Shortly after the election, I taught “Notes on a Balinese Cockfight” to my Anthropological Theory class, as I always do, at that point in the semester. By then we had covered “old ideas” – anthropologists who saw societies as bodies that successfully regulated themselves into homeostasis, cultures as cauldrons that take all that is natural and transform it into all that is social. Then, in the timeline of the history of anthropological thought, we consider the idea of culture as a manuscript, a palimpsest of layered stories, endlessly rich in meaning – stories that work both like horcruxes, where the soul of the culture is encoded, and as mirrors, reflecting how life is lived back to the ones that live it.
“The Balinese Cockfight” is, as every anthropologist knows, a classic article written in 1972 by Clifford Geertz, who observed cockfighting during his fieldwork in Indonesia. The cockfights are illegal but widespread, with cocks – roosters – serving as proxies for powerful men and their status competition. Geertz wrote that “the cockfight is the story the Balinese tell themselves about themselves.” When I teach this article, I always start the class by saying out loud what I’ve learned students are wondering and giggling about – I tell them, “yes, the whole article is basically one protracted dirty joke. Yes, he writes about cocks exactly for the reason you think. He even notes that the wordplay where a cock is both a rooster and a penis exists in Balinese just as it does in English.”
Intellectuals have an interesting critical relationship with archetypes, especially when they appear as instances of synecdoche – they are such concentrated semiotic clusters that when they are intentionally deployed in fiction, we are taught to read them as allegory. When an archetype is virtually merged with that which it signifies, to the point of word slippage around a homonym, we have critical skills training to acknowledge that a point is being made, and symbolically exaggerated, for effect. I am afraid that critical perspective, where our eye is trained to see exaggeration for symbolic purpose, spills over into “reading” (the way Geertz, who thought of culture as a manuscript that had to be “read”) real culture, real life – when the cesspool from which the ugliest archetypal values arise is rendered legible and transparent, we don’t register that it’s not exaggerated representation for effect, that it’s not a literary device.
If the narrative of this election were written as a short story, with actual events and quotes worked into the plot, an English class somewhere would analyze it as a feminist commentary – where the sexism of mainstream society is made visible through ongoing instances of explicit phallocentrism. They would write five-paragraph essays and, as the three examples, required by the five-paragraph essay format, they would point to Trump bragging about the size of his penis, the accusation so many women, myself included, experienced that we were voting “with our vaginas,” and the fact that at the last, crucial moment before the election, it was Anthony Weiner’s, pardon my technical term, dick pics, that triggered Comey’s announcement about the re-opening of the investigation. The man could not have been more appropriately named if we were in a medieval morality play (and at times it felt like we were). They would write in the conclusion that through these explicit, and perhaps hyperbolic examples, the author aims to make visible the underlying sexism of our political discourse and praxis.
Except this is not a short story. This is not hyperbole. This is what actually happened in this election. Each of those three examples is real – it does not “stand” for anything, it *is* – we simply just experienced an election where the sexist and literally phallocentric subtext of American politics finally manifested as text, with Jungian synchronicity providing a man named Weiner as the proximate trigger for the final denouement of the character trashing of Hillary Clinton. The cocks are both symbolic and real. This election is the story America told itself about itself.
Ironically, given my application here, Geertz’s article has been critiqued, for example by William Roseberry in his article “Balinese Cockfights and the Seduction of Anthropology” for its interpretive neglect of the role of women in his story about the Balinese society. The women are there, in his footnotes (and in the traditional markets appended to the cockfights), but their omission itself is obfuscated, as Geertz’s famous generalization jumps scale to a universalizing scope. A story that the Balinese men tell themselves about themselves becomes the story of and by “the Balinese” in general. In our election, the woman made it into the competition ring, and yet the interpretive frameworks that I see circulating are already de-centering gender, instead centering the issue of the working class, represented in the media through figures located in domains that are usually gendered as “male” – automotive workers, coal miners. So, the election then becomes not just a story America told itself about itself – but also a story about how America tells itself stories about itself, which lenses it reaches for, which interpretive framework it relegates to the footnotes.
In another classic essay, “The Effectiveness of Symbols,” Claude Levi-Strauss explores the power resultant from the merging of a substance and a symbol. In ritualistic moments of such synthesis, magical power can be deployed. One could write a separate essay on Trump’s occult online supporters who believe that “meme magic” got him elected, or on Marina Abramovic’s “spirit cooking” art project that, due to the public’s inability to differentiate between literal vs. metaphorical framing, precipitated Pizzagate and a widespread belief that the DNC was involved in Satanic dinners, and that Hillary Clinton ran a child pornography ring, as hyperbolic apex moments of the symbolic wars that constituted this election. But it also behooves us to think about the consequences in the material reality of such alignment between substance and symbol, cock and cock, man and ideology, Trump and the patriarchy. The effectiveness of symbols is not only for the kind of shamanic healing Levi-Strauss describes – it is also for undoing the material infrastructure and fabric of reality, particularly its fraught and contested patches. Americans told this story to themselves about themselves – but suddenly it is no longer a story. On the second day of Congress reconvening, two weeks out from the inauguration, Republican lawmakers have already initiated a push to defund Planned Parenthood. Women’s body sovereignty is under increased threat in a number of states. State Department employees are fearful that they are being targeted for work on gender related staffing, programming, and funding. “Grab’em by the pussy” T-shirts are available from online retailers in a number of designs and colors. Just like in the Balinese cockfight, symbolic, or at least proxy fighting, has real-world consequences in terms of financial stakes and recognition of status. The election has illuminated our cultural pecking order. A man who admits to and brags about sexual assault is about to be inaugurated instead of a woman widely considered the most qualified presidential candidate in history. Now that the symbolic hierarchy has been re-affirmed in the arena, the material, legal, epistemological consequences follow, both as a massive attack on women’s rights, and the obscuring of gender as an analytical framework in explanatory discourses about an election characterized by misogyny more than anything else.
Geertz, Clifford. “Deep play: Notes on the Balinese cockfight.” Daedalus (1972): 1-37.
Lévi-Strauss, Claude. Structural anthropology. Vol. 1. Basic Books, 1963.
Roseberry, William. “Balinese cockfights and the seduction of anthropology.” Social Research (1982): 1013-1028.
Dr. Veronica Davidov is an Assistant Professor of Anthropology at Monmouth University. Her research focuses on human-nature relations, with a specific emphasis on how natural resources are constructed and contested. She has conducted fieldwork in Ecuador and Northern Russia. She co-edits the journal Laboratorium: Russian Review of Social Research, and co-directs the Ecology and Culture University Seminar at Columbia University.
Book Forum –– Nancy Rose Hunt’s A Nervous State: Violence, Remedies, and Reverie in Colonial Congo by Todd Meyers
When Nancy Rose Hunt suggests that her book “joins the ferment” of colonial aggressions and uncertainties “while taking up harm and pleasure in a shrunken colonial milieu and in postcolonial historiography too” (4), an uninitiated reader might mistake Hunt’s appraisal of her project as attempting the impossible labor of largeness of scope and precision of subject. After spending time with A Nervous State:Violence, Remedies, and Reverie in Colonial Congo (Duke University Press, 2016), it becomes obvious that Hunt’s words verge on understatement. A Nervous State weaves the medical and administrative anxieties of infertility through violences and joys of life (lives worn thin, lives rich and dense) through songs and words, as a pursuit of futures. Hunt’s archive is immense, and she places it on offer in writing both lyrical and complex. It’s no wonder that the book was awarded the 2016 Martin A. Klein Book Prize in African History from the American Historical Association. The commentaries that follow give diverse readings of Hunt’s remarkable book. We hope you enjoy.
Beyond Catastrophe: The Pasts and Futures of Kinship in Colonial Congo
Wayne State University
Tensions of Empire Redux?
Richard Keller and Emer Lucey
University of Wisconsin–Madison
Music and Infertility in the Nervous State
School of Oriental and African Studies
Enclaves and States in (Post)colonial Congo: Spatial Logics and Epidemiological Metaphors
Wits Institute for Social and Economic Research (WiSER)
Laboratoire d’Anthropologie Sociale, Collège de France
Nancy Rose Hunt
University of Florida
And so ends 2016 – a year many have regarded as pretty topsy-turvy and trying at times. The focus of this month’s web roundup relates to how we operate when faced with uncertainty. The last twelve months have certainly shed light on how it is within our nature to crave and create structure and meaning for ourselves, and what happens when we are confronted with disruptions to our sense of what is fact, what is a result of our own belief systems, and where the two intersect.
One fact that we can all agree on is that we now live in a time of unprecedented access to information, with seemingly limitless ways to find out what we want to hear, precisely when we want to hear it. This article addresses the question of why so many are afraid of so much, with the authors suggesting that fears themselves create a new risk for our health and well-being that need to be addressed. Perhaps when it comes to anxiety in relation to the unknown, it is sometimes better for us to be pessimistic from the start rather than suddenly thrown into the realm of uncertainty. The illusion of hope is more anxiety-inducing that the certainty of failure, and sometimes we are more adversely affected by not knowing if a result is going to be positive or negative than we are by expecting a negative result, as suggested here. Misperceiving certain risks may actually be more significant, and hazardous, than any one individual risk, however this is very much culturally based.
With risk comes uncertainty, something that can be seen in the proliferation of stories on the web related to how we arrive at our beliefs. In social psychology, there is the idea that the more uncertainty that exists in a person, the more a space is created for influence. There has been a lot of talk in the last few months about truth, fact, and the consequences of having so much information available to us. Psychological mechanisms such as confirmation bias, in which we seek to confirm or validate what we already know, are one reason the notion of “echo chambers” have taken hold in explaining the increasing polarization taking shape on a global scale. It is our own relationship to the unknown that steers how and what we choose to believe, something taken up in an interview with Jerome Ravetz, a “pioneer of post-normal science and a leading advocate of citizen science” discussing why it might be time to move beyond the doctrine of scientific certainty. The idea of democratizing science in an age of uncertainty positions specialized expert knowledge as not always being adequate to solve problems with multiple solutions. Whether it is lay knowledge, leaked documents, or other non-traditional sources of information, the extended peer community, or “citizen scientists” are crucial to emerging debates.
Addressing the question of scientific certainty and fact is no doubt central to the times we’re living in, and this growing wariness/skepticism around the idea of expert knowledge contributes to an unsettling sense of not knowing where to turn for the facts, and indeed what exactly constitutes a fact in the first place. This level of uncertainty fuels the spread of fake news (another talking point of 2016) as well as a lack of trust toward previously “established” sources of credible information (even scientific joke papers, once a lighthearted and funny addition to some peer reviewed journal publication years are now having a moment of reflection regarding how funny such pieces are in an age when just about anything can be adopted and perpetuated as factual ). The importance of lay knowledge in contributing to advances in, for example, service user led mental health movements has been a great boon to the decreasing stigma surrounding mental illness. But what about when competing, often contrary, lay knowledges drive the debates, as with climate change or links between vaccines and Autism. Our beliefs shape the core of our identity (one reason why its so hard to change someone else’s political beliefs, for example) leading any questioning to feel like a personal attack for many. This article in Nature profiles Hans Rosling in his quest to dispel outdated beliefs. He argues that experts can’t seek to solve major challenges if they are not operating on facts, however erasing long held beliefs and preconceived ideas is a challenge in and of itself. Facts, uncertainty, and belief are sure to be at the center of more and more discussion and debates in the social science in the years ahead, as social media becomes even more prevalent, and mechanisms for communication more sophisticated.
This post began with mention of the anxiety stemming from not knowing who or what to believe. Perhaps one small way to help alleviate this is in the form of a reminder of ways in which we are all connected. I didn’t want to end 2016 on a note of uncertainty, so I encourage you to have a look at this very cool website Radio Garden which allows you to listen to radio stations from even the most remote corners of the world.. Not directly related to anything else in this post, but perhaps a reminder of both the vastness and smallness of this world we share, and a reminder that amidst all of the uncertainty and questioning, we can still reflect on the beauty of human communication across borders.
Best wishes for a happy 2017.
Here is the second part of our article roundup for December (find the first set of articles here). Happy reading, and happy new year!
In 2004, the Italian Parliament passed a controversial law on medically assisted reproduction (Law 40/2004). The Law obliged clinicians to create a maximum of three embryos during one in vitro fertilization (IVF) cycle and transfer them simultaneously into the patient’s uterus. With this “three embryo” standard, the Parliament sought to secure the realization of rights of IVF embryos. Drawing on the concepts of boundary-work and bioconstitutionalism, this article explores the role that the constitutional obligations of the Italian State towards its citizens, including IVF embryos as its new “citizen subjects,” played in how it envisaged and demarcated the professional boundaries of medical expertise. It argues that the latter depended upon how it balanced its commitments to protect the rights of IVF embryos and those of adult citizens. As such, the demarcation of the jurisdictional boundaries of medical expertise, and the definition of constitutional rights, formed two sides of the same governing project.
In this paper, I argue that uncertainty and nonknowledge, and not just research results, can be important vehicles of translation through which genetic research participation comes to affect the lives of research participants. Based on interviews with participants in a genetic research project, I outline epistemic, emotional, relational and moral implications of research participation. Many of them resemble what the literature has described as the social implications of genetic counseling, but here they stem from interaction with knowledge-in-the-making or what I simply call nonknowledge. While policies aimed at stimulating translation from bench to bedside tend to build on the assumption that research only works when knowledge translates into technological ability and creates utility, I suggest acknowledging that research has implications long before any clinical applications are at hand. Research questions, and not just results, may serve as a generative form of knowledge that can travel as fast as any answer.
Voluntary DNA-based information exchange and contact services following donor conception: an analysis of service users’ needs
Marilyn Crawshaw, Lucy Frith, Olga van den Akker & Eric Blyth
Medical science has enabled the creation of families through the use of donor conception but some lifelong policy and practice implications are only recently being recognized. Research and practice have shown that donor conception can, for some, carry substantial long-term consequences. In this paper we present findings from a questionnaire-based study that sought to shed light on donor-conceived adults’ and gamete donors’ views on service and support needs when searching for genetic relatives with the aid of DNA testing. The findings demonstrate the complexity and sensitivity of providing services in this newly emerging area of need. Such provision requires collaboration between very different disciplines and agencies (scientific and psychosocial), introduces the potential for blurring of lines of accountability and responsibility, and highlights the challenges of identifying appropriate funding streams. In addition, the findings demonstrate the opportunities and limitations afforded by the use of DNA in identifying unknown genetic relatives.
This paper explores the promise of induced pluripotent stem cells as a model system for the study of neurodegenerative diseases of Alzheimer’s, Parkinson’s and other diseases of the aging brain. Research in these areas, as in neuroscience more broadly, has struggled with the imperfect mapping between human and animal brains. The paper argues that the contemporary promise of induced pluripotent stem cells for research is established through their potential to resolve problems of translation, bridging laboratory and clinical contexts by acting as a model of “real” patient bodies. However, the paper shows how this promise is contested and renewed through a rearticulation of the relationship between neurodegeneration, aging and the qualities of “young” and “aged” bodies. This not only results in the introduction of new qualities and attributes to the model system, but also a re-imagining of how aging features within both late and early-onset neurological diseases.
Social media as a space for support: Young adults’ perspectives on producing and consuming user-generated content about diabetes and mental health (open access)
Gillian Fergie, Kate Hunt, Shona Hilton
Social media offer opportunities to both produce and consume content related to health experiences. However, people’s social media practices are likely to be influenced by a range of individual, social and environmental factors. The aim of this qualitative study was to explore how engagement with user-generated content can support people with long-term health conditions, and what limits users’ adoption of these technologies in the everyday experience of their health condition. Forty semi-structured interviews were conducted with young adults, aged between 18 and 30 years, with experience of diabetes or a common mental health disorder (CMHD). We found that the online activities of these young adults were diverse; they ranged from regular production and consumption (‘prosumption’) of health-related user-generated content to no engagement with such content. Our analysis suggested three main types of users: ‘prosumers’; ‘tacit consumers’ and ‘non-engagers’. A key determinant of participants’ engagement with resources related to diabetes and CMHDs in the online environment was their offline experiences of support. Barriers to young adults’ participation in online interaction, and sharing of content related to their health experiences, included concerns about compromising their presentation of identity and adherence to conventions about what content is most appropriate for specific social media spaces. Based on our analysis, we suggest that social media do not provide an unproblematic environment for engagement with health content and the generation of supportive networks. Rather, producing and consuming user-generated content is an activity embedded within individuals’ specific health experiences and is impacted by offline contexts, as well as their daily engagement with, and expectations, of different social media platforms.
Social networks, social participation, and health among youth living in extreme poverty in rural Malawi
Amelia Rock, Clare Barrington, Sara Abdoulayib, Maxton Tsoka, Peter Mvula, Sudhanshu Handa
Extensive research documents that social network characteristics affect health, but knowledge of peer networks of youth in Malawi and sub-Saharan Africa is limited. We examine the networks and social participation of youth living in extreme poverty in rural Malawi, using in-depth interviews with 32 youth and caregivers. We describe youth’s peer networks and assess how gender and the context of extreme poverty influence their networks and participation, and how their networks influence health. In-school youth had larger, more interactive, and more supportive networks than out-of-school youth, and girls described less social participation and more isolation than boys. Youth exchanged social support and influence within their networks that helped cope with poverty-induced stress and sadness, and encouraged protective sexual health practices. However, poverty hampered their involvement in school, religious schools, and community organizations, directly by denying them required material means, and indirectly by reducing time and emotional resources and creating shame and stigma. Poverty alleviation policy holds promise for improving youth’s social wellbeing and mental and physical health by increasing their opportunities to form networks, receive social support, and experience positive influence.
The Quality and Outcomes Framework: Body commodification in UK general practice
Armando H. Norman, Andrew J. Russell, Claudia Merli
The UK’s Quality and Outcomes Framework (QOF) is the largest pay-for-performance scheme in the world. This ethnographic study explored how QOF’s monetary logic influences the approach to healthcare in UK general practice. From August 2013 to April 2014, we researched two UK general practice surgeries and one general practice training programme. These environments provided the opportunity for studying various spaces such as QOF meetings, consultation rooms, QOF recoding sessions, and the collection of computer-screen images depicting how patients’ biomarkers are evaluated and costed through software systems. QOF as a biomedical technology has led to the commodification of patients and their bodies. This complex phenomenon breaks down into three main themes: commodification of patients, QOF as currency, and valuing commodities. Despite the ostensible aim of QOF being to improve healthcare in general practice, it is accompanied by a body commodification process. The interface between patients and care providers has been commodified, with QOF’s pricing mechanism and fragmentation of care provision performing an important role in animating the UK economy.
Everyday tactics in local moral worlds: E-cigarette practices in a working-class area of the UK (open access)
Research into e-cigarette use has largely focused on their health effects and efficacy for smoking cessation, with little attention given to their potential effect on health inequalities. Drawing on three years of ethnographic research between 2012 and 2015, I investigate the emerging e-cigarette practices of adult smokers and quitters in a working-class area of the UK. I first use de Certeau’s notion of ‘tactics’ to describe the informal economy of local e-cigarette use. Low-priced products were purchased through personal networks and informal sources for financial reasons, but also as a solution to the moral problems of addiction and expenditure on the self, particularly for older smokers. E-cigarette practices were produced in local moral worlds where smoking and cessation had a complex status mediated through norms of age and gender. For younger men, smoking cessation conflicted with an ethic of working-class hedonism but e-cigarette use allowed cessation to be incorporated into male sociality. Continued addiction had moral implications which older men addressed by constructing e-cigarette use as functional rather than pleasurable, drawing on a narrative of family responsibility. The low priority which older women with a relational sense of identity gave to their own health led to a lower tolerance for e-cigarette unreliability. I draw on Kleinman’s local moral worlds to make sense of these findings, arguing that smoking cessation can be a risk to moral identity in violating local norms of age and gender performance. I conclude that e-cigarettes did have some potential to overcome normative barriers to smoking cessation and therefore to reduce health inequalities, at least in relation to male smoking. Further research which attends to local meanings of cessation in relation to age and gender will establish whether e-cigarettes have similar potential elsewhere.
Realities of environmental toxicity and their ramifications for community engagement
Justin T. Clapp, Jody A. Roberts, Britt Dahlberg, Lee Sullivan Berry, Lisa M. Jacobs, Edward A. Emmett, Frances K. Barg
Research on community responses to environmental toxicity has richly described the struggles of citizens to identify unrecognized toxins, collect their own environmental health facts, and use them to lobby authorities for recognition and remediation. Much of this literature is based on an empiricist premise: it is concerned with exploring differences in how laypeople and experts perceive what is presumed to be a singular toxic reality that preexists these varying perspectives. Here, we seek to reexamine this topic by shifting the focus from facts to facticity—that is, by exploring the many types of knowledge that communities develop about toxicity and how these knowledges articulate with the ideas of scientific and governmental authorities about what kinds of information are valid bases for policymaking. In making this shift, we are influenced by work in semiotic anthropology and science and technology studies (STS), which emphasizes that lived experience generates distinct realities rather than different perceptions of the same underlying state. Using this framework, we present an analysis of oral history interviews conducted in 2013–14 in the small American town of Ambler, Pennsylvania. Part of Ambler’s legacy as a nineteenth- and twentieth-century center of asbestos manufacture is that it is home to two massive asbestos-containing waste sites, one of which was being remediated by the Environmental Protection Agency (EPA) at the time of this study. Our interviews demonstrate that even asbestos, a toxin with a well-established public narrative, is a fundamentally different object for different members of the Ambler community. For many of these individuals, the epistemology and practices of the EPA are incongruent with or tangential to their toxicity-related experiences and their consequent concerns for the future. As such, our findings suggest caution in framing the community engagement efforts of environmental health agencies primarily as facilitations of citizen science; this approach does not acknowledge the multiplicity of toxic realities.
Suffering and medicalization at the end of life: The case of physician-assisted dying (open access)
Hadi Karsoho, Jennifer R. Fishman, David Kenneth Wright, Mary Ellen Macdonald
‘Suffering’ is a central discursive trope for the right-to-die movement. In this article, we ask how proponents of physician-assisted dying (PAD) articulate suffering with the role of medicine at the end of life within the context of a decriminalization and legalization debate. We draw upon empirical data from our study of Carter v. Canada, the landmark court case that decriminalized PAD in Canada in 2015. We conducted in-depth interviews with 42 key participants of the case and collected over 4000 pages of legal documents generated by the case. In our analysis of the data, we show the different ways proponents construct relationships between suffering, mainstream curative medicine, palliative care, and assisted dying. Proponents see curative medicine as complicit in the production of suffering at the end of life; they lament a cultural context wherein life-prolongation is the moral imperative of physicians who are paternalistic and death-denying. Proponents further limit palliative care’s ability to alleviate suffering at the end of life and even go so far as to claim that in some instances, palliative care produces suffering. Proponents’ articulation of suffering with both mainstream medicine and palliative care might suggest an outright rejection of a place for medicine at the end of life. We further find, however, that proponents insist on the involvement of physicians in assisted dying. Proponents emphasize how a request for PAD can set in motion an interactive therapeutic process that alleviates suffering at the end of life. We argue that the proponents’ articulation of suffering with the role of medicine at the end of life should be understood as a discourse through which one configuration of end-of-life care comes to be accepted and another rejected, a discourse that ultimately does not challenge, but makes productive use of the larger framework of the medicalization of dying.
How food insecurity contributes to poor HIV health outcomes: Qualitative evidence from the San Francisco Bay Area
Henry J. Whittle, Kartika Palar, Hilary K. Seligman, Tessa Napoles, Edward A. Frongillo, Sheri D. Weiser
Rationale: Food-insecure people living with HIV/AIDS (PLHIV) consistently exhibit worse clinical outcomes than their food-secure counterparts. This relationship is mediated in part through non-adherence to antiretroviral therapy (ART), sub-optimal engagement in HIV care, and poor mental health. An in-depth understanding of how these pathways operate in resource-rich settings, however, remains elusive.
Objective: We aimed to understand the relationship between food insecurity and HIV health among low-income individuals in the San Francisco Bay Area using qualitative methods.
Methods: Semi-structured in-depth interviews were conducted with 34 low-income PLHIV receiving food assistance from a non-profit organization. Interviews explored experiences with food insecurity and its perceived effects on HIV-related health, mental health, and health behaviors including taking ART and attending clinics. Thematic content analysis of transcripts followed an integrative inductive-deductive approach.
Results: Food insecurity was reported to contribute to poor ART adherence and missing scheduled clinic visits through various mechanisms, including exacerbated ART side effects in the absence of food, physical feelings of hunger and fatigue, and HIV stigma at public free-meal sites. Food insecurity led to depressive symptoms among participants by producing physical feelings of hunger, aggravating pre-existing struggles with depression, and nurturing a chronic self-perception of social failure. Participants further explained how food insecurity, depression, and ART non-adherence could reinforce each other in complex interactions.
Conclusion: Our study demonstrates how food insecurity detrimentally shapes HIV health behavior and outcomes through complex and interacting mechanisms, acting via multiple socio-ecological levels of influence in this setting. The findings emphasize the need for broad, multisectoral approaches to tackling food insecurity among urban poor PLHIV in the United States.
Culture: The missing link in health research
M. Kagawa Singer, W. Dressler, S. George, The NIH Expert Panel
Culture is essential for humans to exist. Yet surprisingly little attention has been paid to identifying how culture works or developing standards to guide the application of this concept in health research. This paper describes a multidisciplinary effort to find consensus on essential elements of a definition of culture to guide researchers in studying how cultural processes influence health and health behaviors. We first highlight the lack of progress made in the health sciences to explain differences between population groups, and then identify 10 key barriers in research impeding progress in more effectively and rapidly realizing equity in health outcomes. Second, we highlight the primarily mono-cultural lens through which health behavior is currently conceptualized, third, we present a consensus definition of culture as an integrating framework, and last, we provide guidelines to more effectively operationalize the concept of culture for health research. We hope this effort will be useful to researchers, reviewers, and funders alike.
First depressed, then discriminated against?
Stijn Baert, Sarah De Visschere, Koen Schoors, Désirée Vandenberghe, Eddy Omey
Each year a substantial share of the European population suffers from major depression. This mental illness may affect individuals’ later life outcomes indirectly by the stigma it inflicts. The present study assesses hiring discrimination based on disclosed depression. To this end, between May 2015 and July 2015, we sent out 288 trios of job applications from fictitious candidates to real vacancies in Belgium. Within each trio, one candidate claimed to have become unemployed only recently, whereas the other two candidates revealed former depression or no reason at all for their unemployment during a full year. Disclosing a year of inactivity due to former depression decreases the probability of getting a job interview invitation by about 34% when compared with candidates who just became unemployed, but the stigma effect of a year of depression is not significantly higher than the stigma effect of a year of unexplained unemployment. In addition, we found that these stigmas of depression and unemployment were driven by our male trios of fictitious candidates. As a consequence, our results are in favour of further research on gender heterogeneity in the stigma of depression and other health impairments.
After 9/11/2001 the United States launched a global War on Terror. As part of this War, terrorism suspects were detained by the U.S. military and by the C.I.A. It is now widely recognized that the United States tortured a number of these detainees in the context of its ‘enhanced interrogation’ programme. This article examines how and why U.S. organizations developed standards that allowed healthcare professionals to become involved in torture; why the standards developed by U.S. security institutions failed to control the actions of enhanced interrogation personnel on the ground; and what the role of standards were in stopping the enhanced interrogation initiative. The article concludes by discussing the general lessons that the enhanced interrogation programme has for social science research on standards, namely that individuals can experience ambivalence when caught between competing organizational and professional standards and that it might be inherently difficult to successfully enact certain protocols when these relate to deviant or destructive acts.
Increased drug use and the timing of social assistance receipt among people who use illicit drugs
Emanuel Krebs, Linwei Wang, Michelle Olding, Kora DeBeck, Kanna Hayashi, M.-J. Milloy, Evan Wood, Bohdan Nosyk, Lindsey Richardson
Background: The monthly disbursement of social assistance (SA) payments to people who use illicit drugs (PWUD) has been temporally associated with increases in drug-related harm. Yet, whether SA receipt changes drug use intensity compared to levels of use at other times in the month has not been established. We therefore examined this relationship among PWUD in Vancouver, Canada (2005–2013).
Methods: Data were derived from prospective cohorts of HIV-positive and HIV-negative PWUD. Every six months, participants were asked about their illicit drug use during the last 180 days and the past week. We determined whether SA receipt occurred within the assessment’s one-week recall period. We employed generalized estimating equations controlling for confounders to examine the relationship between SA receipt and the change in drug use intensity, defined as a 100% increase in the average times per day a given drug was used in the last week compared to the previous 6 months. We tested the robustness of this relationship by stratifying analyses by whether individuals primarily used stimulants, illicit opioids or engaged in polydrug use and examining the timing of SA receipt relative to date of assessment.
Results: Our study included 2661 individuals (median age 36, 32% female) with 1415 (53.2%) reporting SA receipt occurring within the one-week recall period of the assessment at least once. SA receipt was independently associated with intensified drug use (Adjusted Odds Ratio [AOR]: 1.79; 95% Confidence Interval [CI]: 1.53, 2.09), and remained significant when stratified by primary use of stimulants (AOR: 1.87; 95% CI: 1.54, 2.26), opioids (AOR: 1.96; 95% CI: 1.23, 3.13) and polydrug use (AOR: 1.53; 95% CI: 1.11, 2.10).
Conclusion: We found a temporal association between SA receipt and drug use intensification. While the health and social benefits of SA are significant, these findings suggest that alternative disbursement strategies, such as staggered or smaller and more frequent SA payments may be able to mitigate drug-related harm. Alternatives should be tested rigorously.
A home for science: The life and times of Tropical and Polar field stations (open access)
P Wenzel Geissler, Ann H Kelly
A ‘halfway house’ between the generic, purified space of the laboratory and the varied and particular spaces of the field, the field station is a controlled yet uncontained setting from which nature can be accessed and anchored. As living quarters for visiting scientists, field stations are also enmeshed in the routine and rhythms of everyday domestic life, and in longer cycles of habitation, wear, and repair. This introduction considers the empirical and conceptual significance of Polar and Tropical field stations as homes for scientific work and scientific lives. The field station’s extra-territorial yet intimate character affects the credibility and circulation of knowledge along science’s frontiers. The challenge of making a home in the (non-temperate) field and the mundane experiences of expatriation and appropriation establish particular political dynamics of knowledge-making in these locations. They bring into focus the imaginaries of nature and science that drive transnational research and put into relief the aesthetic and affective dimensions of work and life in these distant homes for science. All these themes are pursued and amplified in a different medium by the artists who contributed to our research and are also featured in this special issue.
Habituating field scientists (open access)
This article explores the sensory dimensions of scientific field research in the only region in the world where free-ranging bonobos (Pan paniscus) can be studied in their natural environment; the equatorial rainforest of the Democratic Republic of Congo. If, as sensory anthropologists have argued, the senses are developed, grown and honed in a given cultural and environmental milieu, how is it that field scientists come to dwell among familiarity in a world which is, at first, unfamiliar? This article builds upon previous anthropological and philosophical engagements with habituation that have critically examined primatologists’ attempts to become ‘neutral objects in the environment’ in order to habituate wild apes to their presence. It does so by tracing the somatic modes of attention developed by European and North American researchers as they follow bonobos in these forests. The argument is that as environments, beings and their elements become familiar, they do not become ‘neutral’, but rather, suffused with meaning.
Field station as stage: Re-enacting scientific work and life in Amani, Tanzania (open access)
P Wenzel Geissler, Ann H Kelly
Located high in Tanzania’s Usambara Mountains, Amani Hill Station has been a site of progressive scientific endeavours for over a century, pushing the boundaries of botanical, zoological and medical knowledge, and providing expertise for imperial expansion, colonial welfare, national progress and international development efforts. The station’s heyday was from the 1950s to the 1970s, a period of global disease eradication campaigns and the ‘Africanization’ of science. Today, Amani lies in a state of suspended motion. Officially part of a national network of medical research stations, its buildings and vegetation are only minimally maintained, and although some staff report for duty, scientific work has ceased. Neither ruin nor time capsule, Amani has become a quiet site of remains and material traces. This article examines the methodological potentials of re-enactment – on-site performances of past research practices – to engage ethnographically with the distinct temporalities and affective registers of life at the station. The heuristic power of re-enactment resides in its anachronicity, the tensions it introduces between immediacy and theatricality, authenticity and artifice, fidelity and futility. We suggest that re-enacting early post-colonial science as events unfolding in the present disrupts straightforward narratives about the promises and shortfalls of scientific progress, raising provocative questions about the sentiments and stakes of research in ‘the tropics’.
How does science make a home for itself in a public hospital? This article explores how scientists working in ‘resource poor’ contexts of global health negotiate relationships with their hosts, in this case the doctors, nurses and patients who already inhabit a provincial-level hospital. Taking its lead from recent works on science, ethics and development, this article seeks to ‘provincialize the laboratory’ by focussing on the scientific tropics as a space of productive encounter and engagement. A view from the hospital reveals the tenuous process of ‘setting up’ a place for science, in a world that does not immediately recognize its value. The article examines the material exchanges of infrastructure, bodily tissues and labour that enable one young scientist to establish a scientific life for himself. The success of those transactions, it argues, ultimately derives from their objectification of scientific vulnerability and their enactment of relationships of mutual recognition. As opposed to asking how scientific knowledge is produced in the tropics, the view from the hospital challenges us to focus on the establishment of relationships between scientists and their hosts as a productive endeavour in its own right.
Science, ethnography, art (open access)
Excerpt from the introduction by P Wenzel Geissler and Ann H Kelly: The conference ‘A Home for Science’ from which this special issue originated, and the larger project of which the conference was part, sought to combine anthropological and historical studies of science, and contemporary artists’ engagements with scientific practice, to jointly interrogate scientific work in marginal places (Geissler et al., 2016). Collaborations between ethnography and conceptual art have evolved in recent decades, drawing on older convergences between anthropology and art practice (Gell, 1998). Conceptual artists entered into broadly ethnographic terrains and found inspiration in ethnographic methods, while social and cultural anthropologists and archaeologists pursued experimental methods beyond social scientific realism, gesturing towards or learning from conceptual art – variously contriving social situations and observing their unfolding, studying the social by way of material objects and forms, or emphasizing performative and playful dimensions of fieldwork, seeking poesis and surprise rather than ‘data’ (Marcus, 2010; Pearson, 2004; Schneider and Wright, 2013; Ssorin-Chaikov, 2013) … What follows are samples of the art presented at the ‘A Home for Science’ conference, along with excerpts from the statements that artists made about their work.
Here is the first part of our December article roundup. Three journals have special issues this month (abstracts in the post below):
- Body and Society: The New Biologies: Epigenetics, the Microbiome and Immunities
- Ethos: Anthropology and Psychoanalysis
- Medical Anthropology Quarterly: Special Focus Section on Comorbidity
Enjoy reading (and what’s left of the holidays)!
Betsey Behr Brada
One consequence of the recent expansion of anthropological interest in humanitarianism is the seeming obviousness and conceptual stability of “humanitarianism” itself. In this article, I argue that, rather than being a stable concept and easily recognizable phenomenon, humanitarianism only becomes apparent in relation to other categories. In short, humanitarianism is contingent: it depends on circumstance and varies from one context to another. Furthermore, its perceptibility rests on individuals’ capacity to mobilize categorical similarities and distinctions. One cannot call a thing or person “humanitarian” without denying the humanitarian character of someone or something else. Drawing on research conducted in clinical spaces where Botswana’s national HIV treatment program and private US institutions overlapped, I examine the processes by which individuals claimed people, spaces, and practices as humanitarian, the contrasts they drew to make these claims, and the moral positions they attempted to occupy in the process. More than questions of mere terminology, these processes of categorization and contradistinction serve as crucibles for the larger struggles over sovereignty, inequality, and the legacies of colonialism that haunt US-driven global health interventions.
Abortion laws offer a point of entry for “the state” to intervene in intimate clinical matters. In this article, I explore the various uses of scripts and scripting in state-mandated abortion counseling following the implementation of North Carolina’s (2011) Woman’s “Right to Know” Act. The law mandates that women receive counseling with specific, state-prescribed information at least 24 hours prior to an abortion. Drawing on interviews with abortion providers in North Carolina, I analyze how the meaning of scripting shifts across different clinical and bureaucratic contexts and show that abortion providers perceived themselves to be scripted by “the state” even though their words were not explicitly chosen by lawmakers. Thus, rather than viewing the law merely as a product of North Carolina legislative activity, I argue that abortion providers also help to create the law, and its social and moral power, by interpreting and enacting it. However, abortion providers also revealed creative strategies for “scripting dissent” from the law—that is, rejecting, challenging, or otherwise subverting the state’s ideological message. This demonstrates that the linguistic force of the script stretches beyond its textual meaning to encompass the way it is performed within a particular context and how it is sometimes used for unexpected ends.
In contemporary England, amateur paranormal investigators actively seek empirical evidence of the paranormal. These investigators are self-fashioned experts who aim to balance scientific and spiritual perspectives in hopes of researching the existence of ghosts from an objective perspective. Despite actively seeking out ghosts and amassing firsthand paranormal experiences, investigators remain deeply doubtful about the nature of their evidence and the existence of the paranormal. Here, I explore the production and experience of doubt by examining paranormal investigators’ struggles to define and quantify the paranormal. Competing ideas about the substance or nature of ghosts lie at the heart of this struggle. Paranormal investigators agree that collecting and analyzing electromagnetic energy offers the most promising pathway for establishing empirical evidence of the paranormal. However, there is analytic uncertainty regarding the meaning of electromagnetic energy: it might indicate a spiritual or natural presence. Here, I argue that these two competing frames of interpretation engender and sustain states of doubt among investigators; however, paradoxically, these very states of doubt allow them to maintain and sustain embodied encounters with the very paranormal forces they doubt.
Christine Hauskeller and Lorenzo Beltrame
Umbilical cord blood (UCB) is an important source for stem cells used in clinical treatments. For this purpose, UCB has to be collected at birth and stored in biobanks. The discourse about UCB biobanking practices commonly holds that it occurs in two opposite economies, the public sector and a competing private one. They correspond with moral economies of gift-giving in a redistributive economy versus private ownership of cord blood in a market economy. Our analysis of UCB banking in Europe shows that this opposition narrative is both empirically and analytically unsatisfactory. Using the analytic concepts of entanglement (Callon) and biomedical platforms (Keating and Cambrosio), we demonstrate how the network of actors, objects, interests and practices in biobanking creates different kinds of value and shared issues across public and private services. Our case study illustrates how the interrelation between technical, ethical, economic and logistical considerations plays out and generates a field of practices where redistributive and market economies coexist, are co-dependent and hybridize each other. The narrative of opposition therefore can inform STS studies regarding the normative values written into the public facing side of biobanking, but bioeconomic analyses benefit from building on concepts that enable the examination of the complex interrelations between the wider network of heterogeneous elements on which UCB banking relies.
Annette Leibing, Virginie Tournay, Rachel Aisengart Menezes, and Rafaela Zorzanelli
This article focuses on Canadian stem cell researchers working on therapeutic applications of autologous stem cells for heart disease. Building on the concept of ‘multiverse’ – coined by William James and then further developed by Ernst Bloch – we are interested in the simultaneity of the certain and uncertain, sometimes contradictory arguments articulated by these scientists. In the first part of the article we illustrate some of the factors that provide certainty for researchers and clinicians. The second part analyzes the ways in which uncertain elements become integrated into a discourse of certainty. What we would like to show, using the concept of multiverse, is that a relatively new bio-technology such as stem cell treatments generally relies on both certain and uncertain reasoning. However, uncertainty has to give way to a platform of partial certainty, if crucial action is to be taken on issues as diverse as treatments and grant applications. The principle mechanisms we found that can make this kind of transformation possible target future developments (what we call ‘if only arguments’), including past encouraging results in need of further research.
Thinking with the vital materiality of placentas as it is evinced in a placental stem cell research lab in Korea, this article explores the relations and practices of care that are essential to the circulation of biological matters as infrastructure of tissue economies. I attend to the flows of care that sustain tissue economies with the notion of ‘placental economies’. Shifting attention from donor subjects and tissue objects to practices and relations of care as an infrastructure for the circulation of tissues, I explore how the vitality of biological matters is an achievement made and sustained through the relations and practices of care that animate the placenta in different forms. On the basis of an ethnographic fieldwork conducted in Korea, this article focuses on two different forms of care (lab workers’ care of cells, and pregnant women’s care of fetuses) that enable the (re)production and circulation of placenta-derived stem cells possible. I argue that the flows of tissues and vitality are indeed the flows of care, as an anticipatory as well as responsive practices, without which the vitality cannot exist in its current form. Furthermore, I suggest that relations and practices of care are a kind of infrastructure of promissory biotechnological enterprises.
State regulation of oocyte donation in the context of human embryonic stem cell (hESC) research has increased since California’s landmark passage of Proposition 71 and the establishment of the first state-funded stem cell agency, the California Institute for Regenerative Medicine (CIRM). Scholarship has largely focused on California’s regulation of stem cell research as a patchwork of private sector and state regulations, reflecting major debates about the social contract for science. Given California’s political exceptionalism, how does examining alternative state histories, political structures, and institutions at the state level illuminate the ways that bio-innovation is being regulated in a federal regulatory vacuum? Examining state management of oocyte donation in the context of hESC research, this article considers New York and California as comparative sites of stem cell science regulation, which enriches our understanding of how regulation of stem cell science arises out of an engagement with representative politics and the private sector in the United States. Employing a process tracing of policy development in New York and California, this article highlights alternative democratic pathways to the management of oocyte donation in research contexts: given differences in direct democratic action, legislative representation, executive leadership, and publicly funded state stem cell research institutions, distinct regulatory outcomes occur with important bioethical implications for publics and participants in stem cell science at the state level.
Alison Kraft and Beatrix P. Rubin
This paper analyses the changing conceptualisation of cellular differentiation during the twentieth century. This involved a move away from a view of this process as irreversible to an understanding of it as contingent. We examine the import of this shift for the transformation of stem cell biology, including the therapeutic promise attributed to this field, and how it came to challenge historical conceptions of both the cell and stem cell. We take as our starting point the 2012 Nobel Prize for Physiology and Medicine awarded jointly to John Gurdon and Shinya Yamanaka. In the view of the Nobel Committee, their work delineates a paradigm shift in the understanding of cellular differentiation, one that incorporates the concept of ‘plasticity’. We explore the emergence, uses and meanings of this concept within this specific biological context, examining and emphasising its role as an epistemological tool. In this setting, ‘plasticity’ was introduced by cell biologist Helen Blau in the course of research undertaken in the 1980s into the genetics of cell differentiation. We argue that Blau’s experimental and theoretical contributions were seminal to a reconceptualisation of this process and provide a crucial link between the work of Gurdon and Yamanaka. Overall, the paper highlights the contested process of conceptual change within the biomedical sciences. It also draws attention to the dynamic and reciprocal relationship between conceptual and technical change, exemplified here in the changing conceptions of cell differentiation following from the analysis of gene expression using new cell fusion and cloning techniques. More broadly, the paper also affords a window onto the shifting priorities, goals and values within late twentieth-century biomedical research.
Special Issue: The New Biologies: Epigenetics, the Microbiome and Immunities
Beginning in the 1940s, mass production of antibiotics involved the industrial-scale growth of microorganisms to harvest their metabolic products. Unfortunately, the use of antibiotics selects for resistance at answering scale. The turn to the study of antibiotic resistance in microbiology and medicine is examined, focusing on the realization that individual therapies targeted at single pathogens in individual bodies are environmental events affecting bacterial evolution far beyond bodies. In turning to biological manifestations of antibiotic use, sciences fathom material outcomes of their own previous concepts. Archival work with stored soil and clinical samples produces a record described here as ‘the biology of history’: the physical registration of human history in bacterial life. This account thus foregrounds the importance of understanding both the materiality of history and the historicity of matter in theories and concepts of life today.
Megan Warin, Vivienne Moore, Michael Davies, and Stanley Ulijaszek
Bourdieu suggested that the habitus contains the ‘genetic information’ which both allows and disposes successive generations to reproduce the world they inherit from their parents’ generation. While his writings on habitus are concerned with embodied dispositions, biological processes are not a feature of the practical reason of habitus. Recent critiques of the separate worlds of biology and culture, and the rise in epigenetics, provide new opportunities for expanding theoretical concepts like habitus. Using obesity science as a case study we attempt to conceptualise the enfolding of biological and social processes (via a Deleuzian metaphor) to develop a concept of biohabitus – reconfiguring how social and biological environments interact across the life course, and may be transmitted and transformed intergenerationally. In conclusion we suggest that the enfolding and reproduction of social life that Bourdieu articulated as habitus is a useful theoretical frame that can be enhanced to critically develop epigenetic understandings of obesity, and vice versa.
Rebecca Scott Yoshizawa
Extensively employed in reproductive science, the term fetal–maternal interface describes how maternal and fetal tissues interact in the womb to produce the transient placenta, purporting a theory of pregnancy where ‘mother’, ‘fetus’, and ‘placenta’ are already-separate entities. However, considerable scientific evidence supports a different theory, which is also elaborated in feminist and new materialist literatures. Informed by interviews with placenta scientists as well as secondary sources on placental immunology and the developmental origins of health and disease, I explore evidence not of interfacing during pregnancy, but of intra-action, or the mutual emergence of entities in simultaneous practices of differentiation and connection. I argue that attending to evidence that can be figured as intra-action enables us to recognize, account for, and attend to diffuse responsibilities for fetal–maternal outcomes that extend beyond mothers to the biosocial milieus of pregnancy. In reimaging the intra-action of placentas, a new understanding of what constitutes a ‘healthy pregnancy’ becomes possible.
The issue of what is proper to nature, or life itself, is central to critical accounts of biomedicine and its complex interrelations with social, political and economic forces. These engagements, namely biopolitical accounts of medical practices and ethical-political critiques of biomedical discourse, grapple with the indistinction between the political and biological that biomedicine enacts. Making a significant contribution to both literatures, Ed Cohen’s A Body Worth Defending argues that the emergence of the concept of biological immunity signals the entry of politics into life itself and, as such, constitutes a concrete example of biopolitics. This article examines Cohen’s account of how the political becomes biological, and the view of life it assumes. Seeking to open up the question of biology, it draws on the work of Georges Canguilhem, and New Materialist accounts of matter–meaning entanglement, to offer a reading of knowledge and life, or politics and biology, as ontologically entangled.
Mark Davis, Paul Flowers, Davina Lohm, Emily Waller, and Niamh Stephenson
This article examines discourse on immunity in general public engagements with pandemic influenza in light of critical theory on immuno-politics and bodily integrity. Interview and focus group discussions on influenza with members of the general public reveal that, despite endorsement of government advice on how to avoid infection, influenza is seen as, ultimately, unavoidable. In place of prevention, members of the general public speak of immunity as the means of coping with influenza infection. Such talk on corporeal life under microbial threat is informed by self/not-self, network and ‘choice’ immunity, and therefore makes considerable allowance for cosmopolitan traffic with others, microbes, ‘dirt’ and immune-boosting consumer products. The immuno-political orientation of members of the general public, therefore, appears to trend towards a productive cosmopolitanism that contrasts with more orthodox bioscientific and governmental approaches to pandemic influenza. We reflect on the implications of the immuno-cosmopolitanism of everyday life for the advent of global public health emergency and for biopolitical rule in general.
Joshua I Newman, Rachel Shields, and Christopher M McLeod
This article offers a series of critical theorizations on the biopolitical dimensions of methicillin-resistant Staphylococcus aureus (MRSA), with specific attention to what has recently been referred to in the United States as the ‘MRSA Epidemic’. In particular, we reflect on the proliferation of biomedical discourses around the ‘spread’, and the pathogenic potentialities, of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). We turn to the work of Roberto Esposito and Jean-Luc Nancy to better make sense of how, during this immunological crisis, the individualized fleshy and fluid body is articulated to dimensions of community and corporeal proximity; the body is thus conceived in popular biopolitical framings as a site of transmission, inoculation, and isolation – as a living ecological and pathological vessel. We give emphasis to the spatial relations of flesh, namely in how biomedical ‘experts’ have sought to (bio-)technologize spaces of heightened communal bodily contact (such as playgrounds or gymnasia).
Devon E. Hinton, David H. Barlow, Ria Reis, and Joop de Jong
We present a general model of why “thinking a lot” is a key presentation of distress in many cultures and examine how “thinking a lot” plays out in the Cambodian cultural context. We argue that the complaint of “thinking a lot” indicates the presence of a certain causal network of psychopathology that is found across cultures, but that this causal network is localized in profound ways. We show, using a Cambodian example, that examining “thinking a lot” in a cultural context is a key way of investigating the local bio-cultural ontology of psychopathology. Among Cambodian refugees, a typical episode of “thinking a lot” begins with ruminative-type negative cognitions, in particular worry and depressive thoughts. Next these negative cognitions may induce mental symptoms (e.g., poor concentration, forgetfulness, and “zoning out”) and somatic symptoms (e.g., migraine headache, migraine-like blurry vision such as scintillating scotomas, dizziness, palpitations). Subsequently the very fact of “thinking a lot” and the induced symptoms may give rise to multiple catastrophic cognitions. Soon, as distress escalates, in a kind of looping, other negative cognitions such as trauma memories may be triggered. All these processes are highly shaped by the Cambodian socio-cultural context. The article shows that Cambodian trauma survivors have a locally specific illness reality that centers on dynamic episodes of “thinking a lot,” or on what might be called the “thinking a lot” causal network.
Descriptions of patient mistreatment fill ethnographic accounts of healthcare in resource-poor settings. Often, anthropologists point to structural factors and the ways that the global political economy produces substandard care. This approach makes it difficult to hold parties accountable when there is blatant disregard for human life on the part of individuals providing care. In this article, I draw on the illness narrative of Magaly Chacón, the first HIV positive individual in Bolivia to file charges of medical negligence after failing to receive care to prevent mother-to-child transmission. Magaly’s narrative demonstrates how structural conditions are often used to explain away poor patient outcomes, shifting attention away from and normalizing the symbolic violence that also perpetuates substandard care of marginalized patients. I use Magaly’s accusations to interrogate how defining acts of mistreatment as medical negligence can be a productive exercise, even when it is difficult to disentangle structural constraints from blatant acts of negligence. Defining who is negligent in resource-poor settings is not easy, as Magaly’s case demonstrates. However, Magaly’s case also demonstrates that accusations of negligence themselves can demand accountability and force changes within the local structures that contribute to the systematic mistreatment of marginalized patients.
Emily Mendenhall, Kristin Yarris, and Brandon A. Kohrt
In the past decade anthropologists working the boundary of culture, medicine, and psychiatry have drawn from ethnographic and epidemiological methods to interdigitate data and provide more depth in understanding critical health problems. But rarely do these studies incorporate psychiatric inventories with ethnographic analysis. This article shows how triangulation of research methods strengthens scholars’ ability (1) to draw conclusions from smaller data sets and facilitate comparisons of what suffering means across contexts; (2) to unpack the complexities of ethnographic and narrative data by way of interdigitating narratives with standardized evaluations of psychological distress; and (3) to enhance the translatability of narrative data to interventionists and to make anthropological research more accessible to policymakers. The crux of this argument is based on two discrete case studies, one community sample of Nicaraguan grandmothers in urban Nicaragua, and another clinic-based study of Mexican immigrant women in urban United States, which represent different populations, methodologies, and instruments. Yet, both authors critically examine narrative data and then use the Center for Epidemiologic Studies Depression Scale to further unpack meaning of psychological suffering by analyzing symptomatology. Such integrative methodologies illustrate how incorporating results from standardized mental health assessments can corroborate meaning-making in anthropology while advancing anthropological contributions to mental health treatment and policy.
“Air (aire, also aigre) in the body” is a frequent explanation of illness according to the traditional medical beliefs in Mexico. Anthropologists have generally scrutinized aire in the context of other common folk illnesses treated by traditional healers (curanderas). However, drawing on my research in the communities of Northern Oaxaca I suggest that aire occupies a more distinct position in the folk medical cosmology than it has usually been credited with. This distinction rests on the notion’s exceptional ambivalence and openness to multiple interpretations. “Air” is recurred to as the cause of illness mainly in situations where every other explanation, either “traditional” or “biomedical,” seems to be inadequate. The physical properties of air—its transparency, invisibility, apparent immateriality, near omnipresence, and virtual “nothingness”—render it a suitable explanation of the last resort. Local understandings of what aire “is” are often vague and elusive, and in many respects the term functions in folk medical discourse as an “empty signifier.”
Hikikomori, often glossed as “social withdrawal,” emerged as a sociomedical condition among Japanese youth at the end of the twentieth century, and it continues to fascinate and concern the public. Explanatory frameworks for hikikomori abound, with different stakeholders attributing it to individual psychopathology, poor parenting, and/or a lack of social support structures. This article takes an interpretive approach to hikikomori by exploring parents’ narrative constructions of hikikomori children in support group meetings and in-depth interviews. I argue that some parents were able to find hope in hikikomori by ‘emplotting’ their children’s experiences into a larger narrative about onset, withdrawal, and recovery, which helped them remain invested in the present by maintaining a sense of possibility about the future. Contrary to literature that examines hikikomori as an epidemic of isolated individuals, I demonstrate how parents play a key role in hikikomori through meaning-making activities that have the potential to shape their children’s experiences of withdrawal.
Julie Netherland and Helena B. Hansen
The past decade in the U.S. has been marked by a media fascination with the white prescription opioid cum heroin user. In this paper, we contrast media coverage of white non-medical opioid users with that of black and brown heroin users to show how divergent representations lead to different public and policy responses. A content analysis of 100 popular press articles from 2001 and 2011 in which half describe heroin users and half describe prescription opioid users revealed a consistent contrast between criminalized urban black and Latino heroin injectors with sympathetic portrayals of suburban white prescription opioid users. Media coverage of the suburban and rural opioid “epidemic” of the 2000s helped draw a symbolic, and then legal, distinction between (urban) heroin addiction and (suburban and rural) prescription opioid addiction that is reminiscent of the legal distinction between crack cocaine and powder cocaine of the 1980s and 1990s. This distinction reinforces the racialized deployment of the War on Drugs and is sustained by the lack of explicit discussion of race in the service of “color blind ideology.” We suggest potential correctives to these racially divergent patterns, in the form of socially responsible media practices and of clinical engagement with public policy.
Ruth Kevers, Peter Rober, Ilse Derluyn and Lucia De Haene
In the aftermath of war and armed conflict, individuals and communities face the challenge of dealing with recollections of violence and atrocity. This article aims to contribute to a better understanding of processes of remembering and forgetting histories of violence in post-conflict communities and to reflect on related implications for trauma rehabilitation in post-conflict settings. Starting from the observation that memory operates at the core of PTSD symptomatology, we more closely explore how this notion of traumatic memory is conceptualized within PTSD-centered research and interventions. Subsequently, we aim to broaden this understanding of traumatic memory and post-trauma care by connecting to findings from social memory studies and transcultural trauma research. Drawing on an analysis of scholarly literature, this analysis develops into a perspective on memory that moves beyond a symptomatic framing toward an understanding of memory that emphasizes its relational, political, moral, and cultural nature. Post-conflict memory is presented as inextricably embedded in communal relations, involving ongoing trade-offs between individual and collective responses to trauma and a complex negotiation of speech and silence. In a concluding discussion, we develop implications of this broadened understanding for post-conflict trauma-focused rehabilitation.
Population Control and Reproductive Politics in Cold War Asia
Like many developing countries in the 1950s and 1960s, Taiwan experienced a social process of constructing and controlling population that relied on demography and fertility studies as essential governing tools. This article investigates population politics and biopolitical knowledge production in postwar Taiwan through synthesizing three bodies of literature that have just begun to comment on one another: histories of postwar population control, analyses of the technoscientific turn in Cold War history, and forensics into the production of social-scientific knowledge via science-study approaches. Along with the complexities of Asian biopolitics, three main social elements affecting the production of biopolitical knowledge at the time are discussed: (a) the historical backstage on which the Cold War and the civil war met, (b) the acting group of Taiwanese and US agencies and individuals who took part in the process, and (c) the three types of fertility studies and the data from them that ultimately expanded the focus of the process of population control from the population in general to the reproductive behavior of women. The complexities of Asia biopolitics are also discussed.
This article studies the formation of Japanese ventures in family planning deployed in various villages in Asia from the 1960s onward in the name of development aid. By critically examining how Asia became the priority area for Japan’s international cooperation in family planning and by analyzing how the adjective humanistic was used to underscore the originality of Japan’s family planning program overseas, the article shows that visions of Japanese actors were directly informed by Japan’s delicate position in Cold War geopolitics, between the imagined West represented by the United States and “underdeveloped” Asia, at a time when Japan was striving to (re)establish its position in world politics and economics. Additionally, by highlighting subjectivities and intra-Asian networks centered on Japanese actors, the article also aims to destabilize the current historiography on population control, which has hitherto focused either on Western actors in the transnational population control movement or on non-Western “acceptors” subjected to the population control programs.
Special Issue: Anthropology and Psychoanalysis
This article is based on fieldwork in a Chinese Protestant house-church in Beijing—more specifically, it focuses on a form of group therapy, which took place in the vicinity of the church. It combines two phenomena usually studied separately, namely the popularity of Chinese underground churches and China’s so-called “psycho-boom.” Drawing on attachment theory, I focus on the psychic conflicts that draw certain people, in this case a young woman, Lin, to this kind of therapeutic/ritual context. Filial piety, the moral value that children should respect and honor their parents, who have sacrificed so much for them, remains a strong social norm in Chinese society. I argue that forbidden feelings such as anger directed at parents found expression in this Chinese house-church. The ritual and therapeutic context can be understood as a cultural defense mechanism, which celebrates an inversion of dominant societal norms.
Tine M. Gammeltoft
Across the world, existing research indicates that many women respond with silence to marital abuse. This article offers an ethnographic investigation of the social and psychic forces behind Vietnamese women’s silencing of violence and a theoretical exploration of how the psychoanalytic concept of fantasy—understood as unconscious or subconscious mental processes—may contribute to the analysis of everyday violence and psychic distress. Distinguishing between what I term deliberate and subconscious silence, I explore the role that fantasy plays when Vietnamese women silently endure intimate partner violence. Closer ethnographic attention to the fantasy-constructions that sustain day-to-day lives can, I argue, strengthen the capacity of anthropology to comprehend how systems of everyday violence are upheld and rendered socially invisible.
Henrik Hvenegaard Mikkelsen
As states across the world develop strategies for administering their aging populations, different assumptions and anxieties regarding the condition of old age and how they haunt people are disclosed, across national-cultural settings. Within recent years, loneliness has been identified as one of the key threats to the well-being of the elderly in the Danish welfare society, and the tendency to view solitary seniors in terms of “loneliness” and “social isolation”—along with the attempts to reintegrate these solitary seniors into society—reveals how solitude is being tied to detrimental states of existence. Based on an ethnographic fieldwork among healthcare workers and solitary elderly men in the rural area of southern Sealand, Denmark, this article lays out the Danish configuration of what has been called the paradigm of “successful aging.” However, not only is the attention to loneliness among Danish eldercare professionals a sign of an inherent fear; at the same time, I will argue, it reveals an inherent inability to conceptualize “solitude” as other than “loneliness.” By employing the concept of the Real—the enigmatic realm within Lacanian psychoanalysis that represents the limit of language—the aim of this article is to uncover how the current discourse on successful aging renders solitude “unthinkable.”
Lotte Buch Segal
This article argues that over the course of the past three decades a mood change has occurred in terms of how Palestinians relate to the ideal of an independent Palestinian state. During the first Intifada, from 1987 to 1993,1 which constitutes the golden age of Palestinian resistance towards Israel’s occupation, the Palestinian resistance movement was characterized by a passionate belief in the possibility of a revolutionary transformation. Due to the consistent stalemate and even worsening of the conflict that have followed in the wake of the Second Intifada, from 2000 to 2003, this passionate belief in the realization of a Palestinian state has been replaced by ambivalence toward that ideal. Based on insights from my intermittent fieldwork with families of Palestinian political prisoners from 2004 to 2011, this article suggests that the contemporary ambivalence surrounding the revolutionary project can be meaningfully analyzed using Freud’s notion of melancholia. In Freud, melancholia accounts for the relation between a feeling of indeterminate loss and ambivalent attachment. The notion of melancholia thereby provides anthropology with a concept that can be used to name and explore the frayed attachment to the ideal of a Palestinian state in the context of an ongoing colonial occupation. The passionate politics of the First Intifada enabled a fusing of Palestinian personhood with the overall political project into a subject characterized by active resistance. In contrast, the ambivalent attachment that marks the link between self and state project in the Palestinian territories after the Second Intifada leads to a mood of melancholia. By analyzing the attachment to the political project as an indeterminate loss in the melancholic’s ego, I argue that the Palestinian political project is part of the self and keeps its adherents in a repetitive temporal fold from which they are unable to escape, because they are obliged and compelled to keep fighting for a state that does not seem to materialize. Conceptually, melancholia has the capacity to elucidate the emotional and deeply intersubjective toll it takes to live and aspire to an ideal that seems further from realization by the hour.
The capacity to receive occult messages and look into the future is claimed by individuals in most societies and probably always has been. In Denmark, clairvoyance is a popular service offered at the alternative market for counseling and healing. During my fieldwork among Danish spiritualist mediums in 2007–08, I was often puzzled by the way in which clairvoyants and clients seemed to share the same kinds of problems. This observation steered my interests toward understanding how personal sensations and feelings are exchanged in therapeutic encounters and raised questions about who is doing what to whom. Drawing on Jung’s concept of the wounded healer to highlight the clairvoyant’s role as a channel for societal anxieties and Melanie Klein’s concept of projective identification as a framework for understanding the defense mechanisms at stake in object relations, I argue that psychoanalysis may add an important critical dimension to the anthropology of therapeutic encounters.
In this commentary, I discuss some of the theoretical and methodological issues the contributions to this special issue raise collectively, namely: how do we as anthropologists pick and choose among the many diverse psychoanalytic concepts available to us, especially when these concepts may come embedded in very different, and sometimes contradictory, theoretical assumptions about human behavior? Once we find a psychoanalytic concept that is useful for ethnographic work, can we or should we attempt to relate it to more experience near ethnopsychological terms and assumptions, ones that might seem more understandable and intuitive from a local point of view? How intimately should we know people, biographically or developmentally, before we attempt to apply psychoanalytic concepts to their behavior? And, given that George Devereux is cited as one of the inspirations for this special issue, what role can or should an awareness of countertransference play in ethnographic work, and what are the limits, if any, of psychoanalytic interpretation in an ethnographic context?
The devastating Indian Ocean tsunami of 26 December 2004 caused massive destruction to coastal Aceh, Indonesia, and left countless numbers of people dead or wounded. This article focuses on the embodied narratives of three Acehnese women who survived the disaster and, like many others in Aceh, told their stories ‘through’ their bodies. A detailed ethnographic account of their narratives reveals how the body stretches temporally between the ‘narrated event’ and the ‘narrative event’, both through the representation of the body in narratives and through the embodied performance of narratives. Moving beyond meaning-centred analyses of narratives, I argue that the central accomplishment of these narratives is that they convey poignant bodily experiences to others and thereby create a shared, post-disaster, world. Ultimately, through these embodied narratives of disaster people remake their world, with others, in the wake of its ‘unmaking’.
Inquiring into concerns surrounding death and the afterlife in an underclass enclave in Japan, this article proposes that the politics of survival involves engaging with the enduring relationship between the living and the dead, referred to as ‘necrosociality’. Based on fieldwork carried out in Yokohama, it explores how ‘isolated death’ (kodokushi) and ‘disconnected spirits’ (muenbotoke) have become major concerns in homeless activism and support, giving rise to various necrosocial innovations and practices. The emergent necrosociality in Yokohama conjures up an alternative logic of care that connects people based on the general premise of inevitable decay and decline rather than familial ties and intimate memories. This article suggests that the concept of necrosociality provides a useful framework for analysing how social relations are negotiated, reaffirmed, or negated through bodily remains and graves, effectively shaping the modes of being and care among the living.
Special Focus Section: Comorbidity
Merrill Singer and Nicola Bulled
Based on an assessment of the available research, this article uses syndemic theory to suggest the role of adverse bio–social interactions in increasing the total disease burden of tick-borne infections in local populations. Given the worldwide distribution of ticks, capacity for coinfection, the anthropogenic role in environmental changes that facilitate tick dissemination and contact, evidence of syndemic interaction in tick-borne diseases, and growing impact of ticks on global health, tick-borne syndemics reveal fundamental ways in which human beings are not simply agents of environmental change but objects of that change as well.
This article examines the comorbidity concept in medical anthropology. I argue that the dearth of articles on comorbidity in medical anthropology may result from the rise of syndemic theory. Syndemics recognize how social realities shape individual illness experiences as well as distribution of diseases across populations. I discuss synergistic interactions foundational to the syndemics construct through my research of depression and diabetes comorbidity in vulnerable populations from urban United States, India, and South Africa. I argue that social and economic factors that cluster with depression and diabetes alone and together exemplify the biosocial processes that are at the heart of syndemics. In doing so, I illustrate how social, cultural, and economic factors shape individual-level experiences of co-occurring diseases despite similar population-level trends. Finally, I discuss the relevance of syndemics for the fields of medicine and public health while cautioning what must not be lost in translation across disciplines.
Lenore Manderson and Narelle Warren
Chronic conditions and their resultant difficulties in daily living frequently occur with other health problems, sometimes due to interactions or complications at a biological level, or as a result of common pathogens or risk factors. On other occasions, they develop independently. Drawing on research conducted with Australian women that began in the mid-2000s and is still ongoing, we highlight how chronic structural factors shape the risk factors of “chronic” conditions, influencing health seeking, continuity of care, and health outcomes. Institutional, economic, and other circumstantial factors pertain and impact health trajectories as much in highly industrialized as in resource poor settings. In illustrating how poverty and social exclusion create the preconditions of multiple chronic health problems, and how chronic health problems increase such disadvantages for individuals and their households, we introduce the idea of “recursive cascades” to capture the often inevitable trajectory of increasing ill health and growing empoverishment.
Lesley Jo Weaver
The biomedical definition of comorbidity belies the complexity of its lived experience. This article draws on case studies of women with diabetes and various comorbidities in New Delhi, India, to explore intergenerational transactions surrounding suffering in contexts of comorbidity. The analysis synthesizes sociological theories of chronic disease work, psychological theories of caregiver burnout, and anthropological approaches to suffering and legitimacy to explore how, when, and by whom women’s comorbid sources of suffering become routinized in everyday life. The analysis demonstrates, first, that comorbid suffering is not simply a matter of the addition of a second source of suffering to an existing one; rather, it comprises complex interactions between suffering, disability, family dynamics, and quality of life. Second, it illustrates several social routes through which comorbid suffering can fade into the background of everyday life, even when it is severe. Close attention to how suffering works in cases of comorbidity will be important as comorbid conditions become increasingly commonplace around the world.
Brandon A. Kohrt and Christine Bourey
Our objective was to elucidate how culture influences internal (psychological), external (social), institutional (structural), and health care (medical) processes, which, taken together, create differential risk of comorbidity across contexts. To develop a conceptual model, we conducted qualitative research with 13 female child soldiers in Nepal. Participants gave open-ended responses to intimate partner violence (IPV) vignettes (marital rape, emotional abuse, violence during pregnancy). Twelve participants (92%) endorsed personal responses (remaining silent, enduring violence, forgiving the husband). Twelve participants endorsed communication with one’s husband. Only four participants (31%) sought family support, and three contacted police. Ultimately, 12 participants left the relationship, but the majority (nine) only left after the final IPV experience, which was preceded by prolonged psychological suffering and pregnancy endangerment. In conclusion, comorbidity risks are increased in cultural context that rely on individual or couples-only behavior, lack external social engagement, have weak law and justice institutions, and have limited health services.
In this short essay, I wish to briefly discuss smoking, polypharmacy, the human biome and multispecies relations, and biomedicalization as a means of stretching the common ways we think about comorbidity. My intent is to expand our thinking about comorbidity and multimorbidity beyond the individual as a unit of analysis, to reframe comorbidity in relation to trajectories of risk, and to address comorbid states of our own making when the treatment of one health problem results in the experience of additional health problems. I do so as a corrective to what I see as an overly narrow focus on comorbidity as co-occurring illnesses within a single individual, and as a complement to critical medical anthropological assessments of synergistic comorbid conditions (syndemics) occurring in structurally vulnerable populations living in environments of risk exposed to macro and micro pathogenic agents.
The nation’s fight against fat has not reduced obesity, but it has had other worrying effects. Mental health researchers have raised the possibility that the intense pressures to lose weight have heightened the risks of developing eating disorders, especially among the young. Medical anthropology can help connect the dots between the war on fat and disordered eating, identifying specific mechanisms, pathways, and contextual forces that may lie beyond the scope of biomedical and psychiatric research. This article develops a biocitizenship approach that focuses on the pathologization of heaviness, the necessity of having a thin, fit body to belonging to the category of worthy citizen, and the work of pervasive fat-talk in defining who can belong. Ethnographic narratives from California illuminate the dynamics in individual lives, while lending powerful support to the idea that the battle against fat is worsening disordered eating and eating disorders among vulnerable young people.
Cristina A. Pop
This article locates the symbolic construction of “corrupted purity”—as a key assertion in Romanian parents’ HPV vaccination refusal narratives—within a multiplicity of entangled rumors concerning reproduction and the state. Romania’s unsuccessful HPV vaccination campaign is not unique. However, the shifting discourses around purity and corruption—through which some parents conveyed anxieties about their daughters being targeted for the vaccine—place a particular twist on the Romanian case of resisting the HPV vaccination. Parental discourses took the form of clusters of rumors about state medicine’s failure to provide adequate reproductive health care, additive-laden foods, and exposure to radioactive contamination. In these rumors, corruption becomes literally embodied, through ingestion, consumption, contact, or inoculation. Parental discourses about what is being injected into their daughters’ pristine bodies express their uncertainty around navigating the unsettled post-socialist medical landscape.
This article analyzes informal medical payments that the majority of Lithuanians give or feel compelled to give to doctors before or after treatment. It focuses on how patients and their caretakers encounter, practice, and enact informal payments in health care and how these payments create a reality of health care that is not limited to an economic rationality. Within such a frame, rather than being considered a gift or bribe, it conceptualizes these little white envelopes as a practice of health and care. The article shows how an envelope of money given to a doctor transcends the material patient–doctor transaction and emerges as a productive force for coping with illness, medical encounters, and misfortunes.
This paper follows the ‘moral life’ of epinephrine auto-injectors, devices that people with food allergies and their caretakers use to administer emergency medication to stop serious allergic reactions, in the United States. These devices are potent signifiers of the seemingly precarious nature of life with food allergies. I follow auto-injectors from their social birth as a commodity object, through how they structure doctor-patient interactions and parenting, to the ways that parents and illness advocates talk about their life-saving properties. At every step of the way, their significance is influenced by the political-economic context of health care in the United States, which places significant burdens of financial cost and responsibility for deciding what constitutes ‘good’ care upon individual patients and caretakers. The moral life of epinephrine serves as a model for thinking about how medical devices take on meaning that is at once practical, moral, and economic as they circulate through manufacturing and distribution channels and into the lives and social worlds of users.
Sara Marie Hebsgaard Offersen, Mette Bech Risør, Peter Vedsted, Rikke Sand Andersen
Woven into the fabric of human existence is the possibility of death and suffering from disease. This essential vulnerability calls forth processes of meaning making, of grappling with uncertainty and morality. In this article we explore the uncertainty and ambiguity that exists in the space between bodily sensations and symptoms of illness. Bodily sensations have the potential to become symptoms of disease or to be absorbed into ordinariness, prompting the question: how do we ascribe meaning to sensations? In the context of middle-class everyday life in Denmark, we show how different potentialities of ambiguous sensations are weighed against each other on a culturally and morally contingent continuum between normal and not normal, uncovering the complex interplay between the body, everyday life, and pervasive biomedical discourses focusing on health promotion, symptom awareness, and care seeking.
Miriam Waltz and Fiona C. Ross
Donated human milk’s status comes into question as it leaves the mother-child relationship and is reconfigured through practices and discursive structures that seek to stabilise it as a specific kind of object. Based on research conducted in Cape Town, South Africa, we examine the crucial role of technologies in aiding the milk’s transformation as milk moves from donors’ homes into the clinical setting where it is received by preterm, low-birth weight newborns. We show that the milk shifts back and forth between being a bodily fluid, food, and medicine in the course of this trajectory. Different techniques foreground milk’s diverse properties as a set of moral decisions converges around saving, securing, and sustaining life, and materialising relationships.
This article critically examines the development and current state of speculative bioethics (bioethics discourse concerned with future technologies) as reflecting an intensifying science fictionality, a cognitive/perceptual mode in which the imagined future begins to exert increasing degrees of influence on the present, culminating in a collapse of distance between the two. Future technologies thereby come to be viewed as generating practical ethical issues that need to be addressed well in advance of their arrival. Although this appears to be a prudent effort, it actually bypasses the present as a site of moral agency and locates ethics within a simulation of the imagined future. A constructive form of speculative bioethics must be able to critically assess visions of technological futures if it is to function as an ethics that is of and for the present.
This article considers differences between the representation of mutation in science fiction films from the 1950s and the present, and identifies distinctive changes over this time period, both in relation to the narrative causes of genetic disruption and in the aesthetics of its visual display. Discerning an increasingly abject quality to science fiction mutations from the 1970s onwards—as a progressive tendency to view the physically opened body, one that has a seemingly fluid interior–exterior reversal, or one that is almost beyond recognition as humanoid—the article connects a propensity for disgust to the corresponding socio-cultural and political zeitgeist. Specifically, it suggests that such imagery is tied to a more expansive ‘structure of feeling’, proposed by Raymond Williams and emergent since the 1970s, but gathering momentum in later decades, that reflects an ‘opening up’ of society in all its visual, socio-cultural and political configurations. Expressly, it parallels a change from a repressive, patriarchal society that constructed medicine as infallible and male doctors as omnipotent to one that is generally more liberated, transparent and equitable. Engaging theoretically with the concept of a ‘structure of feeling’, and critically with scientific, cinematic and cultural discourses, two post-1970s’ ‘mutation’ films, The Fly (1986) and District 9 (2009), are considered in relation to their pre-1970s’ predecessors, and their aesthetics related to the perceptions and articulations of the medical profession at their respective historic moments, locating such instances within a broader medico-political canvas.
Early last year, a non-profit organisation called ‘Limbitless Solutions’ modelled a 3D printed prosthetic arm on a fighting suit that features in the popular superhero film series, Iron Man (2008–2013). In addition, ‘Limbitless Solutions’ resourcefully deployed the fictional character and inventor of the Iron Man suit, weapons specialist and philanthropist, Tony Stark, played by Robert Downey Jr, in a celebrity/superhero endorsed promotional short film, showing ‘Tony’, the ‘real Iron Man’, gifting the futuristic military styled ‘gauntlet’ to Alex, a 7-year-old boy with a partially developed right arm. Engaging with scholarly work on the science fiction of technoscience, prostheses and the posthuman, and disability and DIY assistive technology, I analyse ‘Limbitless Solutions’ use of science fiction in a high-profile media event that problematically portrays an impaired child ‘in need’ of ‘repair’ and subsequently ‘fixed’ by technology. Overall, the aim is to integrate science fiction tropes, such as the wounded hero, the fighting suit and prosthetic arm, with disability studies, to highlight the sustained challenges that emerging theories of disability and technology face as contemporary economic, political and ideological forces endorse and promote militarised images of cyborg assimilation over human variation and physical difference.
Lesley Henderson and Simon Carter
There has been considerable interest in images of medicine in popular science fiction and in representations of doctors in television fiction. Surprisingly little attention has been paid to doctors administering space medicine in science fiction. This article redresses this gap. We analyse the evolving figure of ‘the doctor’ in different popular science fiction television series. Building upon debates within Medical Sociology, Cultural Studies and Media Studies we argue that the figure of ‘the doctor’ is discursively deployed to act as the moral compass at the centre of the programme narrative. Our analysis highlights that the qualities, norms and ethics represented by doctors in space (ships) are intertwined with issues of gender equality, speciesism and posthuman ethics. We explore the signifying practices and political articulations that are played out through these cultural imaginaries. For example, the ways in which ‘the simple country doctor’ is deployed to help establish hegemonic formations concerning potentially destabilising technoscientific futures involving alternative sexualities, or military dystopia. Doctors mostly function to provide the ethical point of narrative stability within a world in flux, referencing a nostalgia for the traditional, attentive, humanistic family physician. The science fiction doctor facilitates the personalisation of technological change and thus becomes a useful conduit through which societal fears and anxieties concerning medicine, bioethics and morality in a ‘post 9/11’ world can be expressed and explored.
[This article originally appeared in Limn, Issue No. 7, “Public Infrastructures / Infrastructural Publics”.]
For the past several decades, Flint, Michigan, has staggered under waves of deindustrialization, disinvestment, and abandonment that have left the city depopulated, its built environment in shambles, and its remaining residents reeling from high unemployment and crime rates, a decimated tax base, and dwindling municipal services. While grim, Flint’s decline is by no means unique in a region whose cities have become synonymous with the booms and busts of twentieth century American manufacturing. Nor is the degree of its decay unusual. Aficionados of ruin will find crumbling infrastructures arresting and aplenty in most any “Rust Belt” city. What is singular, however, is the attention that Flint’s contaminated water has received in recent months, an attention that is now amplifying ongoing debates concerning America’s ailing and aging infrastructures. That amplification is especially apparent in variations of a phrase that has recently echoed through local, regional, and national media and activist circles: “We are all Flint.”
With every disclosed email, alleged wrongdoing, and denial of responsibility, the course of Flint’s contamination grows as murky and foul as the water that began flowing from its taps in 2014. In April of that year, the city switched its water source from Lake Huron to the Flint River. The switch unfolded amid a climate of intense fiscal austerity in which state-appointed emergency managers pushed Michigan’s most financially beleaguered cities to cut costs. In Flint, part of this push included a proposal to bypass Detroit’s Water and Sewerage Department as the city’s water supplier, and to instead source cheaper water through a newly constructed pipeline into Lake Huron. Yet until that pipeline came on line in 2016, the city would draw directly from its river. Decades of heavy industry, pollution, and salted roads meant that more than water rolled through that river. Bacteria, chloride, and chlorine-based disinfectants transformed Flint’s treated river water into a highly corrosive soup that ate into aging copper, iron, and lead pipes. Heavy metals then leached from the service lines that connected individual homes, schools, businesses, and factories to Flint’s broader water infrastructure.
Flint’s residents complained almost immediately about the rank, rust-colored water that tasted strange and sickened them. Local water workers and state environmental monitors, however, repeatedly brushed off these complaints, even as they failed to combat pipe corrosion. According to recent criminal charges, some even went so far as to tamper with tests and readings that would have confirmed the heavy amounts of lead in Flint’s water system (State of Michigan Attorney General 2016). Pressure mounted throughout 2015 as residents clamored for action, and as researchers and medical professionals documented high lead levels in Flint’s water alongside a spike in cases of children with elevated levels of this potent neurotoxin in their blood.
“Flint’s Katrina,” as some activists and politicians have taken to calling the contamination, might seem an isolated event born of the catastrophic convergence of emergency management, shifting water chemistry, aging pipes, and failed governmental oversight. After all, what makes an event a disaster is its ability to rupture everyday life, expectations, and routines. Yet “We are all Flint’s” traction in local, regional, and national media suggests something else. Doctors, journalists, and activists have all invoked the phrase when pointing to the ongoing presence of lead in Americans’ everyday lives, especially within the water systems of older cities. If “We are all Flint” is a rallying cry, exactly who and for what does it rally?
In the face such a question, it’s tempting to argue that there is something universalizing about water because it is a substance that all humans depend on. Consider comments made by Erin Brockovich, an environmental activist known for her legal advocacy. In Brockovich’s recent article “We Are All Flint” (2016), the city emerges as just one entry in a list of municipalities afflicted by a common denominator: tainted water. Water is “the one thing that sustains us all,” Brockovich writes, and for that reason, contaminated water doesn’t “see any boundaries of rich or poor, black or white, Republican or Democrat” (Brockovich 2016). Flint is unusual only because it is “the perfect storm” of pollution and government inaction that might just cause “everybody else to wake up” to the presence of toxins in all our lives and bodies (Brockovich 2016). Here, our biological dependence upon water collapses social boundaries, drawing us into a universal political body with a shared stake in clean water.
In the face of such universalisms, it’s also tempting to underscore that not every American navigates tainted water in the same way. After all, it is not just any city being poisoned through its degraded and neglected infrastructures, but an impoverished Black city. Take a recent column by New York Times journalist Nick Kristoff titled “America Is Flint.” “Today the continuing poisoning of half a million American children is tolerated,” Kristoff writes, “partly because the victims often are low-income children of color” (Kristoff 2016). Kristoff’s column does not back away from the sentiments undergirding “We are all Flint.” It merely qualifies them by pointing out the ubiquity of lead in Americans’ lives alongside the uneven distribution of its risks. A more pointed critique might suggest that were “we” to foreground that that unevenness, we might be forced to recognize that if “America is Flint,” it is not because of the ubiquity of lead in our water infrastructures. It is because like Flint, America is a place built on profound, longstanding, and enduring racial and economic inequalities that continue to waste some but not all of its citizens’ bodies and communities. From this perspective, the sentiments that undergird “We are all Flint” bear more than a passing resemblance to those associated with “All Lives Matter.” They gesture to enduring inequalities at the same time they blunt any serious criticism of those inequalities by diluting them in a wash of misdirected solidarity. Here, “We are all Flint” isn’t just hogwash: it’s whitewash.
While American society’s enduring inequalities are troubling, they are not exactly news. News commentary surrounding Flint in fact dwells on how racial animus directed against residents of this “majority minority” city might have driven the neglect and disregard that ushered in its contamination. “We are all Flint’s” power then rests not on the phrase’s affirmation or denial of social inequalities, but on its capacity to summon a “we,” an expansive group comprising countless Americans concerned with “our” aging municipal water infrastructures. In the process, a down-at-the-heels, Black city in a down-at-the-heels state has become emblematic of the dangers that infrastructural degradation poses to all Americans. The question that “We are all Flint’s” traction raises then is not whether this “we” actually includes those Americans most at risk from lead poisoning. It is rather about the kinds of risks that a far-flung group of citizens can recognize as shared, and thus worthy of collective concern and action, and those that will, despite their ubiquity, seem isolated events that will never break the surface of widespread attention. Scholars of mass media in liberal democratic societies have a term for such groups: publics.
Publics form when strangers consume media forms, like newspapers, newscasts, and novels. As they respond to these forms, and imagine countless others throughout their cities, states, or nations doing the same, they constitute themselves as a political whole (Calhoun 1998; Habermas 1991; Warner 2002). Members of publics come to imagine themselves as part of much larger wholes capable of voicing collective interests and making collective demands upon entities tasked with protecting those interests. Publics emerge through speaking, listening, and reading. As such, they are discursive formations. Yet those formations are never divorced from a material world. Brockovich’s readers have no trouble imagining a “we” indignant at tainted water precisely because they have spent lifetimes opening and closing their own taps, lifetimes filling glasses, tubs, and pots with the water that comes gushing out, and lifetimes expecting that water to be clean. And they have spent lifetimes expecting that their taxes supported the care that fellow citizens took with protecting important collective goods such as water. Yet it’s not every infrastructure that raises a public able to make demands about the soundness of the collective goods it delivers. Consider, for instance, the relative silence that surrounds lead’s presence within another major infrastructure: housing.
Housing does not often show up in conversations about infrastructure, but it should. When understood as a thing that draws other entities into relation, an infrastructure need not be limited to the pipes, wires, or roads that so often come to mind whenever we utter the term (Larkin 2013). We can also understand it as a thing that facilitates flows, standardizes distributions, and extends political projects (Anand 2017; Chu 2014; Collier 2011; Joyce 2003; von Schnitzler 2016). Beginning in the 1930s, subsidized housing in both its public and private guises became a premier infrastructure of the American welfare state. On the one hand, public housing, at least in its earliest years, delivered sound shelter to working- and middle-class Americans shut out of housing markets on account of their limited means or the color of their skin. On the other hand, federally guaranteed mortgages allowed many Americans in the middle class—and those who aspired to join its ranks—to stabilize their housing costs by spreading them over several decades. They obtained, on extremely favorable terms, a major asset that they could then leverage to finance things a household’s members might need, or just want: educations, retirements, second homes, business ventures, enough accrued wealth to pass onto children. The trappings of middle-class security became bound up in the mortgaged home and the orientations to time, place, saving, and spending that it disciplined among mortgage holders. But as much as this welfare infrastructure facilitated the expansion and distribution of financial and economic wellbeing, it was also a thing in its own right. And in the course of older American cities, that thing became thoroughly leaded.
By the early twentieth century, lead was common in the pipes that snaked through growing industrial cities and in the soils of areas that surrounded smelters and foundries. When lead became a common additive in gasoline in the 1920s, lead particles in the air and soil became even denser (Shea 2007). Yet it was lead’s presence in house paint that threw—and continues to throw—American children most directly into its path. Consumer tastes for colorful domestic interiors grew in the 1920s. The electrification of cities meant that consumers no longer needed their house paint to cover soot from coal- and gas-burning lamps, and thus dark, oil-based paints fell out of fashion. Lead paint made the surfaces it covered bright, durable, and easy to clean, adding to consumers’ conceptions that it was the most hygienic way to treat surfaces (Markowitz and Rosner 2002; Warren 2000). As lead paint was more expensive than other paints, consumers tended to save it for surfaces that would see more wear and tear, such as baseboards, windowsills, doors, and stairs. And so the very surfaces small children gravitate toward for ballast as they learn to stand up and walk around became covered in a thin, metallic layer. Without regular maintenance, those surfaces could break down and release leaded dusts. Small children easily ingested these dusts because they explore their worlds as much with their mouths as they do with their hands. During the middle decades of the twentieth century, doctors and researchers gradually tied such ingestion to a host of ailments, including lifelong cognitive impairments, behavioral problems, stunted growth, and in severe cases, death (Markowitz and Rosner 2013). More recently, researchers have suggested that lead-poisoned children afflicted with behavioral problems can age into erratic, aggressive, even criminal behavior (Nevin 2007).
By the 1950s, physicians understood that deteriorating paint had ushered in a lead poisoning epidemic among children, especially among impoverished children living in the dilapidated housing stocks of aging industrial cities. They clamored for regulations, and two strategies emerged. The first called for eliminating lead from American life, and a total ban on its circulation. The second, considered far more cost effective, focused on limiting individual instances of exposure (Markowitz and Rosner 2013). Federal regulations finally emerged in the late 1970s that prohibited the use of lead in paint destined for residential uses. Even so, many leaded homes would remain leaded: to this day, health professionals advise homeowners and landlords that aging lead paint poses little risk when neatly sealed with a layer of clean paint, tile, drywall, or wallpaper, and when dust is contained during renovation. The main public health intervention is to direct those who own homes built before 1980 to make sure that lead paint is properly contained, that renovations are properly conducted, and that children avoid suspect surfaces. In short, lead paint still lingers in all manner of homes financed and delivered through governmental subsidies and programs. Yet in a society that takes homeownership aspirations for granted, and treats the responsible mortgage holder as an exemplar of citizenly virtue, it is difficult to parse the lead layered in one’s walls and windowsills as a collective matter that warrants widespread attention and concern. There is no “we” here; there are only individual homeowners and landlords who act more and less responsibly when grappling with the residues of bygone building practices, homeowners and landlords who are more or less able to safeguard the health of both their investments and the people who live within them. This ethos of individual responsibility is in fact so strong that it has come to govern even obsolete housing infrastructures and their disposal.
Consider here the serious effort that another financially beleaguered Michigan city has recently undertaken to mitigate the hazards posed by the vacant houses that litter its landscape. In 2014, Detroit embarked on an ambitious, federally funded plan to take down 40,000 derelict structures. Those coordinating the demolitions put in place measures to suppress the spread of demolition dust, which typically comprises a range of heavy metals, including copper, manganese, iron, and lead. Coordinators have concerned themselves especially with lead. Like many cities in the region, Detroit has struggled with high childhood lead poisoning rates: although rates have fallen in the past decade, they are still nearly twice the national average (Bienkowski 2013). Adopted measures included requiring contractors to forgo the wrecking ball in favor of equipment and procedures that release less dust, to wet down houses and the resulting debris piles as they demolish houses and cart them off to the dump, and to distribute materials to neighbors that offer tips for avoiding dust. While federal regulators have lauded these steps as a “best practice,” they have not required Detroit to undertake any of them. Were this “best practice” to fall by the wayside under mounting criticisms about rising demolition costs and dwindling federal funds to cover them, nothing apart from personal vigilance would stand between a resident and her exposure to potentially hazardous dusts.
Now compare this situation with that of Flint. Federal regulations phased out lead pipes, paint, and gasoline around roughly the same time. And like leaded housing, many leaded water infrastructures have remained leaded because remediation strategies have likewise centered on containment instead of removal. This is where the similarity ends. Federal regulations in place since the early 1990s require water utilities to take standard corrosion control measures (U.S. Environmental Protection Agency [EPA] 1991). Adding phosphates to water during the treatment process coats pipes in ways that inhibit lead and copper from leaching into water from a utilities’ own aging and outmoded piping, but also from consumers’ aging and outmoded piping. This second point is crucial: regulations exist governing the disposal of leaded paint in occupied buildings, but they target the actions and inactions of individual property owners. The responsibility for lead mitigation within water infrastructures is neither localized nor localizable. Instead, the service provider must assume responsibility for the health of water distributed throughout the entire network. As such, it must mitigate leaching risks in the houses of private homeowners by making sure that the water it sends into those houses will not cause aging pipes and fixtures to leach lead. This is the step that water workers failed to take in Flint, and the step that state and federal regulators failed to enforce. In the process, they set off a public health emergency that has captured national attention. Federal and state governments are heavily involved in providing and regulating the goods of shelter and water. Yet in contrast to water, Americans do not generally consider shelter to be a collective good, as evinced by that fact that its provision, maintenance, and regulation is in most instances not centrally administered. Publics raised through water infrastructures can make demands of public entities that publics raised through housing infrastructures generally cannot. This means that heads can and will roll for toxic water in a way that they have not and cannot roll for physically and financially toxic housing.
Once airborne, demolition dusts can circulate beyond the point of their origin. In this respect, they resemble the expansive reach of flowing water. Yet even though dust generated by the demolition of homes poses public health hazards in cities across the United States, we are not all Detroit. Just as we are not all Baltimore, Chicago, or Milwaukee, all cities that have, courtesy of leaded house paint, struggled with epidemic lead poisoning rates. Flint is an entirely different matter because Americans have come to conceive of water and its delivery in an entirely different fashion. Water infrastructures may send water flowing through an individual home, but they are not ultimately of that home. They tap deep into investments in a good whose care seems utterly beyond the reach of any single individual. And these investments float the stuff not just of collective imagination and identification, but also of collective administration and related demands for collective protection. So while “we” might all be at risk for ingesting toxins, some of us can spit back the lead soup that leaches from “our” pipes, even as others must swallow the lead dust that flakes off “our” walls.
Catherine Fennell is an anthropologist at Columbia University whose work examines the social and material legacies of housing in the urban Midwest.
Anand, Nikhil. 2017. The Hydraulic City. Durham, NC: Duke University Press.
Bienkowski, Brian. 2013. “Good News for Detroit: Lead Poisoning of Kids Drops 70 Percent since 2004.” Environmental Health News, February 28. link
Brockovich, Erin. 2016. “We are all Flint: How America’s Moms are Leading the Battle for Clean Drinking Water.” Huffington Post, March 18. link
Calhoun, Craig. 1998. “Community with Propinquity Revisited: Communications Technology and the Transformation of the Urban Public Sphere.” Sociological Inquiry 68(3):373–397.
Chu, Julie. 2014. “When Infrastructures Attack: The Workings of Disrepair in China.” American Ethnologist 41(2):351–367.
Collier, Stephen. 2011. Post Soviet Social: Neoliberalism, Social Modernity, Biopolitics. Princeton, NJ: Princeton University Press.
Habermas, Jurgen. 1991. The Structural Transformation of the Public Sphere. Cambridge, MA: MIT Press.
Joyce, Patrick. 2003. The Rule of Freedom: Liberalism and the Modern City. New York: Verso.
Kristoff, Nicholas. 2016. “America is Flint.” New York Times, February 6. link
Larkin, Brian. 2013. “The Politics and Poetics of Infrastructure.” Annual Review of Anthropology 42(1):327–343.
Markowitz Gerald, and David Rosner. 2002. Deceit and Denial: The Deadly Politics of Industrial Pollution. Berkeley: University of California Press.
———. 2013. Lead Wars: The politics of Science and the Fate of America’s Children. Berkeley: University of California Press.
Nevin, Rick. 2007. “Understanding International Crime Trends: The Legacy of Preschool Lead Exposure.” Environmental Research 104:315–336.
Shea, Edward. 2007. Lead Regulation Handbook. Lanham, MD: Government Institutes.
State of Michigan Attorney General. 2016. “Schuette Charges Three with Multiple Felonies in First Stage of Flint Water Crisis Investigation” [press release], April 20. link
U.S. Environmental Protection Agency (EPA). 1991. Lead and Copper Rule. Washington, DC: EPA, Office of Water.
von Schnitzler, Antina. 2016. Democracy’s Infrastructure: Techno-politics and Protest after Apartheid. Princeton, NJ: Princeton University Press.
Warner, Michael. 2002. Publics and Counterpublics. Cambridge, MA: MIT Press.
Warren, Christopher. 2000. Brush with Death: A Social History of Lead Poisoning. Baltimore, MD: Johns Hopkins University Press.
Book Forum––Science, Reason, Modernity: Readings for an Anthropology of the Contemporary by Todd Meyers
Science, Reason, Modernity: Readings for an Anthropology of the Contemporary is many things — a carefully curated selection of classic texts ranging from Immanuel Kant’s “An Answer to the Question: ‘What is Enlightenment?’” and Max Weber’s “Science as a Vocation,” to Georges Canguilhem’s “The Question of Normality in the History of Biological Thought” and Paul Rabinow’s “Anthropos Today: Reflections on Modern Equipment”; a critical intervention aimed at the core of science studies; an exacting, plowing thesis on the anthropology of the contemporary; and a pedagogical resource crafted for those seeking paths through the briar of scientific method and biological thought (and their historical, social, and philosophical registers). We hope you enjoy a provocative and engaging set of commentaries.
Mediated Experiences: 1-7
Bradley Dunseith + Sean Miller + Antoine Przybylak-Brouillard + Meg Stalcup
University of Ottawa
Canguilhem: the mutual purpose of ethics and science
Goldsmiths, University of London
The Rabinowian Program
University of Liege
Forging Links, Surveying Rifts
University of Pennsylvania
In the Folds of the Contemporary
Gaymon Bennett, Lyle Fearnley & Anthony Stavrianakis
Arizona State University, Singapore University of Technology and Design, CNRS
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On Deanthropologizing Anthropology — An Essay on Tarek Elhaik’s “The Incurable Image” by Tobias Rees
“Are cultural anthropologists ready to shed their habit of using society and culture? (…) No, I don’t feel so. (…) It seems to me that many anthropologists wish to keep the human (…). There is a tricky problem here: concentrating around the human could mean either maintaining this character apart from other entities — the former beings of ‘nature’ defining by contrast what could be called the ‘humanistic’ position —, or it could mean accepting that, as soon as you take the human into consideration, it is suddenly redistributed (not disintegrated, that’s the whole point, but redistributed) in many other roles and connections that make its earlier figurations unrecognizable.”
Could one deanthropologize anthropology? Is it possible to differentiate anthropology, science of the human, from the figure of ‘Man’ as it emerged in the 18th century and made anthropology possible (Foucault 1966)?
At first these questions may sound bizarre — and an anthropology journal an odd choice for asking them. However, the will to leave the human behind is a prominent feature of what one could call contemporary anthropologies of nature. The reference here is largely to the so-called ontological turn (for reviews see Kohn 2015; Boellstorff 2016) and multi-species anthropology (Helmreich and Kirksey 2010; Kirksey 2014).
Admittedly, I find the writings of the multi-species anthropologists and the ontologists — the two groups are best kept separate, precisely insofar as many of the former are not actually ontologists at all — hugely fascinating: I find myself intrigued by the effort to break free from ‘the human.’ I find it fascinating to read anthropology books on mushrooms (Tsing 2015) and cheese (Paxson 2012), on rocks (Povinelli 2016), water and waves (Helmreich 2009; 2015), pigeons (Jerolmak 2013), and insects (Raffles 2010) — to read them as an effort to imagine anthropology as independent from the concept of the human that has historically made anthropology possible. How can one imagine anthropology differently? What could an anthropology of the animal — or the mushroom — look like?
But then, I also find many of the anthropologies of alternative ontologies or multi-species assemblages sobering. Leaving the human behind, whether in substance or in form, seems much more difficult than anticipated. For example, most works in multi-species anthropology happily reproduce the very genre of anthropology from which they seek to depart. Like classical modern ethnographers studied strange and exotic others — the ‘primitive,’ the ‘savage,’ with their seemingly inexplicable rituals —, multi-species anthropologists study strange and exotic animals and their seemingly inexplicable (but endlessly curious) behavior. And like the ‘primitive’ was once invented — or instrumentalized — by ethnographers to put the taken-for-grantedness of our own, Western life style in question, so today the animal is used to question our self-description as human. What is more, just like once every anthropologist had her tribe (Shilluk, Trobrianders, Zulu, Aranda), so each multi-species anthropologists has her animal or plant.
There might be a focus on animals rather than on humans, but in a curious — and at times problematic — turn, animals (or plants) often seem to assume the role formerly reserved to ‘the primitive:’ as a moralizer of the (Western, modern concept of the) human.
Ontology has comparable issues (e.g., Kohn 2007; Viveiros de Castro 2004; Holbraad 2009; Holbraad et al. 2014; Descola 1996a, 1996b, 2013, 2014). The vast majority of ontologists directly or indirectly seem to rely on Latour’s problematization of modernity understood as the separation of nature and culture — and to then argue that the ‘primitive’ has never made that mistake in the first place (Latour 1996). More often than not this argument is offered in form of a critique of modernity that is reminiscent of the 19th century romantic conception of nature (of which the formerly premoderns are the guardians) — a setup that evokes the moral authority of nature in the face of the violent (human) destruction of the environment.
Much of ontology, thus, appears to be a curious inversion of the philosophy of history that has been constitutive of modernity: it is contingent on the very argument it sets out to leave behind.
At least two sets of questions emerge from the sobering effect that emerges from readings in ontology and multi-species anthropology. The first is quite simply this, how to really break free from ‘the human?’ How to decouple anthropology of the figure Michel Foucault called ‘Man’ without immediately reintroducing the vocabulary that stabilized ‘Man’ from within and without simply inversing the nature/culture relationship?
The second set of questions emerges from the, let’s say, ‘narrow’ focus of most of the works that ask the first one: the actual empirical focus of those interested in breaking with human exceptionalism is almost exclusively on nature, on human-animal relations, on bacteria, plants, mushrooms, soil, environments. A bit as if nature or the possibility to establish a human/nature continuum is the only possible point of departure, the only hopeful remedy against ‘the human.’ Indeed, one is occasionally left with the impression that any attention to the human is retrograde, a conservative remnant of a modernist past. This, well, morally charged focus on nature provokes me to ask: Couldn’t one envision an anthropology ‘of’ the human but after ‘the human?’ That is, an anthropology still interested in things human but not ready to assess human things in terms of ‘Man?’ Differently asked, could it be that one venue for deanthropologizing the human could be found not in nature but in the emergence of human affairs that escape the vocabulary that surrounds ‘the human?’
It is in the face of these questions that The Incurable Image, a book by Tarek Elhaik, an anthropologist and curator, gains its significance; it provides an unanticipated, fieldwork-based answer to both of the above questions.
In the early 2000s, Elhaik, left to conduct fieldwork among contemporary artists and curators in Mexico City. Prior to attending University, Elhaik — a native of Morocco — had been a curator of Arab film festivals. While immersed in cinema, he found himself intrigued by the overlap between the themes explored by the films he curated and questions that surfaced in various anthropological projects of the 1990s: questions of decolonialization, of the possibilities and pitfalls of a postcolonial identity, of the figure of the migrant, of cultural differences, of alternative modernities, of the possibility of a — non-Western-based — cosmopolitan politics.
In school (working with Paul Rabinow) Elhaik built an imaginaire that revolved around a clearly defined set of references (think of it as an echo of the 1990s): (1) the sense of play defined by what Marcus and Fischer in 1986 called ‘the experimental moment in the human sciences;’ (2) the critique of western epistemologies today largely (if not quite correctly) associated with Writing Culture and Public Culture; (3) what Jim Clifford described as Ethnographic Surrealism (the overlap of avant-garde, literary modernism, painting, and anthropology especially in the 1920s and 30s); and (4) by Georges Marcus’ exploration of the significance of the cinematic technique of montage for post-Writing Culture ethnographies.
Equipped with this imaginaire as well as with the questions he had fostered since his days as film curator — question of non-Western modernities, postcolonial identity, art, and cosmopolitanism —, Elhaik left, in the early 2000s, for Mexico City.
He was curious what a contemporary, politically as well as epistemologically oriented formation of Ethnographic Surrealism in Mexico City would look like. What if one replaced ‘classical modern ethnography’ with ‘contemporary anthropology’ and ‘classical modern art’ with ‘contemporary art’ (art after the conceptual turn, in the age of media art)?
Mexico seemed an ideal site for posing these kinds of questions. The country has a long — indeed, a spectacular — history of encounters between art and anthropology, between the search for political form and film. Beginning in the 1920s anthropologists and avant-garde artists (Mexican as well as international) came together to invent emblems for a national culture for revolutionary Mexico. Quite literally, anthropology — science of ethnos — was charged with the task to provide accounts, together with artists, film makers, writers, of Mexican culture (Elhaik has many pages on the significance in particular of Eisenstein’s Que Viva Mexico for this collaboration between art, avant-garde, anthropology and revolutionary politics).
Elhaik found himself intrigued by the adventure of exploring what the latest configuration of this interplay of art, politics, and anthropology in contemporary cosmopolitan Mexico City would look like? What new configuration of modernity, of cosmopolitan — but non-Western — politics would emerge?
It seems like the first thing that emerged was, well, a tragic disenchantment with his own set of questions. The reason for this disenchantment — for this intellectual tragedy — was what Elhaik calls his encounters with ‘the post-Mexican scene.’
Only a few years before his arrival, the anthropologist Roger Bartra had published Blood, Ink, and Culture, a volume of essays, several of which can be read as a deconstruction of the collaboration of anthropologists and artists in the invention of a national culture for revolutionary Mexico (from the emblematic cactus landscape to pre-Colombian figurines to the hacienda to the pelado, the disenfranchised urban poor).
Bartra argues that contemporary Mexico has outgrown the images of Mexicaness that anthropologists and artists once constructed — and he shows the indebtedness of the images of Mexicaness to European genealogies. The dream of Mexico was a European dream, a nightmare that configured humans through substantive humanist conceptions of culture, society, the nation, territory.
How to come to terms with Mexico after — Mexico?
It is this question that critically defined the arts scenes in which Elhaik arrived. Many of the most active art and curatorial groups of Mexico City — Curare, SEMFEO, Teratoma, InSITE, and Laboratorio 060 — understand their work as attending to the Post-Mexican moment, a moment which they attend to in terms borrowed from pathology (Elhaik, noticing the close relation between critique and a clinical language often refers to Deleuze’s Essays Critical and Clinical).
To give an example, Elhaik quotes from a curatorial statement written by a member and co-founder of Teratoma:
“Teratoma is a site of encounters, debates, exhibitions, residencies, pedagogy, dialogues, archiving of textual, visual, physical and virtual information in order to allow production, debate and reception of the various cultures to come in our continent. For now, we have decided to adopt TERATOMA as a provisional name for our group. As some of you may already know, the name comes to us from pathology: it is a denomination that refers to a type of tumor that has the nasty particularity to generate all kind of cell types, but without organization. As a result of a failure in the cellular reproductive mechanism, often due to the latency of embryonic cells or to genetic disorder, Teratoma has the tendency to grow in the body by combining, in a quasi-monstrous way, neuronal tissue with pelvic bones, semen with mammal glands, and so on Teratoma appears like a double of the affected body, perfectly identical to it, yet acting as its twin, without top or bottom, left or right, or distinction between function and localization. Teratoma is a metaphor that stands for the rejection of at once the ideal architecture of culture and the evolutionist imaginary. It is the illness of a regression to chaos by a colony of cells that acts parasitically towards the symbolic apparatus.”
Another feature (next to the blurring of the critical and the clinical) of many of the art projects Elhaik studies is that they symbolically use anthropology — science of nations small and large, of territorially imagined societies that are culturally identical with themselves — to bring the sickness of the ethnos-configuration of the human into view.
The exemplary reference here is to Eduardo Abaroa’s La Destrucción Total del Museo de Antropología (2012), an installation of pieces of debris from a symbolically destroyed national anthropology museum.
In Mexico City, thus, Elhaik begins to recognize — and this recognition process is a critical feature of his Erkenntnisprozess — that many of the elements that framed his research when he left for the field were ultimately still refractions of ‘Man.’ He discovers, not without shock, that, ultimately, even the postcolonial, cosmopolitan critique of the West or the search for alternative, ‘culturally’ differently configured modernities (or ontologies, for that matter) is bound to the territorial, the national, the social, the cultural (Deleuze and Guattari). What, after all, becomes of multiple modernities if one takes away the territorial and cultural references so critical for, say, Appadurai’s appropriation of Eisenstadt?
Or take the figure of the migrant as the unsettling cultural other: isn’t this still a reflection of a territorialized culture concept of the human?
The question, of course, is how Elhaik — the anthropologist — responds to his interlocutors’s destruction of anthropology? What form does an anthropology in the moments of its impossibility take?
Elhaik’s takes up this challenge by making his major fieldwork based discovery the object of his book: in eight essayistic chapters he traces how — with what tools, with what concepts — contemporary Mexican curators, media and film artists expose anthropology. However, these chapters are not representations, as if Elhaik were simply saying ‘this is what contemporary artists in Mexico do.’ Were they representations, he would reproduce the form that he — his friends — so vehemently critique. Instead of a representation, Elhaik designed his book as an ‘installation’ book — a book that is as much art as anthropology, that blurs the artists’ exposure of anthropology with the anthropologists’ interest in finding a form of anthropology in the moment in which anthropology as we know it has become impossible.
While Elhaik explores various installation forms, two emerge as most prominent from his research, curation and the incurable.
What is the incurable? It is a metaphor taken from the realm of the clinical to indicate the post-Mexican condition — a situation in which Mexico has already broken with Mexico and still is trapped by the image of Mexico it once has itself fabricated. It is the impossibility of letting go a form even when this form has become impossible — the form composed of an assemblage made up of the revolution, of politics, ethnos, the nation, culture, society, anthropology, art. What is sick — incurable, even untreatable — is as well anthropology. The incurable allows to bring into view a Mexico (an anthropology) that can never be anything but an escape, a discrepancy, a pain, a disease. Like his interlocutors, Elhaik here grounds his work in a language partly borrowed from pathology, partly from existentialist philosophy: he speaks of the incurable, of metastases, of pathology, and — often — of ‘endurance’ (as if all that is left to do is endure the untreatable).
And curation? Curation is first and foremost a form of care, a form of attending to the incurable, the untreatable — which also is to say a form of exposing disease. It is through the broken figure of the incurable image — the image of Mexico, the image of the human, the subject, the migrant, the postcolonial, the cosmopolitan, etc. — that Elhaik attends to the contemporary (im)possibility of Mexico, of anthropology.
For Elhaik, riffing of Abaroa’s total destruction of the national museum of anthropology, the anthropologist today is left with attending — with care, with pain, but also with a certain relief — to debris, with scattered bits and piece no one can put together again into something whole.
It is the rupture with ‘the human,’ that makes anthropology possible (as an attention to the dispersed, the scattered, the fragment).
The Incurable Image is also a book of critique — a critique that emerges from the debris that Elhaik studies. One of the principle objects of the critical energy of the book is alliance of anthropologists and artists around what Hal Foster in 1996 called the “ethnographic turn.”
Elhaik’s intervention is twofold. On the one hand, he writes with vehemence against artists who naively reinstate anthropology as the science of ‘cultural alterity.’ On the other hand, he fiercely turns against those anthropologists who embrace the artist’s suggestion that anthropology is somehow the guardian of the wisdom conserved by the premodern. The climax of this critique is when Elhaik exposes the emergence of a sensory ethnography (the reference here is to Lucien Castaing-Taylor’s sensory ethnography lab).
The background to the ‘turn’ to the sensory, Elhaik explains, is the suggestion by critiques of modernity that ‘the culture’ of ‘the West’ has privileged ‘vision’ over the other four senses; it has thereby established a hegemony of one mode of relating to the world — a mode of observation, of representation, of the cognitive, ultimately of thought and reason. The implication of this critique is that the non-Western — the premodern as documented by ethnographers — has had a sensually more diverse, indeed ‘holistic’ relation to the world. The non-Western world, the story goes, has preserved a haptic way of being enmeshed in the (natural) world through smell, touch, hearing, smell, and also through vision. The implication is as well that the sensory turn in anthropology and in art is a critical exposure of the shortcomings of modernity, of what the West has forgotten.
With verve Elhaik mocks the image of the ‘holistic man’ that emerges from sensory ethnography, mocks the very idea that anthropology is the guardian of the holism that has been preserved among ‘the primitive’ (a story that strangely reflects the turn to social suffering that has made much of medical anthropology a moral science). What is more he exposes the naïve conception of humanity that distinguishes between the West/modern and the rest/premodern and thereby repeats a philosophy of history that has so severely been critiqued by the Writing Culture generation. Some of his sentences are worth being quoted at length.
“Alas, rather than opening new vistas and problematizations, [sensory ethnography] implicitly returns us to a place that still distinguishes between West and non West, and from which we have to choose between conceptual abstract and sensorial material modes of conducting life and research.”
“Of course, it is important to remind ourselves, as Jonathan Crary, Laura Marks, and others have astutely done, of the imperial primacy of vision in Western modernity’s capture of the world and its attendant neglect of the haptic, the aural, and so on. But, it is unclear why and how a sensory ethnographic orientation would enable, simultaneously, the decolonization of the categories of the ethnographic turn, the poststructuralist desire to unseat the sovereign subject and the question of the author, and the geopolitical reconfiguration of artists’ and anthropologists’ mise-en-scene. It is simply unclear why and how, today, the value of the sensory should be the order of the day and the ethical mode framing the relationship between art and anthropology.”
“The sensory mis-en-scene will always be haunted by two ghosts that are ultimately two sides of the same coin: it will claim the so called non-Western, subaltern, and sub cultural practices as occupying a more multisensorial, less ocular centric subject position while attempting, in the same gesture, to search for and redeem, in the present, a pre-visual, communal and artisanal state of affairs which the West has allegedly lost.”
To Elhaik, the ethnographic turn of art — and its reflection in sensory ethnography or the ontological turn — ultimately is a reification of the naive modern primitivism of the 1920s and 30s. With one difference though, “Tragedy the first time, farce the second.”
What makes The Incurable Image a most interesting book is — that it is one the most successful attempts at deanthropologizing anthropology that I know of. What makes the book so compelling, even if this may sound strange, is that it is an intervention in a discussion its author never meant to contribute to: The beauty of the book is that it revolves around questions its author never set out to address. Indeed, it is precisely that — and how — Elhaik’s initial project fails, the perplexity that emerges from this derailment, and, eventually, the effort to find possibilities to conduct anthropology in the moment of its becoming impossible that is so compelling and refreshing.
For Elhaik, the departure from the configuration of the human in terms of culture, society, territory was nothing he had hoped for or planned. On the contrary, it was an (at first) unwelcome, fieldwork based, unanticipated discovery that came in form of a shock. How shocking indeed this discovery has been — how painful (endurance) — emerges from every page of his book.
The consequence of this shock — of the encounter with unanticipated that dissolved his initial project — is that there are no grand arguments in The incurable Image. No universal theories; no ontologies; no declarations of epochal errors (the destructions of nature wrought about by the moderns); no grand alternatives or replacement approaches (what comes after culture or society?). What is more, the book is free from allocation of blame, free from moral judgments (no celebration of the moral authority of nature, the non-moderns, animals, or plants).
Instead of writing in the tone of someone who has broken through to the truth, or of someone who knows what’s wrong, Elhaik offers hesitant fragments — uncertain, honest, perplex probings. Collectively, his probings amount to a broken inventory of possibilities (plural) of practicing anthropology in the moment in which it can’t rely on ‘the human’ anymore. An inventory specific — singular — to his site of research.
The Incurable Image is a subtle, a complex book — many shades of grey, rather than black and white. Indeed, this is one of the most powerful insights that emerge from Elhaik’s book, that in the aftermath of the falling apart of the human (of ethnos) that he documents all (human) generalities may fail: if the ‘the’ human is gone, all there is are scattered bits and pieces, are inchoate venues that don’t add up, differences instances of an elsewhere that remain incommensurable to one another. Call it the joy that emerges from the painful liberation of the grandiose — epochal stories, universal forms, general theories, etc.
The true? The good? Elhaik debunks all those who hold on to these concepts — that is, the good, the truth — as hopeless. To substitute nature for culture is as futile — as damaging — as substituting the animal for the primitive.
Of course this is impossibly provocative! But then, when have you last read an anthropology book that intellectually aroused you? That left you passionate, that radically opened up the question what anthropology is or ought to be?
Coda (no book review without critical comments, however minor). Although I tremendously enjoyed reading the book, I initially came away from The Incurable Image with a mild sense of unease. Elhaik’s language of pathology — the grounding of the critical in the clinical — seemed to be partly owed to a holding on to a form in the moment of the impossibility of this form. Couldn’t one, I wondered, explore the space that opens up after ‘the human’ (after ethnos) more positively? Without “endurance” and instead with a certain joy?
Perhaps Elhaik would agree. In any case, if one reads the few essays he has written after The Incurable Image, one can see the emergence of a response to my critique. In his most recent writings the existentialist trope of ‘endurance’ and the clinical concept of ‘incurability’ seem to recede, and a more positive form of inquiry emerges, one that displays a calm indifference.
I find it fascinating to see how Elhaik now turns to questions of solitude, of beauty, virtue, care, ultimately to the possibility of philosophical life by way of turning to the broken figures of ‘solitude,’ ‘beauty,’ ‘virtue,’ ‘care,’ and the ‘philosophical life.’
Instead of attending to the incurable, he now turns to “Antonioni’s artificially colored landscape, Fatmi’s installations and essays on Levi-Strauss’ voyages, Gruner’s films and sculptures with volcanic stones, Smithson’s entropic earthworks, and Ruiz’s hallucinatory dreamscapes.” “In these minimalist art practices,” Elhaik writes, “human geography and the human figure is rarefied,” is being “dis-figured” and “left behind.” And what interests him is not only that these “de-morphed” humanity “is unlikely to be repairable through ‘sensory’ ethnography.”
What interests him as well is the liberating joy that emerges from these fragments.
That I know of, Elhaik’s The Incurable Images is to date the most interesting and most successful attempt at deanthropologizing anthropology. Not least because it achieves this departure not by turning to nature as non-human but by attending to, well, the human.
Tobias Rees is Associate Professor of Social Studies of Medicine in the Faculty of Medicine at McGill University and a Fellow of the Canadian Institute of Advanced Research (CIFAR). His expertise lies at the intersection of anthropology, art history, the history of science, and the philosophy of modernity and concerns the study of knowledge/thought. More specifically, he is interested in how categories that order knowledge mutate over time –– because of humans, microbes, snails, the weather, or other events –– and in what effects these mutations have on conceptions of the human/the real.
Deleuze, Gilles. 1993. Essais Critique et Clinique. Paris: Edition de Minuit.
Descola, Philippe. 1996a. Constructing Natures: Symbolic Ecology and Social Practice. In Nature and Society: Anthropological Perspectives. Philippe Descola and Gisli Pálsson, eds. Pp. 82–102. Routledge.
Descola, Philippe. 1996b. In the Society of Nature: A Native Ecology in Amazonia. Cambridge: Cambridge University Press.
Descola. Philippe. 2013. Beyond Nature and Culture. Chicago: The University of Chicago Press.
Descola. Philippe. 2014. Modes of Being and Forms of Predication. HAU: Journal of Ethnographic Theory 4(1): 271–280.
Foucault, Michel. 1966. Les Mots et Les Choses. Paris: Gallimard.
Haraway, Donna. 1990. Primate Visions: Gender, Race, and Nature in the World of Modern Science. New York: Routledge.
Haraway, Donna. 1991. Simians, Cyborgs and Women: The Reinvention of Nature. New York: Routledge.
Haraway, Donna. 2003. The Companion Species Manifesto. Chicago: University of Chicago Press.
Haraway, Donna. 2008. When Species Meet. Minneapolis: University of Minnesota Press.
Helmreich, Stefan. 2009. Alien Ocean. Berkeley: University of California Press.
Holbraad, Martin. 2009. Ontology, Ethnography, Archaeology: An Afterword on the Ontography of Things. Cambridge Archaeological Journal 19(03): 431.
Holbraad, Martin, Morten Axel Pedersen, and Eduardo Viveiros de Castro. 2014 The Politics of Ontology: Anthropological Positions — Cultural Anthropology. https://culanth.org/fieldsights/462-the-politics-of-ontology-anthropological-positions. Accessed March 8, 2016.
Kirksey, Eben (eds). 2014. The Multispecies Salon. Durham: Duke University Press.
Kirksey, S. Eben, and Stefan Helmreich. 2010. The Emergence of Multispecies Ethnography. Cultural Anthropology 25(4): 545-576.
Kohn, Eduardo. 2007. How Dogs Dream: Amazonian Natures and the Politics of Transspecies Engagement. American Ethnologist 34(1): 3–24.
Latour, Bruno. 1993. We Have Never Been Modern. Cambridge, Mass: Harvard University Press.
Latour, Bruno. 2004. Politics of Nature –– How to bring the Sciences into Democracy. Cambridge: Harvard University Press.
Latour, Bruno. 2014. Distinguished Lecture at the AAA Meeting in Washington, D.C.
Marcus, George E., and Michael M. J. Fischer. 1986. Anthropology as Cultural Critique: An Experimental Moment in the Human Sciences. Chicago: University of Chicago Press.
Paxson, Heather. 2012. The Life of Cheese: Crafting Food and Value in America. Berkeley: University of California Press.
Raffles, Hugh. 2010. Insectopedia. New York: Vintage Books.
Rees, Tobias. 2010a. To Open up New Spaces of Thought: Anthropology BSC (beyond Society and Culture). Journal of the Royal Anthropological Institute 16(1): 158–163.
Rees, Tobias. 2010b. On the Challenge – and the Beauty – of (contemporary) Anthropological Inquiry: A Response to Edward Dutton: Correspondence. Journal of the Royal Anthropological Institute 16(4): 895–900.
Tsing, Anna. 2015. The Mushroom at the End of the World: On the Possibility of Life in Capitalist Ruins. Princeton University Press.
Viveiros de Castro, Eduardo. 2004. Metafísicas Canibais. São Paulo: Cosac & Naify.
 The beginnings of the contemporary efforts to depart from ‘the’ human can be traced back to the works of Bruno Latour and Donna Haraway (I stress contemporary because there were, of course, previous projects of problematizing the human, just think of structuralism or post-structuralism). On the one hand, the reference is to Latour’s 1993 We Have Never Been Modern and his thought-provoking problematization of European modernity (see as well his search for political alternatives in Latour 2004). On the other hand, the gesture is to Donna Haraway’s troubling of the category of nature in Primate Vision (1989) and Simians, Cyborgs, and Women (1991), and specifically to her argument that “we have never been human” in the Companion Species Manifesto (2003) or When Species Meet (2008).
At least in retrospect, it was largely (of course not exclusively) through these works, that, over the course of the 1990s, the condition of the possibility of a non-human centric anthropology emerged. Latour’s suggestion that the mistake of the self-declared moderns is that they remained blind to the natureculture continuums led (some) anthropologists –– today referred to as ontologists –– to suggest that the supposed ‘primitives’ indeed never made the mistakes of the moderns. And Haraway’s turn to dogs has encouraged others to conduct anthropologies of insects (Raffles 2010) and mushrooms (Tsing 2015), of oceans (Helmreich 2009) and bacteria (Paxson 2012) –– publications today grouped together under the heading multi-species anthropology (Helmreich and Kirksey 2010; Kirksey 2014).
 This is not meant as wholesale critique. There are most excellent works that reflect on –– or subversively play with –– these inversions/relations, see for example Povinelli 2016, Tsing 2015, Helmreich 2009 or Raffles 2010.
 Aside, when ontologies are ‘socially constructed,’ and each ‘society’ has its very own ontology, then I am not sure where the rupture with the anthropocentric epistemology of European modernity has actually occurred: society, after all, is a genuine European concept, born in the France of the first half of the nineteenth century, introduced among other things to set the human apart from the animal, to argue that there is an irreducible human reality, a reality sui generis that needs to be understood in its own (social) terms (see, e.g., Descola 1996b, 2013, Holbraadt et al. 2014 or Viveiros de Castro 2004).
Beyond Miracles: How Traditional Chinese Medicine Establishes Professional Legitimacy in Post-colonial Macau by Loretta I.T. Lou
[Editor’s Note: An earlier version of this article appeared in Imponderabilia: The International Student Anthropology Journal (2014). This piece is updated with new data and photos collected between 2015 and 2016.]
In Search of Reclusive Doctors (xunzhao yin shi yishu) was the first Chinese TV documentary about medical miracles “made” by doctors of traditional Chinese medicine (TCM). When it was first broadcasted in 2001, it evoked great public interest in the Pearl River Delta region. In exalting the Chinese doctors’ miraculous power to save people on their deathbeds, the documentary paradoxically placed great emphasis on the scientific validity of TCM and folk medicine. In line with this, Mei Zhan’s ethnographic study of TCM doctors in Shanghai and San Francisco also found that the legitimacy of traditional Chinese medicine is built upon its ability to treat difficult cases (Zhan 2001:454). She argues that TCM doctors have used “miracle-making” to “craft a niche for traditional Chinese medicine within a biomedicine-centered health care system. The everyday practice and discourse of traditional Chinese medicine has come to be a site for the ‘production of the extraordinary’” (Ibid).
In an environment where TCM is in fierce competition with biomedicine, it is understandable that some TCM practitioners feel they have to establish their legitimacy through miracle-making. However, my research in Macau suggests a different story. A former colony of Portugal (1557-1999), Macau was returned to the People’s Republic of China in 1999 and is now a Special Administrative Region (SAR) of the PRC. Although Macau had the first Western-style hospital in Asia, it was not until 1984 when the Macau-Portuguese government finally reformed its health care system and established a public health network composed of a government hospital and a dozens of community health centers. As of 2015, there are three major hospitals and 708 primary healthcare premises in Macau, most of which are privately operated.
Official recognition of TCM in Macau
Without doubt, Macau’s medical landscape is shaped by its colonial legacy. While TCM doctors in the PRC were endowed with “a clear-cut professional identity” as early as in 1955 (Farquhar, 1994:12), in Macau, it was not until 1998, a year before the city’s handover to China, that the Macau-Portuguese government began to regulate the licensing of private health care services and the qualifications required for entering the profession of Chinese medicine (Decree-Law no. 84/90/M). In terms of the number of practitioners, by 2012, there were 353 registered TCM doctors (zhong yisheng; recognized through an accredited degree) , 204 TCM practitioners (zhongyi shi, recognized by a professional TCM committee), 13 massage therapists, and seven acupuncturists in Macau.
Prior to 1999, Chinese medicine was not a part of the public health service (Serviços de Saúde) in Macau. Centro Hospitalar Conde de São Januário (CSCHJ), Macau’s only public hospital, still does not have a dedicated department for traditional Chinese medicine. The two TCM hospital departments in Macau are run by two private hospitals—the University Hospital and Kiang Wu Hospital. Yet things started to change after the handover in 1999. Not only has Serviços de Saúde begun to run a TCM outpatient service in some of its primary health centers, the government has also made clear its ambition to promote and industrialize the Chinese medicine sector in Macau. This move is closely related to Mao’s successor Deng Xiaoping’s determination to “rejuvenate the nation through science education” (kejiao xingguo), a development strategy to make science and technology (keji) a national priority. This is a significant departure from some of Mao’s earlier policies, which deemed progress as something to be achieved through self-reliance, revolutionary virtue, and mass mobilization rather than Western science and technology (Kirby 1989:24).
When I started this research in 2005, “make Chinese medicine great again” was all talk and no action. But over the past 10 years, the Macau government has made significant progress towards making Macau a “national hub” of traditional Chinese medicine. Local officials are keen to use it as an opportunity to express their patriotism. They also hope that the industrialization of Chinese medicine would help diversify the economy of Macau, which has always been heavily dependent on its gambling industry. Since 2011, Macau has been an active member of the World Health Organization (WHO) Collaborating Centre for Traditional Medicine. Yet the biggest breakthrough was the recent joint venture to construct the Guangdong-Macau Traditional Chinese Medicine Science and Technology Industrial Park (GMTCM Park)—a gigantic, state-of-the-art business park set in Hengqin in the south of Zhuhai, Guangdong province.
It’s “science”, not miracles
Despite the hopeful future, the delayed recognition of TCM within Macau’s legal-medical framework has caused a lot of anxiety among the TCM doctors there. Unlike practitioners in San Francisco and Shanghai, TCM doctors in Macau feared of being further marginalized as the “miraculous healers”. Dr. Tam, a key interlocutor of mine, was really irked by people who think Chinese medicine is a medicine good at making miracles. He complained loudly: “They think Chinese medicine can cure everything? That’s ridiculous! We’re doctors, not deities! To ask us to clean up the mess is to look down on us! A death case is a death case!” Indeed, most TCM doctors that I spoke to in Macau corroborated that miracles are not easily “made”, if they are something that can be “made” at all. So even though miracle-making is an “unmistakable sign of professional accomplishment” for some TCM doctors (Zhan 2001:453), for others the stereotype implied unscientific practices, which they took offence at. Also, since the majority of TCM doctors survive without the halo of miracles, it is imperative to find out other ways of “doing” Chinese medicine.
When Dr. Tam urged me to let my American colleagues have a look at the TCM syllabuses used in the University Hospital, he wanted to make the point that TCM doctors are superior to their Western counterparts. Not only did he stress that modern TCM doctors are no longer trained within the family or through an apprenticeship, which he considered an unprofessional tradition, he also emphasized that nowadays TCM students are required to study both TCM and Western medicine. The following excerpt from The Journal of Chinese Medicine Doctors in Macau accurately captured Dr. Tam’s points:
The scope of Chinese medicine is very wide. It involves literature and history, animal physiology and plant ecology, meteorology and astronomy, geography and geology, chemistry and genetic engineering. Chinese medicine is a holistic discipline that involves much high science and technology. Every Chinese medicine practitioner should be proud of our nation. We are responsible for exalting our nation’s traditional medicine. To achieve this, we should make use of modern science and research new ways of improving our field.
Looking at illnesses together
Besides nationalism, the professional legitimacy of Chinese medicine was reinforced by the practice of “looking at illness” (kanbing) together with patients (Farquhar, 1994:2) rather than producing miracles on deathbeds. The fact that both TCM practitioners and their patients were involved in producing the medical norms (Ferzacca, 2000:30) has greatly contributed to the legitimatisation of TCM in Macau. When I was doing fieldwork in small TCM clinics, I came to realize that many TCM patients were extremely knowledgeable about their conditions. They were able to use TCM jargons such as “fire in the bones” (gu huo), “depleted fire” (xu huo), “cold cough” (han hai), “hot cough” (re hai), “dry” (gan), “wet” (shi) to describe their states of health. They called this jiubing chengyi, which means when you have to cope with an illness for a long time, you will eventually become your own doctor. Indeed, many TCM users said they are able to interpret their own prescriptions.
“Licorice root is yaoyin,” Mrs. Lam analyzed her doctor’s handwritten prescription for me while we were sitting in the waiting room.
“How do you know?” I asked.
“I’ve been eating Chinese medicine for many years now. Jiubing chengyi.”
“Do you think you would be able to read the Western medicine prescription?”
“How could I?” Mrs. Lam laughed. “I’ve only had five years of primary school education. I don’t know English or Portuguese! How could I read it?”
TCM users are also proactive in self-diagnosis. When Mr. Chan was diagnosed with Sciatica, he was sure that his medical doctor got it wrong. “I am pretty sure that it is rheumatism. I felt so much better after drinking the herbal tea you prescribed me last night.” Mr. Chan told his TCM doctor. “Xiyi (doctors of Western medicine) only know to give me pain killers!’
Similarly, when Mr. Lee was diagnosed with mental disorder (jing shen bing) by his doctor in the government hospital, he came to Dr. Tam’s clinic with a short article cut from the newspaper, titled “The Ancient Ways to Cure dian (epilepsy)”. He urged Dr. Tam to give him the treatments mentioned in the article because he seemed to suffer from the same symptoms. “Well, not all dian are the same”, Dr. Tam rejected his request. Mr Lee was so disappointed that he got agitated in the consultation room. “The hospital people said I have mental disorder! I don’t! I just have numb fingers!” Mr. Lee protested as Dr Tam tried to calm him down, “I believe you! I believe you! The hospital is very wrong in prescribing you those drugs.” After Mr. Lee left, Dr. Tam sighed: “Whenever a patient can’t speak clearly, doctors of Western medicine would prescribe him psychotic drugs. Alas, even if he wasn’t crazy, he certainly would be after taking those medications for such a long time!”
In Macau, the legitimacy of Chinese medicine is not built upon miracle making. Instead, it is achieved through a celebration of cultural tradition rejuvenated with discourses of nationalism and modernity, and through the mutual constructions of medical references between doctors and patients. In the TCM circle, the term “science” was used synonymously with ‘modern’—and being “modern” is considered a good thing. The shared cultural references used in TCM also make it possible for both parties to contribute to the conceptualization of health and illnesses. The knowledge of Chinese medicine is thus owned not only by the doctors but also by the patients. Unlike doctors of Western medicine who sometimes feel the need to shift to another identity when they are on duty (Good 1993), TCM doctors tend to speak the language of their patients and are not afraid of showing the more personal side of themselves. Indeed, it warmed my heart that my 70-year-old TCM doctor still remembered I like to have haw flakes with my bitter herbal tea. It is this human touch that helps Chinese medicine keep its strength even in the absence of miraculous treatments.
Dr. Loretta Ieng Tak Lou is a Postdoctoral Associate at the Institute of Social and Cultural Anthropology (ISCA), University of Oxford. Her doctoral research is an ethnographic study of “green living” and its implications for self-knowledge, social relations, ethics, and political mobilization in post-handover Hong Kong. Her research interests lie in the areas of environment, health, science and technology studies, re-enchantment, and social movements in East Asia.
Barnes, Linda L (2007). Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848. Harvard University Press.
Brown, Melissa J (2010). Changing authentic identities: evidence from Taiwan and China. Journal of the Royal Anthropological Institute. 16(3): pp.459-473.
Decree-Law no. 84/90/M. (2005). Translated by U Wan-Ian from Portuguese. Retrieved from the Internet. <http://www.imprensa.macau.gov.mo/bo/i/98/20/declei20.asp>.
Farquhar, Judith (1994). Knowing Practice: The Clinical Encounter of Chinese Medicine. Boulder: Westview Press.
Farquhar, Judith (1994). ‘Eating Chinese Medicine.’ Cultural Anthropology, Vol. 9, No. 4, 471-497.
Ferzacca, Steve (2000). “‘Actually I don’t feel that bad’: Managing diabetes and the clinical encounter.” Medical Anthropology Quarterly. 14(1): pp.28-50.
Good, Byron J. (1993). Medicine, Rationality and Experience: An Anthropological Perspective. Cambridge University Press.
Kleinman, Arthur (1998). The Illness Narratives: Suffering, Healing & the Human Condition. Basic Books.
Kirby, William, C. (1989). “Technocratic Organization and Technological Development in China: The Nationalist Experience and Legacy, 1928-1953. Science and Technology in Post Mao China. Cambridge: Harvard University.
Zhan, Mei (2001). “Does It Take A Miracle? Negotiating Knowledges, Identities, and Communities of Traditional Chinese Medicine.” Cultural Anthropology. 16(4): pp.453-480.
 Any Macau residents with a university degree in Chinese medicine can apply for a TCM license from the Serviços de Saúde. There is no licensing examination.
 Statistics obtained from Serviços de Saúde.
 Admittedly, many other factors may have contributed to the professional legitimacy of traditional Chinese medicine in post-colonial Macau, such as accessibility, price, and public policy. However, in this short article, I want focus on how TCM doctors establish their legitimacy on nationalism and their shared cultural references with their patients.
 Yao yin is also known as yao yin zi. In Chinese Medicine, yao yin serves as a conduit for certain medicines to reach their targeted organs, arteries or veins.
 See Farquhar 1994.
 The word Dian deserves further analysis. Dian literally means ‘insanity’, but it can also refer to epilepsy.
A well-known quote from Hamlet is “Something is rotten in the state of Denmark.” This, of course, refers to the illegitimate and immoral reign of the fictional King Claudius, Hamlet’s uncle. So, while there is plenty of current relevance related to the political and social turmoil hinted at by this line, instead let’s talk about another aspect that I find particularly fascinating — the connection of scent and odor to ideas of morality, good, and evil.
In an odd turn of events, I recently found myself trying to explain to some chemistry students why a quote saying that someone “smells of sulfur” means that they are diabolical, hellish, or somehow antichrist-like. Why sulfur? No, there is really no connection to sulfur’s having an identical number of valence electrons to oxygen, though that would make an interesting story. Some explanation of the history of sulphurous scent as diabolical can be found here: The Smell of Hell: Does Satan Smell of Rotten Eggs? Connections between scent and good and evil actually abound. Fragrantica has a number of excellent articles about the historical and cultural meanings of scent, including Elena Vosnaki’s A Diabolical Whiff: Scents of Hell:
It was sorcerers during the Middle Ages who, suspected to be in cahoots with the devil, were considered to be sulphurous smelling themselves. Given that these were often “wise women” dealing in pharmacopoeia, of which sulphurous materials did make a part, wouldn’t it be evident that handling them would lend them that odor? Try to prove it to the ecclesiastical courts!
And the counterpart, A Saintly Aroma: Scents of Heaven:
In Biblical times, the link between germs and diseases hadn’t been made (it had to wait till the 19th century), so the logical leap that foul smells, entering the body at once with one’s breath, could carry disease isn’t far fetched… Using incense materials, resins and gums high in purifying molecules such as Verbenone (a ketone) or Trans-verbenol (an alcohol), which they collected spending much time and effort, they fought foul odors with pleasant, “clean” ones… Since these aromatic resins burn without residue, symbolizing the heavenly spirits to whom they ascend to when burnt, and since essential oils represent the very spirit of a plant, could they not be the answer to a prayer against the inavoidability of corruption?
These associations of scent and danger have not disappeared with the advent of germ theory. An antiseptic scent has many associations of its own. Perceptions of morality are also marked by purity of scent, and immorality by malodor. As attributions of moral behavior are deeply cultural, it also makes sense that “When two people smell the same thing, they can have remarkably different reactions, depending on their cultural background” (Sniffing Out Cultural Differences). There are also theories that our senses of disgust, perhaps forged in the evolutionary times of high microbial pathogenesis, have now become embedded as an internalized form of social control: “Our ancestors reacted to parasites with overwhelming revulsion, wiring the brain for morals, manners, politics and laws” (Disgust made us human). So, it may be that humanity is a creature of disgust, and that our social institutions are vestiges of our co-evolution with microbial parasites. (I can’t help but wonder, if the web had an odor, what would it be?)
Additional miscellanea of potential interest:
- Scent related:
- Meet the Woman Who Is Preserving the Smell of History (Atlas Obscura)
- Scientists search for death’s aroma and Zombie Apocalypse Survival Chemistry: Death Cologne. (Both from the American Chemical Society.)
- An interesting piece on the meanings of evidence, expertise, and flossing one’s teeth: Flossing and the Art of Scientific Investigation
- Is Physical Law an Alien Intelligence? Because, why wouldn’t it be?
- “The ancient Japanese art of flower arranging was the inspiration for a groundbreaking technique to create tiny “artificial brains” that could be used to develop personalized cancer treatments.”
- And, for a few additional thoughts about science, medicine, and magic in all their intertwined and uncleanly complexity: Found in the Eyes of Rams: The Bezoar and its Powers. “A bezoar is a mass of undigested or inedible material found in the GI tract…Whatever the origins of the belief in curing poison, bezoars were popular in the Middle Ages and into the 17th century as antidotes. They were carried as charms, included as decor or attached to drinking and eating vessels to protect the diner, and tests were even designed to detect fakes –the selling of which was a punishable offense.”
by David S. Jones
The Johns Hopkins University Press, 2013, 336 pages.
My first encounter with David S. Jones’ Broken Hearts was in April of 2016. I had packed it in my carry-on luggage as on-plane entertainment while traveling to Minneapolis, MN for the eighty-ninth annual meeting of the American Association for the History of Medicine (AAHM). How fitting, I thought, to read about the history of heart disease in the “cradle of cardiac care,” a city that transformed America’s medical enterprise by developing many innovative inventions and techniques in the field of cardiology.
And fitting it was. The conference was teeming with allusions to the University of Minnesota’s cardiac legacy. Not only was there an exhibition on the history of cardiac disease epidemiology developed by the university’s School of Public Health, but there was also a guided tour of the Visible Heart Project, a research laboratory dedicated to reanimating mammalian hearts to gain insight into the organ’s physiology. The overarching theme of both the exhibit and tour was one of progress, as both of these special presentations emphasized how far we have come in terms of gathering accurate information about the human heart. Whereas the exhibit referenced the “exponential growth” that the field of cardiac epidemiology has made in terms of understanding the risk and protective factors associated with heart disease, members of the Visible Heart Laboratory claimed that their research had provided unprecedented insight into the functional anatomy of the beating heart. Over half a century after University of Minnesota surgeon Dr. C. Walton Lillehei preformed the first open heart surgery, and, with the help of Earl Bakken, developed the first battery-powered wearable pacemaker, I left Minneapolis thinking that the city continued to be at the forefront of cardiac care. Within the walls of the University of Minnesota, researchers were still developing innovative inventions and techniques that were transforming medical practice and saving lives.
The idea that unprecedented progress in cardiology has been made over the course of the last sixty years is not unique to researchers at the University of Minnesota. Many medical professionals believe that we now know more about the human heart than ever before, and that research conducted over the past sixty years has given us a deeper understanding of cardiac diseases and their causes. However, this black-and-white picture of medical progress is not as straightforward as these AAHM special presentations would have us believe. In spite of the mantra that health science researchers are “conquering cardiovascular disease,” physicians still face many challenges in developing theoretical frameworks for heart attacks, and producing definitive knowledge about the safety and efficacy of cardiac treatments.
One of the first scholars to draw attention to some of these challenges is David S. Jones. His new work, Broken Hearts: The Tangled History of Cardiac Care, unpacks the complex history of how medical professionals have understood ischemic heart disease over time. By examining how American cardiologists have interpreted and responded to heart disease during the mid-late twentieth century (and beyond), Jones reveals the ambiguities and inconsistencies that persist at the core of cardiac surgery, and traces how these uncertainties underpin the development and evaluation of modern medical interventions. Using the history of heart disease as a lens through which to examine the challenges associated with making health choices, Jones presents a fascinating analysis of how the complexities associated with medical decision making influence the way that cardiac care is administered in the twenty-first century.
In order to explore this tangled history of medical knowledge production, Jones divides his book into three sections. In his first section, Jones examines how heart disease has been conceptualized by medical professionals from the early twentieth century to the present day. He starts the section off with the brief and simple statement: “while the heart, at a basic level, is one of the easiest organs to describe, it has been one of the hardest to understand, especially when it comes to coronary artery disease.” The omnipresence of ischemic heart disease, and physicians’ willingness to perform medical interventions like coronary angioplasty, bypass surgery, or prescribe pharmaceuticals like statins and platelet inhibitors (even on a preventative level) suggests the medical establishment’s unwavering confidence in how cardiac care should be administered. However, Jones points out that there has been ambiguity about heart diseases’ underlying etiology since the early twentieth century, and that this uncertainty raises questions about the efficacy and safety of modern methods of treatment.
Providing archival evidence from thousands of medical journal articles, Broken Hearts reveals that, from 1910 onwards, medical professionals have debated the cause of heart attacks. Although most pathologists agreed that arteriosclerosis underpinned coronary thrombosis, many disagreed on the finer details of this process. Whereas some pathologists argued that thrombosis was the result of the rupture of an unstable plaque in the coronary artery (thus triggering a dangerous blood clot), others believed that myocardial infarctions stem from the progressive obstruction of the coronary arteries, which ultimately prevents blood from flowing through the vessel. Uncertainty over the diseases’ etiology has continued to circulate in medical communities up until the early twenty-first century. In fact, the inability of researchers to establish a stable evidence base for and reaching consensus on a particular theory of heart disease is one of the reasons why the ISCHEMIA trial was launched by the U.S. National Heart, Lung, and Blood Institute of the National Institutes of Health in 2011. By assessing whether revascularization reduces the risk of heart disease or death in patients with angina, this trial hopes to resolve whether the theory of progressive obstruction or unstable plaques underpins ischemic heart disease “once and for all”.
After tracing the history of debates surrounding the underlying causes of cardiac disease, Broken Hearts moves on to consider how this theoretical ambivalence on the underlying cause of coronary thrombosis has influenced how cardiac interventions have been developed and assessed. In the book’s second section, Jones looks at the historical development of coronary angioplasty, bypass surgery, statins and platelet inhibitors, and chronicles medical discussions over which one of these methods provides the best treatment for patients. By showing that the popularity and use of medical treatments is predicated on a multitude of factors besides disease etiology, including ideas about cost, convenience, and effectiveness Jones challenges the popular and professional belief that the benefits of cardiac intervention always outweigh its risks. By arguing that doctors devote more energy to proving that treatments work than they do ascertaining complications—thus producing an asymmetrical knowledge base more focused on efficacy than patient safety. This can be seen in the example of bypass surgery as, in their attempt to demonstrate the validity of this revascularization technique in the face of theoretical ambivalence, cardiac surgeons neglected the cerebral complications that often arose as a result of the procedure.
In his last section, Jones raises the issue of geographic and racial variations in medical practice by showing how cardiac care is not practiced in a uniform way across cities, states or populations.
Through looking at how factors like race and place influence how a doctor will identify and respond to cases of ischemic heart disease, Broken Hearts illustrates the often-equivocal nature of cardiac care and the messiness of medical decision making more general. Although Jones doesn’t offer any hard and fast solutions to these problems, he highlights the need to integrate patient and physician priorities, values and preferences into account when developing new models of medical decision making. He also emphasizes the importance of acknowledging the complex social dynamics that underpin “the diseases we suffer, the treatments we can access, the outcomes of those treatments, and our knowledge of those processes.”
All in all, Broken Hearts is a captivating study of the history of cardiology. By moving away from the longstanding tendency to frame the history of cardiology as a progress-narrative, this book makes a great addition to the emerging body of literature that adopts a critical stance towards cardiac care, including Anne Pollock’s Medicating Race , and Janet Shim’s Heart-Sick.  Although this book is definitely geared to an academic audience, because it unsettles contemporary ideas about the coherence of cardiac care, the soundness of medical treatments, and the logic underpinning medical decision-making, I think that Broken Hearts has important lessons for the lay reader as well. Especially for people who are currently undergoing treatment for coronary artery disease.
Jennifer Fraser is a fourth year PhD student studying the history of medicine at the University of Toronto. Her dissertation charts the history of Canadian cancer epidemiology, focusing specifically on how cancer control campaigns were advertised and applied to Indigenous communities during the mid-twentieth century.
“About.” Heart Attack Prevention: A History of Cardiac Disease Epidemiology, Department of Epidemiology; University of Minnesota. 1 May 2016. http://www.epi.umn.edu/cvdepi/about/
“About the Lab.” The Visible Heart Laboratory, Department of Surgery; University of Minnesota. 1 May 2016. http://www.vhlab.umn.edu/about.html
“Conquering Cardiovascular Disease.” National Heart, Lung and Blood Institute. 27 October 2016. https://www.nhlbi.nih.gov/news/spotlight/success/conquering-cardiovascular-disease
Pollock, Anne. Medicating Race: Heart Disease and Durable Preoccupations with Difference. Durham: Duke University Press, 2012.
Shim, Janet K. Heart-Sick: The Politics of Risk, Inequality an Heart Disease. New York: New York University Press, 2014.
Smith, Monica M. “Medical Alley: Tight-Knight Community of Tinkerers Keeps Hearts Ticking, Minnesota (1950s).” In Places of Invention, edited by Arthur P. Molella and Anna Karvellas, 86-110. Washington: Smithsonian Institution Scholarly Press, 2015.
 Monica M. Smith, “Medical Alley: Tight-Knight Community of Tinkerers Keeps Hearts Ticking, Minnesota (1950s),” in Places of Invention, eds. Arthur P. Molella and Anna Karvellas, 86-110 (Washington: Smithsonian Institution Scholarly Press, 2015), 86.
 “Conquering Cardiovascular Disease,” National Heart, Lung and Blood Institute, 27 October 2016. https://www.nhlbi.nih.gov/news/spotlight/success/conquering-cardiovascular-disease
 David S. Jones, Broken Hearts: The Tangled History of Cardiac Care (Baltimore: Johns Hopkins University Press, 2013), 3.
 Jones, Broken Hearts, 96
 Jones, Broken Hearts, 228.
 Anne Pollock, Medicating Race: Heart Disease and Durable Preoccupations with Difference (Durham: Duke University Press, 2012).
 Janet K. Shim, Heart-Sick: The Politics of Risk, Inequality an Heart Disease (New York: New York University Press, 2014).
Somatosphere invites readers to submit to “Aftermath,” a new series examining the consequences of recent nationalist political turns throughout the world, including the US election. We are particularly interested in pieces which reflect on how these events intersect with the thematic concerns of the site – health, medicine and science, broadly construed. We especially welcome pieces which draw on original empirical materials or which bring conceptual materials from anthropology, history, sociology, STS, public health, cultural psychiatry and related disciplines to bear on the current situation. In the interest of cultivating vital discussion and circulating ideas quickly in response to a rapidly changing political environment, we encourage submissions that may seem sketchy, drafty, or unpolished. Potential topics might include but are in no way limited to:
- Possible effects of the 2016 election on the Affordable Care Act
- Mental health and the aftermath of the election
- Health-related dimensions of the Brexit vote and the upswing in nationalist political movements throughout Europe
- The changing politics and science of:
- abortion and reproductive technologies
- climate science
- evidentiary practices surrounding racial and ethnic categories
- threats to disabilities policies
- Resources for teaching about the current political condition, particularly as it affects health, medicine and science
- Strategies for activist academics in the current political climate
Please send your suggestions for pieces, completed pieces, or inquiries to firstname.lastname@example.org
A quarter-century after it was written, Hervé Guibert’s Cytomegalovirus reads both as a vital document of a particular moment in the history of the HIV/AIDS epidemic and as a wonderfully spare account of the banal humiliations and little triumphs of hospitalization in the shadow of a then-terminal illness. Republished with a luminous Introduction by David Caron and a wide-ranging and erudite Afterword by Todd Meyers, this slim volume is by turns poignant, humorous, and startling. We are very pleased to bring you a set of commentaries on Cytomegalovirus.
Northwestern University, Feinberg School of Medicine
Download it on Scribd (pdf):
Hello trusty readers. Check out November’s haul for “In The Journals,” and be sure to check out the special issue of Science, Technology, and Human Values: Feminist Postcolonial Technosciences.
Patty A. Gray
The Moscow street demonstrations of 2011–12 were the largest public gatherings in Russia since the collapse of the Soviet Union. They were also the largest-ever gathering of Russians on social media. While using the Internet to follow such large-scale social movements remotely, researchers experience social media as a context in which anthropology happens. They may think about “being there” in new ways that shift their focus to their own processes of memory making and sense of bodily presence. Experiencing and remembering social media in the body challenges the distinctions we might otherwise make between virtual and physical encounters.
The translation of international biogenetic resource rights to a former apartheid homeland is fostering business partnerships between South African traditional leaders and multinational pharmaceutical companies. In the case of one contentious resource, these partnerships are entrenching, and in some instances expanding, apartheid-associated boundaries and configurations of power. The state and corporate task of producing communities amenable to biodiversity commercialization and conservation is entangled with segregationist laws and spatial planning. Rather than exclusion and the closure of ethnic boundaries, resource rights in this context foreground forced enrollment and the expansion of indigenous group-membership as modes of capitalist accumulation in an extractive economy.
Since the 1950s, views of Earth from above have been critiqued for provoking detachment from and decontextualization of human, terrestrial concerns. These critiques thus establish Earth’s enveloping atmosphere as the ultimate context for meaningful and grounded accounts of humanness, and outer space as a site for abstract, generalizable knowledge. But in outer space, the explanatory work done by “context” is put in question, because spacefaring humans must attend to basic and constantly shifting conditions for life that lie beyond “context” on Earth, including breathing. Attention to humans in real and speculative space environments reveals context as a naturalizing device that establishes universal nature/culture distinctions through recourse to grounding terrestrial ontologies.
This article engages with the animal bodies that haunt the transnational pet-cloning industry: the “used-up” surrogate-mother dogs said to be returned to dog-farms and slaughtered for human consumption in South Korea. I explore how “Western” criticisms that reduce the problem to Korea’s dog-eating culture and lack of bioethics—interlocking with nationalist and cultural relativist responses among Koreans—reiterate postcolonial relations within transnational bioethics, further pushing these animals into the shadows. I trace shame and disgust (as affective remainders of canine bodies) as a way to critically examine the bioethicalization of animal welfare as an operation of the biopolitical order of things among human and nonhuman bodies in the field of transnational biotechnology, in an effort to remind us of the canine others within us.
In this article, I examine the scenario-based exercise as a central technology within Israel’s preparedness apparatus. Drawing on my ethnographic research in NEMA and the Turning Point administration, I analyze how the scenario event works as a technology-based uncertainty, both in its conceptualization of the future and, especially, in its enactment. As Barak argued, the exercise narrative is a chosen event, one that does not replicate the past or attempt to predict the future. Though designed to challenge responders, the scenario represents not a worst-case event but a plausible one. Moreover, although the scenario is based on a preselected, well-designed event, I argue that once practiced, it is actualized as a multiplicity of subevents, or incidents, that the various participants sometimes enact with unexpected consequences. With this technology, the Israeli preparedness system is directed neither toward producing specific responses nor toward discovering the best solutions for an unknown future. Rather, the technology generates uncertainty through its execution, from which new problems are extracted.
Micah M. Trapp
In my work in the Buduburam Liberian refugee camp, located forty kilometers west of Accra, Ghana, I have sought to understand how refugees’ demand for food with what they consider to be good taste is configured in equations of who is deserving, or in need of, humanitarian aid. My questions have centered on how the politics of necessity shape food provision as humanitarian aid. Central to these inquiries are the critical opportunities afforded to refugee subjects by the aesthetics of taste—how cooking and taste reveal forms of refugee subjectivities that counter the humanitarian politics of necessity.
Candice Oster, Julie Henderson, Sharon Lawn, Richard Reed, Suzanne Dawson, Eimear Muir-Cochrane, and Jeffrey Fuller
Mental health care for older people is a significant and growing issue in Australia and internationally. This article describes how older people’s mental health is governed through policy discourse by examining Australian Commonwealth and South Australian State government policy documents, and commentaries from professional groups, advocacy groups and non-governmental organisations. Documents published between 2009 and 2014 were analysed using a governmentality approach, informed by Foucault. Discourses of ‘risk’, ‘ageing as decline/dependence’ and ‘healthy ageing’ were identified. Through these discourses, different neo-liberal governmental strategies are applied to ‘target’ groups according to varying risk judgements. Three policy approaches were identified where older people are (1) absent from policy, (2) governed as responsible, active citizens or (3) governed as passive recipients of health care. This fragmented policy response to older people’s mental health reflects fragmentation in the Australian policy environment. It constructs an ambiguous place for older people within neo-liberal governmental rationality, with significant effects on the health system, older people and their carers.
Marit Haldar, Eivind Engebretsen, and Dag Album
Although the sociology of medicine has developed a rich body of research on patients’ experiences and how they handle their illnesses, few analyses have examined doctors’ concepts of disease. Building on previous research findings that doctors consider some diseases to be more worthy than others, this article focuses on how these differences in disease prestige are articulated and made logical. We presented a focus group panel of doctors a table of 38 diseases rank-ordered by prestige according to the results of a previous quantitative study of doctors. We prompted a lively discussion among the doctors by asking them whether they were familiar with this rank order. In analysing how they managed the prestige knowledge presented to them, we focused on how they handled the value conflict between this informal rank order and the formal value of equality of treatment. Using positioning theory as a theoretical premise and a methodological tool, we found that the focus group participants created positions in their conversations that allowed them to present and discuss views on disease prestige that would be considered illegitimate if they were declared directly. However, they were able to do so without being forced to take a personal stand. Thus, we demonstrate how informal disease rankings can be produced and reproduced.
Olaug S Lian and Frances Rapport
In this article, we explore the role of ‘place’ in shaping people’s illness experiences through a data-led inductive case-study based on experiential data from people living with myalgic encephalomyelitis (ME) in Norway. Our main aim is to understand how they experience, interpret and attach meaning to various places in which they reside, and how they construct the course of a life influenced by chronic illness. The study is based on stories containing photographs and written texts, received from 10 women and men. In their stories, they describe those places where they experience their illness in the least and most taxing ways. Through a narrative and photographic analysis of their stories, we explore how they perceive the relationship between place and illness as experienced, managed and endured. Our analysis is based on a place-sensitive sociology, in which we approach place both as physicality and a symbolic construction. The participants describe how a wide range of places are intimately linked to their illness experiences, and they interpret these links by referring to both physical and symbolic factors. They describe their lives in terms of a need for equilibrium between activity and rest. Risk is a strong underlying theme: whatever they do, they risk losing something. Most of all, the participants describe how they are looking for places to escape to and from. Places to escape to are those places where privacy and peace can be found, which primarily revolve around being at home. Places to escape from are those places that make their energy ‘slowly ebb away’.
Simon M Dyson, Waqar IU Ahmad, and Karl Atkin
The moral turn within sociology suggests that we need to be attentive to values and have a rapprochement with philosophy. The study of illness narratives is one area of sociology that has consistently addressed itself to moral domains but has tended to focus on stories of living with genetic or chronic illness per se rather than liminal states such as genetic traits. This article takes the case of genetic carriers within racialized minority groups, namely, those with sickle cell or thalassaemia trait, and takes seriously the notion that their narratives are ethical practices. In line with the work of Paul Ricoeur, such storied practices are found to link embodiment, social relationships with significant others and wider socio-cultural and socio-political relations. At the same time, such practices are about embodying values. These narratives may be considered as practices that re-fuse what genetic counselling has de-fused, in order to make sense of a life in its entirety and to strive ethically and collectively towards preferred social realities.
Dalit Simchai and Yael Keshet
This article presents a critical analysis of New Age culture. We draw on two empirical studies conducted in Israel and show that the lofty notions about freedom from the shackles of socially structured identities and the unifying potential this holds, as well as the claim regarding the basic equality of human beings, are utopian. Blindness toward ethno-national identity reinforces identification with a self-evident hegemonic perception, thereby leading to the exclusion of peripheral groups such as indigenous populations. This exclusion is manifested in the discourse symbolically as well as in the praxis of complementary and alternative medicine, which is one of the main fields in which New Age culture is involved. Thus, the unifying ethos in the New Age culture becomes an illusionary paradise. This article contributes to the study of power relationships between New Age culture in diverse Western countries and the native and peripheral populations of these countries, and to the sociological study of complementary and alternative medicine incorporated into health organizations.
Alex Broom, Emma Kirby, Phillip Good, and Zarnie Lwin
The shift from life-prolonging and palliative care can be fraught with interpersonal complexities as patients face dilemmas around mortality and the dying process. Nurses can play a central role in managing these moments, often with a focus on promoting and enhancing communication around: the meaning of palliative care, the nature of futility and the dying process more broadly. These sites of nurse–patient communication can be highly charged and pose unique challenges to nurses including how to balance nursing perspectives versus those of other stakeholders including doctors. Here, drawing on interviews with nurses, we explore their accounts of communication about futility and the process of transitioning to palliative care. The interviews reveal nurses’ perspectives on the following: the art of conversing around futility and managing patient resistance, the influence of guilt and individual biographies in shaping communication, the importance of non-verbal and the informal in communication, the impact of conflicting organisational expectations on nurses and the process of learning to effectively communicate. We argue that these transitional moments articulate important, and at times problematic, aspects of contemporary nursing and nurse–medical relations.
Peiling Zhou, Sue C. Grady
- Hospitals are described per spaces, decorations, doctor-patient power relations and discourse between medical encounters.
- Spatial and temporal arrangements of these environments shape doctor-patient relationship to enhance or reduce conflicts.
- Adaptations to improve hospital therapeutic environments for patients and doctors are provided.
Andrea Krüsi, Ryan McNeil, David Moore & Will Small
In this article, we examine how injection drug users who do not attribute their HIV infection to engaging in HIV risk behaviours take up and critique discourses of individual responsibility and citizenship relating to HIV risk and HIV prevention. We draw on data from a study in Vancouver, Canada (2006–2009) in which we interviewed individuals living with HIV who had a history of injection drug use. In this paper, we focus on six cases studies of participants who did not attribute their HIV infection to engaging in HIV risk behaviours. We found that in striving to present themselves as responsible HIV citizens who did not engage in HIV risk behaviours, these participants drew on individually focused HIV prevention discourses. By identifying themselves in these ways, they were able to present themselves as ‘deserving’ HIV citizens and avoid the blame associated with being HIV positive. However, in rejecting the view that they and their risk behaviours were to blame for their HIV infection and by developing an explanation that drew on broader social, structural and historical factors, these individuals were developing a tentative critique of focus on individual responsibility in HIV transmission as opposed to dangers of infection arising from the socio-economic environment. By framing the risk of infection in environmental rather than individual risk-behaviour terms, these individuals redistributed responsibility to reflect the social-structural realities of their lives. In this article, we reflect on the implications of these findings for public health measures such as risk prevention messages. We argue that it is important that such messages are not restricted to individual risk prevention but also include a focus of broader shared responsibilities of HIV.
Philosophy, Ethics, and Humanities in Medicine (open access):
Sayani Mitra and Silke Schicktanz
During a commercial surrogacy arrangement, the event of embryo transfer can be seen as the formal starting point of the arrangement. However, it is common for surrogates to undergo a failed attempt at pregnancy conception or missed conception after an embryo transfer. This paper attempts to argue that such failed attempts can be understood as a loss. It aims to reconstruct the experiences of loss and grief of the surrogates and the intended parents as a consequence of their collective failure to conceive a surrogate pregnancy.
Shahaduz Zaman, Hamilton Inbadas, Alexander Whitelaw, David Clark
Around the world there is growing interest in the manner in which care is delivered to people at the end of life. However, there is little unanimity on what constitutes a ‘good death’ and the appropriate societal responses to the issue of delivering culturally relevant and sustainable forms of end of life care in different settings are not subjects of broad agreement. In this critical conceptual paper we focus on the emerging narratives of global palliative care and offer an assessment of their implications. We relate this to calls to improve end of life care across jurisdictions and settings, attempts to map and grade the development of palliative care provision, and to the emergence of a widely recognised global ‘quality of death index’. We consider an alternative approach to framing this debate, drawn from a subaltern and post-colonial studies perspective and suggest that adopting a truly global perspective will require acceptance of the plurality of past and present local problems and issues relating to end of life care, as well as the plural possibilities of how they might be overcome. In that context, we would not aim to universalise or privilege one particular global future for end of life care. Instead of homogenising end of life interventions, we seek to be open to multiple futures for the care of the dying.
Karen Lowton, Chris Hiley, Paul Higgs
Medical innovations have created a future of survivorship for many groups of people with a variety of conditions that were previously untreatable or untreated. This has led not only to an expansion of medical activity in a whole variety of new areas but also to the emergence of new groups of individuals defined or defining themselves through their experiences, diagnosis and treatment. Through analysis of in-depth interviews with 27 of the now-adult survivors of the pioneer cohort of children receiving liver transplants in Britain in the early 1980s and 1990s, this paper presents how this group not only illustrate the capacities of modern medicine and healthcare to transform the survival prospects of a more diversified population, but also create new narratives of embodied identity. Specifically, we examine how childhood identities were shaped in three settings; home, hospital and school. At home, parents appeared to shape their child’s identity through controlling tightly a daily medical regime focused on the concept of ‘body as machine’, celebrating their survival as a transplant recipient, yet at the same time socialising their child as a ‘normal’ child, albeit one who had a serious illness. The hospital appeared instrumental in shaping parents’ focus on their child’s body, and offered a way, through other patients with liver disease, for children to feel ‘normal’ in their difference. It was in school, through interaction with ‘healthy’ children and teachers, that corporeality and embodiment appeared most salient, and where social identity was negotiated and more often held in contention. Adult survivors of childhood liver transplant straddle the different discourses of normality and difference as their embodied experiences shape their narratives of identity and shed light on an underexplored aspect of the relationship between medicine and society.
Melody E. Morton Ninomiya, Nathaniel J. Pollock
Historically, Indigenous health research in Canada has failed to engage Indigenous peoples and communities as primary stakeholders of research evidence. Increasingly, research ethics and methodologies are being positioned as tools for Indigenous self-determination. In response, mainstream institutions have developed new ethical principles for research involving Indigenous people. While these transformations are necessary steps towards re-orienting research practices, they are not prescriptive. In this paper, we make visible three dilemmas from a case study in which Indigenous health research frameworks provided limited guidance or were unclear about how to balance community priorities with Indigenous research principles. We also discuss the strategies used to resolve each of these dilemmas.
We draw examples from a project that examined the lived experiences of children and youth living with FASD and their caregivers. This project was conducted in collaboration with Sheshatshiu Innu First Nation, an Indigenous community in Labrador, Canada. In doing so, we argue that knowing the key guiding principles in Indigenous health research is not always enough, and that the ‘real-world’ context of practices and relationships can lead to conflicts that are not easily resolved with adherence to these principles.
Sarah M. Frank, T. Elizabeth Durden
The emerging epidemic of obesity and type II diabetes in Mexico has recently propelled the nation into the public health spotlight. In the state of Yucatán, the experience of diabetes is greatly impacted by two cultural constructions of disease. In this setting, elements of Yucatec Mayan health practices as well as the biomedical model affect the approach to type II diabetes. Both frameworks offer unique understandings of the etiology of diabetes and recommend different ways to manage the condition. Based on in-depth and semi-structured interviews with both community members and clinicians, the present study seeks to understand how diabetes is understood and treated in indigenous settings in rural Yucatán. We explore the context in which community members navigate between locally available healthcare options, choose one over the other, or incorporate strategies from both into their diabetes care regimens. The tension between indigenous community members and their biomedical healthcare providers, the changing food environment of this community, and the persistence of traditional gender constructions affect the management of type II diabetes and its associated symptoms.
Tom Douglass, Michael Calnan
Sociological research offers crucial understanding of the salience of trust for patients in mediating a plurality of healthcare activities and settings. Whilst insights generated surrounding the salience of trust for patients are important, other trusting relations within healthcare have largely been neglected. This paper focuses on the significance of trust for doctors, arguing that trust is salient for doctors in facilitating their professional role, in the management of complexity and uncertainty in contemporary medical practice, and is a key mechanism underpinning professional identity. As such, the paper develops a preliminary conceptual framework for researching trust by doctors built upon the idea of a ‘lattice’ of doctor trust relations in various entities and at various levels that may be interconnected. The lattice of doctor trust comprises four primary conceptualisations – trust in patients, self-trust, workplace trust and system trust. The paper explores the notions of doctors’ need to trust patients to provide accurate information and to commit to certain treatment pathways; the relationship between the self-trust of the doctor, clinical activity and trust in others; the need for doctors to trust their professional colleagues and the broader organisational setting to ensure the smooth running of services and integration of care; and notions surrounding the complexity of the broader systems of modern (bio)medicine and the role of trust by doctors to facilitate system functioning.
Jeremiah C. Morelock
Mental health treatment providers today are subject to insurance company regulation. Using grounded theory to analyze 33 interviews of treatment providers, I portray this regulation as a form of surveillance that operates through discourse, and ask how treatment providers communicate with and through this system. My findings reveal that mental health treatment providers are required to deliver information to insurers within a rationalized medical discourse that is supposed to represent treatment, but is inadequate for the task. I argue this bureaucratic system demands that providers communicate with insurers in a distorted way. These findings are theorized in dialogue with Habermas’ communication typology and his theory of lifeworld colonization. I argue that the case of managed mental health care presents an arena of communication and colonization which is best suited by building from the Habermasian framework. Colonization occurs, yet on within a specific channel of communication, despite pretensions of thoroughgoing colonization. Systematically generated communicative distortions occur, but often without necessarily involving self-deceptions or strategic private agendas. This paper contributes to Habermasian theory by suggesting it could be further elaborated upon to account in for forms of colonization and distorted communication that occur in varied social contexts.
Rik Peeters, Marc Schuilenburg
This article addresses the question: ‘In what ways have nudging and other behavioural techniques entered the realm of policymaking for public health and what does that mean for the way contemporary society is governed?’ In our genealogy of Dutch public health policy, we have identified four periods: ‘rational persuasion/individual responsibility’ (‘70s), ‘welfarist emancipation’ (‘80s), ‘neo-liberal regulation’ (‘90s), and ‘management of choice’ (now). We show how a different type of technique, which we call ‘mindpolitics’, has slowly complemented the biopolitics of public hygiene and health care. We argue that to think in terms of biopolitics today means to think of its relation to a world in which public health is managed through architecture of choice and the way individuals are nudged into making better decisions.
Cindy K. Malachowski, Katherine Boydell, Peter Sawchuk, and Bonnie Kirsh
This article employs institutional ethnography (IE) inclusive of its distinctive epistemological stance to elucidate the institutional organization of the everyday work experience of the employee living with self-reported depression. The study was conducted within a large industrial manufacturing plant in Ontario, Canada. We discuss three institutionally organized processes that play a dominant role in coordinating the experiences of employees with self-reported depression: (1) employees’ work of managing and negotiating episodes of depression, (2) managers’ administrative work of maintaining privacy and confidentiality, and (3) the administrative work of authorizing illness. We shed light on how confidential medicalized disability management programs render managers ill prepared and inadequately trained to provide mental health support to their employees. Our findings inform advocacy efforts and facilitate both organizational and policy change to enhance services and supports for employees.
Celeste Campos-Castillo, Daniel J. Bartholomay, Elisabeth F. Callahan, and Denise L. Anthony
Recent health policies encourage electronic messaging with providers to potentially improve health care. It is unclear whether the same potential exists for individuals with mental health symptoms. Whereas these individuals appear interested in such technologies, they may also be concerned about privacy and security risks. To clarify this ambiguity, we conceptualize electronic messaging as an impression management tool for individuals with depressive symptoms, who risk devaluation from others. Consequently, factors that increase the perceived risk of devaluation in face-to-face clinical encounters may increase the likelihood of electronically messaging providers. We empirically examined two factors: depressive symptom severity and trust in physician confidentiality, which is the expectation that one’s regular physician uses personal health information appropriately. We found that reporting severe depressive symptoms increased the likelihood of electronically messaging providers but only among respondents who lacked trust in physician confidentiality. Electronic messaging is potentially a means to reach this underserved population.
Rachel Rowe and Niamh Stephenson
Where modern public health developed techniques to calculate probability, potentiality, risk and uncertainty, contemporary finance introduces instruments that redeploy these. This article traces possibilities for interrogating the connection between health and financialisation as it is arising in one particular example – the health impact bond. It locates the development of this very recent financial innovation in an account of public health’s role within governance strategies over the 20th century to the present. We examine how social impact bonds for chronic disease prevention programmes bring two previously distinct ways of thinking about and addressing risk into the same domain. Exploring the derivative-type properties of health impact bonds elucidates the financial processes of exchange, hedging, bundling and leveraging. As tools for speculation, the functions of health impact bonds can be delinked from any particular outcome for participants in health interventions. How public health techniques for knowing and acting on risks to population health will contest, rework or be subsumed within finance’s speculative response to risk, is to be seen.
Chloe Shaw, Elizabeth Stokoe, Katie Gallagher, Narendra Aladangady and Neil Marlow
The article analyses the decision-making process between doctors and parents of babies in neonatal intensive care. In particular, it focuses on cases in which the decision concerns the redirection of care from full intensive care to palliative care at the end of life. Thirty one families were recruited from a neonatal intensive care unit in England and their formal interactions with the doctor recorded. The conversations were transcribed and analysed using conversation analysis. Analysis focused on sequences in which decisions about the redirection of care were initiated and progressed. Two distinct communicative approaches to decision-making were used by doctors: ‘making recommendations’ and ‘providing options’. Different trajectories for parental involvement in decision-making were afforded by each design, as well as differences in terms of the alignments, or conflicts, between doctors and parents. ‘Making recommendations’ led to misalignment and reduced opportunities for questions and collaboration; ‘providing options’ led to an aligned approach with opportunities for questions and fuller participation in the decision-making process. The findings are discussed in the context of clinical uncertainty, moral responsibility and the implications for medical communication training and guidance.
Lorna Rouse and W.M.L. Finlay
The limited existing research on diabetes management and intellectual disabilities (ID) highlights the need for further exploration of the concept of responsibility. This study explored repertoires of responsibility in accounts of managing diabetes for adults with ID. Fourteen semi-structured interviews were conducted in the UK with seven adults with mild/moderate ID and type 1 or 2 diabetes and seven people who they nominated as supporting their diabetes management. A discursive psychological analysis found that interpretative repertoires relating to competence, independence and accountability were drawn on to construct multiple and sometimes conflicting versions of responsibility. Within these repertoires people with ID were positioned in conflicting ways; as competent, personally responsible, and entitled to independence and choice, but as also lacking competence, dependent on others and incapable of overall accountability. People with ID often took up empowering positions defending against an incompetent identity. Supporters built accounts which negotiated dilemmatic repertoires on the dual responsibilities of empowering adults with ID to self-manage and managing risk to support good and safe care. The implications of available discursive resources and the ways in which they are mobilised are considered.
Teresa S. Puvimanasinghe and Ian R. Price
Sri Lanka has recently emerged from a three decade long civil war between government forces and the Liberation Tigers of Tamil Eelam. Behind the actual arena of conflict, forms of organised violence were often perpetrated on ordinary Sri Lankans who came into contact with law enforcement officials and other state authorities. The effects of these encounters on mental health, well-being, and community participation can be severe and long-lasting. Considering the generally poor availability of mental health services in many low-income countries, brief efficient interventions are required to enhance the lives of individuals and their families affected by torture, trauma, or displacement. In this context, the present study evaluated the effectiveness of testimonial therapy in ameliorating the distress of Sri Lankan survivors of torture and ill-treatment. The results indicated that over a 2- to 3-month period, psychosocial functioning was significantly enhanced in the therapy group compared to the waitlist control group. The general benefits of testimonial therapy, the ease with which it can be incorporated into ongoing human rights activities, and its application by trained nonprofessionals encourage greater use of the approach.
Kimberly Matheson, Amy Bombay, S. Alexander Haslam, and Hymie Anisman
Embracing a shared social identity typically serves to protect group members in the face of threats. However, under some conditions, intragroup dynamics are diverted so that instead, they contribute to disturbances in collective well-being. The present analysis applies a social identity framework to understand how intragroup processes elicited in Indian Residential Schools (IRS) altered the capacity of Indigenous peoples to overcome damage to their identity and collective functioning. With the alleged goal of assimilating the Indigenous population, residential schools in Canada entailed the forced removal of Indigenous children from their communities. A Truth and Reconciliation Commission established in 2008 confirmed the extensive abuse perpetrated by IRS staff, but also raised awareness of the pervasiveness of student-to-student abuse. Supported by qualitative analyses of the reports of social service providers working with IRS survivors (N = 43), it is argued that a key part of the dynamics in the IRSs was the subversion of intragroup processes among Indigenous children in attendance. Understanding intragroup dynamics provides a basis for recognizing the persistent effects of IRSs, and for identifying strategies to heal and reclaim a positive collective identity.
Nicholas J. Carson, Arlene M. Katz, and Margarita Alegría
Clinicians in community mental health settings frequently evaluate individuals suffering from physical health problems. How patients make meaning of such “comorbidity” can affect mental health in ways that may be influenced by cultural expectations and by the responses of clinicians, with implications for delivering culturally sensitive care. A sample of 30 adult mental health intakes exemplifying physical illness assessment was identified from a larger study of patient–provider communication. The recordings of patient–provider interactions were coded using an information checklist containing 21 physical illness items. Intakes were analyzed for themes of meaning making by patients and responses by clinicians. Post-diagnostic interviews with these patients and clinicians were analyzed in similar fashion. Clinicians facilitated disclosures of physical suffering to varying degrees and formulated them in the context of the culture of mental health services. Patients discussed their perceptions of what was at stake in their experience of physical illness: existential loss, embodiment, and limits on the capacity to work and on their sense of agency. The experiences of physical illness, mental health difficulties, and social stressors were described as mutually reinforcing. In mental health intakes, patients attributed meaning to the negative effects of physical health problems in relation to mental health functioning and social stressors. Decreased capacity to work was a particularly salient concern. The complexity of these patient–provider interactions may best be captured by a sociosomatic formulation that addresses the meaning of physical and mental illness in relation to social stressors.
This article examines contemporary Ukrainian psychiatry through the voices of patients, practitioners, and advocates, focusing on shifting objects of knowledge, interventions, and institutional transitions. Currently, we are witnessing the reconfiguration of psychiatry on a global scale through neoliberal rhetoric combined with the call for global mental health. The goal of the movement for global mental health is to scale up psychiatric treatments through greater access to psychiatric drugs, justified through the framing of distress as an illness. Neoliberal rhetoric suggests that cutting social service expenditure through the privatization and decentralization of the health care system will stimulate economic growth and, in the long term, combat poverty. This paper traces how these dynamics are playing out in Ukraine, drawing on ethnographic fieldwork conducted at a psychiatric hospital in south-central Ukraine from 2008–2010, while working with a non-governmental organization
Qais Alemi, Sigrid James, and Susanne Montgomery
This qualitative study explored how Afghan refugees conceptualize frames of mind that may reflect depression in general and as it relates to trauma they experienced. We performed in-depth interviews with 18 Afghans residing in the San Diego area. Views regarding the causes, symptoms, and perceived treatments of depression were gathered through free-listing techniques, and supplemented with narratives relating to pre- and post-resettlement stressors and coping mechanisms. Data were analyzed with standard qualitative content analysis methods. Items endorsed with relation to depression causality included pre-migration war traumas, notably separation from family, and post-migration stressors including status dissonance and cultural conflicts that ranged from linguistic challenges to intergenerational problems. Depressive symptoms were viewed as highly debilitating, and included changes in temperament, altered cognitions, avoidance and dissociative behaviors, and somatic complaints. Relief was sought through family reunification and community support, reliance on prayer, and the academic success of their children in the US. The findings underscore the need for practitioners to take into account situational stressors, cultural aspects of mourning and symptomatology, and existing coping mechanisms in developing interventions that are based on refugees’ articulated needs.
Ayesha Ahmad and Simon Dein
Multicultural societies such as the United Kingdom are host to people with diverse belief systems and behavioral norms. Whilst a country requires that all members of society conform to standardized legal requirements, cases arise that involve certain complexities related to the cultural or religious context in which a certain action was committed. This paper addresses the impact of culture on notions of criminal responsibility and action. Through a case study of a recent event in the United Kingdom, we explore whether a cultural defense is relevant for contextualizing incidents in which an individual commits a criminal action during an alleged period of spirit possession From this analysis, we suggest that using a cultural defense can aid understanding of an individual’s relationship to the society that he or she identifies with and facilitate the practice of justice in a multicultural society.
Special Issue! Resisting Power, Retooling Justice: Promises of Feminist Postcolonial Technosciences by Anna Zogas
In advance of our regular In the Journals post, I want to highlight a Special Issue. Anne Pollock and Banu Subramaniam have guest edited “Resisting Power, Retooling Justice: Promises of Feminist Postcolonial Technosciences,” in Science, Technology & Human Values. Here are the abstracts!
Resisting Power, Retooling Justice: Promises of Feminist Postcolonial Technosciences
Anne Pollock, Banu Subramaniam
This special issue explores intersections of feminism, postcolonialism, and technoscience. The papers emerged out of a 2014 research seminar on Feminist Postcolonial Science and Technology Studies (STS) at the Institute for Research on Women and Gender, University of Michigan. Through innovative engagement with rich empirical cases and theoretical trends in postcolonial theory, feminist theory, and STS, the papers trace local and global circulations of technoscience. They illuminate ways in which science and technology are imbricated in circuits of state power and global inequality and in social movements resisting the state and neocolonial orders. The collection foregrounds the importance of feminist postcolonial STS to our understandings of technoscience, especially how power matters for epistemology and justice.
Informed Refusal: Toward a Justice-based Bioethics
“Informed consent” implicitly links the transmission of information to the granting of permission on the part of patients, tissue donors, and research subjects. But what of the corollary, informed refusal? Drawing together insights from three moments of refusal, this article explores the rights and obligations of biological citizenship from the vantage point of biodefectors—those who attempt to resist technoscientific conscription. Taken together, the cases expose the limits of individual autonomy as one of the bedrocks of bioethics and suggest the need for a justice-oriented approach to science, medicine, and technology that reclaims the epistemological and political value of refusal.
Research often characterized as “new materialist” has staged a return/turn to nature in social and critical theory by bringing “matter” into the purview of our research. While this growing impetus to take nature seriously fosters new types of interdisciplinarity and thus new resources for knowing our nature-cultural worlds, its capacity to deal with power’s imbrication in how we understand “nature” is curtailed by its failures to engage substantively with the epistemological interventions of postcolonial feminist science studies. The citational practices of many new materialist thinkers eschew the existence of what Sandra Harding has called “a world of sciences.” I argue that the “science” privileged and often conflated with matter in new materialist storytelling is the same science destabilized by postcolonial feminist science studies. This does not mean that new materialist feminisms and postcolonial feminist science studies are necessarily at odds, as new materialist storytelling and prevailing conceptualizations of the postcolonial seem to suggest. On the contrary, I suggest that thinking creatively, capaciously, pluralistically, and thus irreverently with respect to the rules of science––about the boundaries and meanings of matter, “life,” and “humanness”––could be understood as a central project for a postcolonial feminist science studies.
This article examines a genetic ancestry testing program called the Living History Project (LHP) that was jointly organized by a nonprofit educational institute and a for-profit genealogy company in South Africa. It charts the precise mechanisms by which the LHP sought to shape a postapartheid genome through antiracist commitments aimed at contesting histories of colonial and apartheid rule in varied ways. In particular, it focuses on several tensions that emerged within three modes of material-discursive practice within the production of the LHP: subject recruitment, informed consent, and participant reflections. In the end, it argues that several contradictory tensions were central to the making of the LHP’s postapartheid genome and that it should be understood as nonracial rather than antiracist.
In 1984, eight-year-old Paula Logares was called into a judge’s chambers and was told the man and woman she lived with were not her parents. Her parents had been disappeared during the dirty war, and now, through her blood, scientists would be able to return her to her birth family. Paula, thus, became the first “stolen” child in Argentina to be identified via the incipient technology of DNA identification. With this forensic first, DNA identification has emerged as a central tool of good governance the world round. From routine crime fighting to international criminal tribunals, DNA plays a crucial role in attempts to reckon with crimes of the body. As an alternative origin for forensic DNA, Argentina offers an early example of science emerging from social movements in the Global South. Drawing on twenty-seven months of fieldwork with family members, activists, and scientists, this article documents the ways in which DNA has emerged as a core site of subject formation for individuals and families affected by the terror of the dictatorship and for the Argentine nation-state, as it reckons with the legacies of repression. Through a feminist, postcolonial frame, I offer the concept of re(con)stitution as a way of attending to the forms of biocitizenship that emerge during times of humanitarian crisis and transitional justice. As a tool of reproductive governance, forensic DNA acts not only as a powerful disciplinary site of biocitizenship but also as a potential space to reimagine the social contract between the body, the public, and the state.
A distinctive form of anticolonial analysis has been emerging from Latin America (LA) in recent decades. This decolonial theory argues that important new insights about modernity, its politics, and epistemology become visible if one starts off thinking about them from the experiences of those colonized by the Spanish and Portuguese in the Americas. For the decolonial theorists, European colonialism in the Americas, on the one hand, and modernity and capitalism (and their sciences) in Europe, on the other hand, coproduced and coconstituted each other. The effects of that history persist today. Starting thought from these LA histories and current realities enables envisioning new resources for social transformations. These decolonial insights seem to receive only a passing recognition in the Latin American social studies of science and technology projects that have begun cosponsoring events and publications with northern equivalents. My focus will be primarily on the decolonial theory and on just two of its themes. One is the critical resources it offers for creating more accurate and progressive northern philosophies and histories of science as well as social studies of science. The second is insights from Latin American feminists that carry different impacts in the context of the decolonial accounts.
Last fall, a group of researchers – mostly biological anthropologists and sleep researchers – published a study of three ‘pre-industrial’ communities, one in Latin America, two in Africa, and claimed that based on their data, consolidated nightly sleep is a human norm, inferring that it is the product of natural selection. The media picked up the research findings, and I read write ups of it in a number of outlets, which led me to the original article and sparked conversations with me and other sleep-interested scholars about the validity of the research. A couple of months later, I was asked by the editor of Sleep Health if I would like to respond to the findings of the article (which you can find here), in part because the researchers made an argument against a claim that I have made – corroborating Roger Ekirch – that human sleep has only recently consolidated, largely as a result of industrial capitalism in the 19th century. But I was primarily motivated by the anthropology-informed opportunity to point out that no contemporary society offers us a window to some pre-industrial past or earlier evolutionary moment. To suggest otherwise – and here I’m quoting myself – ‘verges on scientific racism.’
So what was the assumption that the researchers were working off of that would lead them to such a claim and why would I find it controversial? They took a form of social organization – namely hunter-gatherer foraging – as indicating that the people who practice that form of subsistence share qualities with a stage of human history when that social organization was predominant. Put another way, they assumed that modern hunter-gatherers are fundamentally the same as hunter-gatherers from earlier periods in human history. With that assumption in place, one can infer that beyond their subsistence pattern are other shared practices, including sleep. That these three communities each slept in consolidated, nightly fashion was then taken as a window onto our shared human evolutionary past, and led the researchers to make the further inference that humans have always been consolidated sleepers. Where there is variance from that pattern, we might be seeing something like social preference or ‘culture’ interfering with basic human biological patterns.
This idea that a modern society could stand in for a pre-industrial society is akin to what sociocultural anthropologists refer to as ‘unilineal evolution.’ This understanding of social development arose in the 19th century, at the very beginnings of modern social science, including sociology and anthropology, which were foundational in elaborating the theory. Although there were various theories of unilineal evolution, the overriding assumption shared by its proponents was that Western civilization (in which they meant Western Europe, Canada, and the U.S.) was the most advanced form of social organization, and that all other societies were developing towards this pinnacle of scientific rationality, freedom from violence, objectivity, orderly laws, aesthetics, and economy. So, parts of Eastern Europe might be construed as close to the Western ideal – as might Japan – and Central America, Africa, interior Asia, and the island Pacific were seen as pre-modern. As anthropology developed as a discipline, unilineal evolution was quickly debunked, first by Franz Boas at the turn of the 20th century, and even more profoundly, and through a variety of sociological, historical, and philosophical means, by Johannes Fabian, Eric Wolf, Michel-Rolphe Trouillot, Faye Harrison, and their colleagues in the 1970s and 1980s. By the turn of the 21st century, one would be hard pressed to find a sociocultural anthropologist – or anyone in the social sciences – who believed that any modern society could offer a window onto our evolutionary past.
Where does scientific racism come into the equation? It was no mistake that the early proponents of unilineal evolution were all white men in Europe and the U.S. By building the theory of unilineal evolution in the way that they did, they rationalized Western civilization as the endpoint of social development. In so doing, they justified the civilizing missions of settler colonialism and global imperialism, suggesting that it was ‘the white man’s burden’ to uplift the savage societies of the colonies and American frontier. Race, for these early thinkers, was synonymous with earlier stages of social development, and distinctions were also made among white communities – between the urban elites and rural poor and working classes. White elites were the outcome of the civilizing process. Everyone else was in need of civilizational intervention. To support the theory of unilineal evolution, evidence about ‘modern’ societies needed to be disregarded or ignored, including ideas about superstition, religion, irrational orderings of society, gender bias, and legal and domestic violence. White elites, everyone came to agree by the turn of the 21st century, were just as subject to bias and irrationality and everyone else.
Unilineal evolution leant itself directly to early 20th century eugenics movements, providing ammunition for American and European political organizations that sought the promotion of some races over others. In The Mismeasure of Man, noted biologist Stephen Jay Gould thoroughly critiqued these early 20th century scientists and the implicit biases built into their science that led them to see some people and societies as more advanced and worthy than others. In the present, we continue to see inferences between race and behavior – despite the thorough debunking of the genetic reality of race. Whenever someone claims that a person or society behaves a particular way because of their race, they are participating in a kind of scientific racism that relies on a baseless understanding of race and conflates that with a faulty notion of social development. Similarly, when subsistence patterns – like hunter-gatherer foraging – are mapped onto particular places because of their evolutionary import, the people who practice those lifeways become conflated with earlier stages of human social – and potentially, evolutionary – development.
The debate I had stepped into by commenting on that sleep research is really at the heart of anthropology’s inability to communicate across the subdisciplines as they are currently configured, and emblematic of how anthropologists have a hard time communicating with people outside of the discipline. Biological and sociocultural anthropologists have moved further and further apart over the last century – and especially over the last 20 years – to the point that a whole department’s worth of biological anthropologists can subscribe to forms of biological reductionism that sociocultural anthropologists in the same department actively work to debunk. Medical anthropology, as a subfield, is particularly gripped by this inability to communicate, as we can have positivist, treatment-focused, lab-based scientists publishing in the same journal as deeply constructivist, interpretivist social scientists who conceptualize disease as largely a social byproduct. Moreover, as biological sciences outside of anthropology move further away from the social as an explanatory possibility, when a critique of biological sciences comes out of a society-focused discipline, like sociocultural anthropology, it seems to come as a broadside, spurious, or out of school. Consulting a sociocultural anthropologist at the beginning of a study might have led to the development of a very different research design – and one that stayed away from any controversial assumptions about race, society, and human evolution. Developing those kinds of consultancies and partnerships is important not only to produce socially-aware science, but science that produces valid knowledge.
Now, it has been several months since my response appeared in print, and I wonder if ‘verges on scientific racism’ was untoward. Does suggesting that the interpretation of a set of data might harbor racist or otherwise prejudicial assumptions thwart the goals of critique? Does it shut down the possibility for an interdisciplinary conversation, or are we just at a point where interdisciplinary conversations are impossible, at least between particular disciplines, and especially those interested in human evolution, biology, and history?
In an earlier version of my response, I hovered over the phrase ‘verges on scientific racism,’ wondering if it was the right wording. My concern wasn’t so much for the authors of the piece – my assumption was that they were unknowingly reproducing assumptions that social scientists and humanists had long debunked – but for people who might read the piece and take its findings at face value. My audience wasn’t the authors of the original piece, but, hopefully, other scientists who might forward a research agenda that would help get away from such assumptions about people, places, and history. I hoped that my critique might be taken as a teachable moment, since there was clearly a point of theoretical contact between the assumptions of the scientists and longstanding bodies of anthropological evidence. My assumption was also that ‘verges on scientific racism’ put enough rhetorical distance between actual racism and the authors of the piece that they might not see themselves reflected in my language – but rather see some of the assumptions in the science as part of the problem and work towards fixing them in the future. In fact, shortly after my response appeared, a group of scientists made a very similar critique.
I fully believe that it’s possible to have racist, or sexist, or classist, or any number of other prejudices buried in science and that you can have well-meaning, non-biased scientists practicing that science – that’s one of the basic assumptions of science studies. And it’s also the basis of critiques originating from science studies: pointing to the unmarked assumptions of knowledge production helps to expose implicit biases and helps to forge new ways forward that will – hopefully – lead us to better scientific understandings of the world and the things that inhabit it. The problem with prejudice, especially in the context of a scientific ideology, is that it rarely names itself (unless it’s The Bell Curve). Individuals can be indoctrinated into scientific practices and unknowingly reproduce findings that have implicit assumptions and biases (for example, the scientists in Emily Martin’s ‘The Egg & the Sperm’ and a recent Wellcome Trust-funded video game about fertilization).
At the end of the day, I chose the wording that I wrote, ‘verging on scientific racism,’ because I fundamentally believe in the advancement of science, and drawing attention to prejudicial assumptions should help us collectively forward a scientific agenda that sheds more light than darkness. I found it distressing that media outlets accepted the assumptions of that particular scientific paper — as if any science should be uncritically accepted. Scientific knowledge production is an ongoing project and no one should be afraid of being proven wrong – in findings or assumptions. Sometimes critique can be difficult to hear – and ‘verging on scientific racism’ might be especially harsh given the contemporary U.S. political climate – but only through honest critique can we begin to unfetter ourselves from the restraints that limit our scientific imaginations and build truly interdisciplinary research agendas that overcome assumptions in the social and biological sciences, especially about race and history.
Matthew Wolf-Meyer is Associate Professor of Anthropology at Binghamton University, in the State University of New York system. His work focuses on medicine, science and media in the United States, and draws on history, contemporary experiences and popular representations of health and illness. Wolf-Meyer is a contributing editor to Somatosphere.
This article first appeared on Anthropology News.
I have had the honor many times to present together with Triqui Mexican migrant farmworkers who have shaped my thinking and writing. These presentations have been planned collaboratively. Sometimes they involved my presenting a formal paper followed by a response from farmworkers. Other times they took the form of a conversation during which I interviewed my farmworker co-presenters, they interviewed me, the audience asked us questions and then we asked the audience questions. These presentations attempted to destabilize the producer and object of knowledge, the expert, the informant, and the respondent (while, in other ways of course, these positions were solidified).
During preparations for our presentation for the 2016 Association of American Geographers meeting, several Triqui farmworkers and I discussed the recent anthropological debates on suffering. In 2013, Joel Robbins, called for an end to what he terms, borrowing from Michel Trouillot, “suffering slot anthropology” and a move toward what he calls an “anthropology of the good.” Joseph Hankins posits a different, yet related dichotomy, suggesting anthropologists should utilize a framework he denotes “ecology” to elucidate connections instead of a representation of suffering that he sees as engaged to build an empathic bridge between the reader and the other in hopes for social change. More recently, Sherry Ortner attempts to patch together this dichotomy she frames as “dark anthropology and its others.”
In our conversations about such dichotomies and their critiques of anthropological attention to suffering, Francisco Ventura Martinez, a Triqui Mexican migrant farmworker and father living in Central California, stated in Spanish, “We suffer a lot [sufrimos mucho]. We suffer crossing the border from Mexico. We suffer bent over picking strawberries or cutting asparagus so people can have food. We suffer being treated badly because of the color of our skin and our language.” Armando Celestino Ventura, his nephew, added, “Children suffer moving between schools when we migrate.”
Of course, these conversations on suffering were interspersed with others attending to joy—giving birth, graduating from school—and resistance, such as recent policy changes won by farmworker organizations. As Leslie Butt and others deftly remind us, it is important to represent people not as mere “suffering strangers” but rather in their full, multi-faceted experiences making sense of, at times legitimizing, and at times resisting and disrupting the systems in which they are positioned and position themselves. Life in many parts of the globe includes suffering, violence, resistance, hope and care, often difficult to avoid as well as often intermingled and difficult to separate. My co-presenters ask that we should not flatten the multi-faceted nature of life by leaving out any of these realities, including those experienced as suffering.
Preparing for a presentation to Sonoma State University, Francisco explained, “it is important for gabachos [white Americans] to hear that we suffer a lot to raise and harvest their food” (see also Carney). Later, during the AAG presentation, Francisco explained to the audience, “I hope that in hearing about our lives and our suffering, hearts will be touched and the ways we are treated will slowly change.” He asked those present to tell others what they heard. At the end of the presentation, Francisco, Armando and Elio Santos, Binational Coordinator of Youth for the Frente Indigena de Organizaciones Binacionales, encouraged the audience to consider how such academic meetings could support immigrants and farmworkers. In these ways, my Triqui and Mixtec co-presenters explicate the sharing of their experiences of suffering as one way in which they exercise precisely what anthropologists conceptualize as moral action, resistance, agency, working toward more livable lives and better futures.
Ethnographic Refusal, Experiences of Suffering and Resistance
In 1995, Sherry Ortner called anthropologists to avoid “ethnographic refusal,” sanitizing through the erasure of uncomfortable realities. I worry that conjectured dichotomies separating attention to suffering from attention to “the good” or elucidation of connections foster a specific ethnographic refusal in which anthropology students are counseled or ridiculed away from theorizing and representing realities their research participants may experience and narrate as suffering and violence.
In the midst of racialized hyperincarceration, urban and rural police, state, and para-military violence, as well as growing social and economic inequalities in the context of multinational corporate exploitation and free trade agreements, many people in the world experience and articulate important aspects of their lives in terms of suffering and violence. Some of these people, like Francisco, Armando, and other Triqui and Mixteco farmworkers I have come to know, ask anthropologists to analyze, theorize, and write about these experiences. They share their stories of suffering both in a frame of interconnected ecology (“we suffer a lot to raise and harvest their food”) and in hope for affective response (“hearts touched”) that may lead to a different future. A refusal to acknowledge and seek to understand the effects of these realities pushes anthropology away from an ethical “passion for society” (Wilkinson and Kleinman) and risks (further) irrelevance to many outside academia. Francisco, Armando, Elio and others have asked academic audiences, rather, to do the opposite.
Who Suffers and Who Cares? Destabilizing Dichotomies
At Cosumnes River College, a student asked Francisco what he thought when his family first met me. Francisco replied, “[Seth] was alone in the labor camp and we worried about him. Everyone else was there with family. We didn’t want him to be sad.” I had not realized this was the perception I gave off (or reality I was unable to hide). And I had not realized that Triqui people had shared with me not so much because of my anthropological skills or even simply my friendliness, but rather because they saw me as vulnerable and sad and they engaged in care.
Such multi-vocal presentations remind me that social positions are neither unidimensional nor stable. Rather, Francisco and Armando articulate suffering and care response as important both for anthropologists to understand their experiences and for farmworkers as caring subjects responding to the anthropologist who is vulnerable and suffers.
In ongoing conversation and relationship with those who contribute to our scholarship, we may learn a great deal about ourselves, difference, representations of knowledge, suffering, violence, hope, morality and care. Engaging with, listening to, theorizing, writing about, and attempting to respond to the realities, understandings, and requests of our research participants —including those experiencing and articulating violence and suffering—seem to me the central roles of anthropology into the future.
Seth Holmes is Associate Professor of Medical Anthropology & Public Health at U.C. Berkeley. His work focuses broadly on social hierarchies, health inequalities, and the ways in which perceptions of social difference may naturalize, normalize, or challenge these inequalities.
Now drowned in the torrent of post-election analysis, on October 26, 2016, the journal Nature published a study which traced genomic data in an effort to map the spread of HIV in North America. The newsworthy conclusion of the study was a full-throated scientific vindication of Gaetan Dugas, the man erroneously dubbed “Patient Zero” in Randy Shilts’ And the Band Played On, a popular depiction of the spread of HIV in the United States during the early 1980s. Dugas was a French-Canadian flight attendant who became a person of interest in the epidemiological detection of HIV in its early days, since he had had sexual contact with so many of the early cases on the West Coast. The original researchers dubbed him “patient ‘O’” (for “outside”); Shilts and others translated this as “patient ‘0’”, or the index case. Shilts also portrayed Dugas as willingly careless and negligent. The study published in Nature concluded that Dugas was not the index case in North America; his demonization by Shilts and other media has been corrected.
The fervor over this vindication — garnering editorials and spots in The New York Times (here and here), NPR, the Chicago Tribune, New York Magazine, and Science magazine, among others — led me to reflect on the spectacle of disease narratives, not only what they emphasize, but what they tend to obscure. Epidemics are both disease events and media events. The spectacle of disease — the “literary” construction of a disease event in media, especially visual media — constitutes the social and political force of epidemics.
As someone interested in literature and its cultural stakes, I turn to Priscilla Wald who has written arguably the definitive statement of what an epidemiological narrative is and how it takes shape. In her book Contagious: Cultures, Carriers, and the Outbreak Narrative, Wald argues that disease outbreaks are in large part constructed through the crafting of a narrative, usually involving an index case or a “patient zero” such as Typhoid Mary or Gaetan Dugas (Wald 2008). The production of these narratives is typically bound up with literary concerns, such as the assignment of “hero” and “villain” status to a person or group. These narratives have tangible effects on policy and public health administration. In typical outbreak narratives, the hero is the scientist or doctor, the villain is the disease and its human carriers. “Typhoid Mary,” a woman named Mary Mallon, spent decades in quarantine, and died in custody: she was widely demonized, and public health officials enjoyed the glory of containing such a scourge. Mallon’s nom de criminel is still a euphemism for a person with dangerous influence. For example, a character named “Typhoid Mary”, also known as “Mutant Zero”, appears as a supervillain in Marvel comic books — not as a typhoid carrier but as a lustful, murderous mentally ill criminal.
Mary Mallon’s story is a tragedy, not only because of the people who contracted typhoid from her, but because of the sense we get that all of her “villainous” qualities seemed out of her control: she was an asymptomatic typhoid carrier, but also she insisted that the authorities had no right to imprison her and perform medical tests on her body. Her very resistance was considered criminal — she was putting the public at risk, after all, so her incarceration and forced testing were considered justified in the name of social security. Wald argues that Mallon’s predicament played out in the media as a matter of defense of class and race: “Mallon’s ethnicity, class, and occupation, combined with her condition, ensured her transformation into an object of disgust and reprobation in the public health and medical literature of the period” (Wald 1997, 195). She was criminalized and systematically represented as a threat to social and cultural norms. As with Mallon, since the study in Nature, Dugas’s story has been recast as a tragedy, again not only for the role he played in transmitting a fatal disease, but because we are faced with a case in which the “perpetrator” is also a “victim.” The irony, of course, is that the “truth” of the Dugas story was well known by the CDC investigators who originally interviewed him, and that it took a scientific study — DNA evidence, as in a criminal investigation — to exonerate him.
Charles Rosenberg also highlights the apparent similarities between epidemics and literary narratives. For example, in a 1989 essay “What is an epidemic? AIDS in historical perspective”, Rosenberg outlines the “dramaturgic model” of epidemics in which
Epidemics start at a moment in time, proceed on a stage limited in space and duration, following a plot line of increasing and revelatory tension, move to a crisis of individual and collective character, then drift toward closure. (Rosenberg 1989, 2)
His focus on the tension of an epidemic being “revelatory” — that is, revealing some underlying truth of the demos among which the outbreak has occurred — and the “crisis of individual and collective character” places emphasis on the self-reflective questioning that arises in the heat of epidemic virulence. Suddenly, all the uncertainties, anxieties, and fears that had been kept hidden by the social mores of civilian life bubble to the surface. Neighbors reject one another’s company, government authorities assume strict controls over movement and treatment, and newspapers publish editorials wondering how many civil liberties must be surrendered in order to establish safety and security. In the case of the AIDS crisis, the script may have been flipped: government authorities didn’t do enough to stop the disease or manage its treatment given a (well-documented) moral fear of homosexuality, which had been unscientifically and unfairly tethered to the disease as part of the construction of an “outbreak narrative.”
This leads me away from the sound and fury of the spectacle of epidemics toward the ending of Rosenberg’s drama: the closure, the moment when the curtain drops and the house lights come up, when the narrator falls silent. This is what is “troubling” about the vindication of Gaetan Dugas. He was the closure, he satisfied the need for an “ending,” which is really the hunger for meaning, to impute straight-forward sense onto a brutal, irreducibly complex socio-biological “imbroglio,” to borrow a term from Bruno Latour. The study in Nature, in “setting the record straight” on Dugas, in doing some belated and posthumous justice by de-vilifying him, pulls back the curtain on the HIV spectacle. A spectacular crisis tends to be all-encompassing, such that when the crisis abates and the key to the mystery is unveiled — it was the flight attendant, in the bath house, with the virus — the audience can feel as though it needn’t bother with critical consciousness any longer. With Dugas in his role as villain, the event is given meaning, even if that meaning is false and only serves to perpetuate fear of the Other.
I wonder if the vindication of Gaetan Dugas should highlight the less dramatic and more structural “realities” that give rise to or even facilitate crises at the outset. Perhaps we can be reminded to pay attention to the price of the tickets and the plushness of the seats and the ornateness of the proscenium arch — that is, what is not on stage may be as important and compelling as the main action. When the drama begins, the lights dim, and we cannot see ourselves, or the person sitting next to us. We quiet down; during the intensity of the performance it would be wrong to speak out against what we see. Under the spell of a spectacular outbreak narrative, we are seduced by the immediacy of the crisis and perhaps lose sight of the ongoing social and political inequalities that are difficult or impossible to narrate, either because they are quiet, or invisible, or so slow they do not fit into a news cycle or a sound bite. But we need to remain vigilant.
I am reminded of what is already a classic work of social and environmental criticism, Rob Nixon’s Slow Violence and the environmentalism of the poor. Nixon, a literary scholar who takes aim at social and environmental concerns, analyzes the deep connection between the way we tell stories and the way we act politically. Slow Violence focuses on environmental violence that occurs over long time spans, the urgency of which is undervalued, and that most often affects populations with less power and less privilege. His work resituates catastrophic events like global warming — or for our purposes, global health crises and disease outbreaks — in light of the value we place on the shape of the narrative, its ability to proliferate across contemporary media and to compete with other spectacles vying for our attention. Giving meaning to what happens slowly, unspectacularly, is a real and important challenge. Nixon wonders,
In an age when the media venerate the spectacular, when public policy is shaped primarily around perceived immediate need, a central question is strategic and representational: how can we convert into image and narrative the disasters that are slow moving and long in the making, disasters that are anonymous and that star nobody, disasters that are attritional and of indifferent interest to the sensation-driven technologies of our image-world? (Nixon 2011, 3)
This question haunts me and motivates me as a scholar and as a person, one among many contemplating uncertain political, economic, and environmental futures. How do we more effectively push back against the spectacular narratives that continually recast heroes and villains, the glorious and the unacceptable, the righteous and the deplorable? And how do we craft new narratives that leave the solutions unsettled and that never collapse in a moment of closure?
The public, media-driven morality play of AIDS in America, featuring Dugas as a seductive demon, took shape and ossified rapidly, despite the best efforts of activists and gay rights groups to tell a different story with human rights at its center. The “final” vindication of Gaetan Dugas almost thirty years later undermines the power of the outbreak narrative since it exposes the monster as a lover, a friend, a flawed person caught in the matrix of an “image-world”. It should also help us look askance at the spectacle, to question its purpose, and to wonder about the complex, subtle events off stage-left, in the dark pool created by the spotlight.
Greg Clinton is a PhD candidate in Cultural Studies at Stony Brook University. He is writing a dissertation titled “The Architecture of Safety: Bunkers, Shelters, and Clean Rooms” that analyzes the practices and production of “safe space” in the context of toxic, risky, violent, and porous environments. Greg is managing editor of Somatosphere.
Nixon, Rob. 2011. Slow Violence and the Environmentalism of the Poor. Cambridge, Mass.: Harvard University Press.
Rosenberg, Charles E. 1989. “What Is an Epidemic? AIDS in Historical Perspective.” Daedalus 118 (2): 1–17.
Wald, Priscilla. 1997. “Cultures and Carriers: ‘Typhoid Mary’ and the Science of Social Control.” Social Text, no. 52/53 (October): 181–214. doi:10.2307/466739.
———. 2008. Contagious: Cultures, Carriers, and the Outbreak Narrative. 1 edition. Durham: Duke University Press Books.
Commentary and speculation after this election have focused on voters’ motives and emotional states, and, especially in the day or two after the result, why experts didn’t know in advance how this would turn out. Why did public opinion polling skew the way it did? What does this teach us about voting and its psychological and social dimensions? These questions touch upon areas of interest and practice among Somatosphere readers—intention, the plastic brain, political subjectivity, and biosocial and neurosocial collaborations have all been addressed in these pages in ways relevant to understanding politics. Still, we readers and contributors may not usually be professionally involved in the political arena; we may feel less than personally addressed by questions about prediction and public opinion, and the popular debate about “media responsibility” that ensues. I’m not going to suggest that we change either of those things and “get involved.” But with all our varied expertise, at the interface of the mind, the body, and the social, we may have more tools handy than we might think to help in understanding—really understanding—current events. While we might want to continue cultivating our gardens, as it were, I think that just working over our own specialist knowledge and theories at a time like this can itself contribute something of importance to the public sphere, and in fact provides a basis on which we can know more about what just happened. The historian and New Yorker writer Jill Lepore said, on the “Politics and More” podcast on November 11, that when it comes to historical models and political science predictions, “what we thought we knew we don’t know anymore.” Other kinds of knowledge about politics are urgently needed.
After the election, for myself, I started to think about psychoanalytic theory and what it tells us about the results and their consequences. For example, Freud observed long ago that the kinds of persons who occupy high political office matter, and not only because of the power they wield; the events (both public and personal) that touch those offices and their incumbents affect people’s psychic lives (I’m thinking of the “Mass Psychology” and “Fetishism” essays). Freudian theory indicates that how we identify with politicians and even abstract institutions can determine what within ourselves we are able to find valuable, what parts of our own character we can cultivate. On this understanding, political results have deep implications for the culture we live in.
But Freud was not the most immediate source, for me, of insights of value and use. I wanted to think more concretely about what certain psychoanalytic (and anthropological) theories offer by way of a widened understanding of technical issues of democracy. I wanted to think about how public opinion is forged and democracy is done. An essay by D. W. Winnicott, “Some Thoughts on the Word ‘Democracy’” came to mind, and upon re-reading it seemed to have tangible lessons to offer. In what follows, I will discuss what Winnicott had to say about what he called “democratic machinery”—voting, opinion, and leadership. The broader lesson I want to take away from this reading is that our interpretive disciplines, forms of personal knowledge, and ethnographic work may in fact offer a robust basis for critical engagement with how our legal and political institutions work, as well as offering insights into how they work upon, with, and also within us. Understanding these latter dimensions of politics—for which we don’t even have a common vocabulary—is one prerequisite for better institutions.
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In 1950, the psychoanalyst D. W. Winnicott tread upon the specialist terrain of political science, with apologies for his ignorance of their technical vocabularies, to offer “Some Thoughts on the Word ‘Democracy’” (this essay was originally published in Human Relations and has been reprinted twice, in The Family and Individual Development and the collection Home is Where we Start From; page numbers here are from the latter). He stipulated that democracy is a psychological and a social achievement of a healthy and mature society, a matter of “democratic machinery” which allows for “the expression of feelings, apart from conscious thoughts” (241, italics his). Specifically, he argued that unconscious feelings and identifications are uniquely expressed through the secret ballot, and by this means become integral to democratic functioning. Moreover, in order for an election to really express a collective judgment of what is to be done, the secret ballot is not enough: there must be persons for whom to vote, not ideas or principles, because only a person can make promises, respond to unconscious demands, and change if necessary to meet new situations (249). Only a person can bear the delegated responsibility which is equally important to democracy.
Through such democratic machinery, the voter’s inner world is “turned into a political arena for a limited time,” while psychological struggles play out—in intensified, dramatic forms—in the external world of political competition (241). Winnicott was careful to add that because it implicates the unconscious and personal psychic realities, democratic machinery has to work in ways that allow for irrational results—as the legitimate expression of real unconscious feelings—but also to provide means of fixing them.
As for public opinion polling, Winnicott cautioned that, without the anonymity and secrecy of the voting booth, polling can only solicit reiterations of abstract party-principles or slogans. It cannot measure the underlying feelings they tap into, and hence, opinion polls can provide only limited indications of actual ballots. He of course was aware of the highly technical nature of polling and opinion research, and noted that “a great deal of trouble is taken to avoid exactly this pitfall” (250), but in his view the problems remained (as, perhaps, we have just learned again).
Winnicott’s thoughts on gender and the role of women in politics seem less timely, even particularly limited and limiting (we need to read psychoanalytic theory with a healthy dose of feminism and even melancholy, insofar as both can widen our sense of what kind of identifications are possible within and across genders). He noted that, at the time of his writing, men occupied almost all the high political offices in the world, but he grounded this political (in a deep sense) fact in a psychological complex, a fear of dependency that he traced back to the infant’s ambivalent love and hate for its mother who both cares for it and controls it. This verges on a parody of psychoanalytic speculation. But Winnicott’s argument is not about actual men and women and their relative fitness for command of the political unconscious (as Margaret Thatcher’s much later political success indicated, among other late twentieth century women leaders). Rather, Winnicott notes that whosoever successfully appeals to unconscious fantasy—fearful and unmasterable ideas buried in our psyche—will by this means be gifted with the group’s power, in compensation for the unthought debt which emerges from our bodily dependence on each other, as a condition of our very social being. In his own words:
“The tendency of groups to accept or even seek actual domination is derived from a fear of domination by a fantasy Woman. This fear leads them to seek, and even welcome, domination by a known human being, especially one who has taken on himself [or herself] the burden of personifying and therefore limiting the magical qualities of the all-powerful Woman of fantasy, to whom is owed the great debt” (253).
Read today, these thoughts about unconscious domination offer much more than just a psychoanalytic theory of charisma, and indeed say something beyond their immediate reference to dictatorship. Winnicott seems to be addressing here the potential within democratic machinery for its own subversion, when its users fail to understand the wellsprings of the power it provides. He draws our attention to unacknowledged debt, felt (but not thought) resentment, and unsatisfied yearnings for solidarity (misconceived as “greatness”), as elements of that machinery that must be reckoned with if the machinery itself is not to break down. Progressive politicians may have something to think about, in these terms.
Understanding and anticipating the outlook of voters is perhaps the most challenging task of any democracy, and it is both a technical craft and a political art. But there is a real danger, internal to democracy, when the search for understanding becomes too technicized, too demographic and instrumental. That is what Winnicott was talking about when he emphasized the need for, the positive value of, a machinery that can deal with unconscious identifications while not manipulating or directing them. In a sense, he was pointing to the moral importance of core democratic values of letting each individual decide for him and herself (though not in a vacuum or absent other considerations that may shape the alternatives presented).
Most importantly, reading Winnicott helps highlight the danger of political words, messages, and slogans that mean too little as much as too much. Winnicott helps us see how democratic machinery can be affected not only by the charismatic leader who sways the passions, but also by the small-bore demagogue who only speaks to the conscious, distorted, “split off” level of thoughts. This kind of politician produces only narrow reactions rather than truly personal actions of the voter as a whole person, with her complex and individual history. On this understanding, and at this moment of crisis, we might then recall that recovering persons and their history is the special task of psychoanalysis and ethnography, and this can also be their political vocation.
Leo Coleman is Associate Professor of Anthropology at Hunter College, City University of New York. His book A Moral Technology: Electrification as Political Ritual in New Delhi is forthcoming from Cornell University Press. email@example.com
Book Forum — Emily Yates-Doerr’s “The Weight of Obesity: Hunger and Global Health in Postwar Guatemala” by Rebeca Ibáñez Martín
It is a pleasure to convene this forum for The Weight of Obesity: Hunger and Global Health in Postwar Guatemala. Marianne de Laet, Simon Cohn, and Jeannette Pols, have provided spirited commentaries on Emily Yates-Doerr’s ethnography of metrics, weight, and care in highland Guatemala. The author’s talent to illustrate the complex choreographies that produce the problem of obesity makes this a truly delightful piece of work to collectively unpack. We hope you enjoy the discussion.
Rebeca Ibáñez Martín
University of Amsterdam
Marianne de Laet
Harvey Mudd College
London School of Hygiene and Tropical Medicine
Academic Medical Centre of Amsterdam
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University of Amsterdam
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