The lead for a story on the Ebola outbreak is, by now, familiar: on the 22nd of March, the Guinean Ministry of Health declared an outbreak of Ebola, the first ever in the region. The virus has since spread through the countryside and across its borders: west to Sierra Leone, south to Liberia, and most recently, north into Senegal. Cases in Lagos and Port Harcourt, Nigeria have put countries across the region and beyond on high alert; as far away as Kenya, public health posters inform people about modes of transmission. With now almost 4,800 people infected and over 2400 dead, the WHO has declared the outbreak ‘an extraordinary event,’ and is demanding drastic attention from governmental and non-governmental aid organizations. As levels of hostility to foreign aid and health care workers rise and efforts to remove bodies and enforce quarantine become increasing violent, tracing contagious contacts has become all but impossible. Following the high-profile infection of foreign medical personnel, the news media have exploded with unsettling images of doctors in full body protective gear and residents running from police in riot gear attempting to cordon off neighborhoods. Twitter feeds and Facebook pages are rife with apocalyptic scenarios, rumors and blame for the failure to stamp out the spread of the virus.
From the perspective of social scientists working in the context of global health delivery and policy, there is much to say about the failures of biosecurity measures, the racist undertones of many media representations, and the histories of violence inscribed in weak health infrastructures and the misrepresented and poorly understood resistance to biomedical practices. However, what is worthy of note is that this commentary does not take place on the margins of policy, but rather is articulated in reports delivered by the WHO. As the outbreak continues to accelerate, it is clear that conventional tools of containment are failing; where transmission has slowed, it is mainly in areas where afflicted populations have put in place their own protective measures. With the hopes of garnering these community resources, anthropologists have been increasingly brought into the containment response and their ethnographic insights sought out. As in other emergency settings, the urgency for immediate action to control Ebola often runs counter to the demands of a time-consuming and slow-paced research methodology. The question remains: how best to bring ethnographic insights to bear on containment practices? When faced with the immediate public health demands of an outbreak, what does an anthropologist do?
We represent an anthropological team involved in an interdisciplinary project on another viral hemorrhagic fever endemic in parts of West Africa, Lassa fever (LAROCS). Coordinated by Charité Berlin, the project was set up to interrogate and intervene in the spread of the virus from rats – its primary reservoir – to humans. When the Ebola outbreak in Guinea was first identified, our colleague Almudena Mari-Sáez was conducting ethnographic research in the area. She was asked to join two different Ebola containment interventions.
The first involved the Wild Chimpanzee Foundation Guinea (WCF), the Max-Planck Institute for Evolutionary Anthropology, and the Robert Koch-Institute, and aimed to identify the point of primary transmission and in so doing, shed light on the most likely animal reservoir for Ebola. The team worked in Meliandou, the site where the first or index case (a one-year old child who died in early December) was believed to have originated as well as two other locations with known wildlife densities. Building upon the working hypothesis that bats were the primary vector, Almudena gathered information about bat behaviors from the people who live with them (and sometimes consume them). Extending ecological investigations on species density and diversity through an detailed ethnographic description of bat-human relations, the team integrated perspectives on bat behaviours—roosting habits, feeding preferences—with anthropological insight into domestic spaces and practices—cooking, praying, food storage—illuminating the forms of proximity that create occasions for viral transmission.
Understanding the socio-material practices of hunting has been crucial. Almudena has documented the different tools and techniques used to handle, kill and butcher animals, as well as the ways in which game is distributed. She has sought to unpack the very concept of the ‘hunter’ – a designation that in this particular context entails the use of fetishes to assist in hunting and the social obligations that come with bringing meat home or to the market. Critically, her work has illuminated the role of children who hunt smaller bats and rodents near their homes, and who often are the first to come into contact with reservoir species.
This kind of ethnographic work is intense, and its insights into mechanisms of primary transmission are still preliminary at best. However, even at this early stage, this attention to modalities of multispecies existence opens up new fields of investigation in outbreak situations, deepen understandings of primary-transmission, and provide richer accounts of the spread of Ebola across sites of encounter. The prevailing rumor that Ebola is not real, hinges on the fact is that these communities have been living with animals and in this environment “for centuries” and they never before have seen this kind of disease. The epidemic becomes linked instead to practices never before seen or out of context: disinfecting houses, erecting barriers, taking relatives to the hospital, from where they do not return. Disease becomes then a logical extension of the efforts of government officials and foreigners to keep them out of the forest.
As the outbreak continued to gain pace, Almuenda and Matthias Borchert, a clinical epidemiologist and the principal investigator of LAROCS, were asked to join a team led by the Guinean Ministry of Health and Médecins Sans Frontières to carry out an investigation into community perceptions of Ebola containment interventions. In particular, the question animating this intervention was why some groups had welcomed medical response teams while others had not. In-depth discussions with communities underscored the importance of funeral rites—key occasions of transmissions and the source of much public health anxiety. For the communities with whom we spoke, death is a journey, and for this journey one needs to be equipped with materials such as clothes that need to be washed and ironed before the coffin is closed. Critically, the dead person can also transport things for others in the afterworld. Attending a burial, even entering into physical contact with the dead body, is seen as an obligation not only to the living, but also to previously deceased kin.
These kinds of insights underscore the fact that changing burial practices is not merely a mater of improving hygiene but also a disruption of the social fabric of kinship. Breaking these forms of contact with the dead is on a par with severing ties with the living – it implies a forced separation from the present as well as the past. Ethnographic attention to the concrete organization of burials and the social dynamics of morning rendered a further insight with potential epidemiological relevance: detailed ledgers of attendance offered a critical instrument for tracing inter-personal contacts.
The groundbreaking work in outbreak contexts of anthropologists such as Barry and Bonnie Hewlett, Julienne Anoko or Alain Epelboin (has underlined the important role that ethnographic research can play alongside medical response teams and the affected communities. This role includes the development of burial practices that are safe but incorporate people’s deeply felt need to care properly for the bodies of their loved ones, or the attempt to take seriously rumors and expressions of distrust and use this appreciation to build relations of trust between response teams and afflicted communities. In this way, ethnographic work can help break down stereotypes – or, as Annie Wilkinson puts it, “the simple narratives that blame the epidemic on local people.”
In the context of an outbreak, anthropologists are often among the few professionals willing to ‘be there’. There were multiple occasions when Almudena and Matthias were the only visitors who could stay in the village long enough to speak to people and, critically, listen to their concerns. To contain this epidemic we must come to grips with dynamics of fear and obligations of care in a context where everyone is afraid. It is an anthropological truism, but this means seeing populations not as a stumbling block to halting the spread but as our only resource.
Almudena Mari-Sáez is a postdoctoral fellow at Charité Berlin working on hemorrhagic fevers in Guinea and Sierra Leone. Her previous ethnographic work focused on maternal health and local medicines in Benin and Sierra Leone and on women’s participation in local politics in Mauritania.
Ann H. Kelly is a Lecturer of Anthropology in the Department of Sociology and Philosophy at the University of Exeter. Her work centers on the pragmatic dimensions of public health research in Africa, with special attention to the built-environments, material artefacts and practical labours of experimentation in former British colonies. She is also a member of Somatosphere’s Editorial Collaborative.
Hannah Brown is a lecturer in the department of Anthropology at Durham University. Her research interests include economies of care, the management of epidemics, and human-animal health in Africa.
For this installment of “Top of the heap,” we spoke to Sarah Willen, Assistant Professor of Anthropology and Director of the Human Rights Institute’s Research Program on Global Health and Human Rights at the University of Connecticut.Sarah Willen
This summer I found myself puzzling deeply over the notion of dignity. In fields like political philosophy, bioethics, law, and human rights, interest in dignity has grown like gangbusters, especially in the past half-decade. As debates have raged, anthropologists, for the most part, have been quiet. Some might find this anthropological silence strange. Doesn’t our field presume an incipient link among all ἄνθρωποι (anthropoi), whether wealthy or indigent, modal or transgressive, living or dead? If so, might something like dignity not name that link?
In working on this summer puzzle, I stumbled upon some exciting new work that does, in fact, engage dignity anthropologically, albeit at oblique angles and with varying degrees of depth and success. Among them is Rahul Chandrashekhar Oka’s work with Somali refugees in a Kenyan refugee camp. These refugees, Oka explains, pursue what economists would call “irrational” consumer practices (using scarce resources to buy – and, notably, to share – luxury consumables like tea, soft drinks, meals with fish or meat) in an effort to achieve some measure of “sharaf” (Somali) or “heshima” (KiSwahili), both of which Oka renders in English as “dignity.” In Antina von Schnitzler’s study of sanitation, citizenship, and judicial claims-making in Soweto, dignity appears not as a “presocial and prepolitical value that universally grounds claims to human rights,” but as a mutable concept whose “precise meaning … is ultimately often produced in court.” And Clara Han’s ethnography of crushing debt, political violence, and social connectedness in Chile explores how the liberalization of the Chilean economy plunged poor families into debt – and how the new key to “vivir con dignidad” (living with dignity) in the post-Pinochet era is to save face by sustaining an outward appearance of solvency and material success. (Jarrett Zigon also has an interesting Heideggerian take on dignity up his sleeve.)
Dignity also figures explicitly in research on health and on the proper treatment of human bodies and their constituent parts. Nora Jacobson, for instance, recently published a compelling (if rather overly schematized) study of how dignity and dignity violation are experienced in Canada. In a very different place and vein, Sherine Hamdy’s ethnography of bioethics, Islam, and organ transplantation in Egypt explores the links among dignity, personhood, and the proper disposition of human bodies and their parts. Curiously, it is only in the final dotting of i’s and crossing of t’s that Hamdy comes to recognize the centrality of dignity to her analysis, which she characterizes in a retrospective epilogue as revolving around two distinct but related concepts: karama (the dignity of the living) and hurma (the dignity accorded the body after death).
Still, none of these works resolved the question that puzzled me most this summer: Does the notion of dignity – a concept so heavily weighted with intellectual and cultural baggage – really have a place in anthropology? Should it? Michael Jackson’s existential-phenomenological approach long ago convinced me that it does, as my dog-eared, marked-up copy of Existential Anthropology can attest. But this summer I wanted to dig deeper, not least because the book I’m writing – about the impact of illegalization on unauthorized migrants and their advocates in Tel Aviv — has lots to say about illegalization as a form of sociopolitical abjection: a form of abjection that’s profoundly “dangerous to dignity” (as Jacobson puts it).
This summer’s meandering quest for insight took me places both familiar and unexpected: to Sam Moyn’s probing inquiry into the uses, meanings, and misappropriations of dignity in discussions of human rights; Serena Parekh’s fantastic book about the phenomenology of human rights for Hannah Arendt; Avishai Margalit’s The Decent Society; Fanon’s Black Skin White Masks; Judith Butler’s reflections on “a livable life”; Martin Luther King Jr.’s “Letters from a Birmingham Jail.” Here’s where I landed, at least for now:
It is not the ethnographer’s task to hammer out a precise definition of dignity, nor would there be much value in seeking out conceptual correlates across languages and cultural settings. Reified or abstract conceptions of dignity, whatever their genealogy, would seem to hold little anthropological value, especially those ripped from the intersubjective matrix of human being-in-the-world. Instead, the notion of dignity becomes ethnographically visible, and anthropologically meaningful, only in motion: as dignity harmed, denied, violated, or stripped away – or, conversely, as dignity pursued, safeguarded, recuperated, reclaimed.
From this vantage point – which relinquishes any desire to define, schematize, or quantify – dignity is more vector than thing. We might think of it as a lodestar that guides the striving of individuals and groups within relational social fields that are gridded by constraint and fraught with indeterminacy. Like physicists’ particles and waves, metaphors like these – vector, striving, lodestar – can help decompose abstractions like dignity and reassemble them in ways that bear new explanatory power. When explored ethnographically, such metaphors can help us untangle their meaning in complex human lifeworlds.
Thus understood, an ethnographic approach to dignity can enrich anthropological understanding of subjectivity, intersubjectivity, and experience, including what some call moral experience. At the same time, the flourishing scholarship on dignity in fields like philosophy, political theory, and human rights can be enriched by empirically grounded, anthropological engagement with the fundamentally relational and intersubjective ways in which both violations of dignity as well as its pursuit figure in shared human struggles, including the struggle for what Judith Butler calls the “minimum conditions for a livable life.”
As for the book I’m most burning to read, one wins, hands down: The Ground Between: Anthropologists Engage Philosophy, edited by Veena Das, Michael Jackson, Arthur Kleinman, and Bhrigupati Singh. In this collection, some of the most provocative and inspiring anthropological voices of our time “explore the attraction and the distance that mark the relationship between anthropology and philosophy” (1) and consider how “the philosopher’s anthropology and the anthropologist’s philosophy may mutually illuminate” while insisting that “it is also the friction between them that allows us to walk on our respective paths” (3). No doubt this volume will prove illuminating as I keep swimming those murky waters in which philosophical and anthropological approaches to dignity might meet.
A final comment. I have the privilege of helping to select this year’s Eileen Basker Memorial Prize, awarded annually by the Society for Medical Anthropology to celebrate “a significant contribution to scholarship on gender and health.” Although I can’t reveal this year’s list of nominees, I can tell you it’s a magnificent bunch, and that the winner will be announced during the SMA Business Meeting at this December’s AAA meetings in Washington, D.C.
Sarah S. Willen is Assistant Professor of Anthropology and Director of the Human Rights Institute’s Research Program on Global Health and Human Rights at the University of Connecticut. She has guest edited or co-edited special issues of Culture, Medicine, & Psychiatry, Social Science & Medicine, Ethos, and International Migration as well as three book: Transnational Migration to Israel in Global Comparative Context (Lexington, 2007); A Reader in Medical Anthropology: Theoretical Trajectories, Emergent Realities (Wiley-Blackwell, 2010); and Shattering Culture: How American Medicine Responds to Cultural Diversity (Russell Sage, 2011). Her work has also appeared in Medical Anthropology Quarterly, International Migration, the Journal of Human Rights, and the Harvard Review of Psychiatry, among other scholarly publications. She is a founding member of the editorial collective for the blog AccessDenied: A Conversation on Unauthorized Im/migration and Health.
Image: Guy Laramee, “Book Carving.”
Verso Books, 2013. 133 pp.
Years ago, I gave a talk at Stanford University, an hour drive north from Santa Cruz. During the question and answer period after the talk, an economist in the audience raised a question about my argument that despite widespread belief in the emergence of a 24/7 global society, in fact, what we’ve seen over the last two decades is the gradual and uneven retreat from a 24-hour society. It wasn’t a question so much as a statement that I was wrong. I suggested that from the perspective of Manhattan or Tokyo or Berlin, it may in fact look like we inhabit a 24-hour society, but that for the vast majority of people around the world, the 24-hour society has disappeared in the face of the widespread availability of the internet; who needs to go to the mall at 3 AM when they can just go shopping online instead? Moreover, for most American businesses, the 24-hour model is just unprofitable: employees want more pay, and few patrons mean that this higher pay is a precarious expense. And then there are the many, many people around the world who lack not only access to the internet, but also reliable nighttime lighting. To them, the idea of a 24-hour society must be entirely alien. The economist was undeterred: for him, the 24-hour society was already here and would soon engulf the world. As an idea, the 24/7 society is really only relevant to a select class of people, a global elite, for whom technology suffuses their daily lives and there is always more to be done – and so it seems for Jonathan Crary, who argues in 24/7: Late Capitalism and the Ends of Sleep (2013) that “24/7” has attained the level of what Gilles Deleuze and Felix Guattari refer to as an “order-word,” the use of language to create a social reality (Crary 2013: 26). The idea of 24/7 is compelling enough, Crary suggests, that it influences individuals to act as if it is the social reality that actually exists; as such, it eventually brings that reality into being through collective belief and action.
What is that social reality? 24/7 is “the modeling of one’s personal and social identity…to conform to the uninterrupted operation of markets, information networks, and other systems. A 24/7 environment has the semblance of a social world, but it is actually a non-social model of machine performance and a suspension of living” (9). Moreover, “within 24/7 capitalism, a sociality outside of individual self-interest becomes inexorably depleted, and the interhuman basis of public space is made irrelevant to one’s fantasmatic digital insularity” (89). 24/7 appears as a caricature of the Protestant spirit of capitalism: individuals are fragmented from each other and focus only on their own personal gain. Even when they find themselves together, “there will always be something online more informative, surprising, funny, diverting, impressive than anything in one’s immediate actual circumstances” (59), so during our face to face interactions, we’re always thinking about what we could be watching on YouTube (as if YouTube is that easy to navigate!). As a concept, 24/7 is reminiscent of Marc Augé’s “supermodernity” (1995 ): that supreme disenchantment associated with modernity and the production of spaces around the world that are devoid of content, and yet always familiar – airports and hotels foremost among them. Everything is the same everywhere, and this allows for the seamless integration of a global elite into any space, any social relation. But I’m not entirely sure that there’s any actual basis in reality for this 24/7 world, and, if there is, it is only for a very small set of individuals who choose to inhabit that world. The rest of us may be driven to check our email more frequently than we should, and we might carry our phones with us everywhere, but for most of us, there’s no actual need to be timed to the market, information networks and “other systems.” As such, 24/7 feels less like a diagnosis of a contemporary reality, and more like a screed without a subject. At its best, 24/7 feels paranoid; at its worst, it feels out of touch with reality.
24/7 first appeared just months after my own book about sleep and capitalism was released, and, like most junior scholars, I felt a narcissistic pang when I realized a more senior academic had just published a book about a similar topic. When I flipped through the endnotes, I quickly realized that Crary’s project is much different than my own, as he avoided engaging with any of the literature that has appeared over the last decade devoted to the critical study of sleep. Although “sleep” is in the subtitle of the book, there’s very little attention to sleep throughout it, other than to mention that “sleep is the only remaining barrier, the only enduring ‘natural condition’ that capitalism cannot eliminate” (74). Sleep, for Crary, stands as a romanticized, natural resistance to the endless search for profit. For readers interested in sleep, there is a host of other, more empirically grounded works that has been produced over the last decade. But Crary’s stance on sleep is emblematic of a kind of late Marxism that insists nature will lead us out of our contemporary cuckolding and simply depends on us throwing technology out the window. More attention to either sleep as it is actually practiced, or to technology and how people engage with it, would surely have made 24/7 less of a polemic, and more of a diagnosis of how people are living with the competing demands on their everyday lives.
It seems that every so often, the idea of the 24/7 society resurfaces and compels someone to write a tract like 24/7. In the 1970s, sociologist Murray Melbin started such a project, which came to fruition in Night as Frontier: Colonizing the World After Dark (1987). Melbin had earlier published a similarly titled essay in the 1970s about the inevitable encroachment of capitalism into every spatial and temporal corner of American social life, but by the time he conducted the entirety of the research that laid the basis for Night as Frontier, his attitude had changed somewhat: yes, there was activity at night, but it was far from all-consuming, and the people who worked at night – police, truck drivers, nurses, restaurant servers – had a camaraderie based on their shared existence in the marginalized social world of night work. Arriving the same year, and more akin to Crary’s book, was Jeremy Rifkin’s Time Wars: The Primary Conflict in Human History (1987). Rifkin, whom I discuss in a recent article, sees the rise of the computer as an encroachment on human social life and foresees that the integration of the personal computer into daily life will lead to the widespread experience of “computime,” in which every second of our days will be measured by and against the productivity made possible by computers. And so it is for Crary: social media, blogs, smart phones, and television too – which he suggests might be a cause of autism (85), based on a deeply problematic study – are all taking us away from honest interpersonal communication, which might lay the basis for political change. Recent social movements, Crary insinuates, are less potent that those of the 1960s, when, it seems, they were based on an organic desire on the part of the individuals who participated in them (111-113). If this seems a little curmudgeonly, it may be due to the fact that, unlike Melbin, the basis of Crary’s analysis is not the everyday lives of individuals, but the imagined experience of some unnamed individual, impelled to live a 24/7 existence, constructed through the casual reading of news items and 20th century French philosophy, with a sprinkling of references to paintings, documentaries, and a Philip K. Dick novel.
This lack of an empirical grounding is the most troubling aspect of 24/7, and it’s most likely to be the most frustrating aspect about the book for many readers. Crary doesn’t situate his analysis in any one location or time, but instead rambles from the late 1700s through the turn of the 21st century. Crary is at his most convincing when he lingers on contemporary marketing technologies that have grown out of surveillance technologies (48-50); one can’t help but imagine that a book focused on these technologies would produce a much more supple understanding of contemporary American capitalism by one of the leading scholars of technologies of visualization. But instead of limiting his attention to one kind of media or technology, he brings together texts that inspire his momentary attention. This leads to, or grows out of, his conception of capitalism, which is an abstract, placeless force that seems to have no instrumental actors, but, instead, only hapless victims – except for the artists and critics who are able to extricate themselves from capitalism’s morass. But social scientists have been working through capitalism’s local particularities over the last decade to show how, for instance, Japanese capitalism isn’t the same as capitalism’s American iteration, and this is apparent even in the sleeping practices of Japanese (Steger 2003) and American citizens.
When I first started the project that eventually became The Slumbering Masses (Wolf-Meyer 2012), my assumption was much like Crary’s: I imagined that sleep was a kind of natural barrier to the expansion of capitalism, that it was part of the human experience that could not be capitalized upon. But, as I immersed myself in the worlds of sleep in the U.S., I quickly came to realize that the ideal type of subjection produced by American capitalism is not insomnia, but, rather, narcolepsy. As I write at the end of my book and Crary mentions at the beginning of his, military experiments with sleeplessness offer a tantalizing if fearsome vision of a future of insomniacs – workers who can work endlessly, or, alternatively, a new class division between the sleepless and the sleepers. Despite decades of research, we seem to be no closer to the sleepless American. Instead, what we see is that Americans are increasingly relying on alertness-promoting chemicals and sleep-inducing ones, which aligns with the experience of narcoleptics – drugs to both wake you up and put you to sleep. Crary imagines sleep as existing outside of value production, but, in fact, the pharmaceutical industry depends on sleep-inducing drugs more than alertness promoting ones, and the last two decades have witnessed a revolution in bed technologies and other gear expressly marketed to make us better and more efficient sleepers. Sleep and dreaming are revolutionary, Crary would have us believe, but he gives the reader nothing to dream about; the interested reader might seek out Thierry Paquot’s The Art of the Siesta (2005 ), which is much more hopeful about the future possibilities of sleep in its outlook.
Crary takes the time to note that those who don’t participate in the 24/7 society are its detritus, only valuable to the degree to which they can provide fresh organs for the elites in need of a transplant or as sex slaves (44). What’s troubling is that these people also seem to be cast aside by Crary. There is no sense of who is being left out of the new global economy, in the U.S. or elsewhere. And this runs parallel to Crary’s citational practices: there are no people of color cited, nor any work of art or text produced outside of the North Atlantic. Engagement with scholarship and art produced by those capitalism would cast aside, or obscure the presence of, might have provided 24/7 with more nuance and more of a promising dream of revolution. And this oversight seems like the most promising avenue for those enamored with 24/7 (the idea) to pursue: how is 24/7 spreading around the globe and across class lines? How is it that once only elites were required to be on call at all times, and now even minimum wage workers need to respond to emergency phone calls from their employers when off shift? How is time-discipline, which E.P. Thompson characterized in the age of industrialization (1993), becoming sutured to ideas about 24/7 – or not? If 24/7 is such an order-word, who, exactly, does it compel, and how, precisely, is it capturing the imaginations and everyday practices of people around the world? And whom does it fail to seduce, and how are they articulating themselves against 24/7? True elites live beyond the seduction of 24/7 as much as the truly downtrodden do; it seems that 24/7 is aspirational, but only some will ever bother to aspire to it, regardless of the damage that ensues. But without firm empirical grounding from Crary, the reader can only imagine who that might be.
On my drive home from that talk at Stanford, after a dinner and drink with friends, I found myself 15 minutes into my drive and needing to pee. I stopped at off ramp after off ramp to see if I could find a gas station. At 10 PM on a weeknight, the only station I could find was closed, and the bathrooms were locked. Lacking a bathroom, I found a dark space on the street and relieved myself. 24/7 might be a compelling idea – and even something to fear – but it is very far from being a material reality for the vast majority of Americans and people around the world. I’m sure that in Manhattan I could have found any number of places to pee, but in sleepy Cupertino – less than a mile down the road from the home of the early 21st century’s capitalist paragon, Apple – I still had to find a dark spot on the side of the road.
Matthew Wolf-Meyer is Associate Professor of Anthropology at the University of California, Santa Cruz. His work focuses on medicine, science and media in the United States to make sense of major modern-era shifts in the expert practices of science and medicine and popular representations of health. His book The Slumbering Masses: Sleep, Medicine and Modern American Life was the first book-length social scientific study of sleep in the United States. It offers insights into the complex lived realities of disorderly sleepers, the long history of sleep science, and the global impacts of the exportation of American sleep. He is currently finishing a book manuscript on the alternative histories of American neuroscience, seen through the lens of neurological disorders, tentatively titled The Other Century of the Brain: Disability, Neuroscience and the Politics of American Care. He is in the beginning stages of a project entitled The Colony Within on the history and contemporary medicalization of digestion and excretion in the U.S.
Augé, Marc. 1995  Non-Places: Introduction to an Anthropology of Supermodernity. J. Howe, transl. New York: Verso.
Crary, Jonathan. 2013 24/7: Late Capitalism and the Ends of Sleep. New York: Verso.
Melbin, Murray. 1987 Night as Frontier: Colonizing the World After Dark. New York: The Free Press.
Paquot, Thierry. 2005  Art of the Siesta: A Book About Stealing Moments of Repose. K. Hollings, transl. New York: Universe.
Rifkin, Jeremy. 1987 Time Wars: The Primary Conflict in Human History. New York: Simon & Schuster.
Steger, Brigitte. 2003 Getting away with sleep — social and cultural aspects of dozing in parliament. Social Science Japan Journal 6(2):181-197.
Thompson, Edward Palmer. 1993 Customs in Common: Studies in Traditional Popular Culture. New York: New Press.
Wolf-Meyer, Matthew. 2012 The Slumbering Masses: Sleep, Medicine, and Modern American Life. Minneapolis, MN: University of Minnesota Press.
Here’s the first selection of articles published in September. Enjoy!
In this article, I examine anthropology’s embrace of the informed consent doctrine at the end of the 1990s. Although acknowledging its utility in resolving the tensions between disciplinary ideals of openness in field research and the diverse array of contexts in which anthropologists now work, I argue that it has not been in our best interest to co-opt the concept. Bringing together the prior critiques of the informed consent doctrine’s application to ethnography, I criticize the tendency of some ethnographers to characterize ethnographic practice as “insuperably flawed,” pointing instead to the problems with the doctrine itself. I tease out underlying assumptions about the nature of research (and researchers and research subjects) that it presumes, and I conclude by suggesting the need for anthropology take a principled stance against the informed consent doctrine.
In this article, I consider Howard Becker’s 1955 research among medical students in relation to my own late-2000s research on standardized patients, or SPs (i.e., people hired to portray patients in staged clinical encounters with medical students). Becker’s mid-20th-century subjects used the term crock for patients who presented obstacles to their acquisition of valued kinds of clinical “experience.” SP simulations, as one among many forms of simulation used to teach clinical skills today, exclude the possibility of crocks. While medical education has changed, so too has ethnographic practice. Becker’s account of his fieldwork, like many at midcentury, portrayed the ethnographer as a clueless “bumbler” who, through experience, gains understanding and expertise and is transformed into a professional anthropologist. Today, by contrast, the necessity to account in advance for the risks, rewards, and outcomes of ethnographic research has rendered bumbling inadmissible. I argue that the disappearance of the “bumbler” and the “crock” as regular figures in the discourses of anthropology and medicine points toward a revaluation of “experience” in both fields and a shift toward new regimes of accountability, grounded in the changing political economy of knowledge production. At risk of being lost in the process are faith, surprise, and humor.
In this article, I present the first comprehensive examination and analysis of what remains, nearly sixty years after its initial publication, not only one of the most frequently read articles in the history of American Anthropologist but also one of the more widely circulated English-language pieces of 20th-century social science. Combining archival research at Horace Miner’s home institution, interviews with family members and former colleagues, and examination of over 50 partial or full anthological reproductions of the piece spanning five decades, I examine the genesis and reception of the work with an eye to unpacking the reasons for its extraordinary longevity. My conclusions are, first, that the work has been read in a surprisingly atomized rather than holistic manner, resulting in a misunderstanding of Miner’s likely intentions. Second, the work has accumulated diametrically opposed readings as either illustrative of or, since the late 1960s, radically skeptical of basic ethnographic method. Third, this and other paradoxes inherent in the composition and reception of the work, combined with its comic traits, qualify it as a latter-day example of the carnivalesque.
Patient-Centered Development? Comparing Japanese and Other Gynecological Examination Tables and Practices
Kyoko Mimura, Minori Kokado, Hyunsoo Hong, Chiungfang Chang and Azumi Tsuge
In Japan, gynecological examinations (GEs) are normally conducted on a specially designed examination table called naishin-dai. Recent naishin-dai are remarkably high-tech, equipped with mechanisms to automatically position the patient perfectly for the GE, so “all patients need to do is sit.” However, such high-tech machines are not commonly used in the West. To determine what sociocultural contexts legitimize and encourage such development, we conducted semistructured interviews with manufacturers of naishin-dai and gynecology practitioners in Japan, as well as gynecology practitioners in Taiwan, South Korea, Britain, France, and the United States. Comparative analysis of these data by employing the concept of genderscript revealed that multilayered and interrelated inscriptions of gendered norms and relations provided such legitimacy and encouragement. Furthermore, the genderscripts of naishin-dai are in fact East Asian genderscripts, which reveal how traditional East Asian stereotypes of women patients are framed in the practice of modern Western gynecology.
As the capacities of Reproductive Genetic Technologies expand, would-be parents face an increasing number of reproductive decisions regarding testing and screening for different conditions. Several studies have acknowledged the role that ‘experiential knowledge of disability’ plays in arriving at decisions around the use of these technologies; however, there is a lack of clarity within this literature as to what constitutes ‘experiential knowledge of disability’ and an over-reliance on medical diagnoses as a shorthand to describe different types of experience. Drawing on both social model of disability theory and the literature on chronic illness, this article presents an analysis of data from an in-depth qualitative interview study with 64 people with an inheritable condition in their family, Spinal Muscular Atrophy, and reports their views around reproduction and Reproductive Genetic Technologies. An experiential typology is presented which demonstrates the way in which experiences of ‘disability’, ‘embodied experiences of impairment’ or ‘embodied experiences of illness, death and bereavement’ are strategically privileged in accounts of reproductive decisions, in order to validate reproductive decisions taken, and, specifically, justify use (or non-use) of Reproductive Genetic Technologies. By highlighting the experiential categories within which participants embedded their reproductive decisions, this article draws attention to the porous and collapsible nature of diagnostic categories in the context of reproductive decision-making and genetic risk, and suggests new ways of researching ‘experiential knowledge of disability’ within these contexts which are able to account for the various contours of the embodied lived reality of life with ‘disability’.
Mental health/illness and prisons as place: Frontline clinicians׳ perspectives of mental health work in a penal setting
Nicola Wright, Melanie Jordan, Eddie Kane
This article takes mental health and prisons as its two foci. It explores the links between social and structural aspects of the penal setting, the provision of mental healthcare in prisons, and mental health work in this environment. This analysis utilises qualitative interview data from prison-based fieldwork undertaken in Her Majesty’s Prison Service, England. Two themes are discussed: (1) the desire and practicalities of doing mental health work and (2) prison staff as mental health work allies. Concepts covered include equivalence, training, ownership, informal communication, mental health knowledge, service gatekeepers, case identification, and unmet need. Implications for practice are (1) the mental health knowledge and understanding of prison wing staff could be appraised and developed to improve mental healthcare and address unmet need. Their role as observers and gatekeepers could be considered. (2) The realities of frontline mental health work for clinicians in the penal environment should be embraced and used to produce and implement improved policy and practice guidance, which is in better accord with the actuality of the context – both socially and structurally.
Background: There are major gaps in knowledge about beliefs, stigma and discrimination in Uganda, including the relationship between different cultural beliefs and stigmatising responses, how stigma and beliefs result in discrimination and the impact of social factors such as gender, poverty and ethnic conflict.
Aim: This exploratory study aims to understand beliefs, stigma and discrimination associated with mental health in Uganda in more depth from the perspectives of different stakeholders.
Methods: Focus groups and interviews were undertaken with mental health activists, policymakers, practitioners, non-governmental and human rights organisations, journalists and academics.
Results: Stigma was reported by individuals, families, communities and institutions, including health services. The study also found stigmatising beliefs linked to traditional, religious and medical explanatory frameworks, high levels of ‘associated stigma’, common mental health problems rarely medicalised and discrimination linked to poverty, gender and conflict.
Conclusions: The findings suggest the need to address stigma in their cultural and social context, alongside other human rights initiatives.
This article examines the implications for parents and family members when a child is diagnosed with a genetic syndrome. In particular, it describes how practices of understanding are shaped when the syndrome occurs “de novo,” that is, when it has not been inherited from either parent and where there is no family history. Despite a significant body of research exploring the social implications of genetic disease and diagnostic technologies, sociological understandings of the implications of a de novo mutation are considerably limited. This article draws on semi-structured interviews conducted with 23 parents of children diagnosed with 22q11 deletion syndrome, a syndrome associated with high rates of de novo cases. Three themes were identified: “lay” understandings of genetics, making genetic connections and genetic gatekeeping. Overall, this article articulates and confirms the enduring significance of family for contextualizing health and illness.
Social, ethical and legal considerations raised by the discovery and patenting of the BRCA1 and BRCA2 genes
Yann Jolya and Patricia N. Tonin
The discovery of the BRCA1 gene had an immediate and profound impact on medical practice by providing a means to assess and manage breast and ovarian cancer risk in individuals and their families carrying a mutation in the gene. The patenting of BRCA1 and then BRCA2 (another cancer-predisposing gene) by Myriad Genetics Inc. raised controversial ethical and legal issues relating to access and research, and its enforcement caused growing discontent. In the USA, the validity of the patents on the isolated BRCA1 and BRCA2 genes was challenged in court. After a four-year legal battle, the US Supreme Court invalidated both patents. This commentary reviews the discovery of these cancer-predisposing genes from the perspective of one of the co-discoverers of BRCA1. It also discusses the socio-ethical impact of the patenting of BRCA1 and BRCA2 and the legal implications of the US Supreme Court’s decision.
The use of DNA technologies for criminal investigation purposes illuminates an interplay of knowledge and expertise where meaning and relevance of biological traces are negotiated. Through the analysis of five criminal cases that took place in Portugal between 1995 and 2010, and where DNA technologies were used, this article will focus on the dialogues established between the police and the forensic laboratories. I will argue that, on the one hand, the police investigators’ uses of DNA technologies seek to legitimate and provide an external source of neutrality and objectivity to the constructed narratives surrounding the commission of a crime. On the other hand, laboratories and forensic experts engage in the delimitation and preservation of their professional autonomy by developing boundary work around their scientific expertise through the translation and conversion of criminal traces into scientific artifacts.
The psychiatric report as moral tool: A case study in a French district court
Fabrice Fernandez and Samuel Lézé
Mental health evaluation within a legal setting is widely seen as a power to judge. The aim of this paper is to challenge this current thesis, which was popularised by Michel Foucault, who encapsulated the notion in a brief sentence: “The sordid business of punishing is thus converted into the fine profession of curing” (: 23). On the basis of an ethnography of a French district court (between September 2008 and May 2009, n = 60 trials) including interviews with judges (n = 10) and psychiatrists (n = 10), we study the everyday penal treatment of sexual offenders using psychiatric reports. Our findings show how (i.) the expectations of the judges select the psychiatrists’ skills (based on the following criteria for their reports: accessibility of knowledge, singularization and individualization of content) and (ii.) reframe the psychiatric report as a moral tool. The clinical reasoning of forensic psychiatrists in their reports offer moral affordances due to their clinical caution regarding the risk of recidivism (therapeutic and criminological reversal, moral prevention). Both the judges’ evaluation and the psychiatrists’ clinical authority are shaped by a moral economy of dangerousness, which eclipses the idea of lack of criminal responsibility. In conclusion, we show that these unintended effects are necessarily of interest to most clinical practitioners engaged in work as expert witnesses.
The social life of health records: Understanding families’ experiences of autism
Amber M. Angell and Olga Solomon
Outside of the epidemiological surveillance studies of autism prevalence, health records of children diagnosed with autism have not been sufficiently examined, yet they provide an important lens for showing how autism diagnosis, services and interventions are negotiated, coordinated and choreographed by families and practitioners across multiple settings. This article provides a multifaceted understanding of these processes from an ethnographic and discourse analytic perspective that reveals structural and interactional phenomena contributing to disparities in autism diagnosis and services. We consider health records as dualistic, material-discursive artifacts that are socio-interactionally co-constructed and variably interpreted, contested and utilized across home, school and clinic contexts. We chronicle several families’ experiences of their children’s autism diagnoses and interventions and describe ways in which health records are socially constructed, curated and placed in the middle of clinical encounters. We show how the parents in our study draw upon health records’ material-discursive properties to display epistemic authority, expertise and knowledge in interactions with healthcare and school professionals involved in authorizing and planning their children’s care. We describe how the parents experience the health records’ clinical portrayals of their children and themselves, and how the parents’ portrayals of their children are tacitly ratified or negated in the health records. The data include health record reviews, narrative interviews with parents and practitioners, and clinical observations. These data were collected between October 2009 and August 2012 as part of a larger study on disparities in autism diagnosis, interventions and services experienced by African American children with autism and their families living in Los Angeles County, California. Our analysis reveals the central role of health records in maintaining continuity of an autism diagnosis, interventions and services. This article contributes to enhanced professional awareness, parent-professional partnerships, and equity in the provision of healthcare and human services related to autism.
Social recovery and the move beyond deficit models of depression: A feminist analysis of mid-life women’s self-care practices
Simone Fullagar and Wendy O’Brien
In Australia, like other advanced liberal democracies, the adoption of a recovery orientation was hailed as a major leap forward in mental health policy and service provision. We argue that this shift in thinking about the meaning of recovery requires further analysis of the gendered dimension of self-identity and relationships with the social world. In this article we focus on how mid-life women constructed meaning about recovery through their everyday practices of self-care within the gendered context of depression. Findings from our qualitative research with 31 mid-life women identified how the recovery process was complicated by relapses into depression, with many women critically questioning the limitations of biomedical treatment options for a more relational understanding of recovery. Participant stories revealed important tacit knowledge about recovery that emphasised the process of realising and recognising capacities and self-knowledge. We identify two central themes through which women’s tacit knowledge of this changing relation to self in recovery is made explicit: the disciplined self of normalised recovery, redefining recovery and depression. The findings point to the need to reconsider how both recovery discourses and gendered expectations can complicate women’s experiences of moving through depression. We argue for a different conceptualisation of recovery as a social practice through which women realise opportunities to embody different ‘beings and doings’. A gendered understanding of what women themselves identify is important to their well-being, can contribute to more effective recovery oriented policies based on capability rather than deficit.
Increasing longevity and prevalence of long-term conditions contribute to older adults being the greatest users of health services. However, relatively little is known about the health and illness beliefs of the oldest old or how they decide to seek help in response to symptoms. Through analysis of in-depth interviews with day centre attendees aged 80–93, we find that a moral, hierarchical approach to health problems and help-seeking exists; similar to Cornwell’s (1984) findings among 50–60 year-olds of a similar social group 30 years ago. However, when acting independently, those in their eighties and nineties report modifying their health and illness beliefs and behaviour, in response to their own perceived old age. Some health problems are ‘demedicalised’, being increasingly attributed to age and by being self-managed. Others are perceived as potentially more serious, leading to increased consultation with medical services. When obliged to act outside their moral belief–behaviour framework by others, the participants expressed feelings of disempowerment, yet resisted modifying their moral beliefs. This may represent resistance to adopt the ‘sick role’, while seeking to maintain control over uncertain health as functional dependence and frailty increases. This study furthers theoretical understanding of the health and illness beliefs and behaviour of the oldest old, with important practical implications.
Inquiries in the UK into mistreatment of older people by healthcare employees over the last 30 years have focused on introducing or supporting employee whistle-blowing. Although whistle-blowers have made an important contribution to patient safety it remains a controversial activity. The fate of whistle-blowers is bleak, often resulting in personal and professional sacrifices. Here we draw on the views of healthcare and social care employees working with older people to explore perceptions of whistle-blowing as well as alternative strategies that may be used to raise concerns about the mistreatment of patients by co-workers. Whistle-blowing was perceived as a negative term. Managers said they promoted open cultures underpinned by regular team meetings and an open-door ethos. Others described workplace norms that were somewhat at odds with these open culture ideals. Whistle-blowing was considered risky, and this led to staff creating informal channels through which to raise concerns. Those who witnessed wrongdoing were aware that support was available from external agencies but preferred local solutions and drew upon personal ethics rather than regulatory edicts to shape their responses. We argue that the importance of workplace relationships and informal channels for raising concerns should be better understood to help prevent the mistreatment of vulnerable groups.
In this article, I discuss intimate practices of self-medication in relation to political preoccupations with the ethics of the pharmaceutical economy, and discursive constructions of illness. Partly self-ethnographic, the article draws from my personal experience of clinical depression, and the discomforts in thinking of myself as a ‘depressed’ subject who consumes medications. Intervening in debates on new materialism and affect studies, I offer an account of dynamics where the material and the discursive, the human and the non-human, the personal and the political converge. I suggest that the experience and performative effects of self-medication lie not only in the activation of chemical compounds, but in the conscious bodily animation of cognitive and affective relations with medications. In this analysis, I employ creative forms of writing, to find a language of distress that blurs the boundary between the material and the discursive.
Finally, in case you missed it, we’ve already highlighted a special issue of BioSocieties titled New Modes of Understanding and Acting on Human Difference in Autism Research, Advocacy, and Care. The guest editors of the issue are Gil Eyal, Des Fitzgerald, Eva Gillis-Buck, Brendan Hart, Martine D. Lappé, Daniel Navon and Sarah S. Richardson.
Five years ago, the University College London Commission concluded that climate change is the biggest threat to human health in the 21st century. Health has entered a new epoch in which environmental factors, under adverse human influence, must become the focus worldwide. This recognition sparked the planetary health initiative, spearheaded by The Lancet, which is motivated by acceptance of the fundamental need for collective achievement of a world “that nourishes and sustains the diversity of life with which we coexist and on which we depend” (Horton 2014). This cage-rattling development has significant implications for the anthropology of health.
Emergence of planetary health constitutes a fifth stage in the historic evolution of the modern population health paradigm. This mode of thinking about health as more than an individual-level condition—the prevailing orientation of biomedicine—has its roots in local public health efforts, especially in Europe during the 19th century, transitioned to tropical medicine as a consequence of the colonial encounter with the infectious diseases of tropical environments, grew during the post-World War II period into international health with the expansion of multinational health initiatives like the World Health Organization, and during the 1990s emerged as global health, a reflection of the consolidation of a global neoliberal economy and global communication systems, combined with recognition that risks to health transcend borders and require multilateral responses. The shift to a planetary health understanding as a further advance in population health thinking was driven by the awareness that not only are human communities worldwide now multiply linked together by flows of commodities, ideas, people, and health-related influences from vectors to medicines, but that the health and well-being of human communities are multiply linked to the environment and to other species. Internally, we are not fully human, in that we are home to massive numbers of microorganisms, some of which are vital to our health, and externally our survival, from the air we breathe to the food we consume, depends on other species. But these relationships are at critical risk in the Anthropocene. As aptly stated in the planetary health manifesto: “Our patterns of overconsumption are unsustainable and will ultimately cause the collapse of our civilisation. The harms we continue to inflict on our planetary systems are a threat to our very existence as a species” (Horton et al. 2014:847). A planetary health perspective, in short, reveals the fundamental ways in which human beings are not just agents of environmental change but are also vulnerable objects of that change.
Humans have acquired through their ability to harness ever more powerful levels of energy, produce prodigious quantities of toxic waste, and rapidly increase their population size the dangerous ability to overtax “planetary boundaries” and “trigger abrupt or irreversible environmental changes that would be deleterious or even catastrophic…” (Rockström et al. 2009). From the standpoint of living systems, human and otherwise, we stand on the precipice of conditions that “can be called, without hyperbole, threatened apocalypse” (Foster, Clark and York 2010:109).
Pivotal to the incipient planetary health movement, as it must be to any meaningful response to the dangers of climate change, is a commitment to equity in a world of unjust societies and unequal relations among societies. As articulated in the planetary health manifesto: “The discipline of public health is critical to this vision because of its values of social justice and fairness for all, and its focus on the collective actions of interdependent and empowered peoples and their communities” (Horton et al. 2014:847). The evidence on anthropogenic climate change demonstrates the consequences of inequity. The United States, with just four percent of the world’s population, produces 25 percent of emitted greenhouse gases. It releases more greenhouse gases than most of the developing countries in Asia, Latin America, and Asia combined (Lindsay 2001:228). The average U.S. citizen accounts for as much greenhouse gas production as nine Chinese, 18 Indians, and 90 Bangladeshis, but even more alarming, a U.S. citizen on average pollutes more than 500 citizens of Ethiopia, Chad, Zaire, Afghanistan, Mail, Cambodia, and Burandi (Roberts and Parks 2007:146). Generally, the least developed countries, which produce comparatively small amounts of greenhouse gas emissions, have the most to lose from global warming because they have fewer resources to use in adapting to its health impacts. Translated into stark moral and palpably human terms, anthropogenic climate change can be assessed as a form of social murder, a term introduced by Frederick Engels in 1845 to characterize the impact of the corporate-owning class on the health and survival of poor and working people. Chernomas and Hudson (2009) employed the term more recently to label contemporary corporate policies designed to maximize the accumulation of private profit while socializing associated risks and costs. Corporate externalization involves two components: 1) shifting significant production costs, such as those inherent in the release of greenhouse gases, onto governments and to the kinds of less powerful communities commonly studied by anthropologists; and 2) underplaying or denying responsibility or adverse outcome of such practices. In an insightful quip about the nature of capitalism and the alleged corrective benefits of market economy by science fiction writer Kim Stanley Robinson, “The invisible hand never picks up the check.”
The theme of social murder in the context of anthropogenic climate change was emphasized by Mohamed Nasheed (2012), the deposed activist president of the Maldives, a cluster of islands that stand no more than about five feet above the ocean’s rising surface: “If we can’t stop the seas rising, if you allow for a 2-degree rise in temperature, you are actually agreeing to kill us.”
The anthropology of health, now grappling with the transition to a global health perspective, is challenged again to consider the implications of planetary health in a time of global warming. At the theoretical level, this entails assessing the pathways through which all health issues everywhere are shaped by a human-impacted environment undergoing advancing degradation driven by the productivist/consumerist ethic that dominates the world economic system and sustains vast social and health inequality. At the practical level, this requires urgent consideration of ethnographically informed pathways to sustainability that counter the march towards environmentally triggered disease and social collapse.
Merrill Singer is a cultural and medical anthropologist with a dual appointment as a Professor in the Department of Anthropology and as a Senior Research Scientist at the Center for Health, Intervention and Prevention at the University of Connecticut, and a member of the executive committee of the Center for Interdisciplinary Research on AIDS (CIRA) at Yale University. He has directed federally funded drinking, drug use, sexual risk, community and interpersonal violence, and AIDS prevention studies since 1984. His current research focuses on both drug use and HIV risk and environmental health issues, including a growing focus on the impact of global warming on international health.
Baer, Hans and Singer, Merrill 2014 The Anthropology of Climate Change: An Integrated Critical Perspective. Abingdon, Oxford, U.K.: Routledge, Earthscan.
Chemomas, R. and Hudson, I. 2009 Social murder: the long-term effects of conservative economic policy. International Journal of Health Services 39(1): 107-121.
Foster, John Bellamy, Brett Clark, and Richard York. 2010. The Ecological Rift: Capitalism’s War on the Earth. New York: Monthly Review Press.
Horton, Richard 2014 Reimagining the Meaning of Health. The Lancet 384: 218.
Horton, Richard, Bealehole, Robert, Bonita, Ruth, Raeburn, John, McKee, Martin, and Wall, Stig 2014 From public to planetary health: a manifesto. The Lancet 383: 847.
Lindsay, James 2001. Global Warming Heats Up. Brookings Review. Fall: 26-29.
Nasheed, Mohamed 2012 Coup in Maldives: Adviser to Ousted Pres. Mohamed Nasheed Speaks Out from Hiding as Arrest Sought. Democracy Now. Available online at: http://www.democracynow.org/2012/2/9/coup_in_maldives_adviser_to_ousted.
Roberts, J. Timmons and Parks, Bradley. 2007. A Climate of Injustice: Global Inequality, North-South Politics, and Climate Policy. Cambridge, MA: MIT Press.
Climate change and human health is a topic of growing popularity and urgency in the public health community. In its draft twelfth working program the WHO repeatedly links climate change to negative health impacts, and the working group II report of the 5th Intergovernmental Panel on Climate Change (IPCC) assessment report dedicates a chapter to the effects of climate change on health.
Despite these high-level engagements with the issue, it is worth slowing down and examining the conceptual challenges associated with climate change. For example, assigning value and credibility to the mere existence of anthropogenic climate change is often a political act. Debates about the “truth” of extreme climate change and its causes abound in media reports. International negotiations are long and frustratingly slow. After years of stalling the White House has only recently developed an action plan.
And we shouldn’t forget that climate-related disasters disproportionally affect vulnerable populations, people living in poverty, near rivers and oceans, in densely populated urban areas. The term, “climate justice” has been coined to illustrate this fundamental imbalance between those contributing to climate change and those being affected by changes first. But then again, we might ask: who defines vulnerability, when qualitative studies have shown, for instance, that not all older people think of themselves as particularly at risk? Risk perception always matters in health, and it matters in climate change research, too. These questions lend themselves to anthropological inquiry.
How will we conceptualize sudden effects like floods resulting from a generally slow and gradual phenomenon like anthropogenic climate change? Can there be any research into climate and health without a transdisciplinary research team? Who frames global responsibility discourses? What role does the body play in climate anthropology?
This series aims at starting a discussion on the connections between climate change and human health from interdisciplinary perspectives. To start us off, Merrill Singer summarizes the links between climatic changes and health from a “planetary health” perspective.
New Modes of Understanding and Acting on Human Difference in Autism Research, Advocacy, and Care — A special issue of BioSocieties by Aaron Seaman
The current issue of BioSocieties is a special issue, entitled “New Modes of Understanding and Acting on Human Difference in Autism Research, Advocacy, and Care” and edited by Gil Eyal, Des Fitzgerald, Eva Gillis-Buck, Brendan Hart, Martine D. Lappé, Daniel Navon and Sarah S. Richardson. Abstracts and links to the articles are below….
New modes of understanding and acting on human difference in autism research, advocacy and care: Introduction to a Special Issue of BioSocieties
Gil Eyal, Des Fitzgerald, Eva Gillis-Buck, Brendan Hart, Martine D. Lappé, Daniel Navon, and Sarah S. Richardson
The papers collected in this special issue examine specific instances of autism research, treatment and advocacy. Their shared aim is to explore not the causes, but the manifold biosocial consequences and theoretical implications of the recent expansion of the autism spectrum. Three such implications are singled out in the introduction as common threads running through all the papers. First, the extent to which developments in the field of autism research, treatment and advocacy pose a challenge to theories of ‘biomedicalization’ and ‘geneticization’. Second, the intimate connection between autism’s recalcitrance to be pinned down and explained and its enormous biosocial productivity. Third, the need to broaden Hacking’s (1998, 2006) concept of ‘looping’ to make sense of the ‘moving target’ that is autism.
This article is about ambivalent dynamics of hope and uncertainty within neurobiological autism research. While much literature has commented on the positive hopes and expectations that surround technoscientific projects, fewer have focused on less promissory visions – and, in particular, on the presence of uncertainty and ambiguity among working scientists. This article shows how autism neuroscientists actually talk about their research in ambivalent, entangled registers of both promising hope and deflated uncertainty. The article locates the dynamic between these in an ‘intermediate terrain’ of autism research – in which autism is both ‘present’ as an epidemiological and social force, but also ‘ambiguous’ as a (not yet) well-defined clinical and scientific object. It argues that neuroscientists work through this terrain by drawing not only on a discourse of unalloyed hope and promise, but by entangling their research within a more complex register of ‘structured ambivalence’, which includes languages of uncertainty, deflation and low expectation. As well as showing the novelty of research within autism’s ‘intermediate terrain’, this adds to a growing literature on the ‘sociology of low expectations’, and analyses the presence of such feelings among scientific researchers particularly.
Autism as a biomedical platform for sex differences research
Eva M. Gillis-Buck and Sarah S. Richardson
Autism has become a ‘biomedical platform’ for sex differences research in fields such as genetics, endocrinology and neuroscience. Increasingly, researchers in these fields pose the male prevalence of autism as a model for investigating sex differences in the brain, and offer basic research on sex differences in the brain as a resource for understanding the etiology of autism. The use of autism as a biomedical platform for sex differences research obscures empirical and interpretive contestations surrounding claims about the male prevalence of autism. We argue that the uncritical use of this research platform across many fields stands to distort scientific research on autism and contribute to harmful gender stereotypes.
It has become increasingly common to view and discuss autism as a form of difference, rather than a disorder. Moreover, the autism spectrum has generated new possibilities for personhood and social inclusion. These developments have typically been ascribed to the recent work of autistic autobiographers and autistic self-advocates associated with the neurodiversity movement, who are providing a sort of linguistic infrastructure to support autistic personhood. Drawing on historical and ethnographic research, this article makes the complementary and analogous claim that parents of autistic children have used autism therapies to create a technical infrastructure to support autistic personhood. The article follows an earlier genealogical thread to argue that parents have used the techniques and technologies of behavioral therapies (sometimes said to be incommensurable with neurodiversity’s philosophy) in ways that have actually helped establish this autism-as-difference view. They have done so by translating their child’s behaviors and utterances and engaging in forms of ‘joint embodiment’ with her to create enabling ‘prosthetic environments’ where her unique personhood can be recognized. Through an ethnographic focus on ‘prosaic technologies’ and the politics of everyday practice, the article also provides a thicker and more grounded account of what Ian Hacking calls the “looping effect of human kinds”.
Research on autism has increased significantly over the past several decades. This upsurge parallels the steep rise in autism diagnoses. Together, these conditions have increased the number of people occupying the social role of research participants, including investigators, analysts and subjects. Simultaneously, addressing scientific questions about autism now involves new research efforts including prospective enriched-risk cohort studies exploring the environmental and genetic causes of autism during pregnancy and early child development. Rather than one-time donations, these studies require extended commitments on the part of all those involved in the research. This article draws on ethnographic observations of research practices and interviews with investigators, study staff and participants to examine the emergent relationships between research and care in this area of autism science. I introduce the notion of ‘taking care’ to describe the forms of anticipatory labor and mutual extraction involved in longitudinal research. Through tracing three modes of taking care across practices of study design, data collection and participation, I argue that research and care become intimately intertwined and mutually constructed during the research process. These findings reflect how processes of taking and giving are constitutive of research participation for all those engaged in the research enterprise. This article considers the relationships between these practices and new forms of community and sociality related to biomedical science.
This article argues that the impact of genetics on psychiatry, and on our understanding of human difference more generally, will be mediated by the threefold social role of diagnostic categories as (i) coordinating devices; (ii) identities; (iii) sites of looping processes. This argument is explored by examining the intersection of a rare genetic disorder – 22q13 Deletion/Phelan-McDermid Syndrome (PMS) – with the much broader but genetically heterogeneous category of autism. We show that a ‘genomically designated’ classification such as PMS thrives as an object of research and social mobilization by virtue of its capacity to interface with, rather than supplant, the existing psychiatric diagnosis of autism. Autism genetics thus functions as a ‘trading zone’ (Galison, 1997) that allows for the exchange of knowledge, biomedical objects and resources despite incommensurable ends and frameworks of understanding.
This summer we posted several calls for submissions for new and upcoming series at Somatosphere. We’re still accepting submissions for all of these series, so here they are again for anyone who may have missed them the first time around:
- “Foreign Correspondents,” a series edited by Stephanie Lloyd (Laval University), features reviews of books published in languages other than English in the social sciences and humanities of medicine, health and science. You can learn more about the series here.
- “The collaborative turn: interdisciplinarity across the human sciences” is a forthcoming (collaboratively edited) series which seeks to open up a critical dialogue on collaboration and interdisciplinarity around topics in health, medicine and science. The full abstract and information about submitting a proposal is available here.
- “Experiments with pedagogy,” a series edited by Hanna Kienzler (King’s College London), invites contributors to consider new approaches to pedagogy in anthropology and the humanistic social sciences, as well as their impact both on students and on our disciplines. You can find the full series abstract here.
Aside from these series, we always welcome unsolicited proposals for posts of various kinds, including (but not limited to) thought-pieces, essays, research reports, conference reports, interviews, photo essays, videos, and other multimedia projects. If you’d like to write a piece for Somatosphere, send us a brief proposal to firstname.lastname@example.org. If you are specifically interested in reviewing a book for the site or would like to suggest a book for review, please contact our Book Reviews Editor, Seth Messinger directly at email@example.com. Finally, if there’s something that you’d like to see the site cover or address, or if you’d like to get involved in working on Somatosphere in any way, please feel free to get in touch with us at firstname.lastname@example.org.
Stanford University Press, 2013; 328 pages.
Scholars of social and cultural memory in the post-Soviet space are well aware of the Memory at War project—the international collaborative effort to understand battles over memory as they were waged in postsocialist Poland, Russia, and Ukraine. This project, undertaken in 2010-2013 by an international group of researchers led by Alexander Etkind, took place contemporaneously with the writing of Warped Mourning and, perhaps unsurprisingly, has a number of affinities with it. Both aim to comprehend the politics and cultural logics of memory in the aftermath of socialism’s collapse, and both approach their subject with an eye for cross-national comparison.
All the more striking, then, are the discrepancies between the two. Unlike Memory at War, the comparative effort in which Warped Mourning engages is less explicit and, surprisingly, almost completely devoid of any references to Poland, Ukraine, or any other East European country. Instead, the book sets up cultural memory of state violence in Russia in contrast to post-WWII Germany, in the sense of the memory of the Holocaust, and that of the Nazi past more broadly. The comparison operates as an analytic device, to highlight both the similarities of the two national traumas (the magnitude of the catastrophe; the state-orchestrated nature of violence; the generational dynamics) as well as the important distinctions (the longer time span of the Soviet terror; its self-inflicted, as opposed to externalizing, logic; a greater diversity and dispersal of its victims; and a number of other factors). The most significant difference, and one that bears directly on Etkind’s inquiry, is, of course, the difference in the practices of cultural memory. In contrast to the German memory of the Holocaust, which has “crystallized its ‘hardware’ in the form of monuments and museums,” the memory of terror in Russia, he points out, is hampered by the lack of national consensus regarding the crimes of the past. As a result, it remains trapped in a cycle of refutation and denial, producing “software” in the form of cultural debates and (increasingly ghoulish) literary texts, but little closure or resolution (p. 246).
In another contrast to Memory at War, then, Warped Morning is explicitly positioned as a study of “cultural,” not “collective,” memory, and as such, the book “de-emphasizes the remembering collective and focuses on the materials of which memory is made” (p. 40). As a result, Warped Mourning seems far less interested in the conflicts and disagreements over memory and pays little systematic attention to the groups and communities that advance these competing memory claims in the public space. Instead, it offers an erudite synthetic portrait of the cultural memory of state terror in Russia as it was (and continues to be) articulated in a range of literary, artistic and filmic works over the lives of several generations, from the 1930s up to the present day.
The book approaches much of Russian literature and cultural life from the 1930s onwards as a work of mourning for the traumas of political repression—mourning that, as Etkind provocatively points out, has a double nature: it is both a mourning “for the people who were murdered for the sake of ideas and for these ideas, which were also killed by this violence” (p.12). It also frequently contains an element of warning about the future.
Drawing on available published sources, the book probes the intellectual effects of the gulag experience on the scholars and authors who survived it and chronologically reviews the engagement of subsequent generations of Soviet and post-Soviet writers and artists with this experience of terror, lingering both on the affinities that marked particular periods across genres and the connections between artists of different generations.
The scope of authors the book surveys is impressively broad, from Mikhail Bakhtin, Andrei Siniavsky, and Yulian Oksman to Viktor Pelevin, Dmitrii Bykov, and even Vladislav Surkov. While Etkind specifies that he is most centrally concerned with literature, he also offers enlightening observations on the work of artists (Boris Sveshnikov, Leonid Chertkov), musicians (Dmitry Shostakovich, Bulat Okudzhava), actors (Innokentii Smoktunovsky), and film directors (Grigory Kozintsev) whose lives were touched by political repressions. Several pages of the book pertain to members of Etkind’s own family, his uncle Yefim Etkind and Yefim’s father Grigory who spent five months in the camp and returned so physically changed that his own son failed to recognize him.
This encounter and the experience of misrecognition that accompanied it provide a set of metaphors that reverberate throughout the book. Indeed, the experience of violence in the camps transforms not only the bodies of the survivors, but also their psyche and intellectual output. Etkind carefully teases out the shared intellectual preoccupations with chance, contingency, the surreal and the grotesque, the primitive and the primordial in the works of Likhachev, Bakhtin, Siniavsky and many other returnees from the camps. He also observes the generational shift in modality, in which what he calls, after Mandelstam, “the longing for world culture” among camp survivors was transformed among the subsequent generation of artists into “the cult of bare life” (p. 107). This is a bold interpretive move which allows him to look at the creative works of those artists who did not have an identifiable biographical connection to the camps (such as the Mit’ki group, or Yevgeny Yufit and the Necrorealists) as engaging in acts of mimetic mourning.
Tracing the lineage of bare life further, Warped Mourning moves on to a discussion of the post-Soviet literary genre that Etkind calls “magical historicism,” which combines wild fantastical and ghoulish images (werewolves and vampires are some of the tamest creatures that populate such works) with references to historical figures and events, weaving together bizarre alternative histories. This necessitates an addition of “ghostware” to the binary of “hardware” and “software” that the author draws on in his theoretical discussion of cultural memory. It is through this “third form” of memory, Etkind concludes, that the presence of the unspeakable and often unknowable past makes itself known in contemporary Russian culture. As he makes clear, the presence of ghosts and zombies on the pages of popular Russian novels “signals the failure of other, more conventional ways of understanding social reality” (p.234). Uncanny, ghostly and monstrous images, he suggests, offer an opportunity to engage in mimetic mourning, by symbolically reenacting the forms of bare life that have become associated with the camp.
It is hard to disagree with Etkind’s assessment regarding the paucity of museums and memorials commemorating the victims of Soviet political violence in Russia. If anything, the pressures currently experienced by the few organizations mentioned in the book (such as Memorial and the museum Perm-36) suggest that the little “hardware” that did exist in Russia at the time of the book’s writing may soon be sacrificed to the intensifying campaign of nationalist mobilization. All the more timely, then, is Etkind’s attention to the way in which the past, when not confronted directly, refuses to go away.
The causes and repercussions of this cyclical, melancholic rehashing of past traumas are more difficult to gauge, and the parallel with German memory is less helpful here, because it is used only selectively (we do not learn about the role of misrecognition or magical historicism in contemporary German prose), but also because it obfuscates other possible ways of dealing with a difficult past (such as the pacto de olvido, or pact of forgetting, in post-Franco Spain).
Still, this is a provocative and intriguing book, one that offers a powerful corrective to the frequent laments regarding historical amnesia in post-Soviet Russia. It prompts scholars of memory to think more broadly and creatively about the forms that remembrance may take in culture, especially in situations when a more direct engagement with the past may be obstructed or blocked. While it offers little guidance as to the causes of such blockage, or to the groups or communities that may be responsive to these forms of cultural memory, it prompts intriguing and resonant questions about cultural afterlife of traumatic events. Published when it was, this book itself constitutes a work of mourning for the crimes of the past and a warning about the future, even as it reminds us that the work of mourning is always— intrinsically—incomplete.
Olga Shevchenko is Associate Professor of Sociology and Chair of the Department of Anthropology and Sociology at Williams College. She recently edited Double Exposure: Memory and Photography (2014, Transaction Publishers). Her current project is a collaborative ethnography of family photography and generational memories of socialism in Russia.
Cornell University Press, 2013. 280 Pages.
In ‘The Pathological Family’, Deborah Weinstein argues that in mid-20th century America, researchers and clinicians developed a new mode of therapy to treat families focusing on structural and relational aspects of family life. In doing so, they implicitly acknowledged that the locus of illness had moved from individuals to the dynamics of family relationships and exchanges. Earlier thinking situated pathology within individual selves and treated it somatically or through psychotherapies centered on a privileged relationship between a single therapist and a patient. Weinstein argues that this move to problematise and treat the family developed in line with the contemporaneous social, political, and economic trends of post-WWII American society, whereby macro level tensions apparent in post-war American life became manifest at the micro level of the family. Families represented healthy, “democratic citizenry” (p. 4) and the movement towards treating families did not merely parallel the social changes occurring at this time, but, Weinstein argues, was integral to these changes. The increasing primacy of medical evaluations of normalcy and the popularisation of a psychologised view of the self dovetailed with the rise of the importance of families in the public gaze. Cultural and social life did not develop separately, she argues, but rather, the therapeutic ethos developed alongside a popular fixation on the family.
She identifies key clinical practitioners and the dynamic interdisciplinarity evident between the social sciences and psychiatry in the formation of the field. Weinstein details the origins and practices of systems theory and its adaptation to family therapy along with thinking about culture and families. Why was the family a crucible for understanding the processes of larger events? Weinstein details changes affecting family life following WW2, as seen in women’s workforce participation, the return of soldiers to family life, and increasing suburbanisation and migration, which markedly changed the social landscape. Family was seen as a “means of repairing the social fabric torn by war” (p. 4). She argues that the therapeutic ethos was joined to political culture as family therapy emerged following Cold War anxieties about family life, mass society, and political stability in the face of global threats represented by communism and fascism.
The book offers evidence for the development of family therapy in line with the rise of popular psychology as an accessible solution for problematic behaviour and changed perceptions about families and family life, whereby problems such as delinquency were believed to be produced within families. As the American family became problematized, so too did parenting practices, which came to be seen as potentially deficient or at worst, contributing to the formation of pathology. Psychiatric practice expanded as psychoanalysis became popularised and people took on psychologically oriented views of the self and family life. The founding members of family therapy brought their expertise to the emergent field and moulded its progression, seeing families as communicating systems with the capacity for intergenerational transmission, focusing on mother and child dyads and the development of schizophrenia, and examining familial patterns of communication. As the therapeutic ethos expanded, the family came into the therapeutic purview of clinical practice.
Weinstein highlights the interdisciplinarity evident in early family therapy thinking and practices, focusing initially on the anthropologist Gregory Bateson’s work on the double bind theory, which saw disordered communication affecting the development and maintenance of schizophrenic symptoms. Families were seen as systems, as ‘communicational units’ with inputs and outputs aimed at maintaining homeostasis, even if this included pathological communications. Emergent therapeutics aimed at disturbing disordered communications and this era established the family as a site of intervention.
Systems came to be replaced by ‘culture’ as a category of analysis, coopted because of its usefulness in examining familial similarities and differences along a range of indexes. Family therapists used culture to contextualise family life. This was coupled with the ‘family turn’ in psychiatry whereby families were pathologised as sites of disorder producing mental illness. Weinstein shows how the idea of culture lent itself as a concept applicable to ever broader contexts, showing how families and culture were utilised in the production of universalising claims as the field made use of cultural variability and cross cultural comparisons. Social factors were increasingly incorporated into pathological understanding of families as they were, for example, seen as the site for transmission of prejudice and perpetuation of social pathology.
Weinstein describes the increase of observational practices within family therapy in its clinical work, pedagogy, and research arms, from naturalistic observation where families were seen in their homes, to hospital settings where initially mothers and their schizophrenic daughters and then whole families were admitted and observed over lengthy periods. Natural observation provided context, and non-clinicians were also involved, bringing perspectives of social critique. Families now included normal as well as pathological forms to determine intrinsic communicational processes. But the move was generally away from families with schizophrenia, and families came to be defined in political as well as clinical terms, incorporating typologies such as authoritarian, democratic, and anarchic to describe and typify their structures. As practices of observation and classification changed, Weinstein importantly describes how visual technologies produced visions of family life.
Visual technologies, including one-way mirrors and film, helped family therapists to become catalysts of change, not merely passive observers and interpreters of familial interactions. Therapists were now able to comment upon and manipulate therapeutic interactions aimed at changing family dynamics. The use of visual technologies also highlighted the production of family performances and performance theory was applied to families as family sculptures, choreography and elements of visuality lent themselves to clinical interpretation and the development of insight into family lives.
The author succeeds in looking at therapeutic culture and family life, at how families came to be seen as the sites of disease and how family therapy arose to treat this. The book makes a contribution to the literature in which histories have tended to outline the development of the discipline and its multidisciplinary base without situating it within broader social and cultural landscapes. Recent feminist critiques of family therapy question some of the traditional assumptions about family structures, and this has challenged presumptions about gender roles and stereotypes within cultural contexts as well.
Increasingly, biological explanations of disease have shaped psychiatric theory and practice as neurobiological and genetic frameworks are explored to understand the nature, cause, and outcome of severe mental illness. What kinds of families now are appropriate subjects for family therapy’s therapeutic processes? What has been the response of family therapy to the increasing biological, genetic and neurological explanations for disorders? How has this been played out in therapeutic encounters and the interpretation of familial dynamics during this period? And conversely, with its focus on lived experience and contextualised understandings of mental illness, how does a recovery orientation inform or challenge the suppositions of family therapy? Bearing in mind these critiques, Weinstein’s work offers an important analysis of the contiguous events shaping the emergent field of family therapy alongside the social and cultural transformations of the post-war period in America. Her work points to the ever-fascinating and changeable knowledge that psychiatry in combination with social science provides in examining, accounting for, understanding, and treating disorder within the complex category of the family.
Amanda Rosso Buckton coordinates medical programs in psychiatry and mental health at The NSW Institute of Psychiatry, North Parramatta, Australia. Her anthropological research focused on understanding the social and cultural contexts in which mental disorders and their treatment were experienced by women in Greece.
Encounters of Violence and Care: Central American Transit Migration through Mexico by Kristin Yarris
A polarized emphasis on origin and destination in international migration studies has left the process of transit itself relatively under-theorized. Taking transit as a site of inquiry moves us as migration scholars beyond the binaries of push/pull factors and origin/destination countries. As medical anthropologists, we are interested in the analytical implications of studying zones of transit for the way we think about illegality, humanity, and encounters of care that sustain the possibilities of life itself for transnational migrants. Further, we view encounters in zones of transit as sites through which we can better understand human vulnerability, risk, and radical inequality, as well as relationality, solidarity, and care. Here, we explore these ideas by drawing on ethnographic vignettes from a recent field research trip in Mazatlán, a particularly precarious site for Central American transit through Mexico (the trip was co-organized by our colleagues at the Universidad Autónoma de Sinaloa – UAS).
We define transit as the encounters, fleeting and permanent, that occur between migrants and the various material, bureaucratic, and social relations that structure transnational journeys and the possibilities of life itself for migrants en-route. Materially, for example, we consider the “bestia”, the Ferromex freight train to which migrants cling as they travel over the thousands of kilometers of tracks that form Mexico’s Ruta Pacífica north from Mexico City and Guadalajara through Sinaloa state towards Mexicali (see Map) and whose imposing steel wheels cut across the landscape (and often across migrant limbs). Bureaucratically, we analyze the structures of legal responsibility surrounding unauthorized migrants that attempt to regulate mobility within the logic of the nation-state. These represent encounters of rupture or disjunction, as when an undocumented migrant in need of urgent medical attention is transferred from a local public hospital to the Mexican National Migration Institute (INM), which then assumes the costs of medical care. At the level of communities, we are interested in how relations of care emerge nearly spontaneously between migrants and local residents who offer them shelter, food, phone calls, and showers. These offers of support are as fleeting and tenuous as migrants’ journeys through these communities, and the relations that form between migrants and community members are entrenched in risk for both.
Materiality of Encounters: Violence
Wendy Vogt has carefully documented how Central American migration through southern Mexico results from the intersection of political insecurity, economic instability, and violence (Vogt 2013). Given historical legacies of civil wars and contemporary realities of insecurity, she writes that, for Central American migrants, “[t]he violence of migration becomes relative to the violence of everyday life at home” (Vogt 2013:768). Besides Vogt’s work, transit migration through central and northern Mexico has received relatively little anthropological attention. In Mazatlán, we heard similar tales of violence, police brutality, and extortion from migrants and their advocates. This stretch of the Ruta Pacífica is, in fact, known to be one of the most dangerous, ironically because it is not controlled by organized criminal entities such as the infamous Zetas, but is rather uncontrolled and therefore ripe for attacks by local-level actors, such as neighborhood gangs, who prey on those journeying along the tracks. Migrants on trains have taken to carrying sticks in their attempts to defend themselves from predators, whether local criminals or police. One group of migrants we met in a Mazatlán colonia while they waited for a departing train told us of having been assaulted and robbed by federal police in La Lechería, an infamous train crossing area just outside Mexico City. According to the migrants, the federales had quite literally offered them food with one hand and robbed them of the little cash they carried with the other. Such encounters are violent reminders to migrants that they are not welcomed in Mexico permanently (El Universal, a Mexican daily newspaper, recently reported that of nearly 10,000 child migrants detained in Mexico in 2013, only 50 were offered asylum).
In fact, the risks of robbery and rape are ever-present and viscerally-felt for migrants in transit. We heard stories of sexual assault of both men and women; for instance, one young migrant was carrying his money inside his underpants and was raped, a theft of both his money and his bodily integrity. For women migrants, the risks of transit are heightened—many start their journeys north by taking a long-acting contraceptive because they view rape as an inevitable part of the process. We met women who formed partnerships with “husbands” or “compañeros”, temporary and strategic kin ties formed in transit that are attempts at mutual protection. Men also benefit from such temporary kin formations because there are various encounters in transit in which travelling as a “family” reduces risk. For instance, we met a private security guard working at a Ferromex train yard who told us that he allowed families—but not single men—past his gated checkpoint (looking the other way while they passed), since it is safer for them to climb aboard the stopped trains before the wheels begin to churn forward along the tracks. These examples illustrate how, within the material violence of transit, fleeting moments of humanity emerge, a point to which we return below.
Bureaucratic Encounters: Structuring Transit
One of our encounters in Mazatlán was with the Sinaloa state branch of the Mexican Instituto Nacional de Migración (INM). Our meeting with the INM director and two immigration agents had been arranged ahead of time by our UAS colleagues and was held in a formal conference room in the INM’s offices, which had been cleaned and prepared for our meeting with a white table cloth and water bottles. Clearly, we were guests of interest, and it was important to the migration officials to portray their work to these visiting academics in a positive light. During the meeting, INM agents attributed the current rise in Central American child migration to the recruiting tactics of coyotes who promise safe passage to the U.S. at the going rate of $7,000 upwards. In this narrative, also prominent in the U.S. media, central culprits in this migration stream of unaccompanied minors are human smugglers, who are portrayed as impersonal, criminal, and malevolent. However, one of our previous field research projects in Nicaragua revealed that coyotes are often known by the families that contract their services; they are extended family, neighbors, friends of friends and their services are sought out by families desperate for ways to reunite with children abroad and confronting their effective exclusion from legal mechanisms for family reunification. This is not to say that there are not highly organized and armed actors involved in the transit of Central Americans through Mexico—there are, such as the Zetas and other cartels that control transit routes. However, there are also lower-level and less formal actors involved. In part, blaming human smugglers for child migration (especially by indiscriminately labeling them all “traffickers”) functions to shift responsibility away from both Mexican and U.S. immigration policies. For, as Wayne Cornelius has shown (2006), heightened securitization at the U.S./Mexican border has created more demand for these smugglers, who promise safe passage. It also forces people into riskier passages, such as across the treacherous Sonoran desert north of Sinaloa, where the Border Patrol has recorded 5,595 deaths of assumed migrants between 1998 and 2012 (see: http://colibricenter.org). Furthermore, the increasing securitization focus of U.S. foreign policy in Mexico and Central America has included training and equipping entities who themselves are implicated in human rights violations against migrants (Vogt 2013: 771). Thus, U.S. policy directly contributes to the dangers of transit encounters.
Interestingly, a 2011 Mexican Immigration Reform Law has resulted in a significant discursive shift among Mexican immigration officials, who emphasize their role as administrative (even humanitarian) agents rather than border police. For instance, in our meeting, INM officials were careful to refer to migrants as “undocumented foreigners”, refusing to use the word “illegal”. When asked about this language, the officials stressed that their new approach is coming from higher up in the INM bureaucracy, and reinforced the idea that immigration officers are administrative agents charged with safeguarding migrants’ human rights by emphasizing that agents are unarmed. They also mentioned their difficulty keeping pace with the flow of migrants through Sinaloa, saying they focus limited resources on monitoring highway (bus and car) travel, rather than the train routes. INM presented themselves as following appropriate bureaucratic procedures with migrants they apprehend, including the evaluation of minors by DIF (Desarollo Integral de la Familia—the equivalent of Health and Human Services in the U.S.), and a series of communications between INM and country-of-origin consulates. Migrants apprehended by INM in Sinaloa are held on-site in the migration offices (which are not intended to serve as shelters), until official clearance is given by home country consulates for their deportation. Perhaps to emphasize the bureaucratic legitimacy of these transfers, at the end of our meeting, INM agents passed around folios of children they had detained and deported in recent months. It was as if these manila files, organized with headshots, dates, notarized stamps, and official signatures, were proof of the legality of forced return set against the illegality of transit migration. Bolstered by these bureaucractic procedures and the discourse of human rights, INM encounters with undocumented migrants are made to seem legitimate and rational even as they are steeped in the radical and irrational inequalities that ultimately determine migrants’ movements.
Encounters of Solidarity and Care
While transit migration is shaped by vulnerability and violence, it is also comprised of very local, often fleeting, encounters of support, solidarity, and care. On one hand, migrants are assisted by formal non-governmental organizations, such as Cáritas, a relief and social service organization of the Catholic Church. In Mazatlán, Cáritas runs a shelter located about a kilometer from the train tracks. (Not all migrants are willing to risk the walk there, however, since they face attacks by local gang members or apprehension by local police in the neighborhoods through which they must pass.) The animated young social worker at Cáritas, “Ana”, told us she registers an average of 10-15 migrants every night, men and women (children are referred to DIF). Ana showed us the registry she keeps as an Excel spreadsheet; it was overwhelming to look down the names, ages and photographs of hundreds of migrants who had sought shelter since January 2014. Also notable was that a good number of these migrants were in their late 60s and 70s; while we don’t often hear about older-age migrants, they are certainly particularly vulnerable to the extremes of transit. At Cáritas, a volunteer physician attends to migrants’ health needs; on the afternoon of our visit, he described the politraumas of transit he encounters in his patients: injuries, loss of limbs, skin infections, foot wounds. However, even before medical care and a hot meal, migrants entering the Cáritas shelter seek showers. After weeks of travel, the ability to bathe and change into clean (donated) clothes reinvigorates and re-humanizes them.
Just as the INM officials have their own discursive way of framing transit migration, so do Cáritas workers. Motivated by their religious orientation towards social justice and service to the poor, all the staff we met at Cáritas referred to migrants as peregrinos. While this word can be generally defined as “someone moving from one place to another”, it has a more specific meaning within popular Catholicism as one on a pilgrimage, who “for devotion or belief seeks to visit a sanctuary”. In the shelter, men’s and women’s dorms, showers, a closet full of linens, and even bottles of hair gel were all labeled with this term, peregrinos. The framing here was one of equality and of service, and it shaped relations of care, such as the offer of a shower, clean clothes, and hot meals—all micro-encounters in transit zones that embody a shared humanity and enable life itself.
Where Cáritas is a formal humanitarian organization, we also encountered other, informal, local actors who offer support to migrants on their journey North. In a Mazatlán colonia situated alongside the train tracks, we met a woman who runs a small venta (store) who for years has been offering migrants bottles of water and a location to have money wire-transferred from relatives back home. In another neighborhood, we met “Eva”, who voluntarily runs a community kitchen (or comedor) several blocks from the train tracks where she cooks hot meals every single day. Word of mouth spreads as it is wont to do, and migrants find their way to her tables to have a meal and replenish their strength. Many of Eva’s neighbors don’t look fondly on what they see as her “attracting” migrants (and the violence that follows them) to their neighborhood. And yet, Eva has created a local network of completely informal care to support migrants—her kitchen is staffed by several neighborhood women volunteers and, nearby, she recruited another neighbor who generously offers her shower to migrants waiting for departing trains.
On one occasion, we visited the comedor to find that a group of migrants had missed a disembarking train. The migrants were at the neighbor’s house showering as they waited for the next departure and that is where we talked with them about their journey. The travelers were from El Salvador, and several stated they were family (husband, wife, 2 year old son; two female cousins). One young woman, “Silvia”, told us she had left El Salvador because the gang violence in her neighborhood had become so intolerable that she felt she had no choice. A female cousin of hers was recently assassinated by a gang, which threatened Silvia that she was next. She cried as she told of the two children, aged 1 and 4 years, that she had left behind in the care of her mother. Silvia was visibly racked with anxiety, her hands trembled as she told us of the danger she and her traveling companions had experienced, which included an attempted rape, several robberies, hunger, cold, heat, and exhaustion from trying to hold onto the trains for days on end without sleep. She seemed to be encouraging herself, however, when she told us that she believed the hardest part of her journey was behind her. We had not the heart to tell her that the next phase of her transit—north through Sonora’s desert and then into the border regions of Mexicali and Tijuana—could be much worse. Indeed, it is estimated that only 20% of all Central Americans who travel through Mexico make it across the border into the U.S. (even fewer actually arrive at their U.S. destinations). For days after our conversation with Silvia, we wondered if she would be among that statistic, or among the other, larger group whose dreams end in detention, deportation, or worse: death.
Illegality, Violence, and Care in Transit Encounters
In Mexico, Central Americans face a triple liminality—unsafe in their country of origin, unaccepted in the country of transit, and marginalized in the destination country (that is, if they make it that far). While the notion of “illegality” does important work in shifting our conceptualization of the lives of (im)migrants, it doesn’t adequately capture the conditions of existence of those in transit. While unauthorized in Mexico, these migrants in transit don’t intend to stay, but are driven towards their hoped-for destination in the U.S. What motivates these journeys of risk is an even more “bare life” in Central America—a sense that even in the country of one’s birth, one’s existence is threatened. For this reason, in addition to thinking about migrants in transit existing in “liminal” or “illegal” spaces, we may borrow the framing of Cáritas and think of migrants in transit as “peregrinos” — “pilgrims”, travelers, those en route. And yet the English “pilgrim” lacks a sense of risk, danger, and vulnerability that the Spanish “peregrino” contains. Marginalized from power, work, and citizenship within contemporary global capitalism, these Central Americans risk life itself in search of life itself. Like the undocumented migrants in France that Ticktin writes about (2006), who are willing to risk HIV infection for the possibility of legal status, Central American transit migrants face rape, robbery, dismemberment and even death in exchange for the possibility of legality in the U.S.
In zones of transit, which are structured by national immigration laws and shaped by contemporary global capitalism, state power is manifest produced in everyday, local interactions (Aretxaga 2003). However, social relations of transit are not fully determined by laws nor politics, but by a sort of local antipolitics, which we are describing here as transit encounters. They are moments, interactions, and exchanges broadly structured by geopolitics of illegality, yet offering the possibility of humanity through gestures of care, however fleeting. Sarah Willen (2014) has used the concept of “inhabitable spaces of welcome” to describe social spaces crafted by unauthorized migrants in Israel in order to lessen the risks and burdens of illegality. Comparing the transit encounters we describe here to Willen’s spaces of welcome reveals important insights. First, we find transit encounters shaped by relations between local community members and migrants in transit—these encounters usually are forged by some gesture of humanity, act of solidarity, or expression of care by Mexicans towards Central Americans. Further, these encounters are less welcoming than they are life-sustaining, even in their impermanence. Transit encounters also involve significant risk and are fleeting. Cáritas shelter staff risk allegations they are aiding unauthorized movement through Mexican territory, the security guard risks his job by allowing migrant families into gated train yards, Eva risks her reputation among neighbors who criticize her for encouraging migrants—and the violence that may follow them—into their colonia, and migrants risk everything: material security, social ties, bodily integrity, and life itself. Finally, as analysts of these encounters, we face the challenge of how to write about them, how to interpret them in ways that don’t contribute to further illegalization of persons in transit nor stigmatization of those who come to their aid.
To conclude, we reflect on how our own encounter with transit migration has somewhat unexpectedly corresponded with heightened public discussion of Central American migration to the U.S. over the past several months. Not wanting to contribute to further misrepresentation of a highly-charged political issue, we find that our ethnographic encounters in Mazatlán have grounded us and informed our nascent thinking about encounters in zones of transit. While we certainly recognize the ways undocumented Central Americans clinging to trains in their transit hacia el Norte embody the vulnerability, violence, and inequalities inherent in contemporary geopolitics of migration, we are also drawn towards the encounters within transit, which are structured by violence but also embody a committed sense of care and common humanity. Recent scholarship on care in medical anthropology emphasizes relationships of obligation and commitment to the well-being of others while acknowledging that caregiving can reproduce social inequalities (for example, see Elana Buch 2013). The relations of care we observe in transit migration are transitory, not based on long-term relations of kinship and reciprocity; care within transit encounters is structured by the very same radical inequalities that shape transnational migration. Thinking about transit encounters is pushing us to rethink our notions of illegality, marginalization, and deservedness (ideas we have been working through elsewhere; see Yarris & Castañeda, in press). By studying zones of transit, we gain new insights into contemporary human relationships, shaped as they are by violence, inequality, and risk, but also by care, support, and solidarity.
Kristin Yarris is Assistant Professor in the Department of International Studies at the University of Oregon. She has a PhD in Sociocultural Anthropology (2011), an MPH in Community Health Sciences (2004) and an MA in Latin American Studies (2004) from the University of California, Los Angeles. Her research areas include: transnational migration, intergenerational & informal caregiving, mental health and illness, and sociocultural determinants of health.
Heide Castañeda is Associate Professor in the Department of Anthropology at the University of South Florida. She received a PhD in Anthropology from the University of Arizona (2007), MPH from the University of Texas (2002), and MA in Anthropology from the University of Texas at San Antonio (2000). Her primary research areas include migrant health, health policy, undocumented/unauthorized migration, and constructs of citizenship.
Aretxaga, Begoña. 2003. Maddening States. Annual Review of Anthropology 32:393-410.
Buch, Elana D. 2013. Senses of Care: Embodying Inequality and Sustaining Personhood in the home care of older adults in Chicago. American Ethnologist 40(4):637-650.
Cornelius, Wayne A. 2006. Impacts of Border Enforcement on Unauthorized Mexican Migration to the United States. At: http://borderbattles.ssrc.org/Cornelius/printable.html
Ticktin, Miriam. 2006. Where ethics and politics meet: The violence of humanitarianism in France. American Ethnologist 33(1): 33-49
Vogt, Wendy A. 2013. Crossing Mexico: Structural violence and the commodification of undocumented Central American migrants. American Ethnologist 40(4): 764-780.
Willen, Sarah S. 2014. Plotting a Moral Trajectory, Sans Papiers: Outlaw Motherhood as Inhabitable Space of Welcome. Ethos 42(1): 84-100.
Yarris, Kristin and Castañeda, Heide. In press. Introduction, Special Issue, Discourses of Displacement and Deservingness: Interrogating Distinctions between ‘Economic’ and ‘Forced’ Migration. International Migration.
When I teach Medical Anthropology, we talk about globalization and infectious disease, with a focus on the increasing speed of global travel. Typically, I discuss a hypothetical epidemic that could accompany a traveller from a distant continent to the local airport. This year, a hypothetical epidemic will not be necessary. Instead, we have the rapid spread of Ebola, poised to make this airline-mediated leap. Of course, showing how it may be coming to get “you” is a means to help students understand that viruses in distant lands are not so distant after all. In a Milwaukee Journal-Sentinel article, Paul A. Biedrzycki of the Milwaukee Health Department reminds us that we should care about the Ebola epidemic for reasons that extend beyond our own fears of contagion: “The Ebola epidemic is not so much a public health wake-up call as it is a call to action on part of the entire global community to protect and take care of each other. The question remains whether we have the courage and determination to heed the call.”
As of August 28, WHO reports that 3069 people have contracted Ebola in Guinea, Liberia, Nigeria and Sierra Leone since March, and there have been 1552 deaths, with an overall case fatality rate of 52%. The New York Times supplies interactive information and maps. “Patient Zero” is reported to have been a two-year old boy living in an area of Guinea that borders Sierra Leone and Liberia; the disease spread to his grandmother, and mourners at her funeral brought it with them as they returned to their own villages. A brief article in the NEJM explains how this conclusion was drawn, including a detailed outline of the likely paths of transmission. Incremental reports of epidemic spread can also be found at ProMED-mail, a system that allows doctors and health officials to report disease emergence as it happens, and it can also be viewed in mapped form.
A form of quarantine called a “cordon sanitaire,” which restricts movement from an entire area, has been established in some countries. In a New York Times article, this method is considered notable because it has not been seen for almost a century, being more associated with “the medieval era of the Black Death.” Monica Green, a historian of medicine (including Black Death) offers some valuable teaching notes to aid in understanding Ebola both in the present and within the historical context of global health. Another historian reminds of the disastrous consequences of a cordon sanitaire imposed during an outbreak of bubonic plague in Honolulu’s Chinatown.
Returning to the local scope (both temporal and geographic), we encounter the question of intervention, medical treatment, and trust, with mistrust resulting in riots in many communities, including a case in Guinea where residents rioted in response to sprayed disinfectant: “Health workers and the hospital in Nzerekore were attacked by people reportedly shouting: ‘Ebola is a lie.’” Fear of doctors, including fears that doctors from MSF or the Red Cross are themselves spreading the disease, has at times lead to attacks on clinics. After the Cholera outbreak in Haiti was traced to UN workers, it is not difficult to understand this sort of fear. Not surprisingly, anthropologists have something to say about this situation. For a consideration of the biomedically-mediated disposal of infected bodies, local meanings of burial and ancestry, and notions of risk, listen to the discussion of “Ebola and Virology” on the podcast “This Anthropological Life.”
As the epidemic spreads, of course people begin to worry about “What Would Happen If Someone Got Ebola in America?” (Or in the UK. Or in Sweden. Or specifically at SUNY Plattsburgh). The Atlantic’s America scenario goes like this: “You wake up and feel a little weak. It’s almost like you have the flu. You stumble to the medicine cabinet and grab a thermometer. You have a fever, so you pop two Tylenols and go back to bed. The fever does not go away. You see your primary care physician, who says it looks like flu and to call her if the symptoms change. The next day, the fever is going strong, and you feel even worse, wracked with chills and a headache. You remember that you recently butchered a West African fruit bat, for some reason. You call 911.” While the fruit butchery example is presumably meant to convey the unlikeliness of this scenario (just in case, here is a picture, so that you can more easily avoid it), Ebola arriving in North America is nevertheless not a trivial concern. The Daily Beast reports on a near-miss case: If he had not died from Ebola in Nigeria the day before, a man traveling from Liberia could have been on his scheduled flight to Minneapolis.
Ethics – particularly concerning resource allocation – have been discussed at length in relation to this Ebola epidemic. Two Americans were airlifted out of West Africa for treatment at Emory University Hospital, and this has generated a great deal of debate about unequal treatment, which is throughly summarized here by The Hastings Center. The use of the experimental drug ZMapp (so far with great success) on these Americans also sparked discussion on many levels, including whether these same drugs should be used broadly for patients in Africa, and more generally, who gets access to these experimental drugs? The WHO has concluded that distributing this drug is ethical. The next questions will undoubtedly continue to focus on supply, logistics, and the responsibilities of the global community to areas devastated by this epidemic; Laurie Garrett at the Council on Foreign Relations argues that the US should already be doing much more.
For further reading, and to trace ongoing developments:
- Commentary from Paul Farmer
- Liberian Observer, “Health Ministry Rejects ‘Saltwater’ Treatment To Cure Ebola”
- CDC Ebola information
- WHO Disease Outbreak News (DONs)
- MSF Ebola information
- New York Times Ebola coverage index
- Scientific American, “Ebola: What You Need to Know”
University of California Press, 2013, 478 pages
This textbook was written for an undergraduate course on global health at Harvard University, compulsory for those enrolled at Harvard Medical School. It aims to introduce ethical, social, economic, and political theories and methods to medics in order to critically inform their analyses of the frameworks used to build and justify global health movements. As such, the emphasis is on giving the reader the capacity to do the analysis him/herself rather than laying out the full exegesis in the book, which focuses more on outlining theories with brief illustrative examples and case studies.
It is edited by eminent physician-anthropologists Paul Farmer, Arthur Kleinman and Jim Yong Kim, the last of whom is now president of the World Bank. Refreshingly, and perhaps indicative of the optimistic tone of the book, the final editor has not yet finished his graduate studies. He is global health activist and joint MD-PhD student, Matthew Basilico. So they are all (or will be) doctors who are also trained in what they refer to as the “resocializing disciplines – anthropology, sociology, history, political economy” (p.3). One key thesis of the text is that the practice of medicine and the theorising of these other disciplines inform one another; both are required to forge the new multidisciplinary global health practice that they advocate. They propose “biosocial analysis” (p.xix) as a means of developing global health to become “more than just a hobby” (p.xvi), using this book as a “toolkit of global hope” (p.xvi). These quotations from the preface immediately set the tone for a text that is frequently stirring and emotionally charged, while mostly remaining balanced and lucid, as we have come to expect from Farmer and Kleinman. (I cannot comment on Yong Kim and Basilico’s previous work as I am not familiar with it).
There are 12 chapters and 478 pages; I do not propose to describe and analyse all of them. They cover a broad range of topics: unpacking the meaning(s) and history of health and global health, exploring the ethical and political claims for and against health for all, exploring how aid does and doesn’t work, as well as examining healthcare delivery models. Instead, I seek to elucidate the key theses, using two chapters to evaluate the arguments and case studies used in the book to support them in order to produce a broad assessment of the successes of the book.
The authors describe the first decade of the 21st century as a “golden age of global health” (p.302). They trace the history of public health from colonial medicine to international health, to Alma-Ata and the primary healthcare movement, to selective primary healthcare, to the neoliberal era and finally to this golden age (which appears to be at risk of ending with the global financial crisis). So what do they mean by this emotive term? In the fifth chapter, Luke Messac and Krishna Prabhu use the example of AIDS to show how technoscience, biosocial analysis, community activism and political will combined to redefine the possible, leading to a massive increase in global health funding. Worldwide development assistance for health rose from $5.6bn in 1990 to $8.7bn in 1998, and then to $23.8bn in 2007. Likewise, in 2000 the USA funded antiretroviral therapy for a few hundred people around the world. By 2009, the President’s Emergency Plan for Aids Relief (PEPFAR) supported 2.5m people in 24 nations for antiretroviral treatment, as well as funding 539,800 interventions for pregnant women who were HIV positive.
What happened? Global health practitioners, previously “socialized for scarcity” (p.115) had been trying to modify use of what little resources they had, i.e. to optimise “use of a tiny resource pie” (p.115). But now they refocused their efforts on expanding the size of that pie. At the same time, activists mobilised political will to take on the pharmaceutical companies through various methods of struggle: legal, journalistic, public protest, etc. They succeeded in forcing the industry to dramatically reduce prices. In other words, rather than starting from a ‘realist’ or prudential standpoint of knowing what resources and funds were available and working within that remit, global health practitioners and activists started from the ethical standpoint that every person suffering with AIDS deserved treatment, wherever they were and whatever their financial and social circumstances. If resources and funds did not allow that, then they had to figure out a way to change that, i.e. they had to reimagine the possible.
So when we move on from AIDS and think of health more generally, how do we figure out what our ethical starting point should be? Another key chapter, written by Basilico and Kleinman as well as several others, examines the moral roots of global health work. It briefly surveys the contribution of utilitarianism, particularly with regard to cost-effectiveness analysis and disability-adjusted life years (DALYs), before moving on to cosmopolitan models such as human rights and Amartya Sen and Martha Nussbaum’s capabilities approaches. By this point, the authors of previous chapters have already laid their cards on the table in stating their belief that health is a human right. However, this chapter demonstrates how the editors have not let dogma cloud their judgement. They recognise the problems of the human rights model: including the various interpretations of human rights discourses co-opted by opposite sides of the Cold War and the prioritisation of civil and political rights over social and economic rights after the end of the Cold War. Human rights theory’s reference to the individual rather than the community is discussed. This model’s promotion of small interventions rather than broad-based social change is mentioned, with reference to Alain Badiou. Finally, the one-size-fits-all universalism of all cosmopolitan models is discussed.
Here the chapter demonstrates one of the shortfalls of the book, inevitable in a text of this nature. The brief but lucid outlines of theory whet the appetite for a more sustained critical analysis that never materialises. In this case, I would have appreciated a discussion of how the supposed universalism of the human rights approach interacts with the actual diversity of interpretations and implementations, perhaps illustrated with ethnographic evidence. Of course this would have led to a bloated textbook, rather than the concise and readable one that we have. And it is somewhat pointless to chide the authors for what is left out of an already pretty heavy tome. This book does not aim to be exhaustive. It is an introduction, with a recommended reading section at the end of each chapter for those who want to probe further. This chapter finishes by stating its aim to be a “springboard to deeper consideration of the moral roots of engagement in this work” (p.285). A more sustained critical engagement with any topic would also likely lose its balance, which is undesirable in an introductory textbook. The authors have clearly made huge efforts not to unduly favour particular schools of thought. In fact their efforts at balance sometimes tip into what appears to be effortful palliation. The discussion of the failures of structural adjustment with regard to improving the health of developing nations is a case in point.
So the authors start from the ethical standpoint of health equity, health as a human right for all. From here they seek to reimagine the practice of global health. They use the example of AIDS throughout the book to illustrate how this has been done in the past, and so can be done in the future. AIDS is analysed through the prism of healthcare delivery models (especially Partners in Health, set up by Paul Farmer and Jim Yong Kim), of funding, of activism, and importantly, through case studies of those suffering with AIDS. The driving thrust of all this is that “the limited vision of what is currently defined as possible… is not immutable” (p.340), i.e. we should not be constrained by it.
This use of AIDS neatly ties the book together, lending coherence to its narrative, a difficult task in a textbook of this size. It also falls on the right side of the fine balance between perseverative redundancy and passionate reiteration of an important point. However, the lack of other examples of how the possible has been reimagined in global health work did lead me to wonder whether AIDS was being used to link the chapters in this way, or was features simply because the authors could not think of any other examples. The construction of the British NHS and Mexican Seguro Popular are both briefly mentioned, but with little critical engagement, and there are no other examples given from the “golden age of global health”.
Overall though, this is a superb, inspiring book introducing the critical tools of social theory to undergraduates. It has much to offer to postgraduates as well, particularly its revision of concepts. When was the last time I saw the Foucaultian concepts of biopower and governmentality explained in four pages with such clarity? Never. Owing to its breadth of scope, I would also recommend this book to general readers and activists. This kind of balanced analysis combined with an openly partisan normative claim for global health equity is a rare thing that should be read beyond the realms of academia. The authors finish with the simple plea for the “pursuit of a more just, fair society that allows our children, wherever they are born, a decent shot at a decent life” (p.353). If this is how medicine is taught at Harvard I wish I had studied there.Piyush Pushkar is a trainee in psychiatry in Manchester, England. He is also a graduate student of social anthropology, currently writing a dissertation on the origins and implications of health as a human right.
Duke University Press, 2012
Julie Livingston’s Improvising Medicine is a lucid, poignant, and devastating book about the stakes of a growing cancer epidemic in sub-Saharan Africa that is trailing the HIV/AIDS epidemic. This ethnography takes place mainly on the recently established oncology ward of Princess Marina Hospital in Gabarone, Botswana. It follows the labors of Dr. P, the tireless, irascible German oncologist, a staff of dedicated Batswana nurses, and family caregivers as they work to provide both oncological and emotional relief to cancer patients. These patients are often arriving at the ward with late stage tumors. Many of these tumors are themselves extraordinary—eyes bulge out of sockets and breasts fulminate and stink. A historian-ethnographer interested in the body as a moral condition, Livingston does not shy away from carefully examining the ways in which both caretakers and patients strive to maintain humanity and humanness in the face of disfigurement and disgust. She treats the cancer ward both as a microcosm that lays visible some of the fundamental hopes and challenges of life in present-day southern Africa. The cancer ward is also, as she puts it, “a powerfully embodied social and existential space,” where one can “contemplate the meanings, practices, and politics of care.”
The book advances three interwoven arguments. The first is that improvisation is a fundamental aspect of the practice and provision of biomedicine in Africa. In a context where drugs are constantly in and out of stock, where blood transfusion services are erratic, and where vital reagents for pathology diagnoses are missing, the striking unpredictability of what may or may not be available profoundly shapes medical practice.
Secondly, she argues that cancer is a fundamentally social experience. It is something that happens “between people.” Understanding cancer as an illness of rapidly dividing cells without end, is something that is actively created at PMH, and often becomes solidified by the unholy trinity of oncological practice—poisoning, cutting, and burning in an effort to shrink tumors and prolong life. And bodily experiences, such as pain and disfigurement, also emerge as deeply social experiences in a context where families are washing stinking wounds, nurses are taking care of their relatives on the wards, and beds stand close proximity to one another, making it impossible to not hear the chorus of vomiting after a round of chemo.
Thirdly, Livingston argues that cancer is emerging as an epidemic which will shape public health in sub-Saharan Africa. Cancer has historically been largely invisible in Africa, in part because of public health imaginaries that have constructed Africans as “biologically simple,” and the continent as a denizen of infectious disease crises. But especially in southern Africa, the advent of antiretroviral therapy has prolonged life, and has also unleashed an epidemic of HIV related malignancies, particularly cervical cancer and of course Kaposi’s sarcoma. This is a sad irony in which one pharmaceutical intervention, which has been so pivotal in softening and stemming mortality from AIDS, has created a context in which an epidemic of debilitating malignancies is now far more visible.
Livingston begins with the last argument, tracing the history of how cancer in Africa was rendered invisible, while highlighting the ironies and contradictions of imagining Africa as a place where life expectancy is so short that it would make sense to use the continent as a dumping ground for toxic waste, as Larry Summers infamously argued. From there the book takes the reader to the wards. The ontological politics of cancer are discussed, as Livingston asks, to what extent is cancer the same thing in New York and Gabarone? A chapter on the moral intimacies of nursing care and the ways in which allocating resources on PMH’s cancer ward echo larger concerns of Botswana’s state to equitably cut the national cake follows. The problem of pain and palliation emerge as profoundly social and historically situated experiences in the book, as does the politics of triage and prognostication, which make up the last two substantive chapters of the book.
The intimacy, care, intelligence, urgency, and fearlessness of Livingston’s writing and thinking make Improvising Medicine a truly masterful ethnography. Throughout the book, Livingston invites you to feel the human stakes, bodily dilemmas, and deep contradictions of oncology when its logic is ripped down to the studs and cannot be softened with chemo ports, recliners, and smooth jazz. Perhaps nowhere is this more powerful than in the pivot point of the book, the interlude “Amputation Day at Princess Marina Hospital,” in which we follow the oncologist and ethnographer on a particularly brutal day where the dilemmas of keeping limbs at the cost of lives are laid bare.
Livingston is quick to point out that Botswana’s cancer ward is just one possible manifestation of Africa’s emerging cancer crisis, and the book opens a broader research agenda for examining cancer in sub-Saharan Africa.
Since 2010, I have worked at the Uganda Cancer Institute in Kampala, which was established in the 1960s to do cutting edge chemotherapy trials on children with Burkitt’s lymphoma and adults with Kaposi’s sarcoma. Founded as a collaborative effort between the American National Cancer Institute and the Makerere Medical School’s department of surgery, this Institute weathered the storm of Idi Amin’s murderous dictatorship, the vagaries of structural adjustment, and an HIV epidemic. Today approximately 60 beds at the Institute provide public oncology goods to a population catchment of approximately 40 million Africans in the Great Lakes region. The Institute is also in a tremendous state of flux—two new buildings are dramatically reshaping the possibility of increasing cancer care capacity in the country.
Many of the improvisations, existential dilemmas, and bodily states that characterize the PMH cancer ward can also be found on the wards in Uganda. But the politics of care are quite different. The Institute’s history as a cancer research facility, where “Research is Our Resource,” means that for many years the Institute prioritized the treatment of cancers that were embedded in clinical trial research protocols. Today newly trained Ugandan oncologists struggle to meet the demands of their busy clinics, where they primarily manage late stage tumors, while remaining internationally relevant and conducting translational research for an emerging global oncology audience. Ironically, despite the Institute’s rich history, cancer has only come onto the Ugandan government’s radar as more and more politicians succumb to cancer themselves, or find that they are not in a position to shoulder the burden of sending multiple grannies to India for treatment.
Livingston is careful to not romanticize Botswana’s African miracle, but the Batswana’s commitment to social cohesion and equitable allocation does remain astonishing. Reading Livingston’s account of the oncology ward in Zimbabwe at Mpilo hospital, one has a sense that Mugabe’s state consumed itself from the inside out. One is reminded of the theorist Jean-Francois Bayart, who coined the idea of the “politics of the belly,” or the ways in which the symbolic power of eating can connote corruption and graft in African politics. Political power and its relationship to eating and consumption takes on a new and sinister twist when we think about cancer. The Red Pepper, one of Uganda’s tabloid newspapers that occasionally carries vital news, recently published an amazing photo essay of politicians stuffing their faces full of local food at an important meeting. The mouths open in mid-bite, the close ups of banana mash in groundnut sauce, the gigantic bellies—these images captured the vulgarity of a state intent on eating itself to death. The sad fact of the matter is that in many countries, and the U.S. is not exempted here, the politics can be downright malignant themselves. In an African context, it is unclear what sort of impact these dynamics will have on shaping cancer services in the decades to come.
I encourage readers to buy the book now and read it this weekend before the school year starts in earnest, if you have not yet had the pleasure of doing so. In addition to the intelligence and empathy of the writing, Livingston is making major contributions to scholarship on ontological politics, public health in Africa in the wake of structural adjustment, the history of the body, the plasticity of where infectious diseases end and chronic illnesses begin. Improvising Medicine would be indispensable in any global health, medical anthropology, or modern African history course. The book could also be read as the second volume of Livingston’s first work, Debility and the Moral Imagination in Botswana, which I recommend to readers if they are interested in a deeper historical and contemporary contextualization of the moral universe of care beyond the space of the cancer ward itself.
It is my hope that the Improvising Medicine, which highlights the pressing need to take cancer in Africa seriously, will be taken seriously by the broader global health community. There are no easy sociotechnological fixes or financial solutions to the dilemmas Livingston presents here. Improvisation will, no doubt, continue to be a fact of life in under funded public tertiary medical centers throughout sub-Saharan Africa. Perhaps what may be deemed the most immediately relevant to the emerging global oncology community is the fact that the cancer epidemic in Botswana, and indeed in Uganda, is in many ways a pain epidemic, and a sane redistribution of the world’s opiate consumption would greatly improve lives.
And closer to home, for all of us who have been touched by the slow and sad decline of a relative, or the untimely departure of a dear friend, or indeed the revelation of our own mortality, I hope this book challenges us to think a little more carefully about the limitations and double bind of the healing and harming qualities of oncological goods.
Marissa Mika is a historian-ethnographer who uses the lens of medicine, science, and technology studies to understand the ways in which ordinary people cope with social change and negotiate politics in modern Africa. Her current project, Malignant States: Creativity, Crisis, and Cancer in Uganda, traces the political and social history of a cancer research institute in Uganda. A second project on medical waste and occupational safety in African hospitals is in development. Marissa will defend her PhD in the History and Sociology of Science at the University of Pennsylvania in spring 2015, and is currently a visiting researcher at the University of California, Berkeley’s Center for Science, Medicine, and Technology Studies.
The Recent History of “Contagious Shooting” (1982-2006) and more recent events in Ferguson, Missouri by Stephen T. Casper
A version of this post first appeared on Stephen T. Casper’s blog, The Neuro Times.
In the decade since the “Decade of the Brain,” the neurosciences have acquired a spectacular cache in the humanities and social sciences. One need look no further than the work of Nikolas Rose and Joelle M. Abi-Rached, scholars who argue in their striking volume Neuro: The New Brain Sciences and Management of the Mind that governing in the future will occur through the brain.[i] While for contemporary neuroscientists and neurologists such an expansion of a-disciplinary neuroscience might and probably should represent a crisis in terms of the public face of their science and practice[ii], I would suggest that when combined with other disconcerting trends in governance, these developments have wider implications in terms of global civil society, policy, common law systems, jurisprudence, and economics. Such a starting place may seem very far away from Ferguson, Missouri. But I think that isn’t the case at all. And in this long essay, I’ll try to explain why.
Whether people identify with it or not, there are undeniable geneticist qua mechanistic currents now pervasive within media analyses (and hence also public understanding) about how we should manage social, economic, and political decay in urban and rural environments. Much of this discourse justifies both excessive violence against and also the dehumanization of people who, for whatever reason, are identified with the marginal, the poor, the weak, the downtrodden, etc. While it is easy to read part of this brutality as symptomatic of the anti-human nature of neoliberal, global capitalism[iii], I think it far more convincing to describe growing authoritarianism seen in developed societies as symptomatic of a war against particular forms of public liberty and of a decline in trust in institutional governance. The militarization of the constabulary is only the most dramatic recent demonstration of the militarization of much in the civilian sphere, including science, a process that began during and has continued since the Cold War.[iv]
It is surprising, of course, to see the advance of this process even up to neuroscience. But only a cursory knowledge of the history of recent neuroscience makes this a particularly credible claim, not least in crass examples of the way knowledge from the civilian neurosciences was mobilized in torture (as detailed by, for instance, by James Kennaway in Bad Vibrations) or in the deployment of the LRAD (long range acoustic device) against public protests, which has been an ongoing police procedure since 2009. Beyond studies of the neuroscience, such thinking has characterized the work of many renowned scholars, including Sheldon Wolin, who, although speaking of statistics and technocracy rather than neuroscience, has painted similarly glum pictures of the nature of growing “inverted totalitarianism.”[v]Tempting as it may be to describe neuroscience as the ‘liberatory’ stuff of the search for secular selfhood,[vi] in this context it is plausible to infer the emergence of such coercive and illiberal strategies and tactics as marking the defining nature of our cultures and encounters with (and beyond) neurodiscourse and neuroscience.
How so? It is obvious that the rhetoric of this science matters and it is mobilized alongside real force. Consider the implicit association test. On the face of it, this psychological test can only provide a cursory understanding of peoples’ propensities towards prejudice. But the way findings from psychological studies using this test are mobilized in the public sphere is often in the service of an apparatus to explain away, among other things, police brutality (and likely in the future instances of person-to-person violence of the kind that killed Trayvon Martin). Automatic and reflexive racism is understood publicly through the findings of tests like these to be a natural precondition of police force and self-defense. The most obvious policy solution – immediately charging police officers with manslaughter or homicide – would likely carry enough force to preempt such tragic episodes, but the very act of naturalizing such discrimination has increased the sense that such crimes are unavoidable, tragic, and require processes permitting circumvention of the law.
I intend such observations to provide this study of “Contagious Shooting” with the flavor of a perhaps too late cautionary tale, not least because many of the details of this case inevitably call attention to the very real and tragic circumstances that have sparked public protests in Ferguson, Missouri. Little in public analysis has spoken to the violence that has plagued interactions between the civilian constabulary and those who pay their salaries. Similarly, little work in the social studies of science and medicine has focused on science as a rhetorical strategy of police power (although there is some scholarship on lie detection). Furthermore, little real analysis has looked at the enormous historical similarity in tactics adopted by the police and their apologists for managing the rhetoric of accountability (although Michelle Alexander’s The New Jim Crow: Mass Incarceration in the Age of Colorblindness has cast a very wide net in calling attention to the broader issues I’m exploring here).
As historian Roger Smith has suggested, history, and specifically the history of the neurosciences, may be able to check both the utopian optimism and the authoritarian impulses that underlie this new discourse as it pertains to the practice of neuroscience through the elaboration of a politics of skepticism,[vii] but I think it is worth underscoring that there is ample evidence all around for the empirically-minded to see what governing through the brain already looks like in circumstances of increasing authoritarianism and repression. It isn’t a pretty picture. No one, of course, has described the shooting of Michael Brown as reflexive or contagious – at least not at the time this essay was written. I would anticipate that some mechanistic explanation will appear as the results of the autopsy become publicly known.[viii] But even more to the point, the implicit logics that underpin police violence of the type that killed the young man (and many before him), is no less mechanistic and deterministic in its assumptions. Equally, critiques of the protestors’ behavior in Ferguson since that violent date of Brown’s death, mirror similarly dismissive and reductionist tendencies in media analysis. To people familiar with the science and culture wars of the 1980s and 1990s, much of this analysis will sound eerily familiar about debates pertaining to genetics and society. There are, however, differences, not least in that neuroscience calls into question cognitive agency. In the case of genes, such determinism leads to discussions about “destiny” and “potentiality.” In the case of brains, such determinism can justify state-sanctioned slaughter. That, putting it mildly, is a very big difference.
Intentional but reflexive
In February of 1999, four police officers in the Bronx, New York, fired 41 shots at Amadou Diallo. He was killed. In 2004 police shot 120 bullets at Winston Hayes, a suspected drug dealer in Los Angeles. Hayes survived. However, a deputy police office was injured by friendly fire, a further eleven bullets hit police cars, and an additional eleven hit five houses in the neighborhood. One year later police in Los Angeles fired 50 shots at Carl Williams, a suspected drunk driver. In 2006, three police officers in the Bronx shot a pit bull 26 times, and in that same year five officers fired 50 shots at a car filled with unarmed passengers. One of the passengers, Sean Bell, was killed. Experts described all of these cases as examples of “contagious shooting,” a condition described in the New York Times as “gunfire that spreads among officers who believe that they, or their colleagues, are facing a threat.” One that supposedly: “spreads like germs, like laughter, or fear. An officer fires, so his colleagues do, too.”[ix]
The Sean Bell case was one among many similar episodes since 1986 that caused tensions between communities and police officers. Denver, Cleveland, Baltimore, Los Angeles, Cincinnati, and New York had all had similar incidents. The victims were almost exclusively poor and non-white. Typically the police officers, with only a few exceptions, were white. Thus, “contagious shooting” was almost always a category of accident that sprang-up in the context of racial tensions. Activists in many of the neighborhoods often regarded the police as trigger happy, violent, and racist. Community activists, moreover, saw the police as representatives of a civil authority institutionally predisposed to racism.
The Sean Bell killing touched a nerve. Bell had been at his bachelor’s party on the night before his wedding. Images of Bell’s fiancé, her public statements, and her obvious sorrow made for gripping television. Bell, too, came across in early accounts as a young African American trying to make good in a community where too many men were behind bars. Media commentators, activists, and experts thus sought various ways of categorizing and contextualizing the bitter circumstances. Representatives of the political Left gravitated towards assertions of latent or overt racism. The political Right dwelt upon the rarity with which police officers drew their weapons, the difficulties of being in a situation that called for lethal force, and the horrors of having fired. “Contagious shooting” emerged chiefly in accounts that gravitated towards explanations like these.
ABC News was one of the first organizations to report extensively on the Sean Bell killing. They cast Bell as another 23 year-old male victim of a rare but recurring problem for police departments around the country. Carol Liberman, a forensic psychiatrist and assistant clinical professor at UCLA’s Neuropsychiatry Institute, told ABC News: “when a fellow officer starts shooting it sends off an alarm, warning the others that they must be in lethal danger…. Not only is there ostensibly a killer on the loose…[but]…the other officers who become affected by the ‘contagion’ are responsible for panicking, becoming blinded by the outbursts of gunfire, and not restraining themselves enough to assess the situation.” Another law enforcement expert saw the instance in New York as rather restrained. “This type of contagious shooting happens out West,” he said, “It’s a cowboy mentality. They like to shoot out there.”[x]
Expert testimony typically oscillated around this axis of responsibility. While Liberman appealed to an infectious metaphor, she nevertheless maintained that officers were responsible for the discharge of their weapons. However, as the idea of “contagious shooting” became more commonplace, questions about individual responsibility became ever more salient. Increasingly media understanding of the concept hardened around the contradictory notion of a reflexive agency. By the end of January 2007, the Daily News argued: “the shootings would never have started at all unless one of the cops thought he was in imminent danger.”[xi] Of course, fearful police officers had intended to kill armed men. For this reason, the violence was a terrible accident.
The Rhetoric of Contagious Shooting
In January 2007, the New York Police Department, reacting to noxious public opinion, commissioned a report from the RAND Corporation. The report, which cost $500,000, focused on firearms training and contagious shooting.[xii] In an interview with the Daily News, Bernard Rostker, PI on the RAND Report, remarked that, “there is not a lot out there, especially on the question of ‘contagious shooting.’”[xiii]
Underlying these appeals to the accidental nature of these circumstances was concern about the growing perception that the New York Police Department was a racist civil institution. In March 2007, Police Commissioner Raymond Kelly asked RAND for a second report to examine evidence of racial bias in police stop and frisk policies. In a news release, the Associated Press reported that the new RAND report would complement the earlier one by focusing on ways to “reduce the incidence of so-called ‘reflexive’ or ‘contagious’ shooting the phenomenon of officers firing an excessive number of rounds in a chain reaction.” This AP bulletin was the first to describe “contagious shooting” as “reflexive shooting.” It was the first press release to use deterministic language.
That March, a grand jury indicted the officers involved – Marc Cooper, Gescard Isnora, and Michael Oliver. Tensions were extremely high in the community. Reverend Al Sharpton, a community civil rights firebrand in New York City, said that the indictment had not gone far enough. More details of the case also emerged. The event had taken place at the Kalua Cabaret, a topless bar with a history of drug violence and prostitution. The police officers claimed to have heard members of the bachelor party mention guns. The three survivors claimed in court that they had thought the undercover detectives were attempting to steal their car. They had thus tried to use the car to get away from a dangerous situation. Michael Oliver, at whom the driving car was directed, had subsequently shot at the men in the car 31 times. Isnora had fired 11 times. Marc Cooper had fired four times. One of Oliver’s shots had passed through the window of an occupied house. One of Cooper’s had smashed through the window of an occupied train station.[xiv] Oliver and Isnora thus faced charges of manslaughter, with potential 25-year sentences, and Cooper faced a lesser reckless endangerment charge.
Cooper’s attorney, the Washington Post reported, expressed frustration at the decision. “We are outraged,” he stated, “that police officers are being charged for actions taken in the line of duty. That just isn’t right.”[xv] The New York Mayor’s Office, which had from the beginning deemed the force used excessive, did not concur. Christopher Dunn, the associate legal director of the New York Civil Liberties Union, placed the event in a much wider legal context. In an interview with a New York Times reporter, Dunn stated: “While it’s certainly an aberration to be shot [by a police officer] – much less to be shot at 50 times – the Bell shooting touches on something that is no aberration, which is the police being very aggressive with those in the black community.”[xvi]
The first article challenging the growing discourse on the neurologically mechanical nature of “contagious shooting” had appeared earlier in a November 2006 article by William Saletan. Saletan, a libertarian skeptic of the arguments being advanced for “contagious shooting” observed that it was natural to seek mechanical explanations. Yet he noted that it was difficult to verify when “contagious shooting” had been coined. He also found that the majority of journalists had referenced the phenomenon in conjunction with explanations for patterns of shooting on basketball courts. Building upon a commonplace hostility to psychiatric diagnoses, Saletan noted that there was something inevitably self-fulfilling about such behavioral explanations:
Once you start describing a behavioral phenomenon as a predictable sequence of events—”post-traumatic stress disorder,” for example—people start reading it as an excuse. Seven years ago, during the Diallo case, a lawyer for one of the accused officers pointed out that “contagious shooting” was in the New York Police Department patrol guide. “I suspect that this phenomenon may play an active role in this case for my client,” he told reporters.
It was a useful line of legal reasoning. As Saletan pithily put it: “You’re not choosing to kill; you’re catching a disease.” A former Captain of the New York Police Department, Edward Mamet, had told CNN news: “It’s sort of like a Pavlovian response. It’s automatic. It’s not intentional.”[xvii]
On the force of such explanations, Saletan could only sputter: “This mess of metaphors is telling. Nothing can behave like germs, sparks, laughter, fog, instinct, and conditioning all at once. That’s the first clue that “contagious” is being used not to clarify matters, but to confuse them.” He added that the Orwellian point was the fatalistic view that such episodes would happen again. An idea mainstream in American culture at the time was that people killed people – not guns. To Saletan, the black and white legal distinction offered by that commonplace view was becoming unclear: “Contagious shooting blows that argument away. If cops fire reflexively, there’s no moral difference between people and guns. They’re both machines….No responsibility, no freedom.”[xviii]
The Sean Bell slaying remained prominent in media sources well into 2008. The Bell family, including Bell’s former fiancé, had gathered for a candlelight vigil in November of 2007, one year after his death. The Gothamist reported that Bell’s fiancé told a crowd: “I want justice.”[xix] In court, one author suspected, the legal arguments would fall between “fog of war” claims and the 50 bullets without return fire. Thus, in court, “contagious shooting” defined in the New York Police Department’s patrol guide as a “chain reaction of shooting” would be cast in neo-Pavlovian terms, an automatic response. To this proposed neurological explanation, there was no scientific retort. The prosecution could only rely on rhetorical questions about the nature of free will, intentionality, instinct, and hope that jury and judge would understand the Pandora’s Box being opened if “contagious shooting” were permitted to stand as a defense for excessive police force.[xx]
Publicly “contagious shooting” had been all but accepted. Kyle Murphy, a former police officer turned graduate student in journalism at Columbia University, wrote in an opinion editorial that it was obvious that the police officers had felt threatened and that once “contagious shooting took hold it was difficult for the others to stop.”[xxi]These were claims he repeated in a nationally broadcasted interview with National Public Radio – the Public Radio Resource in the United States – days later.[xxii] Whether it was arguments like these that prevailed is unclear – court testimony, records, and decisions for the trial are not publicly available. In any case, by May 2008, all three of the officers walked.[xxiii]
The RAND Report
In June 2008 the RAND Corporation finally published its report. Its 114-pages of text chiefly addressed issues of police officer training and usage of non-lethal weapons. It barely analyzed the incidence of “reflexive shooting.” Christopher Dunn of the New York Civil Liberties Union criticized the “cursory” treatment of the topic. The Report’s lead author, Bernard Rostker, admitted that it had been “nearly impossible to tabulate whether incidents had risen or fallen in recent years”, but he averred in The Sun that, “contagious shooting is a rare event.”[xxiv]
Indeed that rarity was reflected in the pages of the report. Although the report’s authors noted that the NYPD categorized “contagious shooting as intentional reflexive discharges” they also admitted in the executive summary that data on the condition had not been easily located. Nor was there psychological research on decision-making processes that led to firearms discharges among police officers.[xxv] In the four-page chapter devoted to the topic, the authors noted that the phenomenon could be described as a “mass reflexive response” characterized by many “intentional reflexive discharges”, which could be distinguished from accidental discharges:
While it is often discussed as a group phenomenon, a single officer can also intentionally discharge his or her weapon out of fear and without knowing specifically what he or she is shooting instead of carefully considering whether the situation meets the requirements for the use of deadly force. Typically, the officer is reacting to the sight and sound of other officers shooting and starts to shoot. An intentional reflexive discharge may involve as little as a single round being fired…(my emphasis)
According to the RAND Report’s authors, this phenomenon was well-recorded in psychological studies. This was a claim not substantiated by any specific literature. Interestingly of the only two scientific works cited in support of the chapter’s claims, one of the studies addressed the automatic response of individuals to perceive but cognitively fail to process environmental stimuli. The argument suggested through this selective citation was that police officers were unaware of all they perceived in the environment. Intentional reflexive discharges occurred as a result of individual reaction to contexts not cognitively understood.
While the report argued that such episodes should be tracked and that further training to prevent such episodes be pursued, an implicit subtext in the report was that the police officers had been conditioned to automatically respond in these ways. Rare, unfortunate accidents like the Sean Bell slaying might continue to occur. At the same time, that conditioning prepared officers for circumstances where lethal force was appropriate. In other words, such reflexive behavior saved lives, even if it sometimes resulted in excessive over-response to stimuli. Police officers needed to respond mechanically to danger before their minds comprehended the context. Their response was always appropriate, intentional, and reflexive. Any individual behaving oddly risked triggering a mass reflexive response.[xxvi]
Critics responded to these claims in a variety of ways. Most pointed out that such instances of over-reaction seemed to most adversely affect minorities. In the courts, claims of contagious shooting tended to be dismissed across the United States as unsubstantiated – but there were court cases in which contagious shooting was used as a defense. Fundamentally, the challenge arose around the question of intent. No one wanted to argue that the police officers had intentionally shot and killed innocents. Everyone agreed that they had acted intentionally to protect themselves. In an instance like this, recourse to a neurological principle substituted for the harder reality that in preparing police officers to protect people, police officer training could lead to tragic outcomes. Perception without cognition equaled almost complete power without culpability.
Historians of neuroscience can puncture the impulses underlying such rhetoric. Criminologists and lawyers have already challenged the empirical veracity of claims of “contagious shooting.” Yet we should understand that governing through the brain might well mean perceiving without cognition. In common law and jury systems that may well be enough to establish a new common doctrine of the nerves – it is certainly enough to overhaul established conventions in jurisprudence. Against such rhetoric, historians can offer the material, social, and cultural context of scientific knowledge. We can argue that the debates that undergird these claims are not new at all, but represent a long history of questioning easily traced back to antiquity, even through all of the disguises of technology, medicine, philosophy, and theology.
The examples of “contagious shooting” offer much as well to understanding the fury and outrage now on display in Ferguson, Missouri. Ferguson is not simply a story of race; nor, for that matter, is the story of “contagious shooting.” Both make clear, however, that it is very easy for the downtrodden and brutalized to see the agency of their oppressors. The oppressors and their apologists, in fleeing to mechanistic, geneticist, and deterministic rhetoric, seek to absolve themselves of accountability for the exercise of power. They perceive without cognitive awareness of their own culpability in the circumstance. In this, however, the police are no more guilty than are those Americans on the Left and Right who sit silently as prisons fill-up with mainly oppressed minority men. They too perceive without cognitive awareness that they participate in racial apartheid.
Science was always supposed to be an ennobling enterprise. But in matters of race and matters of individual self-interest it has often emerged as a tool of oppression rather than emancipation. The analysts who wrote the RAND Report on reflexive shooting were not bad analysts. Nor were they cynics! The scientists who utilize the implicit association test do not do so out of some overt racist agenda. Just as educated people with modest wealth often fail to realize how well off they are in comparison with their poor neighbors, these analysts have failed often to understand that discourse is practice in the public sphere. It makes no difference whatsoever in media accounts that these tests or these metaphors were meant to relay nuance and subtly. What matters is the way they are used; not what they empirically show. This failure to grasp that distance between science and politics is very great, this inability to see that cultural discourse easily trumps evidence, and this blindness to the fact that the exercise of power requires little evidence at all situates our times as particularly tragic. Ferguson reminds us in the same way that Sean Bell reminded us that there is a real person on the other side of the real or metaphoric gun. It also reminds us that our own silence about these grave matters contributes to the pulling of the trigger. Perhaps that is what we all perceive without understanding. Perhaps that is what it will really mean to govern through the brain.
Stephen T. Casper is an historian who has published extensively on neurology, neuroscience, and issues in critical neuroscience. His books include: The Neurologists: A History of a Medical Specialty in Modern Britain, c. 1789-2000 and The Neurological Patient in History. He also recently published “History and Neuroscience: An Integrative Legacy” in a Focus Section in Isis devoted to “Neurohistory and History of Science”. He blogs at The Neuro Times and can be followed on Twitter @TheNeuroTimes.
[i] Nikolas Rose and Joelle M. Abi-Rached. Neuro: The new brain sciences and the management of the mind. Princeton University Press, 2013.
[ii] See: Sally Satel and Scott O. Lilienfeld. Brainwashed: The seductive appeal of mindless neuroscience. Basic Books, 2013.
[iii] David Harvey. Rebel cities: from the right to the city to the urban revolution. Verso Books, 2012.
[iv] See, for instance, John Krige, American Hegemony and the Postwar Reconstruction of Science in Europe. The MIT Press, 2008. Also see Philip Mirowski, “A History Best Served Cold” in edited by Joel Issac and Duncan Bell, Uncertain Empire: American History and the Idea of the Cold War. Oxford University Press 2012.
[v] Sheldon S. Wolin, Democracy Inc. Managed Democracy and the Specter of Inverted Totalitarianism. Princeton University Press, 2008.
[vi] This is a point that I raise more fully in a forthcoming review in Social Studies of Science of Nicholas Langlitz’s excellent Neuropsychedelia: The Revival of Hallucinogen Research since The Decade of the Brain. University of California Press 2008.
[vii] Roger Smith, Being Human: Historical Knowledge and the Creation of Human Nature. Columbia University Press 2007.
[viii] After I wrote this article, CNN.com published an op/ed about the slaying of Michael Brown. Although it does not mention “reflexive shooting”, it does mention physiological indicators and also training. http://www.cnn.com/2014/08/19/opinion/haberfeld-why-six-bullets-fired/index.html?hpt=op_t1
[ix] Michael Wilson, “Fifty Shots Fired, and the Experts Offer a Theory” New York Times, November 27, 2006.
[x] Marcus Baram, “How common is contagious shooting? Such High-Round Incidents are Relatively Rare in New York Compared to Los Angeles and Denver” ABC News, November 27, 2006.
[xi] Michael Daly, “Gun Barrel of Horror” Daily News (New York), January 25, 2007, 16.
[xii] Cara Buckley, “Police Training and Gun Use to Get Independent Review” New York Times, January 5, 2007, 3.
[xiii] Ernie Naspretto and Alison Gendar, “Study will examine cops’ gun training. Kelly hires 500G Consultants” Daily News (New York), January 5, 2007, 8.
[xiv] Pat Milton, “New York police officers surrender to face charges in 50-shot killing”, Associated Press Worldstream, March 19, 2007.
[xv] Anthony Faiola, “Felony Charges for 2 in Groom’s Killing: Indictment of Three N.Y. Detectives in Shooting is Unsealed” Washington Post, March 20, 2007, A03.
[xvi] Diane Cardwell and Thomas Lueck, “After Bell, Critics Want Mayor to Broaden Focus on Police” The New York Times, March 21, 2007, 1.
[xvii] American Morning, http://transcripts.cnn.com/TRANSCRIPTS/0611/28/ltm.01.html, accessed 4 February 2010.
[xix] Jen Chung, “Gone but not forgotten” Gothamist, November 25, 2007.
[xx] Robert Kolker, “A Bad Night at Club Kalua; In the Sean Bell shooting, 50 bullets and many truths” New York Magazine, March 3, 2008.
[xxi] Kyle K. Murphy, “The Fear Behind the Badge” New York Times, April 27, 2008, 13.
[xxii] Lynn Neary, host, “Talk of the Nation: Sean Bell Verdict May Deepen Mistrust of Police” National Public Radio, April 29, 2008.
[xxiii] Sean Bell Supporters Angry About Detectives’ Acquittal in Wedding Day Killing; http://www.foxnews.com/story/0,2933,352622,00.html
[xxiv] Sarah Garland, “Police Use of Stun Guns May Increase” The Sun June 9, 2008, 4.
[xxv] Bernard D. Rostker, Lawrence M. Hanser, William M. Hix, Carl Jensen, Andrew R. Morral, Greg Ridgeway, Terry L. Schell, Evaluation of the New York City Police Department Firearm Training and Firearm-Discharge Review Process (Santa Monica: RAND Corporation, 2008), p. xxiv
[xxvi] Bernard D. Rostker, Lawrence M. Hanser, William M. Hix, Carl Jensen, Andrew R. Morral, Greg Ridgeway, Terry L. Schell, Evaluation of the New York City Police Department Firearm Training and Firearm-Discharge Review Process (Santa Monica: RAND Corporation, 2008).
Welcome to the August 2014 edition of In the Journals, just in time to kick off the transition from summer back to the start of the academic year. Without further ado…
The technical infrastructures of modern life—energy, communications, transport—stand at the juncture between material orderings of society and collective meaning. Public utilities are both material and symbolic, and both aspects require maintenance—and anthropological understanding. However, recent anthropological approaches building from science studies have tended to pursue “flat“ descriptions that replace mystical or hypostatizing concepts of “social forces“ with material associations and have focused on micrological discipline rather than ritual sites where collective identity is formed. By contrast, I identify an “aporetic relation“ between material ordering and symbolic form as the site of ritual, and hermeneutic, processes by which large-scale political collectives are built up—and infrastructures are shaped to serve collective projects. I analyze examples of contemporary and historical infrastructural politics from India and Scotland to develop insights into how collectivities and states are formed, interpreted, and challenged in symbolic contests over their infrastructures.
Ontological dimensions of encounters between Brazilian biomedical Cartesianism and Amerindian perspectivism come into sharp focus in an intensive course in functional anatomy offered to trainee indigenous health agents in Acre state, Brazil. After presenting the biomedics‘ rationalization of the course, which centered on the supervised dissection of a cadaver, I look at Cashinahua students‘ accounts of their participation in the training and consider the broader implications of this particular engagement between two profoundly different philosophical traditions from the angle of the ontogenesis of meaning. I contextualize the students‘ views of the cadaver through discussion of Cashinahua phenomenology of the body and cumulative personhood. Rather than revealing a confrontation between distinct “cultures,“ as suggested by the term interculturality, analysis supports a focus on the interplay between ontology and epistemology within historically specific ontogenetic processes.
Donna M. Goldstein
New narratives of toxic contamination are expanding and challenging our ethnographic sensibilities. In confronting the contamination left behind from the Cold War period, a range of disciplinary approaches, methods, and writing styles is necessary. Ethnography plays a crucial role here, but it cannot fly solo in these sorts of projects. In this review essay, I compare three books from authors belonging to distinct scholarly traditions, each one dealing with complicated cases of radioactive contamination that began in the Cold War era and that demand rethinking in the contemporary one. Anthropologists have much to learn from approaches pursued in other disciplines, particularly if the end goal is a more holistic portrait of contamination and toxicity.
Lucas Bessire and David Bond
What does ontological anthropology promise, what does it presume, and how does it contribute to the formatting of life in our present? Drawing from our respective fieldwork on how Indigenous alterity is coenvisioned and how the lively materiality of hydrocarbons is recognized, we develop an ethnographic and theoretical critique of ontological anthropology. This essay, then, provides an empirical counterweight to what the ontological turn celebrates of Native worlds and what it rejects of modernity. In it, we examine the methodological and conceptual investments of ontological anthropology. The figure of the ontological as commonly invoked, we argue, often narrows the areas of legitimate concern and widens the scope of acceptable disregard within social research. We chart how this paradigm’s analytical focus on the future redefines the coordinates of the political as well as anthropology’s relation to critique. Finally, we formulate three conceptual theses that encapsulate our criticism and open this discussion to further debate.
A prominent animal rights activist in New Delhi, explaining her relentlessness on behalf of animals, said to me the following: “I only wish there were a slaughterhouse next door. To witness that violence, to hear those screams . . . I would never be able to rest.” She was not alone among animal welfare activists in India in linking the witnessing of violence against an animal to the creation of a profound bond that demanded from her a life of responsibility. I argue in this article that this moment of witnessing constitutes an intimate event in tethering human to nonhuman, expanding ordinary understandings of the self and its possible social relations, potentially blowing the conceit of humanity apart. But I also consider another reading, which is how this act of intimacy exacerbates the species divide as the witness hyper-embodies herself as human, “giving voice” for the animal other which cannot speak. Throughout the article, I consider how posthumanist perspectives might trouble both these interpretations and ask what it would it mean to take seriously the animal activist’s “becoming animal.”
My fieldwork among HIV vaccine researchers, activists, and funders has led me to suggest that humanity—when it was first conceived of in the late eighteenth century—emerged as a plan, a plan for how to establish a future anticipated in the present. The powerful implication of this fieldwork-based suggestion is that what humanity is—or if it is at all—depends on the available humanity plans. I argue in this essay that we are currently seeing the emergence of a new—a biological—humanity plan, and I wish to make visible that—and how—this biological humanity plan has outgrown, conceptually as well as institutionally, older humanity plans. I also hope to make comprehensible the massive—intellectual as well as political—challenge this emergence poses.
Ending the decades-long search for the elusive Higgs particle, physicists at the Conseil Européen pour la Recherche Nucléaire, or CERN, in Switzerland announced the news of its historic discovery on July 4, 2012. In the wake of the recent discovery of the Higgs particle, the article aims to give a critical account of the concept of signature used in contemporary particle physics. Appearing as interlopers in the material world of science, signatures engender a complex movement between fact and value, thing and sign, or reference and meaning. This movement is instructive in explaining how discoveries are made in an experimental science, and also in the more provocative problem of how necessary consequences follow from contextual signs. Drawing on two and a half years of ethnographic fieldwork carried out at the Large Hadron Collider particle accelerator complex and integrating it with medieval theories of the signature, the essay offers a renewed interrogation into the topic of things, signs, and relations and their relevance for anthropology today.
Aisha Beliso-De Jesús
In Santería priesthoods, practitioners are “made” into African diaspora bodies in what is called “making santo.” These embodied epistemologies reveal not only the complex historical practices that have emerged through processes of racialization and enslavement but also how a body logic resituates the formations of diasporic feeling and sensing. I argue that practitioners’ everyday acts redefine the capacities of and for action as part of a spiritual habitus. The various rituals, works, and spiritual acts in Santería thus culminate in a different form of bodily engagement with the world, operating in racial space. This article examines Santería body logics, showing how what I call copresences are activated in somatic racial ontologies. I suggest that these diasporic sensings resituate anthropological universalisms, arguing for a disruption in the debate between mediation and practice in the anthropology of religion. Rather than assuming notions of presence, copresence allows for an intervention that hails Santería’s embodied epistemology as a form of diasporic sensing.
After Lemba South Africans participated in genetic tests that aimed to demonstrate their ancient links to contemporary Jewish populations, American Jews began to visit the Lemba to connect with them on the basis of an assumed shared Judaism. Some Lemba people welcomed and endorsed these visits, but they also maintained their own ideas about the meaning of their “genetic Jewishness” and the terms of their new diasporic relationships, which often contradicted the understandings of visiting Jews. This article privileges the perspectives of Lemba South Africans, and the historical and ethnographic contexts through which Lemba genetic data emerged and circulated, to offer an alternative reading of the social and political significance of DNA. It poses the question: How do divergent genomic knowledges articulate with the politics of belonging and the pursuit of citizenship in South Africa and transnationally? I argue that DNA and diaspora converge to create new sites of political belonging, ones marked by precarious connections that balance on the production of knowledge and its refusal. I introduce the concept of genetic diaspora to theorize how these connections, marked by inequality, are tenuously forged through national, racial, and religious difference that is imagined to be the same. Genetic diaspora offers Lemba South Africans the possibility to produce and circulate their own new knowledge about Jewish history and genetic belonging. This article demonstrates that those implicated in genetic studies transform DNA into a resource that authorizes their own histories and politics of race and religion.
Peter James, Mariana C. Arcaya, Devin M. Parker, Reginald D. Tucker-Seeley, S.V. Subramanian
• Fast-food access has been linked to obesity in low income and black populations.
• Most studies cover small areas and use administrative boundaries to define access.
• Do these populations have greater access to fast-food across the United States?
• Neighborhood poverty was not independently linked to fast-food access.
• Higher proportion black neighborhoods had higher fast-food access.
This paper explores the spatial dynamics of health social movement activism in the context of a specific condition, Attention Deficit Hyperactivity Disorder (ADHD). Deploying qualitative research conducted with Irish ADHD organisations, it examines how place and space affect activist networks and the dilemmas that emerge when local ‘mobilisations’ converge at national and transnational levels. ADHD activism in Ireland has been predominantly localist in orientation, but certain organisations have shifted their activism to the European scale as a means of gaining further political and epistemic recognition for the condition. The paper suggests that health social movement studies would benefit from an engagement with the geographies of inter-scalar relations in analysing organisations׳ action repertoires.
Elena Sautkina, Denise Goodwin, Andy Jones, David Ogilvie, Mark Petticrew, Martin White, and Steven Cummins
This paper explores how system-wide approaches to obesity prevention were ‘theorised’ and translated into practice in the ‘Healthy Towns’ programme implemented in nine areas in England. Semi-structured interviews with 20 informants, purposively selected to represent national and local programme development, management and delivery were undertaken. Results suggest that informants articulated a theoretical understanding of a system-wide approach to obesity prevention, but simplifying this complex task in the context of uncertainty over programme aims and objectives, and absence of a clear direction from the central government, resulted in local programmes relying on traditional multi-component approaches to programme delivery. The development of clear, practical guidance on implementation should form a central part of future system-wide approaches to obesity prevention.
Vissého Adjiwanou and Thomas LeGrand
In this study, we measure gender inequality both at individual level by women׳s household decision-making and at contextual level by permissive gender norms associated with tolerance of violence against women and assess their impact on maternal healthcare services utilisation in rural Africa. We apply multilevel structural equation modelling to Demographic and Health Survey (DHS) data from Ghana, Kenya, Tanzania and Uganda to gain better measure and effect of the gender norms construct. The results show that women in Ghana and Uganda, who live in areas where gender norms are relatively tolerant of violence against women, are less likely to use skilled birth attendants and timely antenatal care. In Tanzania, women who live in this type of environment are less likely to attend four or more antenatal visits. In contrast, the effects of a woman׳s decision-making authority on maternal health service use are less pronounced in the same countries.
Nicola Wright, Melanie Jordan, and Eddie Kane
This article takes mental health and prisons as its two foci. It explores the links between social and structural aspects of the penal setting, the provision of mental healthcare in prisons, and mental health work in this environment. This analysis utilises qualitative interview data from prison-based fieldwork undertaken in Her Majesty׳s Prison Service, England. Two themes are discussed: (1) the desire and practicalities of doing mental health work and (2) prison staff as mental health work allies. Concepts covered include equivalence, training, ownership, informal communication, mental health knowledge, service gatekeepers, case identification, and unmet need. Implications for practice are (1) the mental health knowledge and understanding of prison wing staff could be appraised and developed to improve mental healthcare and address unmet need. Their role as observers and gatekeepers could be considered. (2) The realities of frontline mental health work for clinicians in the penal environment should be embraced and used to produce and implement improved policy and practice guidance, which is in better accord with the actuality of the context – both socially and structurally.
Yasmin Y. Ortiga
This paper investigates the challenges faced by nursing schools within migrant-sending nations, where teachers and school administrators face the task of producing nurse labor, not only for domestic health needs but employers beyond national borders. I situate my research in the Philippines, one of the leading sources of migrant nurse labor in the world. Based on 58 interviews with nursing school instructors and administrators, conducted from 2010 to 2013, I argue that Philippine nursing schools are embedded within a global nursing care chain, where nations lower down the chain must supply nurse labor to wealthier countries higher up the chain. This paper shows how this process forces Filipino nurse educators to negotiate an overloaded curriculum, the influx of aspiring migrants into nursing programs, and erratic labor demand cycles overseas. These issues create problems in defining the professional knowledge needed by Filipino nurses; instilling professional values and standards; and maintaining proper job security. As such, these findings demonstrate how countries like the Philippines bear the burden of ensuring nurses’ employability, where educational institutions constantly adjust curriculum and instruction for the benefit of employers within wealthier societies. My interviews reveal how such adjustments undermine the professional values and standards that define the nursing profession within the country. Such inequality is an outcome of nurse migration that current research has not fully explored.
Michael P. Fisher
Despite the long-standing codification of posttraumatic stress disorder (PTSD) as a mental disorder, the diagnosis is a controversial one whose legitimacy is at times disputed, particularly in U.S. military contexts (e.g., McNally and Frueh 2013; McNally, 2003, 2007). These disputes often manifest in a struggle over prevalence rates. Utilizing data from in-depth interviews and relying on situational analysis methodology (Clarke, 2005), I highlight this struggle in the wake of a decade of U.S.-led war in Afghanistan and Iraq. I focus on the objects of contestation employed by public officials, veterans’ advocates, and researchers to make or refute claims about PTSD prevalence. These objects of contestation include the diagnostic category and criteria; screening tools, procedures, or systems; and the individuals who express symptoms of the disorder. Based on these claims, I make two key interrelated assertions. First, PTSD is viewed by some public officials as an overly generalized or invalid diagnostic category that is often induced in or falsified by veterans or servicemembers. As such, PTSD is perceived by these stakeholders to be over-diagnosed. Compounding these perceptions are beliefs that PTSD is costly and negatively impacts military duty performance, and thus overall manpower. Second, there exist perceptions, largely on the part of veterans’ advocates but also some public officials, that many servicemembers and veterans are not seeking treatment (and thus, a diagnosis) when they experience symptoms of PTSD. Thus, PTSD is perceived by these stakeholders to be under-diagnosed. Paradoxically, some public officials make both claims: that PTSD is over-diagnosed and under-diagnosed. I conclude by exploring the implications of these findings.
Preterm delivery (PTD), defined as delivery prior to 37 weeks gestation, is a key contributor to persistent racial disparities in infant mortality in the United States. Five major funding initiatives were devoted to advancing PTD epidemiology during the 1990s and 2000s. By examining content and rhetorical features of 94 studies conducted under these initiatives, and published between 1993 and 2011, this paper considers how calls for more “contextual” approaches (focusing on social and environmental contexts) interacted with more “conventional” approaches (focusing on individual-level risk factors) to PTD epidemiology during this period. Contextual advocates initially emphasized complex biosocial reasoning to better connect social adversity with embodied outcomes. Yet responses by researchers invested in conventional approaches, as well as in studies published under new initiatives that explicitly claimed to incorporate contextual insights, often reframed this complex reasoning in biologically reductionist terms. Subsequent contextual advocates then focused on developing statistical methods to support research about social and environmental causes of PTD, and this strategy appears to have gained some traction with conventional researchers. These findings call for closer attention to language and power in both social scientific studies of epidemiological knowledge production, as well as among epidemiologists themselves.
Michelle Ko, Kathryn Pitkin Derose, Jack Needleman, Ninez A. Ponce
Prior literature on social capital and health has predominantly focused on health outcomes and individual access to healthcare services. It is not known to what degree, if any, community social capital influences the performance or behaviors of public hospitals, a key source of healthcare for disadvantaged communities in the United States. In this study we developed measures of community bridging social capital – horizontal social networks between heterogeneous groups of similar social position – and linking social capital – vertical networks across the status hierarchy – relevant to public hospitals. We examined associations between social capital, and U.S. urban public hospital closures and conversions to private ownership from 1987 to 2007. We found that higher voting participation was associated with a greater hazard of public hospital closure over time (p < 0.01), whereas the number of business, professional and political organizations per 10,000 residents was associated a greater hazard of conversion (p < 0.05). Additional measures of bridging and linking social capital were not associated with either outcome. Taken together, our findings suggest that, at least historically, horizontal forms of social capital among more privileged groups (e.g., business, professional, and political associations) bear influence on public hospital outcomes. Specific efforts to increase engagement of disadvantaged groups and connect them with decision-makers may be needed to fully realize the potential of linking social capital to influence local healthcare policy promoting social protection.
Lantona Sado, Alma Spaho, and David R. Hotchkiss
Women in Albania receive antenatal care and postnatal care at lower levels than in other countries in Europe. Moreover, there are large socio-economic and regional disparities in maternal health care use. Previous research in low- and middle-income countries has found that women’s status within the household can be a powerful force for improving the health, longevity, and mental and physical capacity of mothers and the well-being of children, but there is very little research on this issue in the Balkans. The aim of this paper is to investigate the influence of women’s empowerment within the household on antenatal and postnatal care utilization in Albania. The research questions are explored through the use of bivariate and multivariate analyses based on nationally representative data from the 2008–09 Albania Demographic and Health Survey. The linkages between women’s empowerment and maternal health care utilization are analyzed using two types of indicators of women’s empowerment: decision making power and attitudes toward domestic violence. The outcome variables are indicators of the utilization of antenatal care and postnatal care. The findings suggest that use of maternal health care services is influenced by women’s roles in decision-making and the attitudes of women towards domestic violence, after controlling for a number of socio-economic and demographic factors which are organized at individual, household, and community level. The study results suggest that policy actions that increase women’s empowerment at home could be effective in helping assure good maternal health.
Julie A. Phillips
The increases in suicide among middle-aged baby boomers (born between 1946 and 1964) in the United States since 1999 suggest a changing epidemiology of suicide. Using data from 1935 to 2010, this paper conducts age-period-cohort analyses to determine the impact of cohorts in shaping temporal patterns of suicide in the United States. The analysis demonstrates that age, period and cohort effects are all important in determining suicide trends. Net of age and period effects, the cohort pattern of suicide rates is U-shaped, with cohorts born between 1915 and 1945 possessing among the very lowest suicide rates. Suicide rates begin to rise with boomers and subsequent cohorts exhibit increasingly higher rates of suicide. The general pattern exists for both men and women but is especially pronounced among males. The average suicide rate over the entire period for males is about 28 per 100,000, 95% CI [27.4, 28.7]. For males born in 1930–34, the suicide rate is estimated to be 17.4 per 100,000, 95% CI [15.9, 18.8]; for males born between 1955 and 1959, the rate is essentially the same as the average for the period while for males born between 1985 and 1989, the suicide rate is estimated to be 37.8 per 100,000, 95% CI [33.1, 43.4]. The results dispute popular claims that boomers exhibit an elevated suicide rate relative to other generations, but boomers do appear to have ushered in new cohort patterns of suicide rates over the life course. These patterns are interpreted within a Durkheimian framework that suggests weakened forms of social integration and regulation among postwar cohorts may be producing increased suicide rates.
In this article I report on an investigation of the pharmaceutical industry’s influence in medical education. Findings are based on fifty semi-structured interviews with medical students in the United States and Canada conducted between 2010 and 2013. Participant responses support the survey-based literature demonstrating that there is clear and pervasive influence of the pharmaceutical industry in medical education. They also challenge the theory that medical students feel entitled to industry gifts and uncritically accept industry presence. I investigate how medical students who are critical of the pharmaceutical industry negotiate its presence in the course of their medical education. Findings suggest that these participants do not simply absorb industry presence, but interpret it and respond in complex ways. Participants were uncomfortable with industry influence throughout their medical training and found multifaceted ways to resist. They struggled with power relations in medical training and the prevailing notion that industry presence is a normal part of medical education. I argue that this pervasive norm of industry presence is located in neoliberal structural transformations within and outside both education and medicine. The idea that industry presence is normal and inevitable represents a challenge for students who are critical of industry.
Ann V. Bell and Elizabeth Hetterly
Existing literature characterizes fatalism as a passive reaction to health in the face of powerlessness and constructs agency as a more activist perspective based in self-efficacy and control. Frequently studied together, researchers extol agency as the appropriate approach to decision-making around health, while discouraging fatalistic outlooks. Despite associating such beliefs with social classes—agency with high socioeconomic status (SES) groups and fatalism with low SES groups—there is little research that compares health beliefs across class groups. By examining the medicalized condition of infertility among women of both high and low SES, this study examines how social class shapes reactions to health and illness. Through 58 in-depth interviews with infertile women in the U.S., we reveal the complexity of fatalism and agency and the reasons behind that complexity. We first examine the commonalities among SES groups and their mutual use of fatalism. We then demonstrate the nuance and continuity between the health beliefs themselves—fatalism can be agentic and agency can be achieved through fatalism. In other words, we disrupt the binary construction of health beliefs, their conflation with social class, and the static application of health beliefs as psychological attributes, ultimately exposing the classist basis of the concepts. Doing so can result in improved patient care and reduced health inequalities.
In recent years, science studies scholars have critically examined several methods used by the pharmaceutical industry to exert control over knowledge about drugs. Complementary literatures on ‘medical neoliberalism’ and ‘neoliberal science’ draw attention to the economic ideas justifying such methods of organizing knowledge, and in so doing suggest that neoliberal thinkers may play an important role in developing them. As yet, the nature of this role remains unexplored. Relying on heretofore-unexamined archival evidence, this article establishes a direct link between the Chicago School of Economics and the mobilization of the pharmaceutical industry in the 1970s. It argues that economists affiliated with the Chicago School of Economics sought to influence pharmaceutical policy and science and constructed institutions to do so. These institutions – most notably the Center for the Study of Drug Development – remain highly influential. This article contributes to a historical understanding of how neoliberal ideas came to assume prominence in pharmaceutical policy, the management of science, and scientific practice.
Policies about physicians’ involvement with pharmaceutical companies spawn contradictory ideas. One set of policies aims to stimulate collaboration between private companies and publicly employed researchers to spur innovation and economic growth, another addresses what is seen as the problem of physicians’ conflicts of interest stemming from industry collaboration. This article explores how these contradictory policies interact with everyday practice in clinical hypertension research in Denmark. I argue that ‘corporate’ and ‘academic’ research is entangled as physicians participate in industry trials to pursue their own research. Building on document analysis, observations of contract research, and interviews with clinician researchers and industry executives, I show how the establishment of industry ‘ties’ can serve as a way for physicians to navigate the constraints of research infrastructures and live up to intergenerational norms that knit the medical collective together. I discuss how this entanglement shapes medical research in ways that may run counter to the aims of medical innovation policies and that conflicts of interest policies do little to address. I conclude that appreciation of the ways in which economic and moral valuations come together is necessary to understand the conditions for medical research in an intertwined public–private research environment.
Janet K. Shim, Katherine Weatherford Darling, Martine D. Lappe, L. Katherine Thomson, Sandra Soo-Jin Lee, Robert A. Hiatt, and Sara L. Ackerman
In this article, we explore current thinking and practices around the logics of difference in gene–environment interaction research in the post-genomic era. We find that scientists conducting gene–environment interaction research continue to invoke well-worn notions of racial difference and diversity, but use them strategically to try to examine other kinds of etiologically significant differences among populations. Scientists do this by seeing populations not as inherently homogeneous or heterogeneous, but rather by actively working to produce homogeneity along some dimensions and heterogeneity along others in their study populations. Thus we argue that homogeneity and heterogeneity are situational properties – properties that scientists seek to achieve in their study populations, the available data, and other aspects of the research situation they are confronting, and then leverage to advance post-genomic science. Pointing to the situatedness of homogeneity and heterogeneity in gene–environment interaction research underscores the work that these properties do and the contingencies that shape decisions about research procedures. Through a focus on the situational production of homogeneity and heterogeneity more broadly, we find that gene–environment interaction research attempts to shift the logic of difference from solely racial terms as explanatory ends unto themselves, to racial and other dimensions of difference that may be important clues to the causes of complex diseases.
Ben W. Brisois
The growth of the field of global health has prompted renewed interest in discursive aspects of North–South biomedical encounters, but analysis of the role of disciplinary identities and writing conventions remains scarce. In this article, I examine ways of framing pesticide problems in 88 peer-reviewed epidemiology papers produced by Northerners and their collaborators studying pesticide-related health impacts in Latin America. I identify prominent geographic frames in which truncated and selective histories of Latin America are used to justify research projects in specific research sites, which nevertheless function rhetorically as generic ‘developing country’ settings. These frames legitimize health sector interventions as solutions to pesticide-related health problems, largely avoiding more politically charged possibilities. In contrast, some epidemiologists appear to be actively pushing the bounds of epidemiology’s traditional journal article genre by engaging with considerations of political power, especially that of the international pesticide industry. I therefore employ a finer-grained analysis to a subsample of 20 papers to explore how the writing conventions of epidemiology interact with portrayals of poverty and pesticides in Latin America. Through analysis of a minor scientific controversy, authorial presence in epidemiology articles, and variance of framing strategies across genres, I show how the tension between ‘objectivity’ and ‘advocacy’ observed in Northern epidemiology and public health is expressed in North–South interaction. I end by discussing implications for postcolonial and socially engaged approaches to science and technology studies, as well as their relevance to the actual practice of global health research. In particular, the complicated interaction of the conflicted traditions of Northern epidemiology with Latin American settings on paper hints at a far more complex interaction in the form of public health programming involving researchers and research participants who differ by nationality, ethnicity, gender, profession, and class.
Brandon Andrew Robinson
Sexual health discourses have become a defining part of many gay men’s sex lives. These discourses have effectively linked gay identity to HIV/AIDS discourses through telling most gay men how to rationally have sex and how to routinely get tested. However, some gay men who bareback – the choice often made not to use a condom – engage in condomless sex despite these larger discourses. Through using Weber’s theories on rationalization, I explicate how sexual health and HIV/AIDS discourses are calculable, efficient systems that are about protecting the public good. I show how this rationalized sexual health system disciplines pleasure and intimacy. Through this disciplining, I illuminate how sexual public health has disenchanted sex, specifically for some gay men, where some of these men who bareback may be attempting to find re-enchantment in this disenchanted sexual world. Through this Weberian framework, barebacking may be seen as an act that can allow for the re-exploration of personability, intimacy, eroticism and love.
Barry J. Gibson and Ninu R. Paul
This article seeks to unpack the relationship between social structure and accounts of illness. Taking dentine hypersensitivity as an example, this article explores the perspective that accounts of illness are sense-making processes that draw on a readily available pool of meaning. This pool of meaning is composed of a series of distinctions that make available a range of different lines of communication and action about such conditions. Such lines of communication are condensed and preserved over time and are often formed around a concept and its counter concept. The study of such processes is referred to as semantic analysis and involves drawing on the tools and techniques of conceptual history. This article goes on to explore how the semantics of dentine hypersensitivity developed. It illustrates how processes of social differentiation led to the concept being separated from the more dominant concept of dentine sensitivity and how it was medicalised, scientised and economised. In short, this study seeks to present the story of how society has developed a specific language for communicating about sensitivity and hypersensitivity in teeth. In doing so, it proposes that accounts of dentine hypersensitivity draw on lines of communication that society has preserved over time.
Elizabeth Quinlan, Roanne Thomas, Shahid Ahmed, Pam Fichter, and Linda Mcmullen
The use of popular expressive arts as antidotes to the pathologies of the parallel processes of lifeworld colonization and cultural impoverishment has been under-theorized. This article enters the void with a project in which breast cancer survivors used collages and installations of everyday objects to solicit their authentic expression of the psycho-social impacts of lymphedema. The article enlists Jurgen Habermas’ communicative action theory to explore the potential of these expressive arts to expand participants’ meaningful engagement with their lifeworlds. The findings point to the unique non-linguistic discursivity of these non-institutional artistic forms as their liberating power to disclose silenced human needs: the images ‘spoke’ for themselves for group members to recognize shared subjectivities. The authenticity claims inherent in the art forms fostered collective reflexivity and spontaneous, affective responses and compelled the group to create new collective understandings of the experience of living with lymphedema. The article contributes theoretical insights regarding the emancipatory potential of aesthetic-expressive rationality, an under-developed area of Habermasian theory of communicative action, and to the burgeoning literature on arts-based methods in social scientific research.
This article examines the professional and public response to the television play Through the Night, which aired on BBC1 in December 1975. One of the first British mass media portrayals of a woman’s experience being treated for breast cancer, this play attracted a large audience and considerable attention from both critics and everyday viewers. My analysis of the play draws on sources documenting expert responses to the play in its production stages, as well as critics’ and viewers’ responses to what the play said about breast cancer treatment in particular, and about Britons’ experiences of medical institutions more broadly. Together, I argue, these sources help us see how Through the Night’s critique of what one expert called ‘the machinery of authoritarian care’ reverberated with and supported the efforts of professionals anxious to improve patient experience, and how it crystallised the concerns of activists and everyday viewers.
Liz Ross, Phil Lyon, and Craig Cathcart
This article examines the ameliorative options facing people with hearing loss in mid-nineteenth-century Britain. As reflected in professional journals of the day, medical understanding of diseases and dysfunctions of the ear was limited, yet there was vigorous assertion and counter-claim as to the cause and treatment of problems. At the time, medicine was largely unregulated and quack practitioners were also able to promote their nostrums and services to a credulous the general public with little chance of a genuine cure for their hearing loss. Using the nineteenth-century British Library Newspapers Archive for 1850, 379 advertisements offering cures for deafness were identified and examined to illustrate the variety of nostrums and devices offered to the public. Individuals with hearing loss were easy prey when even qualified medical practitioners had little understanding of cause or treatment, and when scant legal protection protected them from fraudulent treatment claims or offered redress for their failure.
This paper examines the turn toward the small companion animal that occurred in British veterinary medicine in the twentieth century. The change in species emphasis is usually attributed to post-war socioeconomic factors, however this explanation ignores the extensive small animal treatment that was occurring outwith the veterinary profession in the interwar period. The success of this unqualified practice caused the veterinary profession to rethink attitudes to small animals (dogs initially, later cats) upon the decline of horse practice. This paper argues that a shift toward seeing the small animal as a legitimate veterinary patient was necessary before the specialty could become mainstream in the post-war years, and that this occurred between the wars as a result of the activities of British animal welfare charities, especially the People’s Dispensary for Sick Animals of the Poor.
This paper concerns what I call “the moment of recovery,” the time when, in the 1950s, American cancer campaigns abandoned an earlier tendency to downplay post-operative recovery in their public education programs. This change was signalled by the emergence of new patients groups such as Reach to Recovery (founded 1953), and by a new interest in cancer rehabilitation among physicians, nurses, and manufacturers and sellers of equipment and clothing for patients. My focus is on breast cancer and the nurse-patient-industrial complex that drove the new interest in rehabilitation and recovery, but I also argue that the “moment of recovery” in breast cancer was part of a larger “moment” in cancer more generally. Finally, I seek to distinguish the “moment of recovery” of the 1950s from the discourses around the survivor that have emerged since the 1970s and 1980s, what might be called the “moment of survivorship.”
In contemporary writing Axel Holst and Theodor Frølich are being celebrated as the first to produce an animal model for the experimental production of scurvy. But in their time their research was contested by their peers, most vocally by the polar hero and zoologist Fridtjof Nansen. This paper explores how Axel Holst initially started out as a microbe hunter and worked within a bacteriological framework, before he shifted to performing feeding experiments and came to understand scurvy as a deficiency disease. This radical shift in framework may take part in explaining the controversy around their research. But most importantly, this paper argues, we must understand this in light of the contested status of animal models and modelling work in medical science. In order to analyse this, the paper suggests that we attend to a broad set of approaching and defining ‘models’. Moreover, the paper suggests that we extend our discussion from ‘the animal model’ and what an animal model is, to modelling practices and what models can do, and sometimes fail to do. The paper concludes with arguing that Holst and Frølich in fact did not develop an animal model, i.e. a shared example upon which scientists base their work.
translated by Stephen Adam Schwartz. Harvard University Press, 2014. 392 pp.
How is what is “in” our minds, as thought, also something that we share, communicate, and can understand? This question, however posed, must be fundamental for any anthropological approach to mental life. In the course of our research we have to ask ourselves, at least implicitly, what we are doing—mentally—when we interact with others, and how on this basis we can claim to share, and know, another’s experience. In relation to anthropological fieldwork, the cognitivist common sense that makes mental processes the outgrowth of an individual capacity to think (located in modules or states of the brain) raises more questions than it can answer, rendering illegible both the shared worldly context of speech and thought, and the sense which we, collectively, can make not only of what is present to our immediate perception but also of times past and future, distant cultures with alien epistemologies, and even illusions, hallucinations, and compulsions. In his recently-translated The Institutions of Meaning, the French philosopher Vincent Descombes seeks to understand the mind, instead, through a linguistic and interactional account of intention, formulating a challenge to reductive, materialist accounts of mental mechanism and providing an original pathway to the mind through social institutions of shared meaning and exchanges of words and things (often highly unequal ones). In a significant way, this book returns “the mind” to anthropology as a proper object of social research—or, perhaps better, recovers the anthropological dimension integral to any conception of the mind.
The Institutions of Meaning (originally published in French in 2001 as Les Institutions du sens) is a kind of sequel to Descombes’ earlier book, The Mind’s Provisions: A Critique of Cognitivism, in which he argued on linguistic and phenomenological grounds that mental processes, whatever they are, neither happen inside “a” mind nor are they best described as “representations”—an argument which directly opposed the atomistic and additive language of contemporary cognitive philosophy. In a clear and stylish translation by Stephen Adam Schwartz, The Institutions of Meaning, which is subtitled “A Defense of Anthropological Holism,” sets out to provide a different philosophical account of mind, one that roots cognition in pre-existing contexts of exchange and interaction. This book does not directly address formulations developed in psychology or the natural sciences for understanding the mind—it speaks, instead, primarily to other philosophers’ deployments of mentalistic and materialistic notions of cognitive processes, and challenges them with an expanded concept of mind and meaning built, innovatively, from French structuralist anthropology (which Descombes reminds us was always in part an investigation into mental structures). But if this book does not make a direct contribution to the “collaborative turn” that links the human and the natural sciences, as this was defined recently here on Somatosphere, it still has much to say about scientific thought about the mind, insofar as that thought is conducted in terms that are also embedded in social institutions of meaning.
Descombes is a leading figure in philosophy in France—he is Professor at the Ecole des Hautes Etudes en Sciences Sociales in Paris—and he was trained in much the same tradition as the figures whom most Americans might associate with “French Philosophy,” such as Derrida and Foucault. However, unlike these “Continental” thinkers, Descombes is equally influenced by, and contributes to, the philosophy of mind that has developed as part of the analytic tradition of Anglo-American philosophy. In fact, Descombes practices philosophy in the analytic style, and explicitly aims to address the challenges posed by this philosophy, which expels as both non-empirical and non-philosophical much of the metaphysical baggage of the philosophical tradition, and attempts to rebuild philosophy starting from ordinary language and common sense.
Yet the thrust of Descombes’ work as a whole is against the Cartesian presuppositions which remain internal, as “common sense,” to much Western epistemology and ontology. He argues against any dogmatic adherence to principles that causes must come before effects, and parts before wholes, and matter before mind or spirit. Constructively, he seeks to find philosophical, and analytically-acceptable, means and terms for making sense of the anthropological dicta of the holism of social relations: that societies come before individuals; that meaning emerges from structured relations between signs and not from relations of resemblance between words and things; and that mind and meaning inhere in contexts and in interactions, and not “in” material objects, symbols, or even inside human brains. To defend such holistic propositions, he presents a sustained and excellent critique of the notion that breaking things down into elements clarifies their relations. Insofar as this cuts against our common, “scientific” common sense, and instead builds from conceptions of mind and spirit that owe much to Hegel and Husserl, Descombes’ philosophy of mind can only be “semi-analytic.” Indeed, he explicitly grants himself license to employ the resources that exist in French and German for speaking, in one breath, of mind, spirit, and idea (senses that coexist in the words esprit and Geist). He does not pun on these multiple senses, however, but rather aims to describe a real, human and social, totality to which “mind,” in this expanded sense, may refer.
The first half of The Institutions of Meaning focuses on the notion of intention, which is in modern philosophy the defining attribute of mental phenomena. We say, Descombes stipulates, that something is mental when some thing is related to in a way which puts it “under a description”—when it is perceived, thought of, loved, sought—and this only for a particular subject. The definitional relation established here between subjective thought and its object raises the problem of how to bridge the mental act with the real world—how do language, and thought, refer to, and can they affect, their objects? In an aside relevant to anthropological concerns Descombes discusses, as unsatisfactory, various attempts to construct a wider “intentional history” which could, through the concepts of abstraction or discourse, account for the power of ideas in material and social life. He moves from Kojève’s Hegelian thoughts on the power of abstraction to affect real individuals, to Lacan’s aphorism that the “symbol is the murder of the thing,” to, finally, a refreshing and skeptical take on Foucault’s and Hacking’s accounts of the power of discourse. All of these attempts at an “intentional history” have failed, for Descombes, because their impersonal descriptions of an “order of discourse” (Foucault) require—but give only scant account of—a real context of people talking, acting, and behaving intentionally in order to become plausible as descriptions of interaction between the mental and the real (a condition that Hacking’s work, with its doctors inciting speech from patients, in part meets). In order to bridge, and thus move beyond, the dichotomy between the world of instituted and abstracted meanings, on the one hand, and individual mental facts and real things, on the other, Descombes proceeds to pay close attention to the social as a realm of instituted roles and meanings, related systematically in such a way that some actions and descriptions depend on others and thus, in their instituted relation, link the linguistic context to the real one of thought, interaction, and reference.
That is, Descombes argues (following Pierce and Wittgenstein, among others) that there is always a real relation of reference and patterned interaction which comes with the intentional relation—in the intentional action of even the most private thought, something is intended in the worldly context, and this takes intention out of the realm of the purely mental into a world of social relations and conventional, instituted meanings which can bear upon subjects, personally or impersonally as the case may be. This assertion is clarified in his analysis of a concept from “philosophical grammar,” the “intentional passive” (pp. 66ff.) Though not marked in natural grammar in either French or English, the intentional passive, once defined philosophically, helps explain how one can reverse the description of an intentional or mental act such as “Romeo loves Juliet” and yet still arrive at a properly constituted sentence in which the grammatical object Juliet has become the subject of an intentional predicate: Juliet is loved by Romeo. This perfectly normal linguistic feat, seen philosophically, demands some account of how a mental act can be said to bear on another subject as an “intentional passion”: some state that, for that subject, truly is. Though it need not, of course, affect her at all personally, being loved must affect Juliet in some way insofar as she is known through the descriptions of her.
The intentional verb to love, like all words, is part of a system of verbs and nouns, with various functions, and is internally related to them; meanwhile, grammar is linked to social institutions that set apart certain words and make them refer in a special way. Take, for instance, the institution of proper names. That is, whatever the impact on Juliet, Romeo really loves a specifiable person who is called by that name. His thoughts have, potentially, a real effect in the world, but only in virtue of their prior connection to other words, which are connected institutionally to specifiable contexts, and, to continue the argument, also to a situation in which it is a meaningful thing for a young man to love and seek to be loved. This is what Descombes comes to mean by “institutions of meaning”—that there are conventions of which words and signs are the vehicles, and these conventions are not only linguistic, but social and impersonal, albeit lived very personally. The two levels, of brute reality and mere meaning, which other philosophies might want to keep separate, are here united in a quite pragmatic and describable way, which becomes clearer as Descombes works through his examples.
Indeed, Descombes spends a great deal of time constructing examples that complicate and expand the notion of an intentional phenomenon. What does it mean to say that someone is looking for someone else—say a sheriff for a horse thief—and to describe that action as intentional, and therefore mental? “Looking for” seems like a very physical activity—you might look here, or there, or anywhere, but not inside your head! Yet for all its real-world physicality, the action of “looking” also comprehends a number of mental attitudes and suppositions, which problematize any direct notion of reference: you can look for a horse thief even if, in actual fact, one does not exist (a mistake has been made; or the horse is being hid by its owner for other reasons, in which case one “finds” the horse thief when one “understands” the owner’s motives for hiding his own horse—note how densely mental the example becomes!). Moreover, whatever your mental intention at any one point in time, we say that you can find without looking. What, then, is the relation between these real and mental events, and how does intention bear upon its object, which may not even exist, or which may not be intended in the first place?
In another of Descombes’ examples, “expecting” raises the related problem of the continuity of mental acts. What is it to say that I am expecting someone to show up at my house at a given hour? How do I describe that mental fact of “expecting” which may, in fact, not be an idea I am consciously entertaining at any particular moment during the time I am, in fact, doing just that? I may be avidly knitting, or entirely absorbed in a book, and all the while expecting my visitor. And did I not expect after all, if my visitor failed to show up?
Perhaps unsurprisingly, Descombes’ answers to all of these problems revolve on his specification of a holistic relation between the mental act and previously instituted conventions and shared meanings: the search for the horse thief presupposes the institution of property and the fact of a missing horse, and those make possible the mental act of intending to find a thief; the institution of the appointment explains the expectation of a visit, which is surely a mental act even if it is not a consciously or continuously held idea. Finally, the power of different words to refer to the same things or to different aspects of the same things, without disturbing their apparently real identity and separateness, allows us to evade the apparent “holistic paradox” of institutions and relations preceding their objects, and existing independently from the reality of the things related. For we can understand the parts of things which appear, really or irreally, in a given description as the aspect of them which is relevant at that time, or “under that description”. If the Sheriff thought that Mr. Smith was the horse thief and hence looked for him as such, the Sheriff and Mr. Smith are put in a real relation and transformed by it, even if Mr. Smith was in fact neither a thief nor findable—it is not necessary that he be a horse thief for this relation to hold, nor for him to be mistaken for one; it is only necessary that he be, in fact, Mr. Smith, a fact secured by the social institution of proper names.
Richard Rorty has highlighted this last aspect of Descombes’ philosophy: he refuses the “general illusion of metaphysics” that things must have one, singular identity, and understands instead that we get at them only through their multiple descriptions (which change, as do the things themselves). Action under a description admits the priority of relations while it also permits of change, discovery, and partiality. As Descombes puts it here, “We will say that looking for is necessarily ‘under a description’ (secondum quid) but that an encounter is necessarily an encounter with an object tout court (simpliciter). . . . What is at issue is the aspect under which what is looked for is looked for, and the aspect under which it is found. The found object is necessarily richer than the object sought. . . . Oedipus is looking for Laius’s murderer. When he finds him, he also finds someone he was not looking for, namely Oedipus himself” (p. 85).
But what kind of holism does this understanding of intentions and institutions entail? In answer to this question, Descombes engages with structural anthropology in order to define and defend a notion of structure and differentiation which is far from analytic philosophy’s previous accounts of wholes as sets, classes, and collections. What Descombes calls “collectivist holism” would hold—and he has examples of this point being made—that a whole can only be made up of parts which are similar in some logical way: in the way that all members of the same team make up the whole, any collection or set of things thus constitutes its own totality, logically (the paradigmatic logical statement of this position, “all bachelors are unmarried” describes a collection, and hence this position is “collectivist”). Instead, Descombes defines a whole as the interdependent totality of differentiated parts or roles. “Far from receiving from the system the same characteristic trait, they will receive different positions” (p. 117, italics his), he writes, and thus his holism demands a logic not of singular relations of identity, but rather polyadic relations.
Reciprocal but formally non-reversible relations between actors described in distinct social roles (e.g., murderer-victim; donor-donee; father-son) are key to the second half of this book, to the working out of the grammar of anthropological holism. Thus, the structural anthropology of the gift gets a chapter of its own (Ch. 9), where Descombes explores how key anthropologists described such differentiated and reciprocal roles in exchange, kinship, and social order. Here, Descombes extends his core argument that both the object and the “regulative principle” (a term he takes from Lévi-Strauss) of mental life must be located in exterior, public realm of actual human actors and their social relations, adding that these relations must be (following Peirce) at least triadic. That is, a triadic relation is set up when you have a proposition in which someone accomplishes something bearing upon another subject via an object, such that I give you a thing, and I am a giver, you a receiver, the thing a thing given. This cannot be reduced into a purely dyadic relation (donor-donee) without evacuating the specificity of the relation: “in every proposition concerning a verb of giving, one will have a link to the thing and a link between people, and these two will be dissociable” (p. 251). Further, intentional statements are always, in principle, triadic, for “the description of an intentional action is a description of the undertaking of an action at a distance by means of a local action, with the result that its logical form must comprise a multiplicity equal to at least three” (p. 230, italics his).
Descombes’ philosophical interest in description motivates his turn to anthropology, here, and he specifically seeks to reclaim the explanatory force of the ethnographic descriptiveness of Marcel Mauss, whose texts are densely involved in particulars and in the language of their formulation. For instance, Descombes returns to the complex, polyadic reality that is captured by Mauss’s use of an untranslated “indigenous” term hau—the “spirit of the gift” or esprit de la chose donée—to describe how a social rule of reciprocity in Maori gift-exchange is more or less self-consciously expressed as an interpersonal force, as a spirit (esprit) or social intention which links separated, individual actions and projects others across space and time. Contrasted with Mauss’s ethnographic description of the spirit of the gift, Lévi-Strauss’s later attempt to mathematize and abstract gift-exchange into a balanced system of reciprocity, reducible to binary operations—a general symbolic logic of contrasts—is said here to be, in a curious way, entirely unsocial, because it evacuates the content of the thought, the sense of a spirit animating the exchange, the tertium quid which grants direction, meaning, and (potentially) completeness to the relations established via the gift. Ultimately, Descombes’ effort to put intention back into structural accounts of exchange leads him to a useful, and quite faithful, reading of the later development of structural anthropology and in particular Louis Dumont’s “holistic” emphasis on complementarity, differentiation, and hierarchy in exchange relations (I must pass over here the careful work which Descombes does to defend his own position both against charges of “structural causality” and “the myth of the collective individual”).
In the course of his critique of Lévi-Strauss Descombes becomes, uniquely in this volume, ethnographic—that is, he writes about interactions and exchanges which he himself has observed. He offers, in a skillful, writerly turn (pp. 265-66), a response to Lévi-Strauss’s famous example of reciprocity in the exchange of wine in restaurants in the South of France. Rather than the silent and mutual ritual exchange of equivalent amounts of wine between strangers, in order to form the minimal kernel of a relation and make the anonymous context of a roadside hotel tolerable, Descombes describes anxious and risky negotiations over such exchanges, fraught with class content and uneven demands for return, in which the fact of exchange is subordinated to the uneasy question of who should go first (one settled in his example entirely contingently, but opening to questions of value and hierarchy more fully worked out by Dumont). All of this is pursued to buttress his philosophical argument that the only way to capture the reality of the mental is through examination of contexts of interlocution and sense-making, that these contexts are deeply intentional and intensely personal as well as being shaped by a prior world of established and conventional roles and meanings, and that rather than being logically contradictory these two aspects are mutually constitutive within a structure of unequal and differentiated positions.
This book concludes by returning to the individual mind, in its interiority and separateness, and to a philosophical version of the anthropological methodological quandary: how can we claim to know the intentions of others, widely separated from us by language, culture, and custom? Descombes’ last question is, thus: is it possible to say that two separate minds can, in their interiority, think the same thought? If they are linked by social institutions, governed by rules, and situated in a world, he answers, it is. One of the last philosophical examples in the book has to do with the thought of “having an appointment,” mediated by institutions as diverse as calendars and routines of mutual visiting. In this situation, Descombes argues, two people who are thinking about their mutual appointment are not, indeed, having identical thoughts—B is thinking that she must meet A, and A is thinking of her meeting with B—but “it is nevertheless acceptable to speak about the same thought if we take into account the fact that two complementary thoughts are involved” (p. 330, italics his). And this thought is a social one, possessed equally by two minds individually, which puts them in complementary—and likely hierarchical—relation as a function of their common thought. Thus Descombes manages to bring into communication two minds, without mechanism, and without determining in advance the content of their thought, and without the need to impose on their thoughts a given form or language. What is necessary here is simply the anthropological context in which any two people might have an appointment, which thus puts their separate thoughts in a complementary relation and makes them part of the same whole.
The “anthropological holism” of Descombes’ subtitle, then, is a structural one, which he is at pains to remind us has always also meant, in France, an anthropology of the mental, of l’esprit and la pensée. However, this comes with the important caveat that he seeks to preserve both the autonomy of the speaking subject, and the particularity and agonism of social interactions. Descombes cites, in passing, a “profound remark” made by Samuel Butler: “It takes two people to say a thing—a sayee as well as a sayer. . . . A may have spoken, but if B has not heard, there has been nothing said, and he must speak again” (quoted on p. 312). This mediated relation between what Descombes calls “two freedoms”—the freedom held by the sayer and sayee, individually, to speak, to listen, to repeat, to ignore, to insist, or to doubt—has a triadic structure in which the saying, the said, and the hearing or interpretation are each equally necessary, and none can, in advance, determine the outcome. Not only are the social institutions which give words sense important in this account, but so is the fact of their shared “mental” possession and their use in the thought and action through which linguistic and social structures are worked out.
All of this, of course, has implications which have more to do with matters of mutual understanding and interaction than they do with cognitive operations as such, in which latter much more than propositions are involved. And it could be seen as unnecessary to take this detour through an abstracted, philosophical and logical approach to the mind to find ourselves, simply, back at the scene of social interaction—where anthropologists were to begin with. But Descombes is not recommending a simple, common-sense turn to a “real” world of interactions—rather, it is the institutions of meaning that matter to him, and it is the insight into their systematic structuring as the “historical and social context of the human mind” (p. 261) which is most important here. Further, I think this idea of the mind is one which makes sense of some fundamental problems for any anthropology of mental life (which are also problems for the human sciences that take “the” mind as their object): how do we return from the separateness of individual minds to the common context in which we come to know them? It is Descombes’ achievement to have shown that the reduction of mental processes to associations or assemblies of interacting parts is no answer to this question, which demands instead an account of the plurality and holism of the meaningful relations—including those of kinship, class, power—which are in already at play in any intentional context, any situation of human interaction.
Descombes ultimately allies himself with anthropological and philosophical writers who “want to maintain that the social cannot be reduced to the nonsocial” (p. 295). In this, his work stands at some remove from current epistemological and ontological debates in the anthropology of science and medicine and science and technology studies, debates which while not reductive are oriented more toward understanding associations and interactions than invested in describing institutions (or “total social phenomena”) which could give such relations order or form. But Descombes doesn’t merely assert the priority of the social. Rather, he guides us back to the social in a way which renews classical anthropological holism and totality, using it to understand problems of intention and action (a faithful Maussian might add, “again”—and indeed, Descombes invokes “institutions, in Mauss’s sense” on the very last page of this book). Descombes starts from systematic relations internal to language (and their use in thought), moves through their deployment in contexts of reference, to arrive at the world of interaction and “institutions of meaning” in which any human mind must be set, to be able to operate. This structural, holistic pathway necessities abandoning Cartesian notions of causality, reworking ontological claims about individuals, and interrogating the reality of social facts (historic and ongoing challenges for anthropological theory, too). Returning, by this pathway, to dynamic and unequal interactions, social norms and imperatives, and the structural contradictions to which these can give rise, might help us better understand the very real force of social institutions in the situations in which human beings, together, speak and act with consequences beyond themselves and beyond their immediate context—including mental consequences. It may not be a paradox but a finding that we end up needing a holistic conception of the social to get to the mind.
Leo Coleman is Associate Professor of Comparative Studies at the Ohio State University. A cultural anthropologist by training, he is the editor of Food: Ethnographic Encounters(Berg, 2011), and has published several articles on ethnographic method and on urbanism, infrastructure, and legal knowledge in India and the British empire. He is working on a historical ethnography of electrification and state power in twentieth-century Delhi, India.
 The Mind’s Provisions: A Critique of Cognitivism, Stephen Adam Schwartz, trans., Princeton University Press 2001; originally published as La Denrée Mentale, Minuit, 1995).
 Richard Rorty, “The Brain as Hardware, Culture as Software,” Inquiry 47:3 (2004), 235.
Pesticides: can’t live with them, can’t live without them
In Sri Lanka, producers of the illicit liquor kasippu sometimes suspend a bottle of pesticide above the vat during the fermentation process. It is believed the kasippu will absorb the potency of the pesticide and add to its strength, increasing drinkers’ intoxication and pleasure. But there is also a danger the pesticide will fall in, and if so the batch will be poisoned and mass injuries and even deaths ensue.
Why do kasippu drinkers take this risk? Kasippu, a cheap spirit favoured by those on low incomes, is mostly drunk by agricultural smallholders and daily-waged farm labourers, for whom pesticides (a label including insecticides, weedicides, fungicides, etc.) form an integral part of everyday life. Sri Lankan farmers make heavy use of agrochemicals, applying products in large doses throughout the growing season. Faced with ever-increasing market competition, they are required to use greater amounts just to stay in the game—placing them on an ‘agrochemical treadmill’ propelling greater investment in pesticides for no greater return. Large upfront investments in agrochemicals at the start of the season do represent a considerable risk if harvests should fail, which, due to the unpredictability of Sri Lanka’s monsoons in recent years, they often do. Although Sri Lanka hasn’t witnessed the same scale of debt-driven ‘farmer suicides’ as India, the country has reported some of the world’s highest suicide rates.
Even if pesticide debts contribute only marginally to Sri Lanka’s suicide epidemic, pesticides themselves have still been the most popular method of self-harm in country, as indeed they are across many developing nations. It is this fact more than anything that pushed Sri Lanka’s suicide rate up so high, as the spread of pesticides in the island since the 1970s transformed an already-existing cultural practice of self-harm into a highly lethal practice. When in the mid-1990s the most toxic compounds were banned, suicide rates fell by half.
Besides intentional pesticide poisoning, farmers also run the risk of occupational pesticide poisoning and associated acute and chronic health effects. Hospitalisations caused by accidental inhalation are common, and long-term routine exposure can lead to a range of chronic illnesses. Since the 1990s a growing epidemic of fatal ‘kidney disease of unknown aetiology’ (CKDu) in Sri Lanka’s rural North Central Province has been linked to pesticide spraying, and/or contamination of water sources. Estimates have placed the fatality rate of CKDu at between three and eight deaths per day. On the back of this, the Sri Lankan government has issued further pesticide bans, although not without controversy. For example, a recent study suggested that glyphosate, a weedicide more commonly known as RoundUp, when mixed with hard water and other metals, was to blame for the problem. The Sri Lankan President immediately issued a ban on glyphosate, only to retract it a few months later after the European Glyphosate Task Force, a coalition of pesticide companies, questioned the evidence base.
Thus, on the one hand, pesticides have contributed towards economic and social development by promoting farming, reducing food prices, and opening previously hostile environments to cultivation. On the other hand, pesticides have led to economic dependencies and a wide range of health complaints and environmental problems. Although accepting pesticides as ‘dangerous things,’ farmers in Sri Lanka, stuck on an agrochemical treadmill, are unwilling or unable to give them up. Even the President was apparently unable to enforce a ban on glysophate, reversing a personal directive to the bemusement of critics. The ambivalent status of pesticides as objects that people can’t seem to live with, but also can’t seem to live without, is thus well-established in the Sri Lankan psyche. When viewed in this way, kasippu fermentation techniques come to make sense as a locally-grounded practice through which farmers can take control of pesticides’ ‘known and unknown’ effects.
Pesticide roulette and Schrödinger’s cat
One view onto this is to think in terms of risk, which as a sociological and anthropological subject has attracted significant levels of inquiry. Kasippu fermentation techniques can be understood as a kind of ‘pesticide roulette’ through which the benefits and dangers of agrochemicals in farmers’ lives and livelihoods are managed through a calculative process. Swallowing liquor fortified by the sheer presence of a substance that holds the drinkers’ economic and health wellbeing in its hands, but which might also contain lethal traces of that substance, is tantamount to inviting fate to play dice. To drink kasippu only to enjoy the rewards of drunkenness and avoid self-poisoning is to speculate. To imbibe and survive is a good sign. How the risks of pesticides are imagined and ranged against their potential benefits, and how different groups work these calculations within and between translocal contexts, is a fascinating question.
Another view is in terms of ambivalence—the sense of anxiety caused by a failure to classify something—that as a topic has received much less theoretical elaboration. In Modernity and Ambivalence, Zygmunt Bauman argues that ambivalence is a necessary condition of modernity. The project of modernity, according to Bauman, can be defined as an attempt to impose structure on the world through a system of classifications that ultimately serve in the interests of power—to classify, to decide ‘what is and what is not,’ is to rule. Thus ‘modern times,’ Bauman argues, constitute ‘an era of particularly bitter and relentless war against ambivalence.’ As a practice concerned with classification, pesticide roulette places things on a knife-edge, where the proper definition of pesticides—as objects that benefit or harm—is unknown until the kasippu is drunk. It is in terms of ambivalence that pesticides might be more fully understood, as calculations of risk can only be made once agreement has been reached about how an object of ambivalence ought to be classified. Like Schrödinger’s cat, we only know what’s in the bottle if we open it up.
Pesticides are not alone in their ambivalence, and pesticide roulette is just one example of how people around the world who are faced with ‘ambivalent objects’—those commodities and industries thought essential for human survival whilst also posing considerable potential harm—negotiate the dissonances they create. Popular culture is full of ruminations on the socially, ethically, and politically disorientating pace of scientific, medical, and technological advance that promise revolutions in human health and wellbeing whilst generating considerable, even apocalyptic, risks to people and planet. Reflecting the sheer importance of global food demands, many of these belong to the agricultural sphere. The potentials of organic farming notwithstanding, genetically modified crops present themselves as the only alternative to pesticides—even as critics argue that ‘frankenfoods’ could end up creating terrifying hybrids of plants, animals, and insects and do as much harm as chemicals. Pesticides and GMOs are themselves only a subset of a wider class of ambivalent objects. These include nanotechnologies (which might revolutionise medical care, or turn the world into grey goo); psychopharmaceuticals (which might elevate the mental health of developing nations, or co-opt millions into capitalism’s psycho-fictions); and the whole range of alternative energy sources (which might save us from environmental catastrophe, or simply pollute in a whole range of indirect ways).
Ambivalent commodities and technologies embody the conditions of modernity that produce them. Most people agree that but for a few early products, pesticides as we know them have only been around for 70 years or so. When in 1962 Rachel Carson published the seminal Silent Spring, a book charting the human and environmental devastation wrought by pesticides, she began by describing how the Holocaust produced much of the science behind them, when it was realised that chemicals used to kill people could also kill insects. No less significant is the fact that pesticides were born during the turbulent years of World War II, and revolutionised farming at the beginning of the post-war period, becoming the cornerstone of an agroindustry that fed the rapidly growing population of the modern world. Pesticides are not only the first of the ambivalent objects filling the world around us, but a condition of modernity. Pesticides are necessarily ambivalent; they provide objects against which we can range our values and opinions of modernity, even as they create the very conditions that allow us to ask those questions.
Departure points for a study of pesticides
As pesticides criss-cross the planet from points of manufacture to points of use, they pass through multiple contexts that shape responses to ambivalence and create new forms of ambivalence in their wake. Exploratory ethnographic fieldwork conducted in Sri Lanka points towards four inter-related sets of issues that have bearing on how this unfolds. The first set concerns how pesticides’ health effects are conceptualised by homeopathic and allopathic medical systems, including how they position human bodies vis-à-vis agrochemical landscapes. The second set escalates pesticides’ effects to the level of populations, aggregating them with changing concerns of ‘security,’ including food security, health security, and national security. The third set illuminates the ideological assumptions underpinning these problems and the practical interventions they suggest, including tropes of pesticide ‘safe use’ and ‘safe storage.’ The fourth set escalates further still to the level of global health governance, revealing how debates concerning pesticides are buffeted by debates around ambivalent objects and associated non-communicable diseases more widely.
The first set of issues thus concerns pesticides’ health and environmental benefits and risks in the most fundamental sense. In the decades’ worth of arguments stressing their ‘pros’ and ‘cons,’ this is a space where the vast majority of debates concerning pesticides have taken place. Directing these debates are grand traditions of medical and scientific inquiry, from the allopathic biomedical through to the homeopathic Ayurveda, as well as newer cross-disciplines of environmental science and green politics. Far from existing as a field of detached scientific endeavour, pesticides excite passions. Debates on either side have drawn as much from emotional rhetoric as rationale argument, leading to suspicion, misunderstanding, and antagonism between different lobbies. In Sri Lanka, things aren’t much different. CKDu generates lively arguments between camps, often spilling over into academic and political spats. How commentators evaluate and employ the evidence often says as much about departmental affiliation, old boy networks, and views on the current regime.
Yet health traditions themselves are not always so far apart as might be assumed, and homeopathic and allopathic practitioners get together on a range of subjects. Both are concerned that pesticides affect human behaviour at an emotional level, fuelling the suicide rate by heightening levels of impulsivity in the population. How they imagine such connections links bodies and environment in intriguing ways. Margret Trawick’s description of the Ayurvedic understanding of the body as ‘a landscape, an open field with all the processes flowing visibly, at or near the surface,’ is implied in the chains established between crops, bodies, and minds investigated by biomedical health researchers. Sri Lankan Ayurvedic doctors suggest that the island’s suicide rate went up when pesticides entered the food chain, making minds and bodies ‘hot’ and leading to emotional outbursts including suicide. Building a similar causal narrative, allopathic health researchers are investigating correlations between body absorption of pesticides and impulsive suicidal acts.
The second arena escalates these concerns to the level of populations. Since ‘9/11’ fears over bioterrorism and the release of diseases like smallpox, animal-human transmission of influenza strains and resulting pandemics, and the effects of climate change and extreme weather events, have combined to create a nexus of ‘national security’ threats converging on health and environment dangers. The role of pesticides in these debates is, as ever, paradoxical. The Green Revolution was so-called because intensive farming methods including agrochemical use promised ‘food security.’ The use of pesticides to control mosquito-borne diseases like malaria, and, an increasing concern in urban South Asia, dengue, represents a source of ‘health security.’ But the crisis represented by CKDu and the pesticides said to cause it are explained in terms of a threat to ‘national security.’ When another research report indicated high levels of arsenic in rice was responsible for CKDu, the government allegedly blocked publication. According to the director of the national kidney unit, the thought of the ‘everyday plate of rice and curry’ suddenly becoming a major health risk was simply too much – people would revolt. Thus pesticides have transformed from nation-builder to nation-protector to nation-destroyer.
In its satirical cartoon depictions of modern-day crises facing the nation, the Sri Lankan Daily Mirror captures elements of these debates. In Figure 1, we see Sri Lanka’s troublesome relationship with India cast in terms of bird flu, from where it may spread. On the same theme, in Figure 2, in an image reminiscent of those of civil war that until recently filled Sri Lankan newspapers and TV broadcasts, we see a white-coated doctor gearing up to blitz a flock of infected birds. In Figure 3, threats posed by mosquito-borne diseases align with threats from industrial action in the health sector. Finally, in Figure 4, a sorrowful image of the island itself, recovering from a kidney transplant operation on World Kidney Day.
From their effects upon people, planet, populations, and peace, the third set of issues encompasses the solutions that governments, health NGOs, and academics advocate. One of the most common problems cited by people on all sides of the debate concerns the behaviour of individual farmers in their agrochemical practices. On one side, we find the anti-pesticide NGO Pesticide Action Network Asia Pacific (PAN AP) stressing how farmers in the region are unable to afford the necessary protective clothing and equipment, which is anyway too hot and cumbersome to use in a tropical climate. On the other side, we find Syngenta AG, a major pesticide producer, promoting a range of guides in local languages that seek to convey the importance of ‘following the guidelines’ of safe use. A third dimension here is provided by poisoning treatment and prevention organisations like the South Asia Clinical Toxicology Research Collaboration (SACTRC), which argues most suicides by pesticides are committed by impulsive self-harm and so is trialling a lock-up box intervention that seeks to limit access to pesticides in the home.
Within these approaches, we find particular theories of human behaviour and risk evaluation that underpin pesticide interventions, as they aspire to create ‘responsible’ farming practices. This includes how concepts of culture are worked to explain South Asians’ apparent lack of risk sensibility and presence of impulsivity, as well as reflecting interventionists’ ‘Euro-American’ understandings of ‘investment and return’ in farming technologies, particular gender and age divisions of (farm) labour, and globalised notions of risk and reward. At stake here seems to be the creation of an ‘agrochemical citizenship’ to be promoted as a lasting solution to pesticide injuries and deaths in the region. The problem thus confronted is one that has troubled Sri Lanka for some time. In the late 19th century, British colonialists attributed then high rates of homicide to the impulsive character of the Ceylonese, whom they argued were prone to ‘sudden anger.’ As with pesticides today, the British banned open knives with the hope that folding knives would replace them, giving time for the victim to escape while the attacker fumbled with the blade. In addition to this, the colonialists set out to teach boxing to village youth, with the intention of inculcating a sense of ‘fair play’ and ‘self-control’—a foreshadowing of the 21st century pesticide safe storage discussion that was to come.
Finally, we arrive at the fourth set of issues: linkages between theoretical research and the world of policy and practice in the global health governance (GHG) of ‘ambivalent objects.’ At global level, arguments in favour of and against agrochemicals draw from a range of positions concerning the responsibilities of different actors to limit their risks and promote their rewards. These arguments change across the local contexts through which pesticides pass, and in relation to the health and environmental benefits or problems they may cause. Pesticide regulations limiting toxicity and wider human and environmental impacts are of a different order from regulations which respond to flagrant misuse or intentional poisoning and suicide. Whilst for many people the former may be an ethical and moral responsibility of the pesticide industry, the latter could be construed as the responsibility of individuals solely, or perhaps of the state. Thus, on one level, global health debates concerning pesticides are similar to those concerning tobacco, sugar, salt, and trans fats—companies and consumers each have a duty to behave in a more responsible way. On another level, many pesticides are not expected to make it to the dinner table at all, having disintegrated, been washed off, or otherwise removed at an earlier stage. Put another way, tobacco companies and food manufacturers exist more in the public’s mind than pesticide companies ever have, or likely ever will.
These four sets of issues – bodies and landscapes, nations and threats, chemicals and citizenships, and the complexities of governance – sketch a framework for the study of pesticides and their ambivalences. These are just some of the issues I will be exploring over the next three years, as I trace pesticide products from points of manufacture to points of use, within and between Europe and South Asia. The immediate problem is how pesticides are to be understood in social, ethical, and political terms at local and global levels. The wider significance is how processes attendant to globalisation create ambivalent objects, both as a function and as a condition of modern worlds, which are increasingly filling the world around us.
Tom Widger has conducted ethnographic fieldwork in Sri Lanka for the past 10 years. His first book, Suicide in Sri Lanka: The Anthropology of an Epidemic, will be published later this year. He was recently awarded a Wellcome Trust Society & Ethics Research Fellowship, for the project ‘Pesticides and global health: an ethnographic study of agrochemical lives.’ Find out more at http://www.tom-widger.com/pesticides-and-global-health.html. @tomwidger
 For a case history of this practice see: Dias, S.R. (2009) ‘A novel mode of paraquat poisoning’ Ceylon Medical Journal 54(2): 69-70.
 The concept of ‘agrochemical treadmill’ is elaborated in: Dowdall, M.D. & R.J. Klotz (2014) Pesticides and Global Health: Understanding Agrochemical Dependence and Investing in Sustainable Solutions Walnut Creek, CA: Left Coast Press.
 At the time of writing Sri Lanka’s north and east was suffering from an extended drought: http://www.irinnews.org/report/99884/drought-begins-to-bite-in-sri-lanka.
 For a critique of the ‘farmer suicide’ thesis, see: Münster, D. (2012) ‘Farmers’ Suicides and the State in India: Conceptual and ethnographic notes from Wayanad, Kerala’ Contributions to Indian Sociology 46(1&2): 181-208.
 Eddleston, M. & M.R. Phillips (2004) ‘Self-poisoning with pesticides’ British Medical Journal 328: 42-44
 Widger, T. (2014) ‘Reading Sri Lanka’s Suicide Rate’ Modern Asian Studies 48(3): 791-825.
 International Water Management Institute (2014) Review of Literature on Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka Available from: http://www.iwmi.cgiar.org/2014/05/review-literature-chronic-kidney-disease-unknown-etiology-ckdu-sri-lanka/.
 Jayasumana, C., S. Gunatilake, & P. Senanayake (2014) ‘Glyphosate, hard water and nephrotoxic metals: are they the culprits behind the epidemic of chronic kidney disease of unknown etiology in sri lanka?’ International journal of environmental research and public health 11(2): 2125-2147.
 For a review see: Caplan, P. (ed) (2000) Risk Revisited Pluto Press.
 Bauman, Z. (1990) Modernity and Ambivalence John Wiley & Sons.
 Kirmayer, L.J., & H. Minas (2000) ‘The future of cultural psychiatry: an international perspective’ Canadian Journal of Psychiatry 45(5): 438-446.
 Carson, R. (1962) Silent Spring Boston: Houghton Mifflin Company.
 Trawick, M. (1992) ‘Death and nurturance in Indian systems of healing’ In: C. Leslie (ed) Paths to Asian Medical Knowledge London: University of California Press, pp. 129-159
 Author’s ethnographic observations.
 Collier, S.J., A. Lakoff, & P. Rabinow (2004) ‘Biosecurity: towards an anthropology of the contemporary’ Anthropology Today 20(5): 3-7.
 Widger, T. (2012) ‘Suffering, frustration, and anger: Class, gender and history in Sri Lankan suicide stories’ Culture, Medicine, and Psychiatry 36(2): 225-244.
On July 3 of this year, the face became an “organ”. Changes to US Federal health policy came into effect, moving face transplantation into the jurisdiction of medical procedures governed and administrated by the agencies that oversee the US national transplant system – the Organ Procurement and Transplant Network (OPTN) and the United Network for Organ Sharing (UNOS). This policy introduced into the world a new type of thing: the “VCA organ”. The term refers to vascularized composite allografts, complete sections of tissue that are procured for transplantation. The most common VCA procedures are face transplantation and hand transplantation. My research to date has examined how the former has introduced new institutional and epistemic understandings and practices into world of biomedicine. In my book On Face Transplantation: Life and Ethics in Experimental Biomedicine (Palgrave Macmillan 2014), I argue that what is being remade in face transplantation is not only the lives of patients, but also the very ways in which state institutions, surgeons, and families make sense of rights, claims for inclusion, and life itself in the contemporary world.
In this post I want to shift focus a little to think about how the ontological status of body parts in technomedicine are shaped vis-à-vis regulatory practice. One of the most well known examinations of ontology in medicine is Ann Marie Mol’s The Body Multiple (Duke 2003), in which the author masterfully demonstrates how “medicine enacts the objects of its concern and treatment,” that is, how it “attunes to, interacts with, and shapes its objects in its various and varied practices” (vii). While it isn’t yet possible to show in detail how the face for transplantation in enacted in light of this policy change, its new status as a VCA organ has been cause for deliberation by the agencies that until now have been responsible for administrating the procurement and allotment of body parts such as the heart, kidney, and liver.
Recently I have been reading through the minutes of the OPTN VCA Committee, which was established to review agency policy in light of the aforementioned changes to the Federal health law. This has made me consider whether something is missing from those hospital-based accounts of ontology and medicine. Are we leaving anything out if we begin our analysis in the present by looking at how the body is experienced and enacted in and through clinical practice? The deliberations of the VCA committee suggest that we should take more notice of the background work that implicitly shapes the clinical space – that we should examine how ontology in medicine is constituted in/by practice and policy.
In this short post, I want to examine this idea. The changes to national transplant law and the redefinition of an organ to include VCAs mean that the face for transplantation now has a rather peculiar ontological status. It is never just a face and never fully an organ; it is only an organ once it is removed from the donor and transplanted to the recipient, at which point it straightaway becomes a face; as a VCA the face extends past the immediate area of the face to include veins, nerves and extra tissue that would aid operative outcomes. The ontological status of the face in this form of medicine is thus both fluid and fractured. This echoes Mol’s account of how medicine shapes its objects. Let’s have a look then, at how such shaping is mediated by policy and broader sociopolitical concerns.
The Federal changes to the definition of an “organ” sought to standardize clinical practice for VCA procedures and, in doing so:
…ensure equitable access for those awaiting VCA transplantation, [as] there is a need to provide for consistency in allocation processes and reliable outcomes reporting on a nationwide basis. Appropriate Federal oversight of a national allocation system can increase safety of such transplants and provides equitable and consistent national access to such transplants while also conveying to the public that donation for such purpose will serve an essential medical need, (OPTN, Notice of proposed rulemaking).
Contained within the above is an implicit understanding of what both VCA procedures and the US state are about: ensuring equitable, safe and essential biomedicine. In making the face an organ, the Federal government has nationalized face transplantation in two interrelated ways: by standardizing disparate practices and by encoding them with values of what it stood for. From the get go, then, we see that normative sociopolitical concerns have been embroiled in the shifting status of the face for transplantation.
The piece of law that governs organ transplantation in the USA is referred to in short as the OPTN Final Rule. The modifications to this law were made in late 2013 and required the national transplant agency to develop policies for VCA transplant before July 3. Following amendments to the Final Rule, now “Organ means a human kidney, liver, heart, lung, pancreas, intestine (including the esophagus, stomach, small and/or large intestine, or any portion of the gastrointestinal tract) or vascularized composite allograft.” Accompanying the classification of VCAs as an organ are nine criteria. For a graft to be considered a VCA, it must be something:
- That is vascularized and requires blood flow by surgical connection of blood vessels to function after transplantation;
- Containing multiple tissue types;
- Recovered from a human donor as an anatomical/structural unit;
- Transplanted into a human recipient as an anatomical/structural unit;
- Minimally manipulated (i.e., processing that does not alter the original relevant characteristics of the organ relating to the organ’s utility for reconstruction, repair, or replacement);
- For homologous use (the replacement or supplementation of a recipient’s organ with an organ that performs the same basic function or functions in the recipient as in the donor);
- Not combined with another article such as a device;
- Susceptible to ischemia and, therefore, only stored temporarily and not cryopreserved; and
- Susceptible to allograft rejection, generally requiring immunosuppression that may increase infectious disease risk to the recipient, (OPTN Policy Notice 7-1-2014).
The role of the VCA Committee was to assess OPTN policy in light of the new status of composite allografts as organs, making suggestions as to additions to and deletions from previous guidelines. In making policy suggestions to the agency’s board of directors, it was able and required to engage with the interpretive flexibility of the above nine criteria. Until July 3, there were no formal guidelines for performing the procedure, and the three active teams that since 2008 have completed seven such operations did so with the oversight of their respective hospital IRBs. The protocols established and used by these individual teams brought together longstanding organ transplant guidelines with specific measures developed to ensure the success of the operation, such as more rigorous candidate selection to minimize the risks and increase the benefits of the operation (Taylor-Alexander 2014). And while these teams had been gaining “extra” consent from donor families for the use of VCAs from the face, there was no national mandate for them to do.
How Committee members understood the new definition of a VCA organ, and its ramifications for clinical practice, was mediated by their own backgrounds and what they considered to be broader sociopolitical concerns. During six months of contemplations and information gathering, VCA committee members came to tackle a number of related issues that emerged with the introduction of this new kind of organ. These ranged from: ‘what kinds of VCA should be regulated by the OPTN?’ and ‘how should consent for procurement be obtained?’ to concerns that people would be less likely to go on the organ donor registry if they thought it possible that their face or hands would be transplanted. Reading over the meeting minutes, it is possible to see how these issues were settled in tandem; in the process questions of knowledge were coproduced with questions of politics, of social order.
For the purpose of this short post, I will take a look at the above three questions to show how the Committee worked within a broader frame that paralleled federal concerns with equity, safety and public regard for biomedicine. In its first meeting, a teleconference on January 22, the issue of what VCAs should be regulated by the OPTN was raised alongside the question of what exactly a VCA is: Is the recovery of extra vessels/tissue/nerves for the purpose of an enhanced outcome allowed? Members debated whether to employ an encompassing definition with broad guidelines for all composite allografts or to produce specific measures for each kind of VCA – i.e. separate protocols for face, hand, limb, etc. The Committee Chair, UCLA transplant specialist Dr Suzanne McDiarmid, emphasized that one of her aims was to “move relatively quickly into discussing specific elements necessary to better facilitate, and thereby maximize VCA procurements…” She recommended that the Committee therefore focus on face and hand transplantation, as they are the most common VCA procedures performed.
In subsequent meetings, the Committee made a number of policy decisions that simultaneously introduced standardized clinical practice while stabilizing the meaning of Vascularized Composite Allograft. Additional informed consent procedures for harvesting faces and hands for transplant was made a requirement, while the Committee thought it reasonable to work with the same framework established for solid organ procurement when deciding what exactly could be taken from a donor body under the label of VCA. The issue of access was addressed by producing national waiting lists and, in the future, recipients will be allocated organs through updated OPTN/UNOS software, which uses an algorithm to rank patients based on criteria such as patient need. While this bureaucratization of face (and other VCA) transplantation is yet to be explored on a clinical scale, I think it tells a story about how policy influences medical practice and thus the ontology of the body.
The nine criteria that define VCA organs were implemented to secure the status of medicine and the values of the US state as equitable and necessary organizations that exist to protect the health and safety of the population. These policies were introduced on the back of the emergence of new types of medical procedures – face and hand transplantation – which arguably introduced public concern about the limits of biomedicine and the role of the state vis-à-vis the bodies of citizens. The resulting changes at the level of OPTN/UNOS policy have standardized and altered how the face for face transplantation will exist in the clinical space.
Unlike solid organs – kidneys, hearts and livers – the face is not considered an organ until it is harvested and transplanted for therapeutic purposes. There are a number of clinical practices that are necessary for this to take place: how the face is enacted, how it exists in networks of clinical practice is mediated by its new classificatory status. A number of practices must be put in place for this to be possible. Alongside new procedures for informed consent and allocation, how the face is treated in the clinical space has also been standardized. It must be labeled in a new way, travel accompanied by paperwork, not be combined with “another article or device”, and used solely for replacing a person’s body part. (If the procedure does not conform with the last two criteria, it would likely fall under the regulatory authority of the FDA.) What the face is, how it is understood and constituted and the clinical arena, has thus been altered through the implementation of new regulatory policy.
In this short post I have aimed to draw attention to the role of medical policy in the making of clinical practice. In debasing established practices and calling into questions longstanding accounts of what society stands for, emerging technomedical fields often become the site of intense scrutiny and political oversight. The result is what Sheila Jasanoff has termed “constitutional moments,” instances of sociotechnical work that reorder both the social and natural world – medicine and its objects, in this case. Examining the background work that goes into the shaping of clinical practice in such a way, I suggest, is important because it allows us to better grasp how emerging technomedical fields become imbued with understandings of what a nation stands for. “How the Face Became an Organ” is thus a story of how the classification and enactment of the body in biomedicine is shaped vis-à-vis particular conceptions of how the US state should act vis-à-vis its citizens.
Samuel Taylor-Alexander is currently a Visiting Scholar in the Department of Anthropology, University of Copenhagen. He wrote his PhD at the ANU and was a doctoral fellow in the STS program at Harvard University. Samuel is the author of On Face Transplantation: Life and Ethics in Experimental Biomedicine (Palgrave Macmillan 2014). His research seeks to understand how national imaginaries shape everyday and experimental medical practice.
Premise and Summary
This is a very provisional text, part of a broader book-length research (forthcoming from Palgrave in 2015) on ‘political epistemology’, a construct I use to investigate the coproduction of epistemological facts and socio-political values in the history of the life-sciences (e.g.: how certain views of heredity, development, nature/nurture potentially favor certain political values and conversely, how socio-political contexts/pressures have shaped the epistemic construction of key notions in biology such as the gene, the brain, human nature, and so on).
In the spirit of a (developing) political epistemology analysis, this paper aims to problematize the socio-political implications of a return to a neo-Lamarckian framework and to examine a possible unforeseen aspect of the notion of local biologies in policy/public health discourses as a consequence of the recent rise of epigenetic research. Epigenetics, as is well known, is a burgeoning discipline in molecular biology that investigates changes in gene expression that do not imply alterations of DNA sequences. These changes (for instance, methylation) are often driven by environmental inputs (included social interactions for the human species) and are believed to be in some cases stable enough to be transmitted trans-generationally even in higher organisms, humans included.
Epigenetics can be considered the most advanced example of the new postgenomic and context-dependent view of the gene that is making its way into contemporary biology (Stotz, 2008; Griffiths and Stotz, 2013; Keller, 2012, 2014; Meloni, 2013b; 2014a, b; Meloni & Testa, 2014).
In this piece, I ask whether the social, environmental, and contextual shaping of genetic expression which is implied by epigenetics may give rise, in the wider society, to a public rhetoric that identifies local groups/populations with different epigenetic marks (reflecting for instance their disadvantageous conditions over history) and how these potentially vulnerable/risky sub-populations may become the target of a new (postgenomic) biopolitical intervention.
I ask (rather provocatively, I can see that): 1) whether there are any dark unforeseen implications of epigenetics remaking the notion of local biologies and 2) what emancipatory potential (if any) was implied in the notions of universal human nature and universalistic biology that were elaborated after 1945, and have been progressively destabilized since the 1990s.
The fortunes of local biologies and their epigenetic remaking today
The concept of ‘local biologies’ has enjoyed a deserved success since it was coined in the early 1990s by Margaret Lock (1993), as a very healthy antidote to the abstract body of genetics and biomedicine, on one hand, and the disembodied body of social constructionism, on the other. When Lock first wrote about local biologies, the wave of epigenetics studies was still to come and her concept was a result of anthropological observations, not biological measurement, of the continuous exchange between the social and the biological in the production and reproduction of bodies in situated socio-cultural contexts (Lock, 2012).
“Recognition of the embodiment of an historicized biology” (Lock, 2001) suggested a more sophisticated conceptual move than the actual realization, which took place only after the 2000s, that biological signatures of socio-environmental exposures can literally leave marks on the genome, acting as a sort of bio-markers of social position and local contexts.
It is far from me to claim that the current explosion of epigenetics studies of social position is a mere actualization, for the molecular age, of the notion of local biologies. I am aware that Lock has expressed skepticism at the reductionist implications of epigenetics (2005, 2013). Nonetheless, as Jörg Niewöhner has pointed out (2011), it seems fair to recognize that researchers in epigenetics are the first ones who see their research as being practiced under some sort of local biology paradigm. After all, what they are trying to achieve, as Niewöhner claims, is to explore the hypothesis that “gene expression may be connected in significant ways to local cultural practices” (2011).
The point I am trying to make is that epigenetics asks questions which are in a sense possible only in a genuine local biologies approach and which, when the concept was first coined by Lock in the early 1990s, were rather taboo, or even impossible to imagine. These are questions such as: do manual workers have different gene expression compared to non-manual ones? Do the poor have different patterns of methylation than the rich? Are distinct patterns visible across other differences: The psychologically traumatized versus the simply melancholic? The Black versus the White? The obese versus the slim?
For technological and conceptual reasons, all of these questions are now becoming possible to ask and are actually on the rise in the burgeoning field of social epigenetics. Is this a molecular translation of local biologies? Or is this a development to which the notion of local biologies may actually bring a serious critique?
Taking just one example of the recent wave of social epigenetics research, a study by Dagmara McGuinness and colleagues (2012), addresses the correlation between socio-economic status (SES) and methylation patterns in socio-economically deprived and affluent areas of the Scottish city of Glasgow. McGuinness and her colleagues found aberrant levels of methylation in “the most deprived group of participants, when compared with the least deprived” (2012: 157). Manual workers have also been found to have “24% lower DNA methylation content than non-manual”. What seems to emerge from this study is a sort of new social cartography of the city of Glasgow, one based on (dichotomous) differences in the biology of its members (affluent vs. deprived; manual vs. non-manual workers). Epigenetic marks, in this case methylation patterns, act as a sort of “bio-dosimeter” (ibid., 157) assessing the impact of social adversity (past and present) on lifestyle and disease susceptibility (see for a broader reflection: Landecker and Panofsky, 2013).
To the extent that it is not only present social hardship which social epigenetics associates with aberrant patterns of methylation, but also, it is claimed, the transgenerational inheritance of unfavorable environments (“you are what your grandma ate,” as the new epigenetic slogan says), epigenetics is increasingly identified as the missing mechanism to explain niches of neglect and social hardship within specific populations/areas/social classes. And the city of Glasgow of course was an excellent target for such a preliminary exploration given its quite exceptional level “of health inequality not fully explained by conventional risk factors for disease” (McGuinness et al., 2012).
In other words, what emerges with epigenetic research is that my parents or grandparents didn’t only pass on to me a bunch of genes, but also their various misbehaviors (the negative effects of smoking for instance, see Pembrey et al., 2006) or misfortunes. And notice that the distinction between misbehaviors and misfortunes become increasingly blurred in an epigenetic framework (Loi et al., 2013). For instance, they passed on their own exposure to poor nutrition (Hejimans et al., 2008), or, as in the works of Michael Meaney’s group on rats, even the effects of inadequate mothering (see Weaver et al., 2004). Marx’s dictum that “the tradition of all dead generations weighs like a nightmare on the brains of the living” may find a novel epigenetic incarnation in scenarios like the Dutch Hunger Famine or Marcus Pembrey’s studies on transgenerational effects of food availability in North Sweden.
In sum, specific social-environmental experiences become transgenerationally imprinted and embedded in locally defined populations. A certain sort of “inertia” is inscribed and reproduced amongst certain social groups.
How far are we here from the Lamarckian notion of ‘race memory’ that Boasian anthropology fought against? Are we witnessing the beginning of a postgenomic form of classification of ‘kinds of people’ based on novel (non-genetic) biological grounds? What if the emphasis is mostly placed on the perpetuation of harmful environments from generation after generation in specific groups?
To sum up once again: epigenetics, along with related discoveries in molecular biology, may certainly contribute to “undermin[ing] the notion of biology as a universal standard against which human difference may be adequately accounted for” (Lock & Nguyen, 2010: 109). In promoting a view of the “embedded body” (Niewöhner, 2011), epigenetics can be considered an ally (with due anthropological corrections) of the local biologies construct.
However, these findings may also be taken up and circulated in the broader society in a way which differs fundamentally from the original notion of local biologies. Evidence for the existence of social groups with different biological signatures may have more unpredictable effects than merely critiquing the persistent belief in the “universal applicability of biomedical knowledge and technologies” (Lock & Nguyen, 2010: 361). It is the same idea of a universal human biology/human nature that might be challenged by this return to the idea of some sort of Lamarckian inheritance and transgenerational transmission of “local exposures”. And, it has to be remembered, this idea of a universal human biology/human nature was developed after 1945 for well-defined political reasons.
Why a notion of universal human nature was constructed after 1945
After the trauma of eugenics and Nazism at the end of WWII, biological explanations in the social arena were totally discredited. In the period immediately after 1945, public writings by evolutionists on the social implications of biology tended to be rather moderate (or self-restrained): the place of culture and society had to be entirely recognized, no invasion of fields was possible, boundaries between biology and human behaviours were respected (see Dobzhansky & Montagu, 1947: “man has escaped from the bondage of the physical and the biological”).
Biological speculations on the “inequality of men” (Haldane, 1932), which had been rather common even amongst leftist biologists before 1945, were now increasingly silenced. It is not difficult to see why biology in human affairs had such a bad name after 1945 and why biology was used in such a cautious way in public affairs immediately after WWII. In the aftermath of the Nazi catastrophe (Nazism is ‘applied biology’ was after all a very sad leitmotiv of the German regime), the complicity of American as well as European eugenicists, not only in sterilization policies in their own countries, but also in building the Nazi’s murderous program, were evident and scandalous. The explosive effects of biology in the public arena were to be neutralized and its bad name cleaned.
The efforts of people like Ashley Montagu in writing the UNESCO statement on race (published as The Race Question in 1950) were to deflate and de-emphasize the role of biology in defining race. The Race Question emphasizes the universality and the “likeness” of human beings as much more important than their supposed differences. Confucius’ dictum that “Men’s nature are alike; it is their habits that carry them far apart” is quoted in point 9. Biological studies are said in the statement to “lend support to the ethic of universal brotherhood” (UNESCO, 1950, 14).
There were only two possible ways of making sense of post-1945 biology in public affairs. 1) One was to deny that biology had anything to do with human affairs in any specific way. This was the road taken by culturalism, which remained mainstream until the 1970s. 2) The second was to claim that biology had much to do with human affairs, but in the same measure for everyone and everywhere, black-boxing any local differences.
After the emergence of sociobiology in 1975 the latter approach was taken by evolutionary psychologists and the proponents of many varieties of universal nativism (ranging from Steven Pinker to Marc Hauser) which gained ascendancy in the 1980s and 1990s in studies of language or morality. These studies argued that there is a universal human nature hardwired in our biology or our brain that constrains the limits of its (superficial) cultural variation (see for a critique, Meloni, 2013a).
Many discoveries contributed to this universalistic trend, although it is impossible to tell the whole history here. These range from paleoanthropology (the “Out of Africa” theory), to Crick’s dogma of molecular biology (1958) which undermined any possible influence of the environment on genetic information, reinforcing that “encapsulation” of the genetic material (Gottlieb, 2000) already anticipated in August Weismann’s separation of the germline from the soma.
Emphasizing strongly that biology is about a universal human nature shared by all human beings which has remained unchanged since the Pleistocene (as later evolutionary psychologists would claim) was the best insurance policy against the possible resurgence of dangerous ideas in biology. As Tim Ingold writes: “the appeal to an essentialist [and universalist] concept of human nature” was the only way to reconcile evolution with “the new-found commitment to universal human rights” (2006).
I can see the paradox in my claim that sociobiology and evolutionary psychologists partly played a role on the egalitarian side of post-1945 biology. Politics and epistemology are often in a complex relationship, which is never a one-to-one connection. For instance, if one looks at a broader historical context, the associations between Lamarckism and racism are evident (Stocking, 1968; Bowler, 1983), while the links between classic gene-centrism/Neo-Darwinism and egalitarianism are less rare that one might think.
In this sense, the case of Soviet eugenics and the writings of now forgotten Soviet geneticist Yuri Filipchenko are very telling (Graham, 1978). Filipchenko attacked Lamarckism in the name of the Soviet Revolution claiming that if Lamarckism not Mendelism was true “all socially or physically deprived groups, races, and classes of people-such as the proletariat and peasantry and the nonwhite races-would have inherited the debilitating effects of having lived for centuries under deprived conditions. Far from promising rapid social reform, the inheritance of acquired characteristics would mean that the upper classes are not only socially and economically advantaged, but genetically privileged as well, a result of centuries of living in a beneficial environment” (Graham, 1978, my italics).
As we know, this argument was to be dramatically defeated in the Lysenkoist USSR. Nonetheless, to the extent that epigenetics is a sort of return to Lamarckian research, Filipchenko’s argument might deserve a second look in our postgenomic age.
Remaking social classes in the postgenomic era
Social historians like Michael Katz have recently warned that we must pay attention to the present resurgence of biological definitions of the poor (2013) fearing a return to a biologically-based class racism. As Katz claims, “in the late eighteenth and early nineteenth centuries, a harsh new idea of poverty and poor people as different and inferior” took place, what he calls “The Biological Inferiority of the Undeserving Poor”, part of a broader process that made the poor a separate and dangerous kind.
It is too early to say if epigenetic studies of different methylation patterns between poorest and richest areas will be used to offer a revival to such ideas, as Katz himself and many other in social policy fear, and as Filipchenko thought in the 1930s. However, fracturing the universal view of human nature into potentially differentiated sub-groups of risky and vulnerable populations identifiable by different epigenetic biomarkers, because of their persisting exposure to bad environments, may open a Pandora’s box whose political consequences (such as new stigmas associated with race and class) will not necessarily be in the hands of scientists.
This box was thought to have been firmly closed decades ago by biology (with hard-heredity) and anthropology by severing any equivocal link between biological and socio-cultural processes, (Kroeber 1917, see Stocking 1968). But the new epigenetic configuration will be again a moment of equi-vocity, where the different voices of biological and socio-cultural disciplines will become more and more indistinguishable (as in the Latin root of aequivocus). This undoubtedly presents new challenges for the social sciences. In hindsight, the challenges posed by the notion of local biologies may look like just the beginning of a more profound paradigm-change.
Maurizio Meloni is a social theorist working on the history and political implications of the life-sciences, neuroscience and epigenetics in particular. He has published in journals such as Frontiers in Human Neuroscience, Sociology, Economy and Society, The Sociological Review, Subjectivity, Telos, History of the Human Sciences, BioSocieties, in the edited volume Neurocultures (2011) and in a collection on neuroscience and political theory (Routledge, 2012). He is currently preparing a book on biology and social theory in a postgenomic age. After two consecutive Marie Curie Fellowships at the University of Nottingham, he is now affiliated (as Honorary Senior Lecturer) with the College of Social Sciences and International Studies (Egenis), University of Exeter, UK. For 2014-2015 he is a Member of the Institute for Advanced Study (School of Social Science), Princeton, USA, where he has been awarded a fellowship for his research on sociology and epigenetics. Please send correspondence to: email@example.com
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 This a slightly revised version of a text presented at the workshop “Embodied Being, Environing World: Local Biologies and Local Ecologies in Global Health”, organized by Alex Nading, Vinh-Kim Nguyen, and Nathanaël Cretin and supported by the Chair in Anthropology and Global Health in the Collège d’études mondiales and the Fondation Maison des sciences de l’homme, Paris, France on June 5 and 6, 2014. The text has been mostly left as originally presented, and therefore reflects an oral style of presentation, with no ambition of peer-reviewed accuracy. Thanks to Des Fitzgerald for kindly commenting on a first iteration of this text.
 As Lock (2012) writes: “my conclusion after several years of fieldwork, that biological difference must be implicated in the menopausal transition, was inferred from a robust statistical study fully complemented by intense qualitative research, based on symptom reporting of middle-aged women. The idea of local biologies was the result of intense, informant-centered research about subjectively experienced bodily happenings. It was not possible for me to measure biological difference, nor did I seriously entertain the idea, although this has since been carried out”.
 As Niewöhner claims: “the researchers in Szyf’s lab have been the first group of molecular biologists that I have encountered who appreciated the point of the notion of local biology. Trying to incorporate ‘social life’ into molecular analyses makes immediately plausible that even something seemingly hard-wired such as gene expression may be connected in significant ways to local cultural practices”.
 A further intermediate point between (environmental) epigenetics and local biologies is introduced by Niewöhner with his idea of a “customary biology, that is, a biology that is based on custom understood as time-honored, habituated forms of living everyday life situated in a specific environment…. a biology based on patterns of practice and regularities rather than ‘natural’ laws” (2011)
 The anthropologist Chris Kuzawa (2005) often uses the notion of “intergenerational phenotypic inertia” in his brilliant epigenetic/developmentalist studies on health inequalities, and while he means something more specific, there is clearly a nexus between an epigenetic paradigm and certain ideas about the persistence and continuous movement of past experiences.