed to environmental concerns (Arnold 2012; LaDelfa and Kingston 2012). These included a yellow-orange substance on the school athletic fields (Pinsky 2012b; Owens 2012e; George 2012b), the six natural gas wells on the school property (Orr 2012a; Mrozek 2012d), and above all the 1970 spill of trichloroethylene (TCE) on the now-defunct Lehigh Valley Railroad near Gulf Road four miles east of town (Jayson and Weise 2012; Drantch 2012; Orr 2012c). Brockovich and Bowcock maintained a tense, primarily mediated, relationship with the Le Roy superintendent, each side accusing the other of acting unprofessionally and jeopardizing the afflicted girls’ recoveries by thwarting their efforts (see Owens 2012g; Cox 2012).

Vid. 5: Drew Pinsky interviews Erin Brockovich (Dr. Drew, HLN, 2012-01-27)

At around the same time, New Jersey pediatric neurologist Rosario Trifiletti contacted the activist families and offered to examine their daughters for free (Mrozek 2012b; McFadden 2012). Given his support of the idea that some infections could set off an autoimmune reaction that attacked brain tissue and triggered obsessive-compulsive disorder (PANDAS or PANS), it was perhaps not surprising that he reported tell-tale streptococcus and mycoplasma infections in each of the girls he examined (Owens 2012h; White 2012b). In interviews, Trifiletti and the Dent Institute doctors clashed over the interpretation of treatment of the girls’ symptoms, as well as whether and how they needed to coordinate care (see Holmes 2012a; Holmes 2012b; McVige and Mechtler 2012).

The Le Roy school district decided to arrange a second community meeting in early February 2012 to address persistent fears and uncertainty among residents (Owens 2012e; Clarke 2012). The context for the meeting was inflamed by news reporting, which reached its peak in the first half of the month. Journalists’ accounts increasingly featured counter-narratives on the outbreak, some emanating from the environmental activists, some already in circulation in the community–that the new junior-senior high school building rested on contaminated fill from the TCE spill site (Pinsky and Spellman 2012a; Miller in Blue 2012), or that the gas wells were drawing the “plume” of TCE into town (Pinsky 2012b; Owens 2012c). Reporters also emphasized community factionalism spurred by the outbreak (Conte 2012; Redick 2012a; Spellman 2012) and the general tensions caused to Le Royans by being the focus of so much attention (Callahan 2012; Rivers 2012).

At the February meeting, Superintendent Cox introduced staff from Leader Professional Services of suburban Rochester, whom the district had hired to perform more extensive environmental tests and, if necessary, to remediate any hazards. Though this could have been interpreted as a victory for their campaign, the activist families objected to Leader’s testing plan (not least its projected expense) and argued for allowing the Brockovich-Bowcock team to continue their independent, pro bono investigations (Redick 2012a; White 2012b). They framed the plan as one more instance of the District downplaying or dismissing residents’ concerns about the environmental quality of the new school building. One earlier instance they cited to support this framing involved unexplained “vapors” that supposedly sickened several teachers in their classrooms (Pinsky and Spellman 2012c). Despite the activists’ objections, both Superintendent Cox and Leader’s staff expressed confidence that the study’s results would bring closure to the community’s environmental concerns (Coniglio 2012; Orr 2012c).

Vid. 6: Chris Conte reports on the second community meeting (13 WHAM News at 6:00, WHAM, 2012-02-04

By late February, new cases of the “mystery illness” had stopped appearing, the activist afflicted were retreating from the media, and reporting was winding down. For Dent patients: counseling, medication for preexisting conditions, and no contact with any kind of media. For Trifiletti’s charges: antibiotics and no media restrictions. Despite these differences–and the continuing hard feelings between the physicians–both groups claimed to improve over the spring and summer (Mrozek 2012c; Owens 2012j; Holmes 2012b; Pinsky 2012e; Dominus 2012). By contrast, Lori Brownell and Alycia Nicholson in Corinth continued to suffer symptoms and haphazard treatment (Crowley 2012), even though they too had sought the media spotlight for the same reasons the Le Roy activist families had.

There were occasional small spikes in news interest from March 2012 on, though nearly exclusively from regional and local organizations. The federal Environmental Protection Agency (EPA) arranged for the removal of barrels of contaminated soil from the Gulf Road spill site in late February (Scott and Buckley 2012), later confirming that no TCE had moved toward the school (“EPA Releases Groundwater Results from LeRoy Train Site” 2012). Leader shared the (negative) results of their school tests in a massive document and a brief press release in June (Noce 2012; Redick 2012b; Crichton 2012), and Bob Bowcock–this time with a New York City lawyer in tow–returned to Le Roy for a late-August town meeting (Adams 2012e; Gruba 2012; Hong 2012; DeSmit 2012c). The last significant flurry of news came when the State Department of Health informed reporters of two new afflicted students in September (Hassett 2012; “Tic-like Symptoms Return To LeRoy” 2012), which the Dent neurologists linked to general tensions over the beginning of the school year and the specific stressor provided by coverage of Bowcock’s meeting (Orr 2012f). Finally, an independently produced documentary involving many of the key actors was aired on Channel 4 in the United Kingdom in late October. While it provided some new insights into the outbreak–including the continued suffering of the first afflicted, Lori Brownell (Blue 2012)–it inspired no follow-up reportage in the US.

Vid. 7: Berkeley Brean reports on Erin Brockovich’s planned town meeting (News 10 at 6:00, WHEC, 2012-08-14

One lone TV news report (Brown 2013) aired on the roughly one-year anniversary of the heaviest mediation of the outbreak. It largely took the Dent Institute doctors’ perspective, interviewing only McVige and Mechtler and condemning the alternative explanations and “media circus” that exacerbated the suffering of the afflicted. While the report could be taken as one indication that the mainstream biomedical interpretation of the Le Roy outbreak won out, there is no independent evidence to suggest that either the alternative explanations–or the community tensions that animated them–have disappeared.

Psyche: Nonphysical Source of Physical Ills

The first question to address with the Le Roy outbreak is why doctors, officials, and scholars converged so quickly–and largely uniformly–on determining the outbreak to be psychological in nature when there appeared to be viable alternative explanations and strong objections to such a determination.

The conventional biomedical model, on which medical professionals based their understanding of the outbreak, differentiates between physical and mental illnesses. This distinction is reflected in and further inscribed by an institutional division between “medical” and “psychological” specialties. However, the model allows for restricted circumstances when a disorder of one type manifests in the other realm. “Somatization” is the term of art for when nonorganic “psychological” suffering manifests in organic “physical” symptoms. Conversion disorder is the transfer of psychosocial stresses into bodily suffering in an individual (Kirmayer and Young 1998, 420), and mass psychogenic illness (also mass sociogenic illness) is contagious conversion within a social group (Boss 1997, 233). Even when news reports cited the research literature on conversion disorder/MPI, they generally ignored the key distinction made by Wessely (1987, 112) between the relatively widespread but transient “mass anxiety hysteria” and the more restricted but longer-lasting “mass motor hysteria” that sufferers in Le Roy exhibited.

Doctors treating the Le Roy afflicted (as well as some of their colleagues) pointed out the positive diagnostic features of conversion disorder, in which the physical-psychological distinction is emphasized. These features included:

1. “symptoms with no plausible organic basis;
2. symptoms that are transient and benign;
3. symptoms with rapid onset and recovery;
4. occurrence in a segregated group;
5. the presence of extraordinary anxiety;
6. symptoms spread via sight or sound;
7. a spread occurring down the age-scale, beginning in older or higher status persons; and
8. a preponderance of female victims” (Bartholomew and Wessely 2007, 667, emphasis added).

To drive home the distinctiveness and legitimacy of conversion disorder, one psychiatrist entitled his commentary supporting the diagnosis “A horse doesn’t look like a pencil” (Merrill 2012).

Medical experts’ statements of defense were usually made in response to charges, some from dissenting physicians (e.g., Pies 2012), that conversion disorder constituted a “diagnosis of exclusion” (or even of convenience) when no other likely diagnosis presented itself (Orr 2012b; Melville 2012). Some doctors further emphasized the expertise of neurologists like McVige and Mechtler in sorting out physical and mental ills. Others noted parallel outbreaks in the contemporary US and, more controversially, at some geographical or temporal remove. The intent of drawing such parallels was not only to emphasize their expert awareness and comprehension of the outbreak, but also to counter the “mystery illness” framing found in journalistic and community narratives. Far from being mysterious, in this view MPI constituted a common human reaction to certain types of stressful psychosocial conditions (Kirmayer and Young 1998, 420).

Both doctors and officials took pains to emphasize the ontological reality–thus the legitimacy–of the patients’ suffering. They also pointed out that, as a diagnosis, conversion disorder was preferable to biological illness, in that it promised to be treatable without causing lasting damage (see Fitzsimmons in Moran 2012). But they acknowledged anticipating resistance by the afflicted and their significant others to the diagnosis (Bauerle 2012; Brown 2012; Orr 2012d). Despite that foreknowledge, doctors especially lamented how this resistance undermined the very treatment and recovery that resisters claimed to seek (Waitzkin and Magaña 1997, 822; Kirmayer and Sartorius 2007, 836; Bartholomew and Muniratnam 2011, 236). In some cases, medical experts blamed a generic “human nature” (Owens 2012f; Zach and Rose 2012) as the root cause of the resistance; in others they cited culturally and historically specific factors, like post-9/11 conspiracy theorizing in the US (Tan 2012a; McVige and Mechtler 2012). To believe the former assertion, the afflicted were arguably expressing concern over social identities they feared spoiled (Goffman 1986) by a diagnosis of mental illness. To take seriously the latter assertion, the afflicted and their families must be tactically aligning themselves with an oppositional, counter-expert knowledge to take some control back from medical and governmental authorities.

Whatever the doctors’ claims, cultural systems of meaning have been shown to affect humans’ interpretation and experience of suffering. This is apparent in the diagnosis of, and reactions to, conversion disorder/MPI by the afflicted and their families, who protested that the illness could not be “all in their heads” when it was so obviously “in their bodies” (Hass 2012). More subtly, they and the counter-experts searched for the ultimate (physical) cause of the (mental) conversion reaction since it made little sense to them that the arrow of causation could point in the other direction (Moisse and Davis 2012; White 2012b; Andriatch 2012).

Manifest in the reporting on Le Roy was how MPI’s features, and its general psychic origin, made some doctors (and most laypeople) uncomfortable (Waitzkin and Magaña 1997, 813). This stems partly from an evolving but still incomplete knowledge of the presumed biological foundations for the psyche. For example, in interviews (Dominus 2012; Orr 2012d) several medical experts cited so-called mirror neurons as potentially playing a role in the contagious spread of somatized symptoms (cf. Lee and Tsai 2010). While promising to remove MPI from the uncanny realm of the psyche, such a biomedical move would seem to lead to the unpleasant conclusion that humans’ naturally selected sociality itself can make us ill.

A significant portion of the discomfort toward conversion disorder and MPI also grew out of the stigma attached by many Americans to illnesses located in the mind (Bartholomew and Wessely 2007, 666). The afflicted and their kin exhibited concern that they would be treated as “crazy” (Moran 2012) or “fakes” (Zach and Rose 2012) rather than simply “sick” (Owens 2012f; Callahan 2012). They were also concerned with how the diagnosis of “mass hysteria” brought stigma on the community. In Marge Fitzsimmons’ words “it makes it sound like the whole town is crazy” (Adams 2012b). In an opinion piece, reporter Scott DeSmit objected that it lumped Le Roy in with “[t]hird-world countries. Rural. Poor. Weird” (DeSmit 2012b). Research in medical anthropology suggests that this stigma stems in part from a dualistic model of human nature long prevalent in the West, in which the mind is the seat of volition, ratiocination, judgment, and morality, while the body is the source of nonrational or antisocial emotions, appetites, and drives (Kirmayer and Young 1998; Watson, Ottati, and Corrigan 2003; Hinshaw and Stier 2008). Such a model can be read as placing responsibility for their behavior–and perhaps culpability for their illness–on the afflicted themselves.

Given the broad discomfort with “psychological” illnesses manifested by the various actors, including journalists, there remained a persistent opening for challenges to the official diagnosis of conversion disorder/MPI. And yet most of these challenges–substance abuse, poisoning by chemicals, infection by microorganism–were nevertheless grounded in the dualistic biomedical model.

 

Environment: Inhuman Threats to Human Health

The official medical narrative of a “purely psychological” illness seemed to have several points in its favor, not least the evidence that no known toxins would cause the exact symptoms (or disappear with the evident lack of damage) exhibited by the afflicted. This makes it crucial to understand why the diagnosis of conversion disorder/MPI was so strongly opposed by so many in the Le Roy case. The ambivalence toward somatization as diagnosis and as illness behavior is one factor, but the insistence with which environmental causes were debated should alert us to a second important factor.

Academic and medical studies of “mass hysteria” indicate that the frequent presence of credible threats is key to focusing and sustaining outbreaks (Bartholomew and Wessely 2002, 302; Balaratnasingam and Janca 2006, 171). In small-scale and/or strongly religious societies–e.g., Melanesia (Stephen 1999) and the colonial US (Moyer 2012)–one threat deemed credible is witchcraft. In societies racked by intergroup conflict–for example, Palestine (Small and Borus 1987), Kosovo (Papraniku 2005), Afghanistan (Casey 2012), and Uganda (Asedri 2012)–poisoning emerges as a credible charge to level against enemies known or suspected.

For contemporary developed societies, medical and social-scientific studies indicate a particularly close connection between environmental concerns and hysteria (Boss 1997, 233; Bartholomew and Wessely 2002, 301; Bartholomew and Muniratnam 2011, 236). Along with disasters and terrorism, pollution poses a culturally credible threat to life and society (Bartholomew and Wessely 2002, 301; Bartholomew and Muniratnam 2011, 236), and not just because of the media-highlighted proliferation of each threat, though that is not a minor issue. Their credibility is also due to the meanings those phenomena have within cultural systems of risk perception and management (Douglas and Wildavsky 1983). For example, consider how US airline passengers manifested great concern about exposure of their private parts by airport screening technology but no comparable concern about exposure to radiation incurred during flights (Sohn 2010; Simpson 2013). In the case of disasters, terrorism, and pollution, the threat is often conceptualized as something lying outside the bounds of civilized society and beyond the horizon of knowability, something which attacks in an unbidden and unforeseeable manner.

Le Roy residents’ focus on environmental causes for the outbreak has a distinct local basis for credibility. The lifetimes of adult Le Royans included several prominent environmental events in the region. Love Canal, a residential development in Niagara Falls built over a chemical company’s leaking dump, was invoked by a number of those quoted by reporters. For some it served as the prototypical case in which laypersons’ complaints of environmentally linked health concerns were validated by experts and authorities who had initially discounted them (Kingston 2012). For others, it illustrated how different Le Roy was from other stigmatized communities, in that it was “not [another] Love Canal” (Moran 2012). Le Roy’s own history of industrial pollution was infrequently woven into the narratives; for instance, as some residents told an out-of-town reporter, the Jell-O manufacturing plant routinely turned the creek various unnatural colors (Dominus 2012). A number of residents emerged to assert the importance of the frequently neglected Gulf Road TCE spill site (George 2012a; Orr 2012e), an assertion temporarily bolstered by the intervention of counter-experts like Brockovitch and Bowcock. And the ongoing concern over hydraulic fracturing for natural gas in western New York (Groeger 2012; Israel 2013) shaped the reevaluation of the (heretofore uncontroversial) wells on the school property (Mrozek 2012d).

It is also worth noting that the memories of environmental incidents and threats that residents wove into their narratives to explain the outbreak were variable and unevenly distributed. One key example of this was the discrepant claims by residents about how much they and the community knew of the forty-year-old Gulf Road spill. Even within the same family, the adults contradicted each other on how memorable the spill had been (Jayson and Weise 2012; Blue 2012). Claims of nonknowledge were only partly strategic, though they definitely figured in an ongoing struggle with the authorities over responsibility for remediating the spill and its consequences. The claimed ignorance also fits in with contemporary US conceptions of the environment as a repository of threats that lie hidden from human knowledge and control, emerging in unforeseen or obscure ways to wreak havoc (see Coates 1998; Beamish 2001).

In all these instances, the environment is viewed as a source of threats to personal and communal health. Even when created (or unleashed) by humans, these threats were portrayed as separate from humans (Adams 2012c; White 2012a; Orr 2012c). This conception is arguably linked to a view of the environment itself as something outside of–and in various ways impinging on–the body and the community (Wakefield and McMullan 2005, 300; Bartholomew and Wessely 2007, 663; Ward Thompson 2011, 187). Here, too, most of those consulted by reporters put emphasis on the causal arrow pointing from environment (hazards) to humans (illness), even when they acknowledged humans’ role in creating many of those environmental hazards.

 

Insights from the Outbreak

The Le Roy outbreak offers us an opportunity to reflect on some of the contours of health and illness conceptions in the contemporary US. The fact that there was any pushback at all to the official medical diagnosis shows a degree of epistemic diversity and motivational heterogeneity among those involved. That this pushback played up the “mysterious” aspects of the illness indicates not only an ongoing concern with suffering that does not clearly and immediately fit into the biomedical model, but also that even relatively well-defined and integrated types of suffering have such stigma that the afflicted, their families, and their community prefer the scariness of the unknown. That the pushback challenged the official diagnosis from within the biomedical realm–and was, if anything, even more rigidly biomedical in demanding a nonpsychological explanation–highlights an ambivalence toward parts of the otherwise largely accepted model, especially where its “physical” and “psychological” halves meet. That those pushing back sought the ultimate cause of the suffering in human-made hazards also indicates no small amount of ambivalence among Le Royans and others toward their relationship with the humanly-altered landscape around them.

More broadly, the Le Roy case reinforces how humans exist and act within culturally constituted behavioral environments (Hallowell 1955). This is not to say that we create the world around us out of nothing, but rather that we take the elements of the world we experience and imbue them with specific meanings, then behave with reference to those meanings. For Le Royans (as for their fellow Americans), one of the key cultural factors in constituting their behavioral environment was the news media. Reporters working for highly connected media entities engaged with the various actors, linking some of them, setting still more against each other, and were themselves enrolled in the projects of some of these actors. In those interactions and their mediated results, otherwise tacit conceptions of health, illness, human nature, and the environment emerged and were more or less clearly connected to a number of affects and motivations. Mass-mediated controversies like that surrounding the Le Roy “mystery illness” are particularly useful for bringing such constellations of meaning, affect, and motivation to light. And, as I hope this article has suggested, an ethnographic perspective on such controversies can be useful for pinpointing and analyzing those constellations.

 

Ryan J. Cook earned a PhD in cultural anthropology from the University of Chicago.  Pursuing interests in knowledge, expertise, boundary-work, and disasters, he has carried out field research projects in the United States and Mexico. He currently serves as Citizen Science Learning Researcher at the Adler Planetarium in Chicago.

The author extends his gratitude to Eugene Raikhel and the staff of Somatosphere for making the process, from initial idea to finishing touches, a true pleasure. He also wishes to thank Rebecca S. Graff for her extensive and insightful comments on multiple drafts of this article.

The full list of references for this piece is available here.  A pdf version, including both the main text and references, can be downloaded here.

For scholars in the humanities and interpretive social sciences, it sometimes seems like hardly a day goes by without some kind of exhortation towards ‘interdisciplinarity’ – a trend that has only become more pronounced during the ongoing realignment of public higher education in many countries. ‘The humanities are being driven into defensive positions,’ wrote the vice-provost of University College London recently, ‘despite isolated counter-actions, they experience marginalisation as martyrdom and tend to look inwards rather than outwards to new possibilities, such as recovering their status and influence through interdisciplinary working’ (Worton, 2013). Or as John Brewer, the ex-President of the British Sociological Association, was quoted just this week in a reflection on the values of social science: ‘we need to move beyond rather insular profession-oriented courses and introduce courses that have breadth rather than depth…that bring together teachers from a variety of different disciplines’ (Reisz, 2013).

For those of us who work in/on/through topics in the life sciences, of course, these declarations have a special lure: given how practiced we have become at finding the gaps and interstices in the practices of the life sciences, many of us seem well positioned to collaborate with medical and biological colleagues. This opportunity is manifested in ethnographic accounts of interdisciplinary interventions (Rabinow and Bennett, 2009), in historical and genealogical accounts of the split between the bio-logical and socio-logical disciplines, (Renwick, 2012; Rose, 2013), and, of course, in a still-ongoing theoretical retrenchment between concepts, cultures, bodies and biologies (Wilson, 2004; Haraway, 2007).

Somewhat less common, however, are some of the very basic and pragmatic outlines of what a ‘good’ or ‘bad’ moment of interdisciplinary labour between the social and life sciences would actually look like. A sense of this gap was at least part of the impetus behind a recent workshop, and subsequent report, from the European Science Foundation (ESF) – ‘The Good, The Bad and The Ugly: Understanding Collaboration between the Social Sciences and the Life Sciences’ (I was the commissioned ‘rapporteur’ of the workshop, and subsequent author of the report, although note that authorship, in this context, was more a work of collating and summarizing contributions to the workshop than anything else. Note also that what follows here are my own summaries and reflections, and not those of either the ESF or the participants at the workshop). What set the workshop apart was an attempt to identify, in a fairly matter-of-fact and case-driven process, the basic elements of a ‘good’ collaboration between a social scientist and a life scientist – and then to set out what distinguished it from ‘bad’ or frankly ‘ugly’ collaboration. The workshop, steered by a small multidisciplinary committee, then distilled its discussion into groups of recommendations for individual researchers, academic institutions, funders, and policy-makers.

Cases ranged from an account of how the nascent Social Science Genetic Association Consortium (SSGAC) was working to correlate social-scientific variables with large-scale genetic data-sets; to a report on the well-known ‘Whitehall II’ study, where social scientists have collaborated with clinicians to somehow shift the attention of an epidemiology away from the body of the individual, incorporating notions like class in the emergence of disease; to an auto-ethnographic reflection on the sometimes surprising and awkward mixing of theological, anthropological and neurobiological considerations in a study of the neuro-cognitive correlation of religious experience. Not all of the outcomes and recommendations can be repeated here – but I want to draw particular attention to three over-arching three themes of the discussion.

First is that, if working between and beyond disciplinary boundaries is probably more-or-less a good thing, ‘interdisciplinarity’ is still not a good in itself. This sounds like a truism – but can be hard to recall amid ceaseless exhortations towards, for example, an amorphous ‘knowledge exchange.’ More to the point, a taxonomy of bad and ugly collaboration might well be achievable – and although the workshop did not attempt to exhaust this possibility, there were some consistent themes. Prominent, here, was a focus on collaboration rooted in excessive trust or gullibility – and an unwillingness, or an inability, to account for contest and controversy in another discipline. Certainly we all have our favourite (or least favourite) examples of scholars from the interpretive sciences who suddenly discover a monolithic ‘genetics’ or ‘neuroscience,’ and proceed to recover insights from these fields as they if were subject to no degree of internal contest or dispute. But this is tricky too: if excessive enchantment is undesirable in a collaborator, still some degree of trust is required; the hard part is knowing when to trust and when to be critical – which can sometimes be a surprisingly tacit or affective form of knowledge (‘know who the assholes are,’ as one contributor pithily put it).

Second is that an institutional rhetoric of interdisciplinarity is not always matched by sources of funding, or by the provision of genuinely collaborative spaces and resources.  Several of the cases presented at the workshop were dependent on fortuitous access to small amounts of seed funding, or to pots of money that were otherwise unmarked. But these remain relatively rare. Others mentioned the on-going difficulty of accessing data held under the aegis of scholars from another discipline, or a discipline-specific funding body. And almost all stressed the persistent compartmentalisation of national research-funding councils, and of reviewers of proposals, along still fairly rigid disciplinary lines. There are signs that this is shifting (the growth in small-scale funding for ‘sandpits’ and ‘ideas factories’ was mentioned for instance) – but the workshop still stressed the need for many more small-scale, low-stakes and epistemologically-tolerant sources of funding for tentative collaboration between social and life scientists.

Third: doing truly interdisciplinary research remains deeply risky for a lot of people – and can leave junior scholars struggling for both resources and recognition. There is clearly a lag between the rhetoric of working across disciplinary boundaries and, in many of the social sciences at least, the nonetheless profoundly disciplined spaces of scholarly prestige – including high-ranking journals, prestigious funding bodies, and job openings. For too many would-be collaborative researchers, there is a nagging awareness that they still have to build a career amid a community of scholars for whom ‘is this sociology?’ (or economics, or anthropology, or whatever it is) remains an interesting and useful question. No doubt this too is changing – but it remains a salient fact that scholars stepping outside – truly outside – the epistemic boundaries of their own discipline are taking a not-insignificant risk with their careers.

To conclude, let me add three further observations of my own, that I think should also play into future thinking on interdisciplinarity and which might build on the conclusions of this report. First, while I still think that collaborative labour between the social and life sciences is vital to the future of both sets of disciplines, we still need to be sensitive to the ways in which an unproblematized ‘interdisciplinarity’ may be pursued and promoted within an increasingly market-driven and instrumentalized academy. This workshop certainly wasn’t guilty of that – but amid a broader drive for disciplinary entanglement, we need to be wary of eroding the space for intellectual practices that are already marginalized, and to recall that lots of good scholarship within the social study of the life sciences may have little to say to biological or clinical outcomes, or to health policy, or health services research, or whatever it is. Second: there is still scope for a more fine-grained analysis of degrees of interdisciplinarity – and of the different problems faced by researchers at different levels. I mean this, first, in the sense that not all gaps are equal: we should acknowledge that there may not actually be a significant epistemic distance between, for example, political science and genetics, or between analytic philosophy and neuroscience – whereas there may be a much bigger gap between (some strands of) medical anthropology and clinical medicine. Calling collaborators in all of these cases ‘interdisciplinary’ thus obscures some important differences (cf. Maasen, 2000; Schmidt, 2007). But I also mean this in the sense that we need to be mindful that a model of interdisciplinarity that imagines a kind of trade between experts may mandate a very specific prior expertise – and thus a form of mutual exchange that actually maintains a quite conservative attitude to pre-existing epistemic boundaries. There is thus more space, here, to think about the ruptures between an inter-disciplinarity, a trans-disciplinarity, or even a post-disciplinarity (see Thompson Klein, 2010). Finally: we are going to need to be much, much more attentive to the epistemological politics that structure so many interdisciplinary interactions – and, without retreating to a conservative and defensive posture, it is going to become increasingly difficult to ignore the fact that the great drive towards, for example, a ‘neurophilosophy’ or a ‘neuroaesthetics,’ is also rooted in the epistemological, political and financial marginalization of philosophical and literary inquiry. I stress – this is not to get bogged down in a tedious turf war over resources: but it is to remember that collaborative work across the social and life sciences can be vital, and ground-breaking, and mutually re-constitutive of both socio-logical and bio-logic epistemologies – even while it gets filtered through a shifting, ambiguous, and sometimes unhappy politics of knowledge. Learning to pick our way through this challenge, I think, may well mark how ‘good,’ bad,’ or indeed ‘ugly,’ our future collaborations actually turn out to be.

 

Des Fitzgerald is a postdoctoral researcher at the Interacting Minds Centre at Aarhus University, Denmark, where he works on the use of evidence and experiment in the new brain sciences. He received his PhD in sociology from the London School of Economics in 2013.

 

Bibliography:

Haraway, Donna J. When Species Meet. Minneapolis MI: University of Minnesota Press, 2007.

Maasen, Sabine. “Inducing Interdisciplinarity: Irresistable Infliction? The Example of a Research Group at the Center for Interdisciplinay Research (ZiF), Bielefeld, Germany.” In Practising Interdisciplinarity, edited by Peter Weingart and Nico Stehr, 173–193. Toronto: University of Toronto Press, 2000.

Rabinow, Paul, and Gaymon Bennett. “Human Practices: Interfacing Three Modes of Collaboration.” In The Prospect of Protocells: Social and Ethical Implications of Recreating Life, edited by Mark A. Bedau and Emily C Parke, 263–290. Cambride, MA: MIT Press, 2009.

Reisz, Matthew. “Values Are at the Heart of Social Science: John Brewer.” Times Higher Education. Accessed April 4, 2013. http://www.timeshighereducation.co.uk/news/values-are-at-the-heart-of-social-science-john-brewer/2002779.article.

Renwick, Chris. British Sociology’s Lost Biological Roots: A History of Futures Past. London: Palgrave Macmillan, 2012.

Rose, Nikolas. “The Human Sciences in a Biological Age.” Theory, Culture & Society 30, no. 1 (January 1, 2013): 3–34.

Schmidt, Jan C. “Towards a Philosophy of Interdisciplinarity.” Poiesis Praxis 5, no. 1 (2008): 53–69. doi:10.1007/s10202-007-0037-8.

Thompson Klein, Julie. “A Taxonomy of Interdisciplinarity.” In The Oxford Handbook of Interdisciplinarity, edited by Robert Frodeman, Julie Thompson Klein, and Carl Mitcham, 15–30. Oxford: OUP, 2010.

Wilson, Elizabeth A. Psychosomatic: Feminism and the Neurological Body. Durham, NC: Duke University Press, 2004.

Worton, Michael. “Big Picture from All Angles.” Times Higher Education, February 21, 2013. http://www.timeshighereducation.co.uk/make-friends-and-influence-people-michael-worton-urges-the-humanities/2001753.article.

AAA Chicago 2013  Call for Papers: The social lives of biomedical technologies in global health development

 Global health development policy and practice has made a noticeable return in recent years to technical and entrepreneurial solutions to world health challenges.  This panel will consider the social lives of new and re-purposed biomedical technologies including devices, medicines, and protocols in low resource settings generally or as specific features of health development projects.  How do these devices and drugs fit the new mandate for simple, high impact, and low cost solutions? How do local clinicians, policy makers, development workers, and users experience them and adapt them to their own contexts? We welcome papers that focus on a particular moment in the life of a biomedical device or drug or that seek to cover longer career histories and trajectories; familiar issues of access, distribution, and consumption are all important areas for the anthropological study of biotechnical solutions for global health challenges as are issues design and manufacturing.  Both ethnographic and theoretical papers are welcome. Paper topics may include, but are not limited to:

• theoretical approaches to understanding the design, manufacture, and use of biomedical technologies in low resource settings
• creative uses of biomedical technologies by users (including clinicians and lay persons)
• non-biomedical technologies used in health projects (ie cell phones)
• the domestication of medicines and devices usually reserved for clinical settings
• scientific and social debates around evidence and particular uses of biomedical technologies, protocols

Please send a 150 word abstract to Maggie MacDonald Maggie@yorku.ca as soon as possible.