In addition to special issues highlighted earlier this month on Somatosphere — Limn (on “Ebola’s Ecologies“), the Annals of Anthropological Practice (on “Community Health Workers and Social Change: Global and Local Perspectives“), and Social Theory & Health (entitled “Theorising Health Inequalities” — the month provided, as always, a bevy of good reading, including a special section of Social Studies of Science on the ontological turn (see below). Enjoy!
The racialization of individuals in the contemporary United States is increasingly accomplished through institutional actors, including scientists and physicians. As genetic health risks, chronic disease treatments, and pharmaceuticals come to define Americans’ understanding of themselves, a fundamental shift is occurring in the way medicine is practiced and its role in the production of subjectivity. Underlying these changes is an expectation of orderly bodies—of “white” bodies that exemplify social and cultural norms of biology and behavior. Fundamental to U.S. medical ideas of normativity is that the white heteronormative subject is the standard against which disorderly and nonwhite subjects are to be judged. I explore these ideas through the history and contemporary world of sleep: the clinical production and interpretation of related scientific data, advertising use of images of sleep-disordered patients who have been “cured,” and experiences of nonwhite Americans within mainstream sleep medicine.
Patients of Venezuelan state clinics ascribe meanings to doctor–patient interactions that reverberate beyond the immediacy of the clinical encounter to shape political subjectivities. They seek not just medical goods and services from clinical interactions but also expressions of recognition, respect, care, and solidarity from doctors. I argue that patients who had long resented what they saw as the Venezuelan state’s broken promises to use national oil wealth to provide for its citizens now read its efforts to address sociopolitical inequalities in the bodily dispositions of its medical workers. Combining anthropological approaches to doctor–patient interactions and to medical embodiment, I show how doctors’ embodied practices can render biomedical encounters politically significant for patients, activating or foreclosing a sense of sociopolitical belonging. In doing so, I demonstrate how sociopolitical orders are constructed and challenged through the intimacies of biomedical practice.
Cultural Anthropology (Open Access)
Chronic domestic chemical exposures unfold over protracted timelines and with low velocity. In this article I argue that such microscopic encounters between bodies and toxicants are most readily sensed by less nameable and more diffuse sensory practices. The apprehension of conventionally insensible toxic exposures is informed by sustained attention to barely perceptible alterations of somatic function and atmosphere. Slight biochemical impressions, which at first appear simply meaningless or puzzling, accumulate in the bodies of the exposed and reorient them to the molecular constituents of the air and the domestic infrastructure from which such chemicals emanate. Through the articulation of these small corrosive happenings, residents of contaminated homes can accumulate minute changes to body and atmosphere across time and space in a process I call the “chemical sublime,” which elevates minor enfeebling encounters into events that stir ethical consideration and potential intervention. The chemical sublime is a late industrial experience that inverts an Enlightenment-era, yet still dominant, conception of the sublime. Across authoritative and questioned bodies, companion species and humans, this essay asks: in what ways do diffuse sensory practices generate knowledge of, attention to, and engagements with the chemical world?
Philosophy, Ethics, and Humanities in Medicine (Open Access)
Medical professionalism: what the study of literature can contribute to the conversation
Johanna Shapiro, Lois L. Nixon, Stephen E. Wear, and David J. Doukas
Medical school curricula, although traditionally and historically dominated by science, have generally accepted, appreciated, and welcomed the inclusion of literature over the past several decades. Recent concerns about medical professional formation have led to discussions about the specific role and contribution of literature and stories. In this article, we demonstrate how professionalism and the study of literature can be brought into relationship through critical and interrogative interactions based in the literary skill of close reading. Literature in medicine can question the meaning of “professionalism” itself (as well as its virtues), thereby resisting standardization in favor of diversity method and of outcome. Literature can also actively engage learners with questions about the human condition, providing a larger context within which to consider professional identity formation. Our fundamental contention is that, within a medical education framework, literature is highly suited to assist learners in questioning conventional thinking and assumptions about various dimensions of professionalism.
The aim of this article is to analyse the popular perception of the nightmare in medieval Europe. The first section will explore the ways in which the base experience of the nightmare (as documented in neuropsychological research) was interpreted according to Church doctrine, classical dream theories and Galenic medicine. Then, with reference to the remedies used to protect the body against the mara found in Anglo-Saxon medical manuals and the tales of demonic/ghostly assault from twelfth-century Anglo-Norman literature, it will be seen how the authoritative interpretations of the nocturnal assault were replicated, rejected or interpolated in the rhythms of daily life. Ultimately, this article will argue that the nightmare experience can be read as an independent ‘text’; a universal function of the human body that is given substance and coherence depending on the habits, experiences and fears of the percipient.
Using the correspondence of Catalina Micaela (1567–97), Duchess of Savoy, with her husband, Carlo Emanuele I as evidence, this article examines an early modern aristocratic woman’s experience of and attitudes about pregnancy, childbirth, lactation and menstruation. Her letters reveal that some early modern women closely monitored their bodies and from their observations were able to detect pregnancy early—earlier than many scholars have thought—and to calculate their delivery dates with some precision. Her example also shows that their husbands and fathers could be closely involved in the world of pregnancy and childbirth and that, while other scholars have argued that the lying-in period empowered and liberated women, Catalina remained tied to her political responsibilities and was expected to return to her duties immediately after giving birth. Catalina’s well-documented experience thus both enlarges and in some cases challenges the scholarly understanding of early modern pregnancy, childbirth and the confinement period.
‘Nature Concocts & Expels’: The Agents and Processes of Recovery from Disease in Early Modern England (open access)
The ‘golden saying’ in early modern medicine was ‘Nature is the healer of disease’. This article uncovers the meaning and significance of this forgotten axiom by investigating perceptions of the agents and physiological processes of recovery from illness in England, c.1580–1720. Drawing on sources such as medical texts and diaries, it shows that doctors and laypeople attributed recovery to three agents—God, Nature and the practitioner. While scholars are familiar with the roles of providence and medicine, the vital agency of Nature has been overlooked. In theory, the agents operated in a hierarchy: Nature was ‘God’s instrument’, and the physician, ‘Nature’s servant’; but in practice the power balance was more ambivalent. Nature was depicted both as a housewife who cooked and cleaned the humours, and as a warrior who defeated the disease. Through exploring these complex dynamics, the article sheds fresh light on concepts of gender, disease and bodies.
Ignored Disease or Diagnostic Dustbin? Sudden Infant Death Syndrome in the British Context (open access)
Angus H. Ferguson
Sudden Infant Death Syndrome (SIDS) was defined in 1969 and incorporated into the International Classification of Diseases a decade later. To advocates of SIDS as a diagnosis, medical interest in sudden infant death was long overdue. However, the definition of SIDS lacked positive diagnostic criteria, provoking some to view it as a ‘diagnostic dustbin’ for the disposal of problematic cases where cause of death was unclear. This paper examines the development of medical interest in sudden infant death in Britain during the middle decades of the twentieth century. It highlights the importance of recognising the historicity of SIDS as a diagnosis facilitated by changes in law and medicine over the course of the nineteenth and twentieth centuries. It suggests that SIDS provides a definitive case study of the medicalisation of life and death, and a unique example of an officially recognised disease that had no symptoms, signs, pathology or patients.
Inhaling Democracy: Cigarette Advertising and Health Education in Post-war West Germany, 1950s–1975 (open access)
In the late 1960s and early 1970s, the West German government was faced with the challenge of addressing a damaging health behaviour, smoking, in the context of an emerging late modern democracy, when the precedent for addressing that behaviour was set in the Nazi past. This paper details the two-pronged approach which the government took: seeking restrictions on cigarette advertising, whilst educating young people to adopt positive health behaviours in the face of pressure to smoke. This approach can be understood in the social and economic context of the time: an economic commitment to the social market economy worked against restrictions on the sale of cigarettes; whilst concerns about past authoritarian structures prompted the health authorities to seek novel ways of addressing smoking, emphasising choice. In a nuanced way, post-war anti-smoking strategies were a response to West Germany’s National Socialist past, but more importantly, a signal of an increasingly international outlook.
Robert Saunders was a surgeon on the British Turner expedition to Tibet in 1783–85. In 1789, Saunders published a description of a mercury processing method for treating ‘the venereal disease’ that he witnessed at Tashilhunpo. Since Saunders himself used mercury for his patients, the question arises whether he described a Tibetan method of processing mercury or projected his own experiences on what he saw. This paper traces parallels of his description and analyses venereal diseases in Tibetan medical texts. The symptoms described in these texts cannot be easily equated with modern syphilis. This article explores the following questions: How were venereal diseases classified in Tibetan medical texts? Were mercurials mentioned to treat them? Were they intended to cause salivation? In answering these questions, the heterogeneity and exchange of medical practices in Tibet from the seventeenth to the early twentieth century, involving the use of mercury for venereal treatments, becomes apparent.
Historically, venereal disease (VD) has represented a significant manpower problem for the armed forces and the Korean War (1950–53) was no exception. Amongst British, Australian, Canadian and New Zealand troops deployed to the Far East, rates of VD peaked at 387 cases per 1,000. Levels of infection far exceeded those recorded during the Second World War. Over the past several decades, historians have explored the intimate lives of fighting men throughout the twentieth century in great detail. Be that as it may, the Korean War has received little attention. This article represents the first analysis of the Commonwealth experience of VD. It examines how widespread the problem became, as well as the efforts to which officials went to reduce levels of infection. It also explores the reasons why venereal disease was so prevalent at this time and place, and why the Commonwealth Division, and the Canadians in particular, were so affected by it.
The study of the history of private practice in the NHS has generally been focused on either the introduction or the abolition of pay-beds. This article looks at the period characterised as the ‘Quiet Time’ when a political consensus seemingly emerged to retain some form of private provision within the service. This piece argues that rather than ‘a quiet time’ it was a period of intense activity and controversy as to the place and contribution of pay-beds when there were multiple attempts to rationalise and to make them cost effective. This article is an original study of a much-neglected subject in public policy history.
With the migration of the written record from paper to digital format, archivists and historians must urgently consider how web content should be conserved, retrieved and analysed. The British Library has recently acquired a large number of UK domain websites, captured 1996–2010, which is colloquially termed the Dark Domain Archive while technical issues surrounding user access are resolved. This article reports the results of an invited pilot project that explores methodological issues surrounding use of this archive. It asks how the relationship between UK public health and local government was represented on the web, drawing on the ‘declinist’ historiography to frame its questions. It points up some difficulties in developing an aggregate picture of web content due to duplication of sites. It also highlights their potential for thematic and discourse analysis, using both text and image, illustrated through an argument about the contradictory rationale for public health policy under New Labour.
This paper provides a guide to finding historical records of the National Institutes of Health (NIH), the US biomedical research agency funded by the federal government, and one of the world’s largest research funding bodies. Such records are important to an understanding of the development of medicine and biomedicine after the Second World War, yet they can be difficult to find in the organizational maze that is the NIH. This article provides information on where records might be found, the ways in which such records might be obtained, and how the NIH manages the vast quantity of records it produces.
Based on a realist conceptualization of interests, this paper explores how commercial and scientific priorities appear to have converged and diverged during the development of the antidepressant Zelmid. The drug represents the first of the selective serotonin reuptake inhibitors (SSRIs) to reach the market. Zelmid was synthesized in 1971 and launched by the Swedish firm Astra in 1982, but subsequently withdrawn the next year because of adverse neurological effects. This paper draws on in-depth interviews with scientists representing both industry and academia who had high-level involvement in various phases of the project (experimental, pre-clinical and clinical), as well as on textual sources such as scientific articles and memoirs. Zelmid was a product of mechanism-based or “rational” drug discovery from the early 1960s and the associated intermingling of science and commerce. It is argued that both scientists and the pharmaceutical company shared an interest in embracing mechanism-based drug discovery because it simultaneously promised medico-scientific advances and profits. However, the intermingling of science and commerce also strained the relationship between scientific and commercial priorities further along the trajectory of the drug; for example, concerning issues such as dosage strategy and drug use in primary care, where corporate management allegedly took decisions contrary to the recommendations of both academic and company scientists. On such occasions the asymmetry in power became apparent in scientists’ narratives: commercial considerations trumped those of science since, ultimately, decisions rest with management, not with scientists. In addition, temporality appears to be associated with the divergence of commercial and scientific priorities. While rare during experimental and pre-clinical phases, divergence was concentrated downstream to the clinical testing and post-marketing phases. It is hypothesized that a similar pattern of convergence and divergence of commercial and scientific priorities may exist in the trajectory of other drugs.
Ready to give up on life: The lived experience of elderly people who feel life is completed and no longer worth living
Els van Wijngaarden, Carlo Leget, and Anne Goossensen
In the Netherlands, there has been much debate on the question whether elderly people over 70 who are tired of life and who consider their life to be completed, should have legal options to ask for assisted dying. So far there has been little research into the experiences of these elderly people. In order to develop deliberate policy and care that targets this group of elderly people, it is necessary to understand their lifeworld. The aim of this paper is to describe the phenomenon ‘life is completed and no longer worth living’ from a lifeworld perspective, as it is lived and experienced by elderly people. Between April to December 2013, we conducted 25 in-depth interviews. A reflective lifeworld research design, drawing on the phenomenological tradition, was used during the data gathering and data analysis. The essential meaning of the phenomenon is understood as ‘a tangle of inability and unwillingness to connect to one’s actual life’, characterized by a permanently lived tension: daily experiences seem incompatible with people’s expectations of life and their idea of whom they are. While feeling more and more disconnected to life, a yearning desire to end life is strengthened. The experience is further explicated in its five constituents: 1) a sense of aching loneliness; 2) the pain of not mattering; 3) the inability to express oneself; 4) multidimensional tiredness; and 5) a sense of aversion towards feared dependence. This article provides evocative and empathic lifeworld descriptions contributing to a deeper understanding of these elderly people and raises questions about a close association between death wishes and depression in this sample.
‘Healthy anorexia’: The complexity of care in disordered eating
Connie Musolino, Megan Warin, Tracey Wade, and Peter Gilchrist
This paper examines how contemporary understandings of ‘health’ and ‘care’ are engaged with and practiced by women with disordered eating. Based on findings from an Australian study investigating why people with disordered eating are reluctant to engage with treatment services (March 2012 to March 2015), we demonstrate how young women use elements of a ‘health habitus’ and ‘care’ to rationalise and justify their practices. Moving beyond Foucauldian theories of self-discipline and individual responsibility we argue that Bourdieu’s concept of habitus and ethnographic concepts of care provide a deeper understanding of the ways in which people with disordered eating embody health practices as a form of care and distinction. We demonstrate how eating and bodily practices that entail ‘natural’, medical and ethical concerns (in particular, the new food regime known as orthorexia) are successfully incorporated into participants’ eating disorder repertoires and embodied as a logic of care. Understanding how categories of health and care are tinkered with and practiced by people with disordered eating has important implications for health professionals, family members and peers engaging with and identifying people at all stages of help-seeking.
Approaches to the organization and conduct of cancer research changed dramatically throughout the 20th century. Despite marked differences between the epidemiological approaches of the first half of the century and molecular techniques that gained dominance in the 1980s, prominent 20th-century researchers investigating the link between sexual activity and anogenital cancers continuously invoked the same 1842 treatise by Italian surgeon Domenico Rigoni-Stern, who is said to originate the problem of establishing a causal link between sex and cancer. In this article, I investigate 20th-century references to Rigoni-Stern as a case of a broader phenomenon: scientists situating their work through narratives of venerated ancestors, or originators. By explaining shifting versions of originator narratives in light of their authors’ cultural context and research practices, we can reimagine as meaningful cultural symbols the references that previous scholars have treated as specious rhetorical maneuvers. In this case, references to Rigoni-Stern provide an interpretive anchor for American scientists to construct continuity between their work and a diverse historical legacy of cancer research.
The ontological turn: Responses and reply
Ontological turns, turnoffs and roundabouts
There has been much talk of an ‘ontological turn’ in Science and Technology Studies. This commentary explores some recent work on multiple and historical ontologies, especially articles published in this journal, against a background of constructivism. It can be tempting to read an ontological turn as based and promoting a version of perspectivism, but that is inadequate to the scholarly work and opens multiple ontologies to serious criticisms. Instead, we should read our ontological turn or turns as being about multiplicities of practices and the ways in which these practices shape the material world. Ontologies arise out of practices through which people engage with things; the practices are fundamental and the ontologies derivative. The purchase in this move comes from the elucidating power of the verbs that scholars use to analyze relations of practices and objects – which turn out to be specific cases of constructivist verbs. The difference between this ontological turn and constructivist work in Science and Technology Studies appears to be a matter of emphases found useful for different purposes.
Ontology, and in particular, the so-called ontological turn, is the topic of a recent themed issue of Social Studies of Science (Volume 43, Issue 3, 2013). Ontology, or metaphysics, is in philosophy concerned with what there is, how it is, and forms of being. But to what is the science and technology studies researcher turning when he or she talks of ontology? It is argued that it is unclear what is gained by arguing that ontology also refers to constructed elements. The ‘ontological turn’ comes with the risk of creating a pseudo-debate or pseudo-activity, in which energy is used for no end, at the expense of empirical studies. This text rebuts the idea of an ontological turn as foreshadowed in the texts of the themed issue. It argues that there is no fundamental qualitative difference between the ontological turn and what we know as constructivism.
This contribution encourages loosening the cast-iron mould of the ‘turn’ metaphor that the practices of general and ontology-related turn-talking/making in Science and Technology Studies forge and fortify. Could framing novel themes and thinking in terms of ‘turn’ be as good as fettering? Not specific to the ‘ontological turn’ or ‘turn to ontology’, but haunting Science and Technology Studies across the board to signify supposed tidal change, the metaphor warrants dissection. Thus, this commentary expounds four distinct yet not unrelated versions of ‘turn’ – rotation, change of course/direction, change in general and occasion/opportunity to act – together with the worlds they beget. Then, the operation of these ‘turns’ in the debates on the ‘ontological turn’ is pursued. Enactments of the first three modes/moulds of ‘turn’, all entailing and tainted by the inexorable directedness of change the coupled ‘turn to’ framing imparts, either debunk or qualify the extent of the professed ‘turn’, with the effect of betraying its conceptual and methodological offerings. The fourth version, less substitutable with ‘turn to’ and thus less infected by intransigent directedness, escapes the rigidity that diminishes the value of ontology-minded studies. Clear of either a resolution to the debate or an alternative trope to cure the maladies of ‘turn’, the conclusion wishes to open space for pondering how to metaphorize more consciously and judiciously evolution and innovation in Science and Technology Studies.
Missing the (question) mark? What is a turn to ontology?
Steve Woolgar and Javier Lezaun
Our introductory essay in this journal’s 2013 Special Issue on the ‘turn to ontology’ examined the shift from epistemology to ontology in science and technology studies and explored the implications of the notion of enactment. Three responses to that Special Issue argue that (1) there is no fundamental qualitative difference between the ontological turn and social constructivism, (2) we need to be wary of overly generic use of the term ‘ontology’ and (3) the language of ‘turns’ imposes constraints on the richness and diversity of science and technology studies. In this brief reply, we show how each of those critiques varies in its commitment to circumspection about making objective determinations of reality and to resisting reification. We illustrate our point by considering overlapping discussions in anthropology. This brings out the crucial difference between the science and technology studies slogan ‘it could be otherwise’ and the multinaturalist motto ‘it actually is otherwise’.
Disorder and disconnection: parent experiences of liminality when caring for their dying child
Joanne Jordan, Jayne Price, and Lindsay Prior
Parents caring for a child with a life threatening or life limiting illness experience a protracted and largely unknown journey, as they and their child oscillate somewhere between life and death. Using an interpretive qualitative approach, interviews were conducted with parents (n = 25) of children who had died. Findings reveal parents’ experiences to be characterised by personal disorder and transformation as well as social marginalisation and disconnection. As such they confirm the validity of understanding these experiences as, fundamentally, one of liminality, in terms of both individual and collective response. In dissecting two inter-related dimensions of liminality, an underlying tension between how transition is subjectively experienced and how it is socially regulated is exposed. In particular, a structural failure to recognise the chronic nature of felt liminality can impede parents’ effective transition.
Constructing the meaning of ultrasound viewing in abortion care
Katrina Kimport and Tracy A. Weitz
As ultrasound scanning becomes increasingly routine in abortion care, scholars and activists have forwarded claims about how viewing the ultrasound image will affect pregnant women seeking abortion, speculating that it will dissuade them from abortion. These accounts, however, fail to appreciate how viewing is a social process. Little research has investigated how ultrasound workers navigate viewing in abortion care. We draw on interviews with twenty-six ultrasound workers in abortion care for their impressions and practices around ultrasound viewing. Respondents reported few experiences of viewing dissuading women from abortion, but did report that it had an emotional effect on patients that they believed was associated with gestational age. These impressions informed their practices, leading many to manage patient viewing based on the patient’s gestational age. Other aspects of their accounts, however, undercut the assertion that the meaning of ultrasound images is associated with gestation and show the pervasiveness of cultural ideas associating developing foetal personhood with increasing gestational age. Findings demonstrate the social construction of ultrasound viewing, with implications in the ongoing contestation over abortion rights in the US.
Explanations and expectations: drug narratives among young cannabis users in treatment (open access)
Margaretha Järvinen and Signe Ravn
This article analyses how young people enrolled in drug addiction treatment in Copenhagen, Denmark, explain their cannabis careers and how they view their possibilities for quitting drug use again. Inspired by Mead and narrative studies of health and illness, the article identifies four different drug use ‘aetiologies’ drawn upon by the interviewees. These cover childhood experiences, self-medication, the influence of friends and cannabis use as a specific lifestyle. A central argument of the article is that these explanations not only concern the past but also point towards the future by assigning the interviewee a more or less agential position in relation to drugs. Further, the drug narratives are viewed as interactional achievements, related to the social context in which they were produced, namely, the institutional setting of the treatment centres. The article is based on 30 qualitative interviews with young people in drug addiction treatment.
Risk and self-managing chronic joint pain: looking beyond individual lifestyles and behaviour
Andrew Morden, Clare Jinks, and Bie Nio Ong
Self-managing chronic musculoskeletal pain is predominantly framed within a discourse of modifying behaviour, or lifestyle risk factors such as diet, weight loss and exercise by policymakers, researcher and clinicians. Little research has been conducted which explores how ‘risk’ is understood or encountered by those with joint pain and how it may relate to self-management. Drawing from serial interviews and a diary study with 22 participants, the findings demonstrate that people with chronic pain engage in a process of assessing and adapting to hazardous or pain conferring situations in relation to daily activities. ‘Risks’ are embedded within a dialectic between corporeal experience and the design features of everyday social environments. Self-management, in this context, is not necessarily solely related to following clinical advice, rather it includes dealing with ‘risks’ of pain, hazards relating to bodily limitations and the environment, and ensuring the ability to continue with valued activities. Findings contribute to sociological understandings of self-management and risk while demonstrating the limits of viewing self-management as an individualised endeavour of changing behaviour.
‘The problem here is that they want to solve everything with pills’: medication use and identity among Mainland Puerto Ricans
Wallis E. Adams, Irina L. G. Todorova, Mariana T. Guzzardo, and Luis M. Falcón
Taking medications are complex symbolic acts, infused with diverse meanings regarding body and identity. This article focuses on the meanings of medications for older Puerto Ricans living on the United States mainland, a population experiencing stark health disparities. We aim to gain an understanding of the way multiple cultural and personal meanings of medications are related to and integrated in identity, and to understand how they are situated within Puerto Rican culture, history and circumstance on the US mainland. Data is drawn from thirty qualitative interviews, transcribed and translated, with older Puerto Ricans living on mainland United States. Thematic Analysis indicated four prevalent themes: embodiment of medication use; medications redefining self through the fabric of daily life; healthcare experience defined through medication; and medicine dividing the island and the mainland. While identity is impacted by experience of chronic illness, the experience of medication prescription and consumption is further related to the construction of the sense of self in distinct ways. For these individuals, medication use captures the dilemma of immigration. While cultural belonging and well-being remains on the island of Puerto Rico, the mainland hosts both easier access to and excess reliance on medication.
Medical constructions of long-term exhaustion, past and present (open access)
Olaug S. Lian and Hilde Bondevik
Culture and history affect the ways in which medical knowledge is shaped, sustained and changed. The less knowledge we have, the larger the space for the cultural imprint becomes. Based on these assumptions, we ask: how have medical constructions of long-term exhaustion changed over time, and how are changing constructions related to societal change? To discuss these questions we conducted a comparative study of medical texts from two historical periods: 1860–1930 and 1970–2013. Our data are limited to two diagnoses: neurasthenia and encephalomyelitis. After comparing the two periods by identifying diverging and converging aspects, we interpreted observed continuities and interruptions in relation to historical developments. We found that in the medical literature, long-term exhaustion became transformed from a somatic ailment bred by modern civilisation to a self-inflicted psychiatric ailment. At the same time, it changed from being a male-connoted high-status condition to a female-connoted low-status condition. We interpret these changes as contingent upon culturally available modes of interpretations. Medical knowledge thereby becomes infused with cultural norms and values which give them a distinct cultural bias. The historical controversies surrounding this medically contested condition neatly display the socially contingent factors that govern the social construction of medical knowledge.
Pathways to suicide attempts among male offenders: the role of agency
Richard Byng, Amanda Howerton, Christabel V. Owens, and John Campbell
Suicide is common among offenders, who are at increased risk of homelessness, unemployment and mental illness and are prone to impulsivity. Release from prison is a particularly vulnerable time. This qualitative study investigated the views of 35 offenders in South-West England prior to and after release from prison, enquiring into their previous suicide attempts and how they saw their future. Semi-structured interviews were analysed thematically, comparing individuals who had made one, more than one, and no suicide attempts. Multiple attempters were often in despair and enmeshed in substance misuse, with little control over their lives. Most of those with one-off or no previous attempts portrayed themselves as having more mastery. One-off attempters described using particularly violent means. The role of different types of agency in pathways to and from suicide is discussed. Iterational agency, the selective reactivation of past patterns of behaviour, appeared to dominate in individuals who were choosing between further suicide attempts and substance use. Projective agency, having a more future orientation, appeared more prominent in some single attempters and in those individuals with plans to escape crime and social exclusion.
Expanding the conceptual toolkit of organ gifting
Rhonda M. Shaw
In jurisdictions where the sale of body tissue and organs is illegal, organ transplantation is often spoken of as a gift of life. In the social sciences and bioethics this concept has been subject to critique over the course of the last two decades for failing to reflect the complexities of organ and tissue exchange. I suggest that a new ethical model of organ donation and transplantation is needed to capture the range of experiences in this domain. The proposed model is both analytical and empirically oriented, and draws on research findings linking a series of qualitative sociological studies undertaken in New Zealand between 2007 and 2013. The studies were based on document analysis, field notes and 127 semi-structured in-depth interviews with people from different cultural and constituent groups directly involved in organ transfer processes. The aim of the article is to contribute to sociological knowledge about organ exchange and to expand the conceptual toolkit of organ donation to include the unconditional gift, the gift relation, gift exchange, body project, and body work. The rationale for the proposed model is to provide an explanatory framework for organ donors and transplant recipients and to assist the development of ethical guidelines and health policy discourse.
The current issue of Social Theory & Health is a special double issue on theorizing health inequalities. Comprising eleven articles, the issue developed out developed out of a 2012 symposium held at the University of Edinburgh, entitled “Where Next for Health Inequalities?” As guest editors Katherine E. Smith and Ted Schrecker write in their introduction (the full text of which is freely available):
Lewin (1951, p. 169) famously reflected that there is ‘nothing more practical than a good theory’. Yet in health inequalities research, and public health more broadly, the number of theoretical contributions pales in comparison to the ever-growing number of empirical studies. It is certainly true that most of these empirical studies are informed by social theory in that many employ indicators of social categories that reflect theoretical ideas sketched out by Marx, Engels and Weber (see Kapilashrami et al and Scambler and Scambler, this issue) but these theoretical underpinnings are rarely acknowledged, interrogated or considered in any detail. Where theoretical frameworks have been applied to the study of health inequalities, this has often been with the purpose of trying to understand, or help analyse, pre-existing data sets or findings, rather than to inform decisions about how we study, and try to tackle, such inequalities or to develop theoretical approaches that are specifically intended to help us better understand health inequalities as a phenomenon. The collection of articles in this special issue is an attempt to begin redressing the empirical bias described here; to demonstrate some of the practical implications that social theories have to offer those seeking to better understand, and tackle, a social problem as complex and persistent as health inequalities; and to illustrate the indispensability of theory in generating new hypotheses for empirical research, both qualitative and quantitative.
An institutional theory of welfare state effects on the distribution of population health
Jason Beckfield, Clare Bambra, Terje A Eikemo, Tim Huijts, Courtney McNamara, and Claus Wendt
Social inequalities in health endure, but also vary, through space and time. Building on research that documents the durability and variability of health inequality, recent research has turned towards the welfare state as a major explanatory factor in the search for causes of health inequality. With the aims of (i) creating an organizing framework for this new scholarship, (ii) developing the fundamental-cause approach to social epidemiology and (iii) integrating insights from social stratification and health inequalities research, we propose an institutional theory of health inequalities. Our institutional theory conceptualizes the welfare state as an institutional arrangement – a set of ‘rules of the game’ – that distributes health. Drawing on the institutional turn in stratification scholarship, we identify four mechanisms that connect the welfare state to health inequalities by producing and modifying the effects of the social determinants of health. These mechanisms are: redistribution, compression, mediation and imbrication (or overlap). We describe how our framework organizes comparative research on the social determinants of health, and we identify new hypotheses our framework implies.
The insights provided by Gøsta Esping-Andersen’s Three Worlds of Welfare Capitalism on the origins and characteristics of social democratic, conservative and liberal welfare states make explicit many of the political and economic structures and processes that can impact on health and create health inequalities. Broad stroke analysis of welfare state differences indicates social democratic welfare states may fare better at promoting health and limiting health inequalities in specific instances. This article builds on Esping-Andersen’s insights to theorize how differences in sectoral power across and within forms of welfare states can shape the resources and supports available to those occupying various social locations during important periods of the life-course. It also specifies the specific health outcomes of special relevance to those situated in vulnerable social locations across the life-course.
Two decades of Neo-Marxist class analysis and health inequalities: A critical reconstruction (open access)
Carles Muntaner, Edwin Ng, Haejoo Chung, and Seth J. Prins
Most population health researchers conceptualize social class as a set of attributes and material conditions of life of individuals. The empiricist tradition of ‘class as an individual attribute’ equates class to an ‘observation’, precluding the investigation of unobservable social mechanisms. Another consequence of this view of social class is that it cannot be conceptualized, measured, or intervened upon at the meso- or macro levels, being reduced to a personal attribute. Thus, population health disciplines marginalize rich traditions in Marxist theory whereby ‘class’ is understood as a ‘hidden’ social mechanism such as exploitation. Yet Neo-Marxist social class has been used over the last two decades in population health research as a way of understanding how health inequalities are produced. The Neo-Marxist approach views social class in terms of class relations that give persons control over productive assets and the labour power of others (property and managerial relations). We critically appraise the contribution of the Neo-Marxist approach during the last two decades and suggest realist amendments to understand class effects on the social determinants of health and health outcomes. We argue that when social class is viewed as a social causal mechanism it can inform social change to reduce health inequalities.
What can health inequalities researchers learn from an intersectionality perspective? Understanding social dynamics with an inter-categorical approach?
Anuj Kapilashrami, Sarah Hill, and Nasar Meer
The concept of intersectionality was developed by social scientists seeking to analyse the multiple interacting influences of social location, identity and historical oppression. Despite broad take-up elsewhere, its application in public health remains underdeveloped. We consider how health inequalities research in the United Kingdom has predominantly taken class and later socioeconomic position as its key axis in a manner that tends to overlook other crucial dimensions. We especially focus on international research on ethnicity, gender and caste to argue that an intersectional perspective is relevant for health inequalities research because it compels researchers to move beyond (but not ignore) class and socioeconomic position in analysing the structural determinants of health. Drawing on these theoretical developments, we argue for an inter-categorical conceptualisation of social location that recognises differentiation without reifying social groupings – thus encouraging researchers to focus on social dynamics rather than social categories, recognising that experiences of advantage and disadvantage reflect the exercise of power across social institutions. Such an understanding may help address the historic tendency of health inequalities research to privilege methodological issues and consider different axes of inequality in isolation from one another, encouraging researchers to move beyond micro-level behaviours to consider the structural drivers of inequalities.
This article will explore the utility of Swidler’s concepts of cultured capacities and strategies of action in mapping the pathways through which area-based, multiple deprivation and inequality impact upon resources for health, health outcomes and health inequalities. It will be argued that these concepts have the potential to bring the collective and aggregated impacts of resource distribution to the fore in unpicking the processes through which area-based inequalities become manifest in health outcomes. This has the potential to illuminate the some of the economic, social and political processes though which neoliberalism has generated widening health inequalities in the United Kingdom. To that end, these concepts will be employed in a case study of the post-industrial town of Clydebank. It will consider the implications for population health of changes in: the amount and quality of employment on offer; the quality and affordability housing; and the accessibility of social and political resources for those who live in more deprived areas. Swidler’s concepts will be used to theoretically map the relationships between the growing wealth inequalities, widening place-based inequalities and increasing health inequalities observed over the past few decades in the United Kingdom.
Theorizing health inequalities: The untapped potential of dialectical critical realism
Graham Scambler and Sasha Scambler
We here extend our previous contributions to a neo-Marxist sociology of health inequalities via an engagement with Roy Bhaskar’s dialectical critical realism (DCR). We argue that Bhaskar’s re-grounding of the philosophies of Marx and Engels has the potential to re-invigorate sociology’s input into: (a) explanations of health inequalities and (b) interventions to reduce health inequalities. We also show that DCR provides rationale and opportunity for an action sociology beyond current professional, policy, critical and public sociologies. We briefly summarize current sociological models of health inequalities before protesting their lack of theoretical ambition. We then proffer a professional-cum-critical theory that emphasizes the continuing causal efficacy of social class in general, and of Britain’s ‘governing oligarchy’ in particular, for any credible sociological account of health inequalities. Bhaskar’s basic and dialectical critical realism are then introduced and the frame supplied by the latter commended for a deepening of the neo-Marxist theories of health inequalities being developed by us among others. The article concludes by drawing on this same frame to insist on a logical and moral commitment to an action sociology beyond any institutional constraints faced by practitioners of the discipline.
It is now widely accepted that health inequalities are directly linked to inequalities in power and material resources. Reflecting this, persuasive accounts of both the production of health inequalities and the failure of high-income countries to reduce these inequalities have been underpinned by references to structural (particularly neo-Marxist) theories of power. Such accounts highlight the importance of macro-level political and economic policies for health outcomes and, in particular, the unequally damaging impacts of policy reforms collectively referred to as ‘neo-liberal’. This article draws on interviews with researchers, civil servants, politicians, documentary makers and journalists (all of whom have undertaken work concerning health inequalities) to examine what these conversations reveal about these actors’ perceptions of, and responses to, the political context of health inequalities in the United Kingdom. In so doing, it illustrates the fluid and networked nature of political ‘power’ and ‘context’, findings that point to the potential utility of post-structural theories of power. This article argues that, if conceived of in ways that do not deny power differentials, post-structural theories can help: (i) call attention to ‘neo-liberal’ inconsistencies and (ii) explain how and why individuals who are critical of dominant policy approaches nonetheless appear to participate in their ongoing production.
Social theory and health inequalities: Critical realism and a transformative activist stance?
Chik Collins, Marjorie McCrory, Mhairi Mackenzie, and Gerry McCartney
The failure successfully to project evidence on health inequalities into the policy imagination is likely related to the fact that the research community is yet to provide an appropriate critical theory of health determination – integrating different social phenomena through identifiable mechanisms and pathways across different levels and scales, and opening up a realistic perspective on how unjust outcomes might be subject to change. On what social-theoretical basis might this task most usefully be addressed? This article critically explores the utility of the work of Archer which has been applied to health inequalities by Scambler, and argues that it is quite problematic in relation to the task of theorising health inequalities. It then proceeds to explore the relevance of a longer-standing tradition of work deriving from the early twentieth century Soviet school of ‘psychology’ led by Lev Vygotsky and coalescing today under the heading of Cultural-Historical Activity Theory. Within this tradition, we highlight the particular contribution of Anna Stetsenko. We argue that this tradition, and the contribution of Stetsenko in particular, merits our close attention in developing a basis for a more expansive critical theory of health.
Theorising participatory practice and alienation in health research: A materialist approach
Claire Blencowe, Julian Brigstocke, and Tehseen Noorani
Health inequalities research has shown a growing interest in participatory ways of working. However, the theoretical ideas underpinning mainstream approaches to participation remain underexplored. This article contributes to theorising participatory practice for the kind of egalitarian politics to which many of those focused on reducing health inequalities are committed. First, we argue that the ambitions of participatory practice should be concentrated on ‘overcoming alienation’, rather than ‘attaining freedom from power’. An over-emphasis on negative freedom may help to explain a worrying confluence between participatory democracy and neo-liberal marketization agendas – we look instead to traditions of participatory practice that emphasize positive freedom and capacities for collaboration. Second, we discuss some such perspectives though consideration of critical pedagogy, but highlighting the role of materialised relations of authority, spaces, objects and encounters. Third, we explore the relationship between objectivity and alienation, arguing that participatory politics, against alienation, can look to reclaim objectivity for participatory, lively, practice. We then seek to show that participatory practice can play a role in creating common knowledge and culture, and in fostering a sense of public ownership over objective knowledge and institutions concerned with health. We conclude by asking what this looks like in practice, drawing some ‘rules of thumb’ for participatory practice in health inequalities research from existing inspiring examples.
Fantasy paradigms of health inequalities: Utopian thinking?
Alex Scott-Samuel and Katherine Elizabeth Smith
This article argues that, while it can be politically expedient for governments to engage with health inequalities, they cannot, within the confines of neo-liberalism, realistically propose actions that evidence suggests will effectively reduce them – such as tackling power inequalities, social status and connections or class inequality. Indeed, a dominant ‘policy paradigm’ prioritising economic growth restricts the ability of policy actors to imagine alternative, more equitable scenarios. In this context, some policy actors and researchers have devised a parallel fantasy world in which proximal, downstream, easily tackled exposures are posited as potential solutions to health inequalities. The consequence of this is a widespread public sector culture in which well-meaning policymakers, practitioners, researchers and members of the public collude in sustaining a ‘cargo cult’ of health behaviourism. In examining this situation, we draw on accounts and critiques of utopian thinking to help explain: (i) the remarkable persistence of policy proposals to tackle health inequalities via downstream interventions, in spite of the strength of evidence challenging such approaches; and (ii) the limited extent to which more upstream proposals inform policy debates. We argue Ruth Levitas’ notion of ‘utopia as method’ offers an imaginative and potentially useful avenue for future health inequalities research.
Health justice after the social determinants of health revolution
Daniel M. Weinstock
Social Determinants of Health (SDH) theorists claim that the distribution of social goods such as income, housing and education, has as great or greater an impact on health outcome than does health care, narrowly construed. This article attempts to integrate this claim into a plausible theory of justice. I argue that such a theory must be both political, in that it focuses on goods that states can distribute or regulate effectively and appropriately, and holistic, in that it must integrate the various values that are relevant to distribution into a plausible overall theory. While SDH-based theories are appropriately political, many of their exponents tend to undertake the task of integration in an implausibly monistic manner. I argue that monists about health are caught between the horns of an unattractive dilemma: either they employ a narrow conception of health, in which case their prescriptions are grounded in an implausible conception of the human good, and give rise to an extreme form of paternalism; or they use a broader conception of health, which leads them to address the challenge of holism in a purely rhetorical manner. I argue for a pluralistic mode of integration, one that accepts that social goods are regulated by both consequentialist and non-consequentialist considerations, and that the range of consequences that are relevant do not relate merely to health.
These days, it is fun to “hack” almost everything. You can hack your life, you can hack your home, and you can even hack your period. So, as the web continues to grow more material on synthetic biology, let us turn once again to the world of biohacking.
A particularly interesting piece considers the possibility of Open Source Insulin. Insulin, like any bio-commercial product, can be simultaneously life-saving and expensive. For those people who can’t make their own (with an embedded pancreas), why not homebrew? You could also inject your eyeballs with a kind of chlorophyll analog called Chlorin e6 in order to improve your night vision, hack your ears to hear Wi-Fi, or extract DNA from some strawberries. (Just don’t forget to kill your adorable little abominations before you pour them down the drain.)
The application of the Open Source movement to biology is another way in which technologies and bodies can intertwine, touching on the tensions between private property (both patents and selves) and science as an aspirational public good. For the moment, we can find an open source language for programming cells, the BioBricks Foundation, Open Wetware, and physical spaces for workshops and experiments, like Genspace.
But, you may ask, is biohacking really a thing? It’s not like you can get a home CRISPR machine – at least, not quite yet. (For a fun if slightly noisy overview of CRISPR, listen to science reporter Carl Zimmer on Radiolab: “Of CRISPR and dragons”). But even without a kitchen-counter gene-editing appliance to slide in next to your bread machine, CRISPR technology leaves us with plenty to discuss. For example, scientists in China have successfully modified human embryos, which has spawned many discussions about the ethics of human germline modification, and what this all means for the future.
Editing humanity is a topic full of fear and promise. Gene editing holds the potential for innovation in treatment of many diseases, particularly cancer. (And there are also some odd proposals, even accounting for good intentions.) The invocation of dragons may be a subtle reference to the location of this research in China. But at the same time, like the dinosaur parade of the “Jurassic” franchise, Dragons serve as a broader metaphor for the dangers of meddling with nature. The Radiolab piece expresses it like this (excerpted from minutes 21-23):
Voice 1: “I don’t know if it’s a religious thought or just the thought of a conservative person, but … I don’t know where the sacred begins and ends anymore, on that particular turf… As the human beings get more and more power to create and design and essentially create a future, that future will include the imaginations both light and dark of humans… [I don’t think we should outlaw it], I think we should cringe a little as opposed to having a big party.”…
Voice 2: “OK, let’s all cringe… ready…”
Voice 1: “You cringed with attitude!”
Voice 2: “But you’re afraid of, like, dragons!” [laughter]
Of course, this dragon metaphor is not new. Medieval manuscripts were known to “make explicit the connection between the dragon and the devil, aligning the fantastical creature with evil, deception, ‘vainglory and human pleasures.’” The dragon is also very much like the Beast of the Apocalypse, often depicted with an array of multiple and and often multi-species heads, like this one described at the British Library, or this one. There can be overlap between the whimsical and the satanic.
Putting the “Play” back into “Playing God”?
The shifting divisions between nature, the sacred, and the abomination have often been explored through art. As an emergent art form, BioArt explores this interstitial space, reaching into Biodesign and Molecular Cuisine. There is even a Federation of American Societies for Experimental Biology BioArt contest.
Intersections of science and religion tend to appear here as well. For yet another perspective, see “Why I Became a Christian Transhumanist.” There is the saying that the road to hell is paved with good intentions. Or is it actually a mouth with a flaming cauldron (complete with goat-men and a bird-headed creature with an additional posterior face stoking the fire with bellows)? Maybe there is more than one way to get to hell.
- What is biohacking and why should we care?
- Where will synthetic biology lead us? (first mentioned in Somatosphere way back when)
- Read about A Million Core Silicon Brain at MindHacks.
- Every Virus a Person Has Had Can Be Seen in a Drop of Blood
- Are you interested in ancient DNA? Sure you are.
- I’m still trying out collecting links at delicious.com @smbergst #Biohack
“Is writing seemly? Does the writer cut a respectable figure? Is it proper to write? Is it done?”
- Jacques Derrida, “Plato’s Pharmacy” in Disseminations
~ ~ ~
“I choose… Estrella. Yes, you can call me Estrella when you write.”
“Are you sure?” I asked.
Estrella nodded her head, a wisp of dyed honey-blonde hair coming loose from behind her ear. Her long earrings, the gold paint flaking around a plastic ruby, swayed back and forth as she nodded in affirmation. Yes, she was sure.
“You can write if you want,” Estrella gestures to my notebook that sits on the table. I write instead on a napkin. It feels less official and thus less obtrusive. “Unless you prefer napkins… This is what you call anthropology?” She laughs and pats my hand, pen frozen on the flimsy paper.
I look at my scrawl on the napkin. I have written the date, her chosen pseudonym, and the location of the café where we sit. “Yes,” I tell her. This is what I call my anthropological practice of ethnography. I bring out my field notebook, already swollen with the additions of drawings and pressed plants that women have given me. The drawings are the result of trying to keep sex workers’ children occupied while I talk with their mothers, which at times becomes a baby-sitting arrangement if a client interrupts our conversation. Estrella leafs through these. She has several children of her own, but they live with her mother in another part of Peru. That childhood home is far from her adopted one, which is a place of work in the prostíbars (brothels) of the Peruvian Amazon’s region of Madre de Dios (Mother of God).
“Do you always ask people what name they want to use?” She wanted to know.
At the time of this initial dialogue with Estrella in 2011, this was true. But ideas and ethnographic practices change with the dynamism of everyday life. I offer this participatory process of “choosing names” as an ethnographic case, one way that ethnographers can serve to further the trust of people whose lives and stories we analyze. My fieldwork, which had begun in 2010, examined three modes of “traffic”: in women destined for the sex-trade, plants studied by pharmaceutical companies for reproductive health, and gold, made solid via liquid mercury along Latin America’s Interoceanic Road. I traveled the 3500-mile road from the Brazilian Atlantic to the Peruvian Pacific coast, traversing the Brazilian, Peruvian, and Bolivian Amazon. From rainforest to laboratory, from brothel to bank, “traffic” functioned as my analytic to examine physical encounters and collisions as well as entwined questions of the dynamic value of people and things traveling across borders and through global commodity-chains.
The gold mining, which fueled interdependent economies, had its greatest concentration in Madre de Dios where I first met Estrella. Situated near the borders of Brazil and Bolivia, Madre de Dios had earned the nickname “El Wild Wild West” for the implosion of lawlessness and prostitution reminiscent of the North American gold rush. The fall of the U.S. dollar and the rise of the price of gold had coincided with the construction of the Interoceanic Road, which was the first paved thoroughfare in the region (marked in black on the above map). Where artisanal mining had previously meant backbreaking work for little return, the price was now right for a livable wage. Male miners from Brazil, Bolivia, and Peru streamed into the rainforest mines. Female sex-workers hailed from these countries, in addition to Colombia and Ecuador. During my two years conducting research along the Interoceanic Road (2010-2012), I would ask miners and sex-workers, along with environmental engineers, biologists, indigenous leaders, and government officials, what name they would like me to use when I wrote.
Government officials almost entirely chose their own names for accounts written about them. Sex-workers already operated under a host of fake names to protect themselves and their families from embarrassment and, in some cases, violence from clients and police (who were often one-and-the-same). Miners similarly conducted their operations illicitly. They did not employ their legal names (if they had a national identity card from Peru or a neighboring country) – not among one another in the mines, not with the environmental engineers who tried in vain to regulate the proliferating artisanal application of liquid mercury in the mines, and certainly not with me. I asked people how they would like to be “named” because people’s words have a different quality when their narratives become legible as a creative process and practice of co-authorship.
Despite my desire to make my ethnographic fieldwork as interactive as possible, I soon realized that I could not always uphold a practice of inviting people to choose without any intervention on my part. As I became more ensconced in fieldwork, I realized the high stakes in employing people’s legal names, even if they wanted me to do so. When it came to writing about indigenous activists, I did not always feel comfortable honoring a person’s request to employ their full and legal names. Gaining one’s identity card and displaying nametags has become a proud gesture for people – indigenous or not (and that category of the person also goes up for debate) – so often ignored by the State. This process echoes Marcel Mauss’s notion that having a name forms a critical step in taking on an identity as a person (Mauss 1985). Yet while indigenous activists may have felt confident in their personhood and in asking me to use their full names, environmental activists, particularly indigenous ones, represent easy assassination targets for disgruntled loggers, oil speculators, miners, and drug traffickers. Naming people in full might not only undermine their efforts, it might also put their lives in danger.
Sex-workers, unlike indigenous activists, did not tell me their real names and I did not ask for them, knowing that they protected their own identities from their customers as well. I may never have learned Estrella’s real name had a competing exotic dancer not stolen it. “Véronica” became the first person that selected a pseudonym that I refused to employ on ethical grounds. Véronica knew Estrella’s full legal name and had taken it to represent her exotic dancing persona. This meant that she exposed Estrella to social harassment at best and to police violence at worst. Most worrisome for Estrella, however, was that in the event of a police raid, the news media – armed with video cameras – would take footage and reveal her identity. Family members did not know about her line of work, and Estrella feared that they would find out. She hid under the beams of police searchlights and news cameras as best she could. It was she who pointed out to me some of the similarities and differences between sex-workers and indigenous activists. “We are both trying to stay alive. The government needs us but also hates us. They will stand and show face, but we do not.” Estrella’s comment that the government both needed and hated sex-workers and indigenous activists came from her observation that both were necessary for a strong tourist industry. But both were too often found floating dead downriver.
In November 2014, just as Peru prepared to hold climate talks in Lima, four indigenous activists died when illegal loggers attacked them. Death threats had become a common way of life for activists and leaders at the indigenous federation of Madre de Dios (Federación Nativa del Rio Madre de Dios y sus Afluents – FENAMAD). Hunt Oil, the powerful petroleum conglomerate, began its drilling in 2006. It’s not clear whether the Peruvian army, police officers, company cronies, or all of them together physically attacked protesting indigenous groups. The Peruvian government renewed the nine-year contract with Hunt Oil for another three years, without consultation with the indigenous communities living on the land under extraction (FENAMAD). With oil and gold ever more extractable, and with growing infrastructure, people and information traveled faster than they had along rivers when I first arrived in 2010. I now constantly question how quickly – or slowly – my own words and naming practices might also travel.
This might not have been a necessary concern had my fieldwork not come to an abrupt and undesired end in March of 2012 when a gold mining strike in Madre de Dios turned bloody. The Peruvian government sent its army to pacify protesting miners, joined by the indigenous federation of Madre de Dios. An estimated 15,000 gold miners went on strike to continue working, demanding an alleviation of environmental regulations. Several thousand sex-workers joined them. The indigenous federation, misjudging the political climate, walked with the gold miners in hopes of entering negotiations with the State over land claims. The plan backfired. The Peruvian media painted the indigenous federation as betraying the earth by making an alliance with the gold miners. Already targets if they did not cooperate with marauding loggers and miners, Amazonian activists once again became the focus of the Peruvian government’s “extraction” efforts (large-scale protests in 2009 along the InterAmazonian Highway had also turned bloody). The choice of the word “extraction,” as Peruvian secret servicemen explained to me while asking me to provide names and information to help them, was a euphemism for “extermination.”
Forced to leave and worried that I would endanger people who had trusted me with their words, I set about destroying identifying data. Without a strong Internet connection to digitally save interviews, everything went onto a small external hard-drive. This ended up pressed between my skin and the elastic of my clothing. I jammed the RAM on my computer so that it would not turn on anymore. I explained to the government agents going through my bags that the rainforest humidity, former ethnographic foe-turned-friend, had destroyed my digitized data.
Making ethical decisions about how to protect the people that anthropologists work with during ethnographic fieldwork is, as Paul Stoller notes, “a very messy business.” The debates surrounding Alice Goffman’s book, On the Run, have helped to crystalize a difference between journalists and ethnographers: whereas journalists must check their facts, the very concept of a fact and what constitutes truth have becomes part of a critical inquiry for social scientists. Ethnography is not about “fact-checking,” Stoller notes, but rather a weaving of personal and professional interactions into fruitful, if not fruitfully frustrating, entanglements. Acknowledging the precariousness of other people’s lives, a precariousness that the writer often does not share, may mean blending the “facts” to protect people’s identities.
The theoretical ground as well as the lived terrain surrounding Goffman’s use of anonymity has incited continuing debates that dance around the issue of race. While I find the critiques from journalists on this question of fact-checking easily addressable, the dynamics and ethics of race, and of what it means for a white social scientist to do an ethnography in/of an African-American community, merit further thought. Whether one agrees or not with Goffman’s fieldwork location and subsequent analysis, I do advocate for the care that she took to blur details, places, and events. She gave pseudonyms to protect – which I gather was also done out of respect – for the people who shared their lives with her.
These swirling debates around Goffman have given me pause to reflect on Derrida’s questions that I pose at the beginning of this piece. “Is writing seemly? Does the writer cut a respectable figure? Is it proper to write? Is it done?” I brought these questions with me into (and out of) the field because they not only urge me to consider my whiteness and privilege when I write, but also how I write. The attempt to collaborate in the choosing of pseudonyms is one way that I attempt to answer the questions of what it means for the writer to cut a respectable figure when analyzing the lives of others. Paulo Freire, Brazil’s revolutionary thinker and writer, espoused a pedagogy that was a “naming” of the world, engaging in a dialogue with others. “If it is in speaking their word that people, by naming the world, transform it, dialogue imposes itself as the way by which they achieve significance as human beings” (Freire 1970: 88). This resonates with Mauss’s assertion that to become a person, one must first have a name. Freire’s formulation, however, goes one step further in highlighting (as he does throughout Pedagogy of the Oppressed) human relationality, how we bring one another into existence through naming practices. For Franz Fanon, being called a name other than one’s own creates a severe sense of trauma and alienation from one’s self (Fanon 1967).
This is why inviting people to participate in their pseudo-naming, and telling them why I may not be able to honor their requests, meant something more important than “fact-checking.” It meant explaining to Véronica, who had stolen Estrella’s true name for her nightly activities, why I would not do as she wished. This did not provoke a positive response from Véronica, but it did mean that trust with Estrella and her network of sex-workers deepened. This in turn enriched my connections with them. Mauss’s concluding words, after considering whether the stable category of the person and naming might someday fade away, brings my own ethnographic case to a close: “Let us labor to demonstrate how we must become aware of ourselves, in order to perfect our thought and to express it better” (Mauss 1985: 23). That strikes me as a seemly and respectable answer to my own questions of how writing might be done.
This piece is dedicated to Jorge Payaba and his sister, Juana Payaba, indigenous activists in Madre de Dios.
Ruth Goldstein, PhD is a medical anthropologist in the Anthropology Department at the University of California, Berkeley. Her research stems from over ten years of examining human rights and environmental issues, with a particular focus on gender-based violence and women’s reproductive health. She can be reached at firstname.lastname@example.org.
FENEMAD. Gobierno amplía por tres años contrato de licencia a Hunt Oil para explorar Lote 76, Noticias Fenamad, August 5, 2015. http://www.fenamad.org.pe/noticias/gobierno-amplia-por-tres-anos-contrato-de-licencia-a-hunt-oil-para-explorar-lote-76/
Derrida, Jacques. Disseminations. Barbara Johnson, trans. New York: Athlone Press, 1981, p. 74.
Fanon, Franz. Black Skin, White Masks. New York: Grove Press, 1967 .
Freire, Paulo. Pedagogy of the Oppressed. Myra Bergman Ramos, trans. New York and London: Bloomsbury Academic, 2000 .
Mauss, Marcel. “A category of the human mind: the notion of person; the notion of self.” Translated by W.D. Halls. In The Category of the Person: Anthropology, Philosophy, History. Edited by M. Carrithers, S. Collins, and S. Lukes, pp: 1-23. Cambridge; New York: Cambridge University Press, 1985.
Stoller, Paul. “Alice Goffman and the Future of Ethnography.” Huffington Post, June 15, 2015.
Stoller, Paul. “In Defense of Ethnography.” Huffington Post, August 24, 2015.
Watts, Jonathan. “Spotlight on murders of activists as Peru prepares for Lima climate talks.” The Guardian, November 17, 2014.
Soros, Alex. “Local activists are paying with their life to protect their forests in Peru.” The Guardian, November 17, 2014.
Community Health Workers and Social Change: Global and Local Perspectives — A special issue of the Annals of Anthropological Practice by Aaron Seaman
The current issue of the Annals of Anthropological Practice is a special issue, entitled “Community Health Workers and Social Change: Global and Local Perspectives.” The issue comprises an introduction by Kenneth Maes and five articles, the abstracts of which are below. Enjoy!
Major global health institutions, public and private, currently see community health workers (CHWs) as crucial resources. But the daily experiences and complex motives of CHWs, as well as their concerns and criticisms, remain poorly understood by the institutions that promote their value and draw on their labor. Donors, states, NGOs, and other public health institutions often approach the motivations and performance of CHWs as problems that can be solved with a mix of psychological, economic, and management theories; novel incentive packages and supervisory structures; and surveys, interviews, and randomized controlled trials. This special issue shifts the goal toward documenting power inequalities, labor relations, and interactions among CHWs, donors, health officials, supervisors, and care recipients. The articles in this issue offer valuable ethnographic accounts of CHWs in 21st-century Africa, Latin America, and Asia, and deliver a clear message: CHWs participate in important relationships and politics, seeking change in their own job conditions and roles, and other social, political, and economic changes. These forms of “participation” are variable, evolving, and shaped by unique local histories as well as transnational policies and norms. The articles here aim to demonstrate that ethnography and mixed methods can help bring about improvements in policy and practice by explaining and interpreting CHW practices and governance and by encouraging global health actors to treat CHWs not as magic bullets or human resources, but as people with multiple skills, desires, and perspectives.
In December 2012, militants began targeted attacks on workers going door to door in Pakistan delivering polio vaccine, including members of a community health worker cadre called Lady Health Workers (LHWs). Over the next several years, more than 50 workers, most of them women, were murdered as they worked. Media accounts frequently refer to these workers as “aid workers” or “heroes.” This paper complicates and theorizes this conception. Two conflicting moral economies around the work of LHWs existed before the targeted killings began; both have amplified since. One, shared among the LHWs themselves, centers around ideas of community health work as deserving of remuneration just like other government work. The other, promoted by the Global Polio Eradication Initiative at the international level, conceptualizes ground level workers like LHWs as “heroes,” not as labor—eclipsing the LHWs’ own discourse in the international sphere.
Extension agents or agents of change?: Community health workers and the politics of care work in postapartheid South Africa
Christopher J. Colvin and Alison Swartz
Global public health discourse and practice around community health workers (CHWs) often invoke two distinct ideal types: the CHW as an “extension agent” of biomedical health services, bringing health services into community and household settings, and the CHW as a progressive “agent of change,” working with communities to mobilize socially and politically around health inequities and identify and tackle the social determinants of health. In this article, we examine the experience of postapartheid South Africa with CHWs and take a critical look at the degree to which these conventional models of CHWs account for how CHWs in South Africa have emerged, what kinds of work they have done, how they have organized themselves, and what impacts they have had. In the end, we argue that these two models miss much of what is interesting and important about the lives and work of CHWs in South Africa. We further make the case that both mainstream and progressive public health academics and activists tend too often to frame—and reify—CHWs as a much-anticipated solution to a variety of (much bigger) health system and political problems. We maintain, instead, that to adequately understand and support the work of CHWs, one must begin by situating community-based care work within a much broader analysis of these problems.
Using community health workers:: Discipline and Hierarchy in Ethiopia’s Women’s Development Army
Kenneth Maes, Svea Closser, Ethan Vorel, and Yihenew Tesfaye
In this article, we use semistructured interviews and documents produced by Ethiopian government officials and international health donors to examine two key features of the nation’s community health worker (CHW) program: (1) the process and criteria of selecting community health workers; and (2) policies, rhetoric, and experiences of payment and empowerment. We examine these from the varied perspectives of district health officials, Health Extension Workers, and leaders and members within Ethiopia’s so-called Women’s Development Army, whom we interviewed during 2012–14. According to national policymakers and policy documents, the goals of the Women’s Development Army are twofold: first, to reduce mortality and second, to produce “model” women, who discipline themselves and their neighbors to enact healthy behaviors. The Army is supposed to simultaneously “empower” these women to be more autonomous from husbands and more active in development-oriented work. Yet one of the key criteria sought by district-level health officials—willingness to “accept what we teach them and implement what we tell them”—highlights that Army leaders are to remain subordinate to government health officials. Many female members of the Women’s Development Army expressed ambivalence about their selection, particularly as the position was unpaid. Some questioned why women were expected to volunteer when men had previously been paid to do similar work. These data emphasize the differences in goals, aims, and experiences among various actors involved in CHW programs, and the need for researchers to address whether or not respondents are comfortable to express perspectives that might question dominant goals and discourses.
Launched in 2003 by the leftist government of Hugo Chávez, Venezuela’s Barrio Adentro (Inside the Poor Neighborhood) health care program is deeply dependent on local community health workers to implement and administer clinics and various health initiatives. Based on ethnographic research conducted between 2006 and 2009, this article analyzes the experiences of Barrio Adentro community health workers (promotores) in a working-class neighborhood in Caracas, the capital city of Venezuela. My research reveals that community health workers understood their relationship to the state as fraught, but fundamentally collaborative. In contrast, they viewed local residents as the main threat to achieving their community health goals, based on perceptions that some residents were apathetic or politically opposed to the government’s programs to promote social change. In situating this analysis in the broader social and historical context, I show how community health workers represent one of the most significant forms of state-supported activism in a country that has radically expanded social and political participation for historically marginalized groups in the name of “21st century socialism.” I argue that the state’s antineoliberal discourse, substantial investment in public health care, and employment of Cuban doctors distinguish community health work in Barrio Adentro from the experiences of community health work in other areas of Latin America, where community participation has also been framed as a form of empowerment but often serves as a mechanism to devolve state responsibilities for health care onto local communities. In focusing on the broader social, political, and economic context that gives meaning to Barrio Adentro activists, this analysis offers insights that may be applied to community health initiatives in other settings.
Guatemala is one of the first countries in the Americas to establish community health worker (CHW) programs, and CHWs have served a central role in both large-scale national programs and small-scale nongovernmental organization (NGO) projects. The role of CHWs, including their training, responsibilities, and idealized identities, has never been uniform, and has fluctuated over time in response to changing international health paradigms, national socioeconomic and political processes, and local-level power structures and expectations of the position. In this paper, I examine the changing nature of CHWs in the Central Highlands of Guatemala by focusing on the case of the Behrhorst Clinic in Chimaltenango, Guatemala. The Behrhorst Clinic was one of the first to implement a CHW program in Guatemala, and is one of the few NGOs in the region to operate continuously since the 1960s, providing a unique case study to examine the history and transformation of CHWs in three distinct sociopolitical periods: the Primary Health Care era (1960s–1970s); the sociopolitical violence (1970s–1980s); and the aftermath of the violence (1980s–2000s). This longitudinal analysis of the Behrhorst health promoter program highlights central, ongoing issues facing CHW programs in Guatemala and beyond including: the political susceptibility of community participation and empowerment programs; community participation and representation; and the long-term and intergenerational impact of CHW positions that function as a mechanism for socioeconomic advancement through the provision of curative services.
This series aims to get anthropologists and closely-related others talking seriously, and thinking practically, about how to synergize biological and social scientific approaches to human health and well-being, and to what positive ends. In this interview, Christopher Lynn responds to questions posed by series organizer Jeffrey G. Snodgrass.
How and why might cultural anthropologists and social scientists interested in health benefit from integrating biological variables/biomarkers into their research and analysis?
Cultural anthropologists and other social scientists interested in health should be interested in some objective indication of health status as reflective, at least in part, of physiological status. I don’t feel health issues have been sufficiently addressed if they are not approached integratively in this way. That is not to say that all my projects have gotten there yet or that biomarkers are always necessary in all health-oriented research, but without at least an accompanying biological perspective, any interpretation is lacking. One way of taking an integrated perspective and including biomarkers where feasible and informative is through basing research and data analysis in Tinbergen’s four “Why” questions. This ethological approach lends itself to participation as well as observation and recommends that we examine behavior (1) historically (culturally and phylogenetically), (2) developmentally (what is the role of age, maturity, family, expectations of those stages?), (3) functionally (physiologically or functionalist-ly), and (4) proximally (psychological cause-effect).
I guess that’s viewing it from the biological side and seeing culture as critical rather than vice versa. I don’t see that there’s any way around me seeing things through the lens of a biological anthropologist, but it’s important to note that this is distinct from how biologists often utilize ethology and Tinbergen, which often lacks awareness of cultural relativity. I started off as a cultural anthropologist in my undergraduate education (literally, I majored only in Cultural Anthropology through an interdisciplinary program), then gravitated to Biological Anthropology because all the questions I asked about health and humanness simply required a better understanding of biological processes. Upon completing my PhD, I think I’ve moved back to a middle ground where the specific questions I ask and stage of research I’m at dictate whether what I look at takes more of a cultural or biological form. Honestly, it’s just anthropology, but I do feel obliged to make distinctions because it is infinitely confusing to students when we seem to call ourselves one thing and do another.
However, biological perspective does not necessarily mean biomarkers. Biomarkers are kind of like the fMRI of biocultural anthropology, at least among students in my department’s Biocultural Medical Anthropology program. They are something students with a cultural bent seem to throw on to show they’re being biocultural, and such proposals tend to look like pigs with chickens stapled to their backs. On the other hand, students who come from a biological background do the same thing with the cultural consonance approach. Bill Dressler has written extensively on this happy wedding of the biological as integral to the cultural in terms of health outcomes, so I won’t rehash but rather direct readers to the new Biocultural Systematics blog on our Bama Anthro Blog Network that will soon also be published via Anthropology News. Yet biomarkers are useful, and there are numerous ways to include them to test claims made through interviews or interpretations of survey data. Biomarkers can be easy to use and unobtrusive even for the relatively untrained, especially in the era of ubiquitous smartphones. For instance, on the “high-tech” side, Francois Dengah (who has a PhD from the University of Alabama in biocultural medical anthropology and is now an Assistant Professor at Utah State) and I have been working toward integrating low-cost skin conductance and heart rate sensors that plug into Android and Apple tablets and smartphones and interface with free apps. On the other hand, Greg Batchelder, a PhD student currently working with me, plans to collect blood pressure and hair samples to measure cortisol among the Bribrí in a remote area of Costa Rica lacking electricity.
How would you respond directly to one potential cultural anthropological or social scientific critique of such an integrative “biocultural” approach?
One of the common critiques of anything done from a biological perspective is that it tends to be reductionistic. Especially with regard to health-related research, we focus on outcomes and are in danger of missing the trees for the forest. In my studies of dissociative behavior, I’m sensitive to the frustration of some scholars who are wary of the use of generalizing ethnologic terminology, such as “shamanism,” “possession,” “trance,” etc. This is especially true when we researchers with cross-cultural bents try to discuss function. For instance, I would be leery of saying something like, the function of dissociation — the partitioning of awareness we see in possession trance, dissociative disorders, and so many other psycho-cultural contexts — is to reduce stress. We have to be cognizant of referring to biological capacities, cognitive capacities, and look at how psychosociocultural influences interact with such capacities to influence myriad outcomes. The suggestion of function tends to suggest to readers that we think there is a cognitive module or evolved trait or something that is universal, and this is not necessarily true or what is meant. But to think that readers will not read into our use of the term would be naive. However, we do need some conceptual terms to hang our hats on, even if there is no unity in underlying biology. Suggesting that all people have varying capacities for dissociation does not mean there is a dissociation module in the brain or that even the same neural circuits are invoked.
It’s important that critique be constructive and that we take our colleagues’ concerns about our approaches to heart. My policy is that the more a criticism bothers me, the more I need to think about what relevant criticism I might be steamrolling over in my approach. I take critique to heart more than I do praise (which sucks for my self-esteem, unfortunately). There are ways we can, as I so often say to students, throw the bathwater out without chucking babies. One of my favorite integrations of this nature is Carol Worthman’s development of the concept of embodiment. The theory of embodiment came into usage as a way to appreciate what to me seemed an inherent appreciation of the biological but without clear articulation of biological outcomes in the phenomenological works referencing or invoking this term. Worthman, especially in a 1999 piece in the edited volume Biocultural Approaches to the Emotions, outlined clearly that we biologically embody aspects of our local environment, that we embody our environment of development as we grow up, and that we vary in our responses to hardships in ways that influence our health. As I stated previously, without this context — which speaks directly to Boasian historical particularism — analyses of culture are lacking.
What is one potential caution you’d have for cultural anthropologists or social scientists considering a biocultural approach?
Hmm, you should probably ask this of a cautious person. It’s important to be sensitive about collecting biological data. Simply put, people are distrustful and with good reason. For many of our research participants — whether from “developed” or “Westernized” cultures or not — there is a bit of sympathetic magic associated with giving up pieces of you. As Frazer taught us all, cultures throughout the world associate personal power with hair, names, fingernail clippings, blood, saliva, etc. To give these away gives away power. It has never been articulated this way to me, but I have had participants concerned that, in collecting their saliva to measure cortisol, I would do something with their DNA. Another participant in my study of speaking in tongues among Pentecostals was concerned that I would misinterpret her data. She had eight of her own children and ran a home school, frequently felt very stressed, and was concerned that her potentially high levels of cortisol would make God look bad (i.e., as though her relationship with Him was not bringing her any peace or sanity). In my research, navigating the terrain of fundamentalist Christianity to measure biomarkers requires a fair amount of finesse that came rather naturally to me, I’d like to think, because of my cultural anthropology training. On the other hand, because of the widespread familiarity with biomedicine and the normative nature of providing urine and blood samples, many of my participants in that study, surprisingly, were less concerned about the saliva sampling than some of the questions in the survey I used.
Other than that, the previous issue I mentioned — simply tacking a biomarker onto a cultural study or vice versa — is the biggest problem I have encountered. It is important to meaningfully integrate the biological and the cultural in biocultural research. I see cultural factors as driving research design in terms of how and what biological data are collected and biological issues as driving a necessary investigation of cultural variation. They should not seem as though they are two independent studies using the same sample, as they so often do.
What is one piece of research (ideally your own) that points to the benefits of such an integrative approach?
The work I’ve been talking about was the basis of my dissertation. I was interested in the influence of speaking in tongues as a cultural practice exhibited in the context of dissociation on stress response. I started from a functionalist perspective testing the health benefits of trance and quickly discovered that tongues can be negatively interpreted even within a Pentecostal church and increase problems rather than ameliorate them. This discovery led me to be sensitive to the various emic interpretations of the tongue-speaking experience and a nuanced approach to quantifying lifetime tongue-speaking experience. Ultimately, I found that higher rates of tongue-speaking influenced higher stress on worship days, which was expected given the experiential and energetic nature of worship, and relatively lower stress on a nonworship day compared to people within the same churches with less tongues experience. These differences were small but statistically significant. Those data are detailed in two papers in American Journal of Human Biology and Religion, Brain and Behavior.
While this supported my hypothesis, the biggest lesson that has driven much of my subsequent research and approach is that, as a pastor in one of the churches where I did that research once said, “speaking in tongues is not enough.” It is simply the beginning, and there are numerous factors that influence the benefit of Pentecostal practice that often can’t be generalized even beyond one church. Analysis of an event wherein an individual was accused of being under the influence of the Devil rather than God, and which influenced my thinking in this regard, is outlined in an article in Ethos, and a forthcoming article in the Journal of Cognition and Culture reanalyzes previous data with regard to other factors that are influential in benefiting health besides tongues.
How might cultural anthropologists or social scientists interested in such an approach get started?
One of my favorite pieces is “Biocultural Models in Studies of Human Health and Adaptation” by Ann McElroy. Also, I was strongly influenced by a biocultural issue of Ethos that came out in 2005 (Vol. 33, Issue 1), when I was in graduate school, and especially the article “What’s Cultural about Biocultural Research?” by Bill Dressler, with whom I am now a departmental colleague in our Biocultural Medical Anthropology program.
Christopher D. Lynn is a biocultural medical anthropologist and human behavioral ecologist, director of the Human Behavioral Ecology Research Group, and co-director of the Evolutionary Studies (EvoS) Program at the University of Alabama. His dissertation research was on the relationship between glossolalia (“speaking in tongues”) and biological stress among New York Apostolic Pentecostals. He is currently setting up broader studies that examine the neuroanthropology and behavioral ecology of Charismatic religious behavior in Alabama and Costa Rica. The focus of much of his research is on understanding the mechanisms and psychocultural moderation of the mechanisms underlying dissociation/absorption.
“Bioculturalism” aims to get anthropologists and closely-related others talking seriously, and thinking practically, about how to synergize biological and social scientific approaches to human health and well-being, and to what positive ends. It is edited by Jeffrey G. Snodgrass.
From the editors:
“This issue of Limn on “Ebola’s Ecologies” examines how the 2014 Ebola outbreak has put the norms, practices, and institutional logics of global health into question, and examines the new assemblages that are being forged in its wake. The contributions focus on various domains of thought and practice that have been implicated in the current outbreak, posing questions such as: What has been learned about the ambitions and the limits of humanitarian medical response? What insights are emerging concerning the contemporary organization of global health security? To what extent have new models of biotechnical innovation been established in the midst of the crisis?”
Contributors: Lyle Fearnley, Ann H. Kelly, Nicholas B. King, Guillaume Lachenal, Andrew Lakoff, Theresa MacPhail, Frédéric Le Marcis and Vinh-Kim Nguyen, Alex Nading, Joanna Radin, and Peter Redfield.
This case is a story that a soldier told me. I call her Kelly, and she said it was “the craziest story I was gonna get” from her. So for her it was an extreme, a worst case, but also a kind of telos of conditions she lived with and feelings she felt every day in occupied Iraq. It was a case of something not happening. As is fitting for those tensions of normalcy and emergency and rule and suspension that characterize state violence, it was both exceptional and part of a pattern: the pattern of soldiers’ embodied terror and vulnerability (even as they surely inspired terror in vulnerable others) and the pattern of the mechanisms that shaped their thought and action. It was a case of something that might have happened to Kelly but didn’t, that she might have done but didn’t do, and of things that were treated as if they were real even when they turned out not to be. It was a case of a potentiality or hypothetical attaining a curious afterlife of actuality.
Kelly was a junior enlisted engineer in her early twenties who spent a tour in far western Iraq building bridges to replace ones that had been destroyed by the US counterinsurgency campaign. Kelly was in her unit’s headquarters section and so spent a lot of time convoying around with the company commander, making thrice-weekly visits to the bridge construction site. She was the driver for their high-riding utility truck, called an LMTV, in the middle of a small convoy of similar vehicles and Humvees. Her NCO sat beside her in the passenger seat and a gunner stood behind them manning a mounted .50 caliber machine gun. The .50 cal (or M2 Heavy Machine Gun), along with its smaller cousin the M249 Light Machine Gun, is a ubiquitous tool in contemporary US wars. Large and heavy enough that it must be mounted on a vehicle or tripod, it can nevertheless be operated by a single individual, firing rounds the approximate size of an adult’s thumb either singly or in a continuous stream, and quite efficiently tearing apart metal, wood, concrete, and flesh.
The main threats confronting Kelly and her unit were roadside bombs and what in Army argot are called VBIEDs, for “vehicle-borne IED,” pronounced “vee-bed”—car bombs delivered into the middle of convoys or checkpoints. Everyone was afraid of these bombs. People Kelly knew in other units had been hurt and killed by them. Once a Humvee right in front of her in a convoy was hit, another time a trailing vehicle. A Marine tank that left the FOB (forward operating base) right before her convoy got blown in half. “In my eyes, in everybody’s eyes, we got lucky a lot” when it came to bombs, she said. “Somebody was totally looking out for us.” These cases didn’t belong to Kelly, but she was still being shaped by them. Indeed, they brought into existence her own parallel set of cases: “getting lucky a lot” in the face of the risk and vulnerability that were affirmed by these other incidents.
One day, on a run to inspect the bridge, their convoy of trucks and Humvees rolled past a long line of oncoming civilian vehicles that pulled over and stopped at their approach. Except one car continued right on toward the lead Humvee in the convoy; from her elevated vantage, Kelly watched anxiously as it came on and listened over the radio as the soldiers in the lead Humvee found their .50 cal jammed as they prepared to fire on the car. The car pulled over at the last instant and let the Humvee pass. But then it continued to advance directly toward Kelly’s oncoming truck. She was terrified; one of the Marines stationed with her unit had been killed in a VBIED attack that occurred in exactly this way. The middle of the convoy, where she was, is a better target, and also a more probable location for a command vehicle. “I about shit myself,” she said. “I was praying, ‘Dear Lord, forgive me for my sins!’” Suddenly the death that had been stalking friends and fellow troops seemed to be staring her right in the face. “It was the perfect scenario of everything that was going wrong with the other convoys, and it was scary as shit.” Kelly yelled to her gunner to shoot, but for reasons she didn’t know or explain to me, he didn’t shoot. The car came closer, and kept coming, and then drove on past without incident. The command group completed their inspection and their trip back to the FOB. But when she got there, Kelly said, she and a friend who had been riding in another vehicle went to her room and prayed together, “cause it was that traumatic.” They felt like they had narrowly escaped dying. The violence that they had seen claim other soldiers—people who they resembled in all the ways that mattered in this scene—was all of a sudden that much nearer, even though it remained unrealized. “It’s not your friends anymore, it’s starting to hit you.” Virtual or not, false alarm or not, she felt touched by the threat.
So she now had her own case, scary as shit, but I wondered what it meant. I asked Kelly how she felt about the fact that the driver had not actually been a bomber. She explained that the escalation of force protocols she had been trained in defined the driver’s behavior as threatening. “If somebody came at you, if they even get in the vicinity of your convoy, you blow them up. Cause it’s considered a threat. Cause they know the rules, they know they’re supposed to pull over. And that was scary because there was clearly people pulled over”—other civilians—“knowing that that was what they were supposed to do.” The driver “knew what he was doing was wrong.” And Kelly, it seemed, knew that she had to fear him as a result.
She allowed that the driver may just have been impatient, as she said she probably would be herself if convoys of armed foreigners were constantly jamming up traffic as they pushed their way through her hometown, or that he may have been in the grips of some emergency, as she had seen earlier in her deployment when a family with a sick child were shot by soldiers as they rushed through a checkpoint on their way to a hospital. The specifics of the driver’s case were unknown to her but they were not impossible to imagine. If her gunner had listened to her, “this dude would’ve been dead.”
The story tacked between two poles: the intensity of this “traumatic” brush with death and a vague sense of reflection and relief that the gunner hadn’t fired. “The fact that he didn’t blow us up was just astonishing to me, because in our minds, it was like, that was what was gonna happen.” The “we” of this shared mind remains unclear in her telling, since her NCO and gunner didn’t appear to share her assessment of the situation, even if some of the soldiers in the lead vehicle, the one with the jammed .50 cal, did share it. But the fact remained that for Kelly, the threat was not just potential, but actual, an ontological reality that extended to her fellow soldiers, endangered along with her even if, in her telling, many of them did not share her perception of the situation. “His actions were threatening,” she asserted of the driver, and she wondered, despite her knowledge to the contrary, “Why didn’t he blow?” “I would’ve felt terrible,” she said at one point right before the subject changed and our conversation moved on, and at another, “I almost feel bad,” her language curiously contingent. “I had the intention of killing him and it wasn’t a threat. It’s weird. I’m sure it happens a lot”—this disastrous bad luck paralleling, but somehow not equal to, how she and her soldiers “got lucky a lot”. “That’s probably the best story you’re gonna get out of me!” she said. And then she laughed.
The thing that made this story eventful for Kelly was not the narrowly averted killing of an innocent civilian, described in vague and contingent almosts and would haves, but the sense, articulated far more concretely, of narrowly avoided death: his actions were threatening, she said, she did pray in the terror of the moment and afterward, and she believed she was almost killed. Despite the sympathy with which she was able to regard the driver’s perspective—in his situation, she said, “I’d be like ‘fuck that!’”—and the divergent perceptions of her fellow soldiers—some contravening her call to shoot and others sharing her sense of narrowly-avoided death—her telling of the story remains framed by the fact that she was following the well-established escalation-of-force rules while the driver “knew what he was doing was wrong.”
In this story, as in many others I heard from soldiers, the proverbial “fog of war” is something both less and more than the morass of potential moral and existential hazards depicted in popular representations. The battlefield is frequently a chaotic and ambiguous environment, but one in which discipline, training, mission objectives, and rules of engagement provide both a technical, procedural rubric, and a sort of embodied, affective pedagogy that makes otherwise benign behavior and objects into deeply felt mortal threats. Such knowledge and action are technical, automatic, systematized, and distributed—an effect of the way that, as Michel Callon and John Law put it, “the knowing individual” disappears into the capacities and obligations of the network. This particular network happens to have the necropolitical mission of identifying killable, “rule-breaking” bodies and deputizing killer actors. At the same time, individual knowledge and capacity to act do not emerge seamlessly and uniformly from that network; they are irregular, perspectival and vexingly partial ways of knowing and doing. Kelly’s training told her that the driver was a threat, just as it told the crew and gunner in the Humvee in front of her, who tried and failed to fire on the car before she even started yelling to her gunner. The decision whether to fire wasn’t hers alone. It only arose because of the accident of the jammed weapon in the lead vehicle, without which the Iraqi driver would likely have been killed before he got anywhere near Kelly’s truck, and then it fizzled with the intercession and inaction of Kelly’s gunner and NCO. Such circumstances demand careful consideration of what it means to make a decision in the first place: who the deciding agent is, how an action takes shape, and how an aftermath is sorted out. What Kelly describes is less an instance of morally anguished trade-off or a brush with transgression than it is a moment of powerful but strangely non-eventful certainty in the face of seemingly glaring contradiction.
I want to conclude by suggesting a couple of ways to think this case anthropologically. The first is via its exemplarity, not just as a piece of data but as part of a project of understanding human experiences of routinized violence. Do we imagine Kelly’s case to be a distortion, attenuation or exception to this human experience? Or can we take it as an expression of that humanity, however discomfiting that might be? What does it mean to take Kelly’s terror seriously while taking equally seriously the Iraqi driver’s terror as he made his way through overlapping fields of high-caliber fire? And might a careful understanding of the former help trouble the notion that the latter is simply an inevitable side effect of well-intentioned liberal war-making? This seriousness of consideration does not have to be a matter of somehow letting Kelly off the hook—as if most of us are not in one way or another hung on that same hook—or of confining our analysis to the narrow moral economy of this particular scene of sovereign violence. It can instead be cause for interrogation of a far more unquestioned mode of liberal subjectivity that is both given responsibility for acts of violence and cast as the thing being defended by such acts. In the name of defending a highly unimaginative vision of freedom, this subjectivity stubbornly and violently privileges autonomous action and individual responsibility. So another way that this is a case: it is a case of precluded possibilities for sensing and responding to the agency of others, for recognizing that doing and knowing are always ours and not-ours, and for unsettling just what defines the “us” to which these things belong.
Ken MacLeish is Assistant Professor of Medicine, Health, and Society and Anthropology at Vanderbilt. He studies how war, broadly considered, takes shape in the everyday lives of people whose job it is to produce it—U.S. military servicemembers and their families and communities. His book, Making War: Everyday Life at Ft. Hood, examines the everyday lives of the soldiers, families, and communities who personally bear the burden of America’s most recent wars.
 There is a widespread but apocryphal claim that it is illegal under the Geneva Conventions to use .50 caliber rounds against human targets, but no such prohibition exists. It is common, however, for unit-level rules of engagement to limit the use of the M2 and other large-caliber weapons to non-human targets, though in urban combat that involves shooting at buildings or vehicles, such distinctions may in practice be meaningless.
 cf. Kenneth MacLeish, “Armor and Anesthesia: Exposure, Feeling, and the Soldier’s Body,” Medical Anthropology Quarterly 26, no. 1 (2012): 49–68.
 Michel Callon and John Law, “After the Individual in Society: Lessons on Collectivity from Science, Technology and Society,” The Canadian Journal of Sociology / Cahiers Canadiens de Sociologie 22, no. 2 (April 1, 1997): 165–82.
What follows is a series of conversations conducted after the recent Image as Method symposium, which took place on May 4th and 5th, 2015, at Columbia University’s Heyman Center for the Humanities, organized by Brian Goldstone. The symposium featured numerous presenters and commentators: Diana Allan, Vincent Crapanzano, Robert Desjarlais, Angela Garcia, Gökçe Günel, Michael D. Jackson, Julie Livingston, Stuart McLean, Natasha Myers, Anand Pandian, Elizabeth Povinelli, Hugh Raffles, Stephanie Spray, and Lisa Stevenson. Rather than summarizing the event or attempting to reproduce every presentation and commentary, below I follow a few conceptual paths made at the symposium through conversations with Brian Goldstone, Stuart McLean, Anand Pandian, and Robert Desjarlais, who, each in his own way, describes an alternate way of thinking through the use of the image in all of its forms (visual, literary, photographic, phantasmagoric, etc.), as an invitation, a marking out of some “elsewhere” within anthropology itself.
The interest in images for anthropology has grown rapidly in recent years. This shift towards the imagistic has nonetheless come in many different forms. From the recent surge of ethnographic films invested in sensory experience and the ‘haptic’ forms of visuality, to photo-ethnographic works and a ‘literary anthropology’ whose aim is, in part, to think and write imagistically, anthropology finds itself at a threshold where images are no longer complementary, illustrative, or indexical to larger frames of thought, but instead themselves have value for thinking and doing anthropology.
While the critical interest in images has seen a renewal, anthropology has a long tradition of thinking imagistically. As Anand Pandian points out, for Malinowski, anthropology was experienced cinematically as his fieldwork encounters unfolded in “moving picture speed.” Similarly, Richard Baxstrom and Todd Meyers in their forthcoming book, Realizing the Witch, write, “Indeed, among Malinowski’s many achievements, his active, quasi-cinematic writing style still stands out as one of the most striking and valued elements of his work nearly one-hundred years later” (147). More than anthropology’s own history of thinking with and through images, there is a philosophical current that carries these sorts of pursuits forward in unexpected directions. As Brian Goldstone notes, “There’s the philosophical genealogy running from the proto-cinema of Plato’s cave and the emergence of the Cartesian dreamscape, to the early Wittgenstein’s so-called picture theory of language and the Deleuzian image of thought.” And as much as images forge their own philosophical grammar, they are heavily implicated in the contingencies and uncertainties of the everyday. Images, like the everyday, reveal themselves as fraught and clouded, never fully decoded, or in Roland Barthes’s words, they are “messages without a code” (1977: 17), “continuous messages” that demand invention as much as grasp.
Andrés Romero (AR): Brian, first and foremost, thank you for putting together such an exciting event that presented an impressive lineup of scholars, all doing cutting-edge work on questions that relate to thinking through images and with images, and as you noted, images “as what we do; image as method” — hence the title of the symposium. I wanted to ask you about how the symposium came to be. In other words, from what types of conversations was the symposium a product of and a continuation of?
Brian Goldstone (BG): I guess the idea for the symposium came about through the realization that my own increasing preoccupation with the life of images in anthropology — their capacity, in some cases, to do and say and show certain things that a more recognizable mode of inquiry might not permit — was resonant with the aims and sensibilities of a range of recent works; and this in a manner, moreover, that seemed to go beyond the various circumscriptions, be they thematic or area-focused, that so often manage to prevent such otherwise disparate works from being brought (thought) together. More concretely, I had been having an ongoing — and, for me, incredibly fruitful — conversation with Robert Desjarlais about his poignant and unsettling photographic memoir, which he had just finished, and — in tandem with encountering such books as Lisa Stevenson’s recently published Life Beside Itself (which is where the title of the symposium was taken from), along with all the fantastic stuff that was emerging from places like Harvard’s Sensory Ethnography Lab — it made me think that an event of this sort might be worthwhile. Finally, the symposium was an excuse to bring together, in one place, some (though certainly not all!) of the people whose work has meant the most to me.
AR: Part of what I felt the symposium managed to do (which you also noted in your lecture) was to expand an understanding of what the image is, or could be, in the sense that images take on different forms — beyond the visual image. In fact, ‘the image’ could take form through many of the interconnected registers (that are associated with sensory experience): the sonic image, the thought-image and dream-image, the memory-image, and, as Vincent Crapanzano reminded us, the literary image, just to name a few. One of the questions you posed as part of the description of what this symposium set out to do was, “What would an imagistic — as opposed to a more conventionally discursive or didactic — anthropological mode of knowing necessitate?” I wanted to ask you if you could expand or even attempt to answer this very question.
BG: Well, in terms of how I would answer the question of what an imagistic anthropological mode of knowing might look like or necessitate, I guess I’d have to say that the presentations and commentaries at the event were — as I very much hoped they’d be — themselves responses to such a question. In fact, I was blown away by the power and rigor of the particular “anthropology” that was on display at the symposium, with each of the participants confirming, in their own very distinct ways, two related intuitions that provided the impetus, or aspiration, for the event.
The first is that, if a symposium such as this is going to be compelling, at least for me, it will be so to the extent that it says something about images — or, more aptly perhaps, does something with images — that is more than, or perhaps simply different from, what media theorists or art historians or philosophers are going to say about them. To be sure, this event wouldn’t have been conceivable without a serious engagement with such works, both canonical and more recent ones, beyond anthropology proper, and indeed much of this broader intellectual reservoir was drawn upon throughout the course of the event.
But the most interesting moments came, I think, when a thought or a passage from, say, Benjamin in the case of Lisa’s presentation, or Deleuze in the case of Beth’s, Anand’s, and Stuart’s work, or Blanchot in Bob’s, became otherwise, something else, in their proximity to the materials (ethnographic, cinematic, photographic) in question — even or especially if this “other” potential wasn’t always articulated or explained as such. And this brings me to a second intuition, which, to borrow a phrase from Lisa’s book, is the proclivity of certain images to “express without formulating;” their tendency, that is, to “drag the world along with them,” as she also puts it. For me, this way of naming the force of images (and it’s important to emphasize that by “images” we were by no means confining ourselves to the visual, but rather trying to think images in much more capacious way to include, for instance, dreams, sounds, particular linguistic forms, modes of writing, etc.) helpfully articulates the elusive, often ephemeral and difficult — but also, because of this, intellectually compelling — character of a more “imagistic” anthropology, of “image as method.”
AR: Stuart, a running theme in a lot of your works is the question of the in-between, given much emphasis in anthropology on “liminality.” And yet, as you note in Transcultural Montage (2013), the in-between has often been treated as a void between phenomena that becomes definable only by the conceptual categories from without. Pointing to the ways in which material processes and their potential to generate “unpredictable affects” often become evaporated at the expense of pre-existing conceptual categories, you note: “…it is society as an assumed structure of relationships and classifications that is prioritized as providing an explanatory framework for understanding the liminal, as we are led away from the elusiveness of the liminal itself and back to the (allegedly) more stable and knowable terrain of social relationships and cultural significations” (2013: 61). Could you comment on your various engagements with the liminal and how your work seeks to expand such frames? Additionally, your understanding of montaging extends beyond the sonic, visceral, textual and cinematic understandings into a space and time where montaging is actually a mode of engagement and sensibility into the world — a sensorial attunement that seeks to be aligned to the very immanence and “generative instability” (2013: 59) of phenomena outside of pre-existing domains of signification. Could you expand on the relationship between montage as mode or method to think with, and perhaps even experience the so-called liminal?
Stuart McLean (SM): The between has certainly been an abiding preoccupation of my work and will I’m sure continue to be so, not least because it seems to me to have profound implications for the way in which one approaches a whole range of questions and subject matters. Brian Massumi puts it very succinctly when he talks about the challenge of trying to conceive of a “being of the middle” rather than just a “middling being.” The tendency usually (in anthropology and elsewhere) is to talk about the between in terms of a lack, a void, an absence. Obviously there are different ways of formulating this and it’s possible even in these terms to talk about the between as generative — as I think Vincent Crapanzano does in his Imaginative Horizons book. I’m also interested though in trying to understand the between not as an absence but as an overflowing, superabundant plenitude — and as such, of course, no less resistant to definition and classification. I think that’s why I was attracted to the image of Thingvellir in Iceland and the rift between the North American and Eurasian tectonic plates, where magma keeps welling up from the depths and pushing the two continents further apart. It made it possible to visualize betweenness in very material terms (and as materially productive and consequential) rather than simply with reference to symbolic classifications and their temporary suspension.
I should also say that I have found Victor Turner’s various discussions of liminality extraordinary suggestive. The difficulty is that, for me, he often seems to lack the courage of his own most interesting insights when he gets around to discussing concrete examples (like the lion-human figure in Forest of Symbols) and the explanations offered end up falling back on an assumed framework of social relationships, classifications, society as a “structure of positions,” etc. I’m interested though in the challenges that liminality might pose to that kind of thinking (and I think Turner is also interested in these challenges most of the time). If anything needs to be explained, as far as I’m concerned, it’s the possibility of appealing to notions of historical context, social relationality, and so forth as a means of understanding the world. What decisions about what to include or exclude are implied in making such an appeal and might different decisions reveal a different world?
I would certainly see my interest in montage as linked to my attempts to understand and write about the between as much more than a matter of classificatory ambiguity. I see montage as a practice of the between in this expanded sense — not just a method of cinematic or literary composition but a way of engaging the world that might be equally applicable to, say, thinking about genetic mutations or geological processes. I think you’re right then to say that a lot of my work seeks a performative as much as a conceptual engagement with montage. This comes partly out of a conviction that the between should be approached as a site of experimentation rather than something to be theorized and explained. It’s also informed by my sense that perhaps anthropology’s most radical potential to intervene in the world is not so much a matter of documenting existing actualities as of performing into being new realities, enacting new ways of being human (or other than human) that result from various kinds of encounters across difference.
My interest in montage also grows out of my long-standing fascination with what I take to be an unjustly neglected mode of anthropological writing — namely, the comparative essay. It’s become so much an article of faith in recent years — certainly in American anthropology, less so perhaps in Europe — to assert that anthropology equals ethnography, as though the discipline’s claims to distinctiveness and value consisted entirely in the deployment of a particular method and, by extension, the production of particular kinds of texts informed by that method. Ethnography, however, doesn’t account for all that people calling themselves anthropologists do or write. Some of the most influential works written by anthropologists have not been ethnographies at all but works of comparative scholarship drawing on material from a variety of sources — think of Mauss’s Essay on the Gift or Mary Douglas’s Purity and Danger. More recently, there are works by Tim Ingold and Philippe Descola that I would include in this category, too. I’m interested in revisiting this form of writing both as a potential means of engaging different and perhaps wider audiences and because it seems to offer a range of intellectual and writerly possibilities that are easily foreclosed if the ethnographic monograph in its various contemporary guises (multi-sited, collaborative, etc.) is taken to define the horizon of anthropological thinking and writing.
I should add that I’m not in the least interested in appealing to the kinds of grand, preconceived explanatory frameworks that are invoked in the works of many nineteenth-century comparativists like Tylor (and that Boas rightly criticizes in his essay on “The Limitations of the Comparative Method in Anthropology,” setting the scene for twentieth-century anthropology’s subsequent turn toward ethnography). What interests me are the juxtapositions and leaps across time and space that one finds in some comparative anthropological scholarship. In a single paragraph of Primitive Culture, for example, we can travel from China, to South America, to the Western Isles of Scotland, to the Malay peninsula, to Bulgaria and so forth. At such moments, it seems to me that Tylor’s writing overspills the stadial theory of social evolution that he appeals to as an explanatory framework for ordering these diverse particulars and we glimpse instead a different set of possibilities, one that bears strong affinities to the principles of montage — that is, the juxtaposition of heterogeneous elements, the play with gaps and intervals as simultaneously linking and separating the elements that are juxtaposed. What appeals to me about this is the possibility of generating new connections and associations rather than simply documenting ones that are assumed to already exist, suggesting not only a multiplicity of possible human worlds, but also the prospect of unpredictable and mutually transformative encounters between spatially and temporally disparate people, places and things.
This leads me to a more serious objection to the contemporary tendency to identify anthropology with the practice and writing of ethnography. To claim that the task of anthropology is that of documenting the existing world — even when this is done with meticulous attention to nuance and detail (what Michael Fischer calls the “jeweler’s eye” of the ethnographer) — risks, I think, enshrining a normative empiricism that absolutizes existing actualities as the unchallengeable horizon of what might ‘count’ as reality. It involves, in other words, a too-ready acceptance not only of hegemonic criteria of ‘interest’ and ‘relevance’ but also of a kind of ontological status quo. It seems to me that to restrict ourselves too narrowly to the task of describing the actual is to settle not only for an unnecessarily impoverished account of reality but for one founded upon the pre-emptive foreclosure of other possibilities. I think that one of the great contributions of the scholars associated with what has sometimes been called the “ontological turn” has been precisely to re-open the question of what ‘counts’ as reality and for whom — although it’s somewhat disappointing that thus far at least most of them don’t seem particularly interested in pursuing the writerly implications of their theoretical arguments.
For me, the montage-inspired comparative method that I’ve explored in some of my own work is another way of keeping open the question of the real — a way of evoking a sense of reality as open-ended and unfinished, as comprising not only the actual (which might accord with commonsense notions of what reality is) but also what Bergson and Deleuze call the virtual — an additional, no less real dimension of unquantifiable potentiality, a power to self-differ that is immanent to the material substance, the “stuff” of the world, but irreducible to any of its actualizations. To affirm this — and it is I think finally a matter of poetic affirmation as much as anything else — is to hold open the possibility of what both the anthropologist Beth Povinelli and the poet Myung Mi Kim have called the “otherwise.” This seems to me to demand an engagement with writing as a material practice involving the enactment of new realities rather than simply the descriptive reporting of existing ones (a view that always seems to risk flattening the real to a particular set of currently dominant definitions). If ethnography continues to be cited as indicative of anthropology’s engagement with the actual, existing world, then I would suggest that comparativism, in theory if by no means always in practice, offers one way of combining such a commitment with an acknowledgement and experimental conjuration of an unbounded multiplicity of worlds-in-becoming.
AR: At the Image as Method symposium, you delivered a very moving, colorful and engaging presentation that was certainly a montage on its own, consisting of disparate phenomena that allowed for various affects to surface — which, I would add, were produced for the audience to think with the vibrancy of sensation and perhaps the exhaustion that comes with some encounters (I’m reminded of Anand Pandian’s presentation where, following Gilles Deleuze, he called for a move towards thinking with sensation). Your paper traversed many registers that engaged with the work of surrealist Swedish poet Aase Berge and the work of the artist Filippos Tsitsopoulos, among others. Your paper also consisted of a montage between Oxford English Dictionary definitions, Shakespearean prose, daydreams, thought-images, and viscerally-charged images — images galore. In the commentary section, you talked about your approach between images and text as having the potential to produce an explosion. Could you talk about your presentation more generally and what you set out to do, and perhaps expand on this idea of the explosion caused by images?
SM: I suppose my presentation at the Image as Method symposium, which was based on a section of my current book project, was an attempt to engage some of these questions via a juxtapositional working with (or thinking with in Anand’s sense) both visual and poetic images. Part of what I was trying to do was to explore the generative possibilities of putting different kinds of things together while acknowledging at the same time a certain density and opacity on the part of the materials with which I was working — that is, a certain capacity to exceed or refuse or thwart my efforts to make use of them in a particular way. Take the OED definitions, for example. The point for me was not just to contrast the dictionary definitions with the more expansive associations evoked by the other texts and images discussed but also to foreground the dictionary definitions themselves as material presences in the presentation, to let their thingness usurp any purely explanatory and classifying role.
There seems to me to be something similar going on in Aase Berg’s extraordinary poetry. On the one hand she’s continuously drawing attention to [the] materiality of language as a medium, but on the other her words are incredibly, densely charged with meaning — to the extent that it produces a kind of signifying overload that can’t be reduced to any kind of readily summarisable informational content. Like Filippos’s work, as I understand it, part of what the presentation was attempting to evoke was a sense of processuality, of transformative potentiality, of a latent capacity to differ lying before or behind a world of apparently fixed and stable forms. I suppose the explosion referred to would be something like the unleashing of such a capacity — which could be emancipatory, or scary, or comical or all three (and more).
AR: As you were working through your presentation, I was reminded of your article “Stories and Cosmogonies” (2009). In this article, among other things, you’re invested in questions of creativity and metamorphosis in relation to the craft of storytelling. You make note of the ways in which [creation] storytellers are not simply those who recount the past, but in fact, they are those who insert themselves in the process of extending such accounts into the present, and perhaps, re-birthing such accounts into being by invocation. You write: “Both native and anthropological stories — indeed all stories — could be understood less as representing a world external to themselves than as participating in and extending the self-making of a world of which stories are both a product and an integral part” (2009: 223). In other words, it appears that your work views storytelling and anthropological writing not as just representations of the worlds they encounter, but as having the potential to actually express those very worlds. I wanted to ask you to expand on this notion of expression in relation to anthropology and writing. Additionally, could you talk about this process of expression as it unfolds in “generative instability” (to borrow your phrase), and what can such experimental pursuits open us to, in terms of knowing and experiencing the worlds we study?
SM: As to storytelling, I’ve certainly tried to think about the relationship of stories to the world in other than representational terms — perhaps more in terms of consubstantiality. Luctetius, for example, likens the letters composing his own verses to the atoms composing the physical universe: text and world are fashioned ultimately from the same material substance. In the book manuscript I’m currently completing (provisionally titled “Fictionalizing Anthropology”) I try to envision anthropology’s role in terms of what Deleuze calls “fabulation” — not so much the re-presentation of a world assumed to be already given ‘out there’ as the creation of fictions (in Geertz’s etymological sense of a fictio, or ‘made thing’ perhaps) that intervene in and modify the world by acknowledging that they are already embedded in and carrying forward the processes of the world’s own self-making. I consider anthropology to be a discipline that deals not only in encounters between differently constituted human worlds but also with the interfaces between those worlds and the other than human materialities by which they are at once constituted and carried beyond themselves. For this reason I see anthropology (along with art and literature, and for similar reasons) as inescapably at the forefront of contemporary struggles to imagine and bring about a different, more just, more sustainable world — a project of ontological poesis rather than comparative ontology, if you will. That’s also one of the reasons why I take issue with “anthropology = ethnography,” a view that risks reducing anthropology’s contribution to that of a kind of more rigorous, better researched investigative journalism. Anthropology is much, much more important than that!
AR: Anand, in your paper, “The Color of Sensation in Indian Cinema,” and in your forthcoming book, Reel World: An Anthropology of Creation — an ethnography that asks us “what happens to life when everything begins to look and feel like cinema” — one of the things that you are very attuned to is the ways that Tamil filmmakers (and the filmmaking practices they attend to) moved through an uncertainty that often was described by your interlocutors as ‘anything can happen at any time’. The radical contingency of cinema, as you noted during your paper (I’m paraphrasing), is an invitation to think with the visceral force of image and sound in its uncertainty, in its open-endedness in that sense of not knowing where it would go, even as it was already taking you somewhere. In other words, and as I interpreted your paper, to think with images, to allow sensations to surge and to think with sensation, one gets the impression of a fundamental shift in the register for taking us elsewhere — experientially and theoretically. Could you comment on these ideas of thinking with sensation and uncertainty, and what kind of promise this shift might have for anthropology?
Anand Pandian (AP): What I have in mind here is the relationship between thinking and feeling, thought and sensation. We often fall back upon the idea that good thinking, clear thinking, is something that happens best at a remove from the world and the sensory tumult of its impressions. But one of the things that is most interesting about anthropology, as a field science, is its commitment to think with the flux of experience, to grapple with the press of things as they come. This commitment, it seems to me, serves also as a kind of invitation to allow those sensations into the substance of our thought, an invitation that can be met with concrete and hospitable response in the very body of what we write, by breaking down the line between fieldwork and writing, between what happens and our accounts of what has happened. Cinema has helped me think, in other words, about anthropology’s stake in the world at hand, and the various means that anthropology has at its disposal to convey this stake and its significance.
AR: One of the running themes that kept resurfacing in the various discussions that took place at the symposium was that of images haunting us — caught in the affective hold of such images. As part of your commentary, you talked about this hold, or hauntedness, that images possess as the “excess” of images, and noted that the question often becomes “what is it that we ought to do with such excess?” Reel World, I feel, appears to grapple with such questions, as it embraces such excess and sensory experience in a way that its writing attempts to give form to, and to display some of the force generated by, the sensorial encounter, not just as a representation of the encounter but as a way that is expressive of the encounter itself. Could you comment on the task for anthropology, bringing what you call the “generative excess” (2012) to the fore?
AP: As I tried to suggest above, the challenge we face here is one of confronting more squarely what is actually at stake in anthropology’s mission to, as Tim Ingold has put it, do its philosophy “out of doors.” Do we go out into the gusting tumult of what is happening outside to seek out things and deeds that we will intend to bring back into the safety and quiet of more familiar domiciles? Or, does the endeavor seek instead to trouble the very distinction between inside and outside that academic knowledge depends upon too often? I take seriously the idea that the work we do in anthropology is something like the work of a channel or a medium. If we are indeed carrying over ideas, impressions and indeed images from one domain into another, seeking to think and work with them in all their forcefulness, then it seems to me that we have to find ways of conveying this force through our own media of expression. Experiments with writing in a more sensory and viscerally unsettling register is one way that we can try to do this.
AR: Bob, many people at the symposium spoke about the image taking possession over the individual, or about the excess of the image. Could you comment on this excess that images carry?
Robert Desjarlais (RD): Quite often images in anthropology have been thought of as documentary, in that the images, like photographs, serve to depict some kind of ethnographic situation. Now, I think more and more people are becoming aware of the ghostly quality of images. And still, we don’t even have the language to talk about these kinds of things. I found this the case recently when I was in Athens, Greece, and became interested in the graffiti and street art covering many of the surfaces of the city. With many of the images found there, I’ve been thinking about a lot of them as ghosts. Because — and I don’t know if it’s the same in Detroit — but you have a lot of images of faces embedded in the walls; they could either be stencils, photographs, or drawings — they’re almost hovering in this kind of underworld. They are almost frozen in a temporality that is distinct from everyday life, and also distinct from the time when they were inscribed on the walls. It’s almost as if they were frozen in time and forgotten by their authors, in a way.
And so you can be in the metro or subway and you just see these faces in the corner of your eye and realize that these images are not just descriptive but have a haunting quality that can possess us. And again, these are not just pictorial images that possess us; they could be in word or writing, or recurring in our everyday lives. Another example that comes to mind: when I was in Athens I remember taking the train to a suburb outside of the center and I would briefly see a man, begging in a very busy street intersection, as many cars were passing by. He had no legs; both of his legs had been cut off both at the knees, and he was there with long jeans on, while walking on his knees, and dragging the lower portion of his jeans along… It was a striking image at this busy intersection, and that image sort of took hold of me, sort of possessed me in a way. I wanted to go back and try to photograph him. I remember that I saw him for a couple of days, and when I thought of photographing the scene, I no longer saw him there.
But it is these kinds of images that are not strictly ‘conceptual.’ They embody a lot of different dynamics and you could say they affect us in a way, and this suggests the strange quality that photographs and images have. They are kind of ghostly.
For a while images in anthropology were largely being treated as cultural objects. I guess the main model was the linguistic/semiotic model, in that images signify something within a cultural world, such that anthropologists tended to think of images under a semiotic model of ‘signifier’ and ‘signified.’ But I think recently people have been getting at the more inchoate aspects of images. For example, with Lisa Stevenson’s presentation, we encounter the image of the raven that she spoke of, the one the person encountered in her dream; no one really knows what this image meant, if its appearance signifies something at all, or anything altogether. Similarly, I think people are now trying to get at those uncertain, inchoate modes of images, rather than just analyzing them in a semiotic way. People are realizing that the semiotics of images are often very unclear and quite murky. And that there is often a very powerful affective force to images, as well.
AR: Speaking of the uncertain quality of images, I wanted to ask you about something you have talked about as the anthropology of phantasmagoria in relation to images.
RD: Right, a phantasmography, if you will. I think there is so much going on in everyday life, as I understand it, that it’s almost multi-dimensional in a way — there is so much that invokes imagery, so much that invokes possibilities, interpretations, and narratives. If you just walk down the street, you see so much, you imagine so much, you interpret so much, you question so much. And none of it is really all that sure.
We give narratives to things, we create these phantasms of possibility. If you think about anthropology, so much of its focus is on the empirical: what’s clear, what’s tangible, and what can be said for sure. I think that’s kind of anemic in a way, compared to how we actually experience our lives. There’s so much going on — there’s so many layers of fantasy and the fantastical qualities of everyday life — and so I have been thinking about how one can write about that, because it presents a challenge anthropologically. If we are trained to attend to what’s empirical and what one can provide evidence for, what about all these other modes of thought that are much more elusive and much more ‘non-empirical’ in a way? The method that I had been developing in that critical narrative is to draw on my own imaginings — because at least I can speak to that — and show how these things play out in so many different ways, and how they shift through time as well. So, for example, you have one imagining or one phantasmagoria one week, and then it shifts into something else the next, and so there is this complex history of imaginings as well, which I think we can pay attention to.
AR: At the symposium you talked about the ways in which photography tears the subject from itself — in fact, this was more or less the title of your presentation. Could you talk about this idea of images tearing us, the viewers, from ourselves?
RD: Well, okay. That’s a good point. Actually, I missed the chance to respond at the symposium when Vincent Crapanzano had asked where the title came from. I should have mentioned that it comes from a passage of Foucault’s in an interview (from some Italian journalist whose name I forget). The journalist asked Foucault what his relationship to phenomenology was, and Foucault’s answer I have found helpful. He says that a lot of phenomenology looks at the everyday — it looks at the commonsensical understanding of human experience — and I think he was probably referring to, in most cases, Merleau-Ponty, Husserl, and thinkers within a more classical tradition of phenomenology. Like that. Foucault goes on to say, however, that what interests him more are the thinkers who basically implode the everyday — who come to the limit of experience (and he mentions people like Bataille and Blanchot) where in effect you are torn from the self, where the prototypical understandings of everyday life and its sensibilities get ruptured in some type of way. They get exposed for what they are and you are sort of torn from your certainty of life. You are torn from what you assumed to be true, what you assumed to be the case, and you meet certain limits of comprehension. So drawing from that phrase, I talk about the ways in which photography tears the subject from the self. Because when you look at an image it can look so clear-cut at first glance. But the more you look at the image, the more complicated it gets, the more multiple it gets, the more elusive it gets, and the more phanstasmographic it gets as well. We tend to have this ontology about the image, where we think that the image is something stable, standard, and ontologically real, but it’s really not the case.
AR: In my own work I’ve been grappling with questions of representation and what forms of life could be rendered imagistically, and particularly thinking of those in contexts of violence and abjection.
[At this point in the conversation we turn to the work of French photographer Stanislas Guigui who has produced a few galleries about people in the ollas of downtown Bogotá where I conduct fieldwork. The images render life at the “limit of experience” in a very Bataillean frame, and some of the “bestial” elements, as Guigui himself puts it, of human experience amidst violence, drug addiction and abject poverty.]
RD: One thing I like about this work, in looking at it for the first time now, is that Guigui is very upfront about his imaginary, and he is pushing the envelope on it. What I like about that is that it’s refreshing because with so many anthropologists there’s a kind of self-righteous quality for what they are doing, as if they feel they are providing a kind of care for the informant. But to me, at least, it’s becoming more problematic to be representing people who are suffering or who are really poor. There is a kind of aesthetics of suffering in anthropology these days; indeed those are the books that sell the most, and there is something that doesn’t quite sit well. Why is this happening? I think people may like suffering — they like to portray and read about suffering — as long as they are not the ones suffering themselves. This is something that I was trying to say at the end of my presentation, when discussing the photographic image of what appeared to be tourists taking a photograph next to a partially-blind beggar in Paris, as well as the rift I had about the thought that, if I had met this individual again, I would have wanted to interview him, to learn more about his story, and his blindness. I note how I would have been tempted to develop a whole new anthropology of suffering. This was my own commentary on people who have made careers out of the suffering of other people. In effect, I wanted to articulate a more open and problematic presentation of that, one that raises these kinds of questions, rather than something that hides or glosses over these problematiques.
And so, in considering Guigui’s photos, I find here that they are not just about representation or documenting life. They are evocative. They’re almost a phantasmagoria of these “souls in hell” (the title of one of Guigui’s galleries) and while I am sure these people may not fully identify with the ways they are being represented, I think they could relate to the images in which they are involved, if that makes sense. Because they know that these images — these phantasmagorias — are circulating in their lives, in terms of how other people see them or how they might invoke themselves in certain moments. I don’t know. It’s interesting. It’s provocative. It’s appealing just now because it’s direct. It’s more open to this question of representation. And I like the subjective quality, that he’s saying this is how he sees it, how he imagines his photographic subjects.
Barthes, R. and S. Heath. 1977. Image, Music, Text. Fontana Press.
Baxstrom, R. and T. Meyers. Forthcoming. Realizing the Witch: Science, Cinema, and the Mastery of the Invisible. Fordham University Press.
Desjarlais, R. Forthcoming. Photos in my Lost Hours.
Desjarlais, R. “Photography Tears the Subject from Itself.” Paper presented at the Image as Method symposium.
Goldstone, B. “Monstra, Astra: An Introduction.” Opening Lecture presented at the Image as Method symposium.
McLean, S. 2009. “Stories and Cosmogonies: Imagining Creativity Beyond ‘Nature’ and ‘Culture’.” Cultural Anthropology 24(2):213.
McLean, S. 2013. “All the Difference in the World: Liminality, Montage, and the Reinvention of Comparative Anthropology.” In Transcultural Montage. Ed. Suhr, C. and R. Willerslev. Berghahn Books.
Pandian, A. 2012. “The Time of Anthropology: Notes from a Field of Contemporary Experience.” Cultural Anthropology 27(4):547-571.
Pandian, A. Forthcoming. Reel World: An Anthropology of Creation. Duke University Press.
Stevenson, L. 2014. Life Beside Itself: Imagining Care in the Canadian Arctic. University of California Press.
Andrés Romero is a graduate student in the Department of Anthropology at Wayne State University. His research interests include the anthropology of the senses and the experience of place in relation to violence and displacement in Bogotá, Colombia.
Brian Goldstone is Justice-in-Education Fellow at the Heyman Center for the Humanities, Columbia University.
Stuart McLean is Associate Professor of Anthropology at University of Minnesota.
Anand Pandian is Associate Professor of Anthropology at Johns Hopkins University. He is the author of the forthcoming book, Reel World: An Anthropology of Creation (Duke University Press).
Robert Desjarlais is Professor of Anthropology at Sarah Lawrence College.
Image + Text engages the landscape of graphic illness narratives. What can the production of comics and other graphic forms tell us about issues of embodiment, biopolitics, or biomedicalizaton? How do our relations of collaboration and translation as interlocutor, ethnographer/artist, or ethnographer and artist work to express subjective and intersubjective moments in complex social worlds that are fraught with illness and power relations embedded in a search for well-being?
by Alberto Prunetti
Edizioni Alegre, 2014, 192 pages.
Amianto. Una storia operaia (Asbestos. A Working-Class Story) is written by Alberto Prunetti, an Italian writer who has published fiction and non-fiction since 2003. The book was originally published in 2012[i] and narrates the life of a factory worker, Renato Prunetti, the author’s father. Renato’s life is reconstructed from the 1960s when he started to work in his first factory, until his death, at 59, caused by an asbestos-related carcinoma in 2004. The second edition of the book integrates a debate (“Il Triello”) between the author Wu Ming 1 and the writer Girolamo De Michele, which further explores some themes of the main text. Wu Ming 1 is part of the writing collective Wu Ming, one of the major authorial voices in Italy today. De Michele, as the Wu Ming collective, has also worked both in fiction and non-fiction, and, as Prunetti, the two other participants also write in the online literary review Carmilla and come from working-class families and from environmentally problematic areas.
Amianto is a hybrid text. Matteo Giancotti, in a review of the book published in La Lettura, described Amianto as not a novel, nor reportage, nor a biography in its classic sense. By combining the salient aspects of the three genres, Prunetti writes a working-class story that, following the movements of the travelling factory worker Renato, retraces part of the history of the working class in Italy, from the 1970s to the end of the 1990s.
Renato’s story passes through a number of important factories, most of which had a high impact both on the health of the workers and on the surrounding environment. From the Solvay (a chemical factory) that gives its name to Rosignano Solvay, in southern Tuscany, Renato passes to the nearby Solmine (another chemical factory), in Scarlino, and to the (then) Italsider (steelworks) in Piombino, before working for a long time as a travelling pipe fitter (tubista) for the Gargano company of Novara. In that role, Renato works at building, repairing and renewing industrial plants in the chemical, petrochemical and steel sectors across Italy, including the other Italsider factories and the Montedison chemical plants. At the very start of his travelling work, Renato works at a refinery near Casale Monferrato (Piedmont), the main centre of production of asbestos in Italy. In 1985 he is forced to take on false self-employment: while continuing to work exclusively for Gargano, Renato is forced to register as self-employed, renouncing a number of rights the firm would have had to assure him. One of the last passages describing the years before Renato’s retirement is set in the Busalla refinery in Liguria.
At the centre of this story that crosses three decades of change in Italian industry is the body of a worker. The working biography of Renato is also the description of the deterioration of a body subject to arduous work. By narrating his father’s story, Prunetti remembers the unhealthy conditions of the work contexts: exposed to different heavy metals and other toxic substances in chemical and steel industries, dressed in asbestos gloves and overalls. The opening image of the book sees Renato working with the blowtorch – as he often did – near petrol tanks, covered by an asbestos cloth to avoid the sparks causing explosions; forced, therefore, not only to breathe the toxic substances dispersed by the blowtorch, but also the asbestos fibres. At 40, more than 20 years of work behind him, the signs of deterioration are visible. He wears a hearing aid, dentures, increasingly thick glasses – prostheses that Renato needs to “connect to the world” (p. 47).
In 1998, Renato manages to retire. But the serenity is short lived. At the beginning of 2003 his health condition rapidly declines. He is hospitalized and the analyses show brain metastases caused by a lung carcinoma. The narrative rhythm intensifies, following Renato’s last months of life. The damage of the therapies and the practical and emotive difficulties linked to taking care of a gravely ill person are interwoven with Prunetti’s reflections on what brought on the death of a man of less than 60 years.
The last part of the story describes the bureaucratic and judiciary experience of Renato’s family in obtaining recognition of the damage caused by the exposure to asbestos. Not surprisingly, these pages describe a slow and uninterested bureaucratic machine. First, the family has a hard time showing that Renato worked for years in contact with asbestos and other materials which caused his illness. INPS (social security) and INAIL (occupational injuries and diseases) initially deny that the exposure occurred, then argue that the exposure lasted less than the 10 years, the minimum contact period required for legally enacting special measures. Documents found between Renato’s papers – mostly pay slips and refunds of travel expenses – allowed it to be ascertained that he was exposed to asbestos for “years 15, months 9, days 21” (p. 124). The result is a small increase in his wife’s pension.
But Amianto is not only the story of the worsening physical condition of Renato and the others who worked at his side. It is a story in which health is – without knowledge of the consequences or freedom of choice – exchanged for rising salaries and relatively stable working and economic conditions. But not even this exchange holds, as the rights and conditions of factory workers fall during the 1980s: Renato’s need to renounce contractual rights and guarantees and return to self-employed work is a sign of this.
When the narration reaches the early 1990s, the life of Renato is seen in parallel with that of his son, the author. Alberto, able to enter a liceo – the upper stratum of the Italian high school system, rather than a technical institute – finishes high school with honours and goes on to graduate from university. This could seem like a classic social mobility story, in which the working-class parents’ labour allows their children to attain the education required to avoid heavy jobs. However, as discussed most plainly in the debate in the second edition, Renato’s expectations have not been realized. The rapid changes that characterized Italian society between the late 1980s and the 1990s have blocked much of the social mobility, as most jobs have seen declining rights and conditions. This includes many jobs that require high educational levels, a fact that frustrates intergenerational educational investment. In the debate section, Prunetti traces his own experience: college educated and specializing in the teaching of Italian, he worked as a teacher, translator and ghostwriter, without ever getting a steady job, and he alternated this work with manual labour, as in agriculture. “[A]ll this and still I cannot live above the level of poverty! Do you understand what kind of impoverishment they produced in just one generation?” (p. 148).
Amianto can be read as a structural story – one in which the relations between the phenomena described are revealed in a way that goes beyond the specific context and allows the reader to understand the structural dimension (Duster, 1989). The work, which can also be read as an ethnographic account of the health and labour of factory workers, clearly shows the connections between the exploitation of the body in capitalism and the way in which this exploitation is hidden and justified. An analysis of bureaucratic language highlights this last aspect: “‘Exposed’ is a nice verb, it is a passive past participle, it does not imply an active action, a responsibility. ‘Workers are exposed…’ Nice phrase. It sounds cleaner than ‘the bosses have killed the workers’” (p. 169). This passage, from the debate that follows the original text, reminds us that the deterioration of bodily capital, to use Wacquant’s (2004) concept, is located in an economic system in which profits are based on such deterioration and the burden of costs is borne by the collectivity. Physical deterioration, risk, illness and death are not generic traits of the human experience, but are strictly linked to one’s class. The theoretical paradigm of intersectionality has urged social scientists for some years now to take into consideration how the dimensions of class, gender and race can affect people’s lives. A work like Amianto, locating class in its relation to the means of production, makes it possible to understand how a class position — in this case a working class position — can affect the life and the health of people.
In the debate in the second edition, the issues of class, with reference to the specificities of the Italian case, are further analysed. The stability in employment of which the 1970s were the most solid example in Italy, are a historical exception that had already rapidly declined in the 1990s, as Alberto Prunetti’s autobiographical passages point out. The debate focuses on the impoverishment linked to precariousness. Prunetti’s attention to the impoverishment of a generation opens new questions about the changes – not for the better – of the relationship between capital, body and work.
For social scientists and for those interested in a critical analysis of occupational diseases, there is much to gain in a dialogue with works like Amianto. Prunetti’s book allows us to see essential aspects of the history of the working class in Italy; it represents a detailed description and analysis of the shortcomings of the protection of workers’ health and brings to the fore important questions about the effects of the continuing intensification of precariousness on the physical and psychological well-being of workers. The strongest advantage of dealing with works that have a literary dimension, especially with quality works such as Amianto, is that the narrative element can bring about what the Russian formalists defined as the “estrangement effect”, the power to make us see in a new light something that has always been before our eyes.
[i] The book was originally published in 2012 by Agenzia X; all the citations are from the 2014 Alegre edition and all the quotes – and any eventual mistake – are mine. An English translation of the last chapter of the book has been recently published by Asymptote.
Duster, Troy. (1989). “The structural anecdote in social analysis.” Paper presented at the Annual Meeting of the American Sociological Association, San Francisco.
Wacquant, Loïc. (2004). Body & Soul. Notebooks of an Apprentice Boxer. Oxford: Oxford University Press.
Cinzia Greco is Ph.D. candidate at the École des hautes études en sciences sociales and the CERMES3 laboratory. Her doctoral research explores the way patients and doctors view and manage post-mastectomy breast reconstruction and cosmetic breast surgery in France and in Italy. In particular, she is interested in learning how gender norms influence breast cancer policies and treatments across these countries.
This series aims to get anthropologists and closely-related others talking seriously, and thinking practically, about how to synergize biological and social scientific approaches to human health and well-being, and to what positive ends. In this interview, Emily Mendenhell responds to questions posed by series organizer Jeffrey G. Snodgrass.
How and why might cultural anthropologists and social scientists interested in health benefit from integrating biological variables/biomarkers into their research and analysis?
Disciplinary muscle within anthropology has always baffled me as a medical anthropologist. This may be due in part to my prior training in public health, which is inherently interdisciplinary. It may also be a reflection of my research, which focuses on interpreting hidden as well as more visible capillaries of power that source health inequities, and incorporating individual-level interpretations of disease and suffering with epidemiological ones. Yet, many anthropological efforts draw from other disciplines or sub-fields (or very well should) to enhance and make their research relevant beyond their field site or in the public arena. Indeed, with some academic departments charged with making anthropology more relevant within the academic curriculum, it is an important time for anthropologists to recognize how integrative, cross sub-field studies can enhance their work and relevance outside of the disciplinary confines of anthropological scholarship.
It could be argued that studies of health and inequality are ideal for interdisciplinary and multi-disciplinary approaches and collaborations. What anthropology brings to this scholarship is recognition of how broader political-economic and social contexts shape not only people’s bodies but also how they cope, suffer, and survive. Such an approach was at the heart of my doctoral training; despite my passion for critical medical anthropology, biocultural approaches pulsated through my program and became ingrained in how I approached anthropological research. This very integrated approach (which I believe is “holistic” medical anthropology) provided context not only for investigating the material effects of inequality on or in the body but also what political, economic, and social factors may perpetuate people’s everyday lives and serve as useful entry points for intervention.
I have argued elsewhere that the syndemics approach exemplifies how one might incorporate more “critical” approaches with “biocultural” methods to generate comprehensive studies of medical anthropology. This also may be interpreted as incorporating “cultural” and “biological” anthropology into a cohesive whole. However, I believe that syndemics also serves as a mouthpiece to make sense of the in-depth anthropological scholarship for a biomedical or public health audience that continues to work in a largely atheoretical realm. This was one of my goals for the book, Syndemic Suffering: Social Distress, Depression, and Diabetes among Mexican Immigrant Women. Matching biomarkers with critical assessments of health inequalities only strengthens arguments and the anthropologists’ abilities to make their work relevant outside of anthropology, weaving robust theoretical arguments with biological or psychological (which may be communicated as biomedical) “evidence”.
How would you respond directly to one potential cultural anthropological or social scientific critique of such an integrative “biocultural” approach?
Some critique that a biocultural approach may cause more critical or cultural studies of health and health inequities to become more biomedical because of the focus on the body (instead of placing the body into the emotional, social, or political world in which one lives). I deeply respect scholars who take a very critical and political approach – many of these scholars are fighting the good fight and making an impact. And, it may not make sense to incorporate biomarkers into their work because 1) it may not be that kind of study, and 2) it may be too costly. But I think there is much value into measuring disease and suffering in the body, as it opens conversations with other applied and clinical scholars and practitioners.
What is one potential caution you’d have for cultural anthropologists or social scientists considering a biocultural approach?
You may receive some criticism by people married to one sub-disciplinary approach or who caution you that you may be perceived as “too applied”. If you are interested in taking an applied approach, or simply speaking to cultural and biological anthropologists together, then brush off those critiques. You eventually will have more breadth on the job market as you can fashion your applications for positions in anthropology, public health, medicine, and especially interdisciplinary positions that value such an approach. I was hired in an interdisciplinary position and truly enjoy such engagement. However, you have to make sure to that you are comfortable sitting apart from and putting in the effort to develop relationships with anthropologists sitting in anthropology departments in your institution. I have found them eager to welcome me and engage with me from my interdisciplinary post.
What is one piece of research (ideally your own) that points to the benefits of such an integrative approach?
Jo Weaver and I recently published an article that discusses exactly this in Medical Anthropology entitled, “Applying syndemics and chronicity: interpretations from studies of poverty, depression, and diabetes.” [i]
I think my book Syndemic Suffering does a good job of this, too.
How might cultural anthropologists or social scientists interested in such an approach get started?
Receiving appropriate training in conducting biocultural research is essential. Scholars interested in applying the biocultural approach to their studies in cultural anthropology should take Thomas McDade and Chris Kuzawa’s biomarker course at Northwestern University’s Human Biology Laboratory in the Department of Anthropology.
[i] Lesley Jo Weaver and Emily Mendenhell. 2014. “Applying syndemics and chronicity: interpretations from studies of poverty, depression, and diabetes.” Medical Anthropology: Cross-Cultural Studies in Health and Illness 33(2):92-108.
Emily Mendenhall, PhD, MPH, is an Assistant Professor of Global Health in the Science, Technology, and International Affairs (STIA) Program at Georgetown University’s School of Foreign Service. Dr. Mendenhall has conducted cross-cultural research on the syndemics of poverty, depression, and diabetes in vulnerable populations residing in urban India, Kenya, South Africa, and the United States. Her first book, published in 2012, Syndemic Suffering: Social Distress, Depression, and Diabetes among Mexican Immigrant Women, was the first book-length analysis of a syndemic and provides the theoretical foundation for her cross-cultural research. Currently Dr. Mendenhall is writing a second book that brings together more than two dozen articles on her research of syndemics in cross-cultural context.
“Bioculturalism” aims to get anthropologists and closely-related others talking seriously, and thinking practically, about how to synergize biological and social scientific approaches to human health and well-being, and to what positive ends. It is edited by Jeffrey G. Snodgrass.
University of Pennsylvania Press, 2014, 283 pages.
Sarah Pinto’s extraordinary ethnography, Daughters of Parvati: Women and Madness in Contemporary India, begins with three epigraphs that have to do with the ethics of writing, representation, and narration. Pinto has much to say about all these things, but the axis on which they revolve is love. In Urdu and Hindi, love and madness are phenomenologically linked as forms of nasha, or intoxication. In South Asia, “mad love”— loving the wrong object, but also, in the sense of love as destructive, cruel, and catastrophic—is everywhere. It is well known that the price of mad, intoxicating love is that (other) things and relations fall apart. These facts of life, Pinto reminds us, are both incredibly “banal and complex” (254). The women we meet in this ethnography—Ammi, Amina, Lata, Kavita, Sanjana, Pinto herself, and many more—are sketched with a depth and vividness that reveals how love, kinship, and gendered vulnerabilities can break a person apart. Through each of their stories, something is also revealed about the limits of both anthropological and psychiatric forms of truth telling and knowledge making.
Pinto describes how crazy love, lost love, maternal love, filial love, illicit love, defiant love, and marital love all saturate the practices of Indian psychiatry, medicine, and even ethnography. As she puts it, “the task [of ethnography] is…to observe how the process of reaching for—freedom, care, love, relationships—is filled with actions as things come undone, and how undoing impacts people in different ways” (261). Throughout the book, we see how women in psychiatric care bear the brunt of dissolving kin relations, and how their vulnerabilities as women and as mentally ill persons “ratchets up the effects of the other” (261). This is not, Pinto is careful to point out, a story of how families and institutions collude to produce forms of spectacular abandonment. Rather, as Pinto argues, oppositions between care and abandonment, or freedom and constraint, in many anthropological critiques of neoliberal psychiatry fail to capture the kinds of crises that families and women who are institutionalized in north India face. In chapter 1, “Rehabilitating Ammi,” Pinto writes about the difficulties of understanding everyday acts, such as committing a family member to inpatient care, or bringing a family member ‘home,’ or making a new home for oneself when things come undone, as forms of either care or neglect. Rather, she writes about struggling, “as did the people involved, not only to respond to crises but also to recognize a crisis in the first place, to differentiate what was inevitable from what was unjust [emphasis mine]” (4). This perspective suggests that the anthropology of medicine may need to attend more closely to whether or not enforcing norms, disciplining, and surveilling bodies is really (or always) the focus of medical and psychiatric encounters.
The book is divided in two halves, representing the different faces of contemporary Indian psychiatry and the two main institutional sites where Pinto worked. Chapters 2 and 3 take place in the ironically named Moksha, a small, private psychiatric clinic where women reside, mostly involuntarily, in a locked ward, largely in the absence of kin and doctors. Rather than being connected by severity or chronicity, all the women in Moksha, Pinto soon realizes, share experiences of divorce and collapsing marriages. In Chapter 2 Pinto beautifully describes how these limits structure the texture of temporality and care in this space: “a sense of crisis was pervasive,” she writes, “conditioned by a web of muted sensation—stillness, quiet, stoppage of movement” (82). While doctors and social workers relentlessly advise patients to “keep busy” and to “stay alert,” Pinto shows how life in Moksha forces the very opposite to happen, thus creating the very object it is meant to treat.
Chapters 4 and 5 signify a major shift in tone and place, since they take us to a psychiatric unit in a large, bustling, government hospital. While both Moksha and Nehru, the government hospital, are the effects of macro-level, ongoing mental health reforms, they could not be more different from each other. Despite the fact that Pinto sometimes goes back and forth between these spaces, even she finds it necessary to keep them apart, splitting her fieldwork time between Moksha (first) and Nehru (second), and maintaining this divide in the book. In contrast to Moksha, in Nehru, women are admitted on a short-term basis and the ward is full of kin who nurse and care for patients. Instead of the stillness of Moksha, Nehru is a fast-paced, hectic, and public ethnographic space. However, as Pinto astutely notes, the effect of kin in the hospital are “two-sided”: “on the one hand, patients were surrounded by kin and cared for by loved ones; on the other, whatever conflicts and stresses were present came into the hospital” (163). As a result, whereas Moksha can sometimes be a breathing space, in Nehru, medicine’s work of stitching frayed relations is done with—and through—kin.
The two halves of the book are marked by a gut-wrenching scene at the end of Chapter 3 in which Pinto returns to Boston with her daughter, Eve, exhausted, sick, between homes, bereft. This event only sharpens what Pinto is trying to do in the book, by showing us how her own personal crisis is refracted through the other crises we learn about in the book, and reminds us how we come to know them, too, through her. Her own explosive homecoming is striking for making apparent what is absent in the rest of the book (barring Ammi’s story): the uncertainty of the return home (after institutionalization or fieldwork). Despite the universal pleas of women in Moksha to go home, the dread, fear, and sense of loss that this journey might involve are illuminated through Pinto’s own excruciating voyage. It is through her that we realize there is really no way back.
In this moment and many others in the book, Pinto’s life and work threaten to collapse into each other. This was, for me, one of the reasons why this work has such resonance. Pinto demonstrates a rare generosity of spirit in the way she allows her readers to “know” her undoing, and in the process, shows us how knowledge is sometimes a process of unraveling, just as much as it is about collecting and gathering. At the same time, we see how these undoings (always) seem to come, not only with kinship, but also with fieldwork and anthropological relations. There are so many doings and undoings during fieldwork that so many, including myself, have experienced, and yet, no one talks about. That Pinto masterfully controls the leaking of theory and methodology not only serves the book, but it is also a significant contribution to ethnographic writing and feminist anthropology. This book is important, not just for medical and psychiatric anthropology courses, or courses in South Asian studies, but for all graduate students readying themselves for fieldwork.
This book is best devoured quickly because reading it is an all-consuming experience. I read it for the first time exactly one year ago, as the haze of the North Carolinian summer slowed everything down around me. I curled up on my couch, underneath a whirring ceiling fan, not so different from the fans in Moksha and Nehru. After letting the cascading effects of this book wash over me, at night, standing on my stoop, I could smell the monsoon.
Saiba Varma is an Assistant Professor of Anthropology at UC San Diego. Her research focuses on psychiatric and humanitarian care in Indian-occupied Kashmir.
An anthropology beyond nature and culture? Tim Ingold and Gisli Palsson’s edited volume, Biosocial Becomings. by Perig Pitrou
Cambridge University Press, 2013, 288 pages.
This essay originally appeared in Portuguese in the journal Mana. Translation provided by Daniela Ginsburg.
Anthropology established itself as an independent discipline by designating the social as a specific field of study, allowing it to distance itself from certain retrograde positions found within the domain of physical anthropology. However, the nature/culture dichotomy on which this division was based has been the object of constant criticism over the past several decades. The two editors of Biosocial Becomings have, like Bruno Latour and Philippe Descola, demonstrated the limits of these concepts in explaining human representations and practices. Now that this deconstruction has begun, the challenge for our discipline is to define an anthropology “beyond nature and culture.” What principles must guide our research? What methodologies should ethnologists apply? Which concepts can render their results intelligible? Within the context of this vast enterprise of re-founding and re-developing, the panel organized by Tim Ingold and Gisli Palsson in 2010 as part of the EASA conference and entitled “Human Becomings: Beyond the ‘Biological’ and the ‘Social,’” sought to formulate theoretical propositions while also beginning to explore new objects. In the book that emerged out of this collective reflection, the project to “integrate the social and the biological” is synthesized by Ingold (in chapter 1, “Prospect”) and by Palsson (chapter 12, “Retrospect”), who establish a theoretical horizon for the enterprise. As for the rest of the pieces, their heterogeneity contains a certain ambiguity. On the one hand, this variety may be seen as evidence of the potential richness of studies that seek to better understand “biosocial becomings” by investigating a plethora of phenomena from across the world. But, on the other hand, this multiplicity raises some difficult questions: what place is given to biological processes in ethnographic studies? Should these studies use biomedical data or, instead, should they try to document, by other means, non-biological conceptions of living beings? What can ethnography of traditional societies contribute to knowledge of life? Although the various chapters in this work do not always explicitly answer such questions, they do at least present the advantage of delineating the problematics that the anthropology of life must address if it hopes to develop.
Ingold’s work has long expressed a desire to go beyond dichotomies; this is one of the main themes of The Perception of the Environment (2001), which proposed studying organisms without abstractly disconnecting them from their environments. His introduction here revisits ideas from that classic text, while affirming even more strongly an alternative conception of biology on the basis of which a renewed anthropology should develop. He begins by polemically declaring that “Neo-Darwinism is dead” (1), before going on to vigorously critique the negative influence of this—in his eyes erroneous—theory on explanations of human phenomena. He reproaches a certain kind of naturalist epistemology for interpreting the evolution of culture on the basis of the Darwinian paradigm by establishing an analogy between genes and memes. For several decades now, Marshall Sahlins has been battling against sociobiology, proclaiming loud and clear the primacy of cultural determinisms. This is not the strategy of Ingold, who seeks instead to dismantle biology’s very concepts, in order to transform the usage that the social sciences may make of biology, without getting trapped in reductionism. Ingold’s criticism targets the notions of evolution and design: “Evolution, in our view, does not lie in the mutation, recombination, replication, and selection of transmissible traits. It is rather a life process. And at the heart of this process is ontogenesis” (6). The argument he uses in defense of this thesis goes back to his 2013 work, Making, and consists in attacking hylomorphism, which he considers to be Neo-Darwinism’s Achilles heal, because it consists in taking the form of an organism to be something already determined before its actual development. With regard to the notions of genes and memes he writes:
the fallacy of this way of thinking lies in supposing that the form miraculously precedes the processes that give rise to it. And the way to overcome the fallacy is simply to reverse the order, so as to give primacy to the process of ontogenesis—to the fluxes and flows of material entailed in making and growing—over the forms that arise within them. (7)[i]
In contrast, Ingold’s understanding of evolution seeks to reconceptualize the relation of organisms to their environment:
What we are accustomed to thinking of as an environment might better be understood as a zone of interpenetration. Within this zone, organisms grow to take on the form they do, incorporating into themselves the lifelines of other organisms as they do so. Every organism is a site of infestation, a vast ecosystem in itself. (11)
Instead of thinking of evolution in terms of lineage, Ingold’s project is to emphasize the importance of “mutually conditioning relations”; interpenetration is just one possible modality of such relations, which shape the forms of beings that co-exist within the same environment.
These mutually conditioning relations together comprise what we can call an ontogenetic or developmental system. Forms of life, then, are, neither genetically nor culturally preconfigured but emerge as properties of dynamic self-organization of developmental systems. (8)
Against the idea of design, Ingold’s emphasis is on the interactions between beings; thus, human beings can be thought “in terms not of what they are but what they do” (8, original italics). Because “life is a task,” (it is also described as a “line of becoming”; see Deleuze and Guattari) it appears that “cultural forms arise within the weave of life, in conjoint activity” (8). That being the case, we must
think of evolution not as change along lines of descent but as the developmental unfolding of the entire matrix of relations within which forms of life (human and non-human) emerge and are held in place. And it requires us to think of these forms as neither genetically nor culturally configured but as emergent outcomes of the dynamic self-organization of developmental systems. [ii] (20)
Rather than integrating cultural phenomena into a classic evolutionist schema, the general theory of evolution defended by Ingold emphasizes the porousness of the boundaries between human and non-human, organism and environment when one takes an (eco)-systemic view, the only view by which one can legitimately claim that “the domain of the social and the biological are one and the same” (9, italics in original). Ingold can claim that, without discontinuity, the dynamics at work in the environment can also be observed in social activity because
The person…is not so much a creature of society as an active and ongoing creator of his or her own others’ selves. In the new language of relationality, the person-selves are seen as “mutually constitutive.” (13)
Gisli Palsson, in the concluding chapter, also considers the implications of non-Darwinian biology on the definition of anthropology and on methods of ethnographic inquiry. Though Palsson does cite Marx, his argument—which is less philosophical than Ingold’s—is based on taking certain advances in the natural sciences into account; in particular, “one of the most stunning discoveries of genomic studies”: “the ease with which genes may be routinely transferred between organisms of different kinds” (240). Here too, the demonstration aims to show that the standard evolutionist model reduces the complexity of the vital phenomenon and, consequently, of social constructions. By bringing in authors such as Lynn Margulis, a major contributor to endosymbiotic theory, and Dorion Sagan, Palsson emphasizes that the “zone of interpenetration” discussed by Ingold is not a metaphor, but an actual relationship between beings. It becomes increasingly difficult to speak of individuals when one knows that, from eukaryotic cells to the most complex organisms, the majority of life forms result from symbiotic association. This leads Palsson to state that “If humans are assemblies or aggregates of life forms, the outcomes of ensembles of biosocial relations, then they have not simply co-evolved with more-than-human microbes; human are microbes” (241, italics in original). Within such an epistemic configuration, the issue of the spatial/temporal scale of analysis becomes central. After a passage on the question of the Anthropocene (we are not far from the Gaia hypothesis, which Margulis also developed along with Lovelock), it becomes clear that humans are not only connected to nature at the level of the infinitely small: “nature, whether at the level of cells, organisms, ecosystems, or the planet, turns out to be just as ‘fleeting’ as society, undermining any attempt to separate the two analytical and theoretical domains in terms of different timescales” (237). If we add to this the ever-increasing evidence of the importance of epigenetic processes (which Palsson examines in chapter 2), we see how the conceptions of the living brought to light by contemporary developments in biology lead to rethinking the epistemological bases of anthropology:
The entanglements of life are both vertical and horizontal and, moreover, social as well as biological, however one defines these terms. In light of this, it seems that the perspective of biosocial becomings is one of the most promising avenues on the theoretical agenda. (233)
According to Palsson, the difficulty then becomes avoiding “disciplinary boundaries” (230 ff.) and the challenge is to develop “alternative theoretical languages” (238 ff.); Rabinow’s notion of “biosociality” and Harraway’s “natureculture” offer good examples of such alternative theoretical languages. In keeping with this, certain seemingly neutral concepts must be abandoned: “It is essential to go beyond anthropocentric terms such as ‘competition’ and ‘cooperation’ which have characterized neo-Darwinian theory in several fields” (232-3).
Once the bases of such an agenda have been established, one must specify the methodological principles by which ethnographic inquiry can construct and study objects located at the interface of nature and society. Taking off from the idea that “humans become human through relations with other becoming organisms and species and the environments within which they are embedded,” (244, italics in original), Palsson goes on to foreground the fertility of “multispecies ethnography” (Kirksey and Helmreich). The “anthropology of microbes” (Benezra, DeStephano, and Gordon), “the interconnected becoming of life in its more-than-human form,” and Eduardo Kohn’s project for an “anthropology of life”—re-baptized “anthropology beyond the human” —all make appearances here as ways to move beyond anthropomorphism and grasp the interactions between living beings within a holistic framework. Having said that, multispecies ethnography is far from being the only way of documenting “biosocial becomings,” as the diversity of the rest of the contributions brought together in this volume attests.
Eugenia Ramirez-Goicoechea (chapter 4) and Agustín Fuentes (chapter 3) both explore the epistemic implications[iii] of notions such as “niche construction” and “multiple inheritance”[iv] for biological anthropology in order to emphasize the importance of taking human activity into account in evolutionary processes. Ramirez-Goicoechea reminds us how advances in epigenetics have led to abandoning a kind of unilateral determinism that is sometimes expressed in discussions of genes: “Gene-centered biology and its related disciplines do not consider the organism (or any other unit) as a co-building agent of its surroundings but rather as a passive recipient of evolutionary forces” (69). In contrast, “the concept of niche construction captures this complex autopoietic process of action in evolution” (ibid.) and sheds new light on, for example, the socialization of children (71). Similarly, Agustín Fuentes writes : “in the new approach I am suggesting here, the static, evolved, endpoint drops away and the focus becomes on how we are evolving in the past and present” (46). Bipedalism, stress, pair bonds, and co-operation are mentioned as examples of phenomena that “biosocial becomings” may fruitfully analyze.
The editors of Biosocial Becomings, as well as the authors of the two chapters discussed above, state that their intentions are to integrate cultural phenomena into the biological study of human populations. However, it is my view that such a disciplinary rapprochement raises certain methodological and deontological problems. Although one cannot but agree in theory with the desire to bring together as many elements as possible in order to understand human phenomena in all their depth, one must not forget the intrusive and objectivizing aspects of biological data collection. How can an ethnographer using participant-observation gather information for understanding processes as complex as those explored by epigenetics? Saying that anthropologists should work in teams does not solve the problem—wouldn’t such a division of labor risk reintroducing the dualism that was supposed to have been left behind? Although the authors in Biosocial Becomings go to great pains to demonstrate the importance of epistemologically and ontologically integrating disciplinary fields and the concepts they produce, little indication is given of how anthropologists are actually to proceed. From one chapter to the next, not only does the ground covered change; most significantly, the place given to biological knowledge by the various authors does.
Within the field of medical anthropology, bridges between the disciplines were built long ago; the task was made easier by the fact that biomedical data and even bio-products (blood and DNA samples, for example) pre-exist anthropological inquiry, freeing the ethnologist from the responsibility of having to take samples him- or herself. This is the case in Aglaia Chatjouli’s chapter on the lives of people with thalassaemia, a monogenic disease requiring patients to undergo regular blood transfusions. Chatjouli’s fieldwork in blood transfusion centers allows her to construct an analysis around the “dynamic role of biosciences in reconfiguring (human) nature” (86). Taking inspiration from Ingold, she explains that she has tried “to illuminate thalassaemic lives in terms of persons-organisms living in an environment (88, italics in original). She emphasizes that a new definition of living beings emerges out of the chronic imbrication of vital and technological processes: “embodiment of transfusion [is] the most prominent and life-long act of biomedical mediation…[it] is paradigmatic of the naturalized biosocial making of the organism” (90). The biological dimension of human existence turns out to be irreducible to genetics and “intrinsically tied to human action, as a developmental and relational process, constantly in the making” (105).
From another point of view—in another “mode of veridiction,” Latour would say—anthropology can study the legal controversies raised by the eruption of new bio-materials into the social space. Here again, social scientists—like jurists—arrive after the battle, so to speak, and ethnologists are not required to themselves collect the data being debated. The goal is to bring out the ontological and political implications of the legal reasoning used to qualify objects that have never before existed in human history. Gisli Palsson discusses, for example, the debates that led a judge in the United States to invalidate patents on two human genes, BRCA1 and BRCA2, mutations of which have been associated with breast cancer (235). Noa Vaisman’s contribution to the volume (chapter 6) addresses this question by examining the implications of a decision by the Argentinian Supreme Court in a case involving identity tests on shed-DNA. During the military dictatorship of the 1970s, the children of hundreds of political opposition members were separated from their parents and then secretly given to other couples with new identity papers. In addition to the emotions this practice still stirs up, complex problems are raised when the judicial system seeks to restore these children’s identities and familial ties. In the case discussed by Vaisman, a (non-biological) family refused to allow a blood sample to be taken from their child Guillermo. When Guillermo reached adulthood, he too refused to have his blood tested—a good illustration of the resistance humans may use to oppose bio-sociological explorations of this kind. Ultimately, the Supreme Court decided to use Guillermo’s personal possessions to extract enough “biological material” to make a decision. Leaving the deontological problems raised by this intrusive sampling to the side, Vaisman investigates the ontological status given by the legal system to these materials, which “while belonging to his [the appellant’s] body, had been detached from it at the moment of confiscation” (110). Vaisman, who also draws on Ingold, proposes treating the human “as an assemblage of environment-organism-humans: a human whose boundaries are always open to the world and whose existence is enmeshed with its surroundings” (113). In this context, “‘shed’ DNA is in fact not shed at all but rather an extension of our body-self, which exists in and through our environment” (114). His study of the various conceptions of personhood that emerge out of the Court’s written decision leads him to conclude that “The Supreme Court’s ruling seems to oscillate between two visions of the subject: the subject as a product of genetic ties and the subject as a product of his or her social world” (116). This kind of decision will become increasingly frequent as human powers over living beings grow, and anthropology will find in these decisions material on the basis of which to trace how reconfiguring the status of persons deeply alters social organizations. This opens the door to new types of analysis, in which sociological explanations will have to incorporate biological data whose status (prescriptive, descriptive, agentive) will vary depending on how knowledge is constructed.
The question of how to bring the disciplines together is not the only one addressed by this book. Whereas the developments I have just been discussing rely on using biomedical data, this is not the case in other chapters, which use the concept of the “biosocial” to tackle the problematic of the living, with authors either situating themselves in the tradition of Ingoldian phenomenology or trying to highlight the specificity of certain non-Western ethno-theories of life.
The first tendency is exemplified by the chapter “‘Bringing Wood to Life’: Lines, Flows, and Materials in a Swazi Swanill,” by Vito Laterza, Bob Forrester, and Patience Mususa, which describes a sawmill in Swaziland. The authors turn to Ingold’s critiques of actor-network theory and the notion of agency to affirm the heuristic value of “meshwork” for observing interactions between beings and focusing on the flows that crisscross the world, rather than making dichotomous distinctions. By adopting such a perspective, it appears that
anything that might at first seem external to or separate from an organism, will, on a closer look, emerge as immanently related to the organism by some wayfaring line that meshes the apparently separate entities entwined through osmotic exchange and mutual sustenance. (167)
Several pages are dedicated to describing the working of the sawmill, in order to “sensitiz[e] the anthropologist’s—and the reader’s—perception to the flux and movement of real-life becomings” (189) by connecting the sawmill to the vast environment within which organisms and materials co-exist. I leave it to the reader to explore the path taken here, which is accompanied by photographs reproduced by the authors. Though this approach is not without intellectual charm, it raises the question of the contribution that non-Western ethnography can make to the knowledge of life. To the extent that there is, at the heart of Ingold’s project, an ontological thesis of what life is, we may wonder whether studying various human conceptions of life is still important. Isn’t there the risk that ethnographic data depicting emic understandings of life will end up playing second fiddle to a universal conception of vital élan, which ethnologists would then go about detecting in various environments?
Other chapters focus not on this phenomenological approach—within which “openness to the world” is never enough to guarantee against the risk of solipsism—but rather on the ethno-theories that classical methods of fieldwork bring to light; this is the case, for example, with Istvan Praet’s chapter, which returns to the central thesis of his work Animism and the Question of Life (2013). Basing himself on his ethnographic experience among the Chachi of Amazonia, Praet proposes interpreting animism not as an extensive manner of attributing life to a multitude of beings but, rather, as the tendency to create a restrictive understanding of this quality. The originality of Praet’s thesis is to bring ethno-theory into relation with the restrictive representations of humanity held by many different peoples. As Lévi-Strauss explained in Race and Culture, and as the table showing “the worldwide occurrence of restricted humanity” (196-8) demonstrates, it is common for groups to consider themselves the “true humans” and to exclude their neighbors from the sphere of humanity. Similarly, Praet’s subtle argument, which I will not try to trace here, shows that animist conceptions rest on principles of opposition that do not set the boundaries between living and dead at the same places as Western biology and cosmology.
This does not mean that reproducing the understandings of non-Western peoples always leads to accentuating their divergences from those of contemporary science. Palsson’s discussion of the usage of names in Arctic societies (Inuit, Yup’ik, Tsimshian) underscores possible convergences. He interprets the role of names as the manifestation of a conceptualization of heredity, but emphasizes that the resemblances highlighted are not based on essentialism. In the case of these groups,
their own form of epigenetics or developmental systems theory, in fact, moves beyond essentialism to relations and processes. Their notion of sociality and personhood evident in much of their name talk highlight the irrelevance of the idea of the autonomy of the “biological” as commonly understood. (36)
In short, one can say that these groups’ ethno-theory arrives by its own route at a type of formalization that does not conflict with the latest discoveries of Western science. When ethnographic studies seek to render ethno-theories, the goal is not to establish their possible correspondences or discordances with scientific theories, which are subject to paradigm changes. If we wish to truly access the movement of theorization at work in these ethno-theories, it is essential to deconstruct the concept of life. Palsson rightly emphasizes that anthropology, instead of mechanically repeating expressions that have over time become near-clichés (Rose’s “life itself,” Agamen’s “bare life”), must refine its analytical categories by studying “life as such” (Fassin), without forgetting Canguilhem’s distinction between “the living” and “the lived” (242-3). I would go further still, and suggest that “life” is not a unitary phenomenon, and that if we wish to be precise, we must specify which vital process we are referring to when we speak of life: reproduction, growth, regeneration, movement, or relation to the environment, to name but a few examples. Furthermore, it seems to me that anthropology must pay more attention to the distinction between the living (a multiplicity of processes that are manifested in a multiplicity of beings) and life, understood as a set of causes produces these processes. Numerous ethnographic facts prove that among Western and non-Western peoples alike, the theorization of life often consists in imagining life as a making; thus, I have proposed studying life within the framework of a “general pragmatics”[v]. The challenge then becomes to reflect on the various ways of conceptualizing this activity.
The data collected by Gaetano Mangiameli in the Kasena chiefdom of Paga, in Ghana, helps make this issue clear. Though Mangiameli’s analytic framework (expressed in terms of flux and “whirls of organisms” ) owes a great deal to the Ingoldian vision of the world, there are differences—and therefore complexities—that make clear the uniqueness of the Kasena’s relationship to the world. By foregrounding a pragmatic understanding of their sacred groves, he considers how the quality of agency is attributed to non-humans (“It is therefore necessary to assume that things must be described in terms of what they do, or in terms of how they are made and re-made, and furthermore, in terms of how they make themselves” (147). In this framework, accounts of the creation of the world—whether by autopoiesis or by the intervention of a demiurge—constitute interesting objects to examine as concretizations of local theories that explain the organization of the living through the intervention of non-human agents (151). Along the same lines, the description of altars (puru)—sorts of piles gradually fashioned by the inhabitants of a compound—illustrates how vital processes are represented: “In the same way as compounds can grow, decline, and sometimes disappear, the heap can grow or decline, depending on the intersection of atmospheric conditions and demographic trends in the compound” (153). Technical actions play a crucial role here since “the puru is built every day, slowly, through marginal acts. Basically, the puru is a heap made of waste: it is the place where, every morning, women pile up dust and rubbish after they finish sweeping” (153). Mangiameli concludes by saying that “The puru embodies the centrality of life-in-the-making in a West African philosophy of becoming (153-4).
The expression “life-in-the-making” certainly leaves room for ambiguity. Are we to understand that technical processes—a heterogeneous group of actions carried out by humans—help visualize vital processes, as if technical processes themselves consisted in a multitude of actions that modify living beings from within or without? Or, to the contrary, are we to follow Ingold’s interpretation, which sees making as a sort of growing, turning the technical gesture into an extension of the larger morphogenetic processes at work in the transformation of living beings? In my opinion, as I have stated elsewhere[vi], the fact that vital processes cannot be reduced to morphogenesis compels me to give more weight to the former option. It is my position that this explanation has the advantage of accounting for a greater multiplicity of processes and of the causes different peoples may assign to them. Instead of starting off from a universal conception of life as movement, it opens the investigation to the complexity of ethno-theories developed in order to render intelligible the complexity of life. Regardless of the status we decide to give to making and to technique, it is remarkable that, in spite of their diversity, nearly all the articles in Biosocial Becomings convey, more or less explicitly, the idea that the study of vital phenomena has an interest in privileging a pragmatics-inspired approach in order to map the configurations within which human and non-human agents interact, constitute themselves, establish mutual relations, are formed, etc. We may think here of Palsson’s remarks concerning the concept of “milieu” in Canguilhem: “The focus on milieu does not mean that the living organism has disappeared from sight, devoid of agency: on the contrary, the organism is the radiating center of pragmatic activity” (27). Similarly, in her chapter “Life-in-the-making: Epigenesis, Biocultural Environments and Human Becomings,” Eugenia Ramirez-Goicoechea emphasizes the importance of “action-in-relationnality” (70).[vii]
The originality of the positions defended by the editors of this work and the diversity of the fields explored by its contributors make Biosocial Becomings a crucial work for current debates in anthropology. The epistemological and methodological problems it raises will not fail to revitalize thinking around the nature/culture opposition and will contribute to the project of theoretical transformation currently underway in our discipline.
[i] On the basis of a similar ontological thesis and the same rejection of the notion of design Ingold develops an original approach to technical activity, seeing it as the continuation of the vital movement that gives form to artifacts. According to him, from the point of view of morphogensis, it is wrong to think of making and growing, artifact and organism as opposites.
[ii] “[Evolution] can only be understood topologically, as the unfolding of the entire tapestry—of the all-embracing matrix of relationships wherein the manifold forms of life that we call ‘cultural’ emerge and are held in place. Within this matrix, the becoming of every constituent both conditions and is conditioned by the becoming of other constituents to which it relates” (8).
[iii] “Epigenesis is key to the post genomic shift from genetic determinism to a focus on the interactional networks of stochastic genomic processes in environments of development. This shift is fundamental to a biopsycho-sociocultural approach to human becomings and to showing how life is in-the-making” (80, italics in original).
[iv] “Niche construction theory suggests that humans and their environments are mutually interactive participants in the evolutionary process through ecological inheritance. Multiple inheritance theory proposes that evolutionarily relevant inheritance can take place at genetic, epigenetic, behavioral and symbolic levels” (53). The analyses of “multiple inheritance” are based in particular on the works of Jablonka and Lamb published in Evolution in Four Dimensions (2006).
[v] Perig Pitrou, 2014. « Life as a process of making in the Mixe Highlands (Oaxaca, Mexico). Towards a ‘general pragmatics’ of life », Journal of the Royal Anthropological Institute (http://onlinelibrary.wiley.com/doi/10.1111/1467-9655.12143/abstract).
[vi] Perig Pitrou 2014, « La vie, un objet pour l’anthropologie ? Options méthodologiques et problèmes épistémologiques », L’Homme, 212.
[vii] Other quotations : “Cells under stress may mobilize systems that reshape their DNA by turning genes on and off (cf. Jablonka and Lamb 2005: 88)” (28); “According to the growing field of nutritional epigenetics, as Landecker points out (2011: 177), “food enters the body and never leaves it, because food transforms the organism’s being as much as the organism transforms it” (29-30); “Moss (2003) suggests such a pragmatic perspective to theorize life beyond codes and genes”; instead of genes, he emphasizes that “‘it is the living organism, as an active agent of its own adaptative ontogeny and evolvability, that is once again poised to move back into the ontological driver’s seat’ (Moss 2003: 198)” (32-3).
Perig Pitrou is a researcher in the Centre National de la Recherche Scientifique, Laboratoire d’Anthropologogie Sociale, Paris. He is the author of Le chemin et le champ. Sacrifice et parcours rituel chez les Mixe de Oaxaca (Mexique) and the co-editor of the book La noción de vida en Mesoamérica (CEMCA-UNAM, 2011). In 2013-14, he conducted the research programme ‘Of Living Beings and Artefacts: The Interrelation of Vital and Technical Processes’ (Fondation Fyssen). He is now Deputy Director of the interdisciplinary programme ‘Domestication and Fabrication of the Living’ (CNRS-PSL)
In June 2015 The Bellagio Task Force on Epidemics and Xenophobia met to discuss the resurgence of xenophobia across the globe—one most recently prompted by fearful and unsympathetic responses to the Ebola epidemic and those afflicted communities and healthcare workers who returned home. The problem of xenophobia is however part of a much larger and pernicious problem, one that falls most heavily on global migrants and stateless peoples. Thus, we ask for co-signers worldwide to support the following statement.
Statement on Epidemics and Xenophobia
Given the recent resurgence of xenophobia across the globe, and especially the increasing inability and unwillingness of governing bodies to assist the rising numbers of those in need, we the undersigned ask that decision-makers worldwide take concerted action to provide stateless peoples with human rights protection and to desist in treating them as potential bearers of disease.
We maintain that the current reticence of governments and citizens to acknowledge the tragic human rights needs of stateless peoples has been fuelled historically not only by ethnocentrism, but by the improper attribution of blame for infection and contagion—social and biological—to outsiders and foreigners. The connection between disease and xenophobia is deeply entrenched, making an underprivileged foreign location or population ground zero for every illness outbreak and related social ill.
The damaging connection of foreigners with danger and disease relies on false analogies based on biological and social models that promote racial apprehension and fear of the foreign. New images of border patrols wearing hygienic masks make clear that countries continue in the belief that the poor and desperate are carriers of cultural and biological infection, and that such people are profoundly threatening to citizens and national homelands.
Today the danger of equating others with the sources of contagion and disease is made worse by unexpected changes to natural and human environments that have ignited an unprecedented movement of economic and political refugees on a global scale. The dangers of migrating are also made worse by profiteering on the part of those paid to facilitate irregular migration and by profoundly undemocratic financial practices that limit resources governments have to help those in need. The loss of state revenues caused by the large-scale shift of financial capital offshore has given way to a commensurate lack of local and regional investment, and to the unwillingness of governments to support much needed assistance.
It is our firm belief that new forms of inequality and accumulation are largely responsible for the inability of governing bodies to meet their moral commitments—not only to stateless peoples, but to their own citizens. We the undersigned, therefore, believe it is time to draw upon new foreign relations models that guarantee basic human rights for all people on our planet.
The Bellagio Task Force on Epidemics and Xenophobia
1) David Napier, University College London
2) Christos Lynteris, University of Cambridge
3) David Nugent, Emory University
4) Paul Stoller, West Chester University
5) Samuel Cohn, Jr., University of Glasgow
6) Ruth Kutalek, Medical University of Vienna
7) Paul Kadetz, University of Oxford
8) Todd Meyers, Wayne State University
9) Adia Benton, Brown University
10) Michael Fischer, Massachusetts Institute of Technology
11) Rudolf Mrázek, University of Michigan
12) Carlo Caduff, King’s College London
13) George Marcus, University of California Irvine
14) Mary-Jo DelVecchio Good, Harvard University
15) Emily Martin, New York University
16) Linda Garro, University of California, Los Angeles
17) Ruth Mandel, University College London
18) Warwick Anderson, University of Sydney
19) Paul Clough, University of Malta
20) Nancy Scheper-Hughes, University of California, Berkeley
While conducting ethnographic fieldwork on indigenous political organizing in northwest Guatemala in the mid 2000s, I encountered, quite by accident, an apparent epidemic of Bell’s Palsy—an illness involving the paralysis of one half of the face, known locally as derrame facial (facial stroke) or parálisis facial. After conversing with sufferers, I began to wonder what their condition and the prevalence of cases might reveal about how marginalized Guatemalans experienced social life after decades of injustice and reactionary violence in the midst of a failing democratic transition.
US clinicians define Bell’s Palsy as a temporary paralysis of one side of the face caused by trauma to the seventh cranial nerve. Researchers in Minnesota found that the condition affected 20-30 in 100,000 people. Although there are few identified risk factors, pregnancy and advancing age are understood to play predisposing roles. Central to the dominant US medical model of facial paralysis is a bodily trauma that causes the cranial nerve to swell against the narrow and bony fallopian canal, affecting all functions associated with the seventh nerve: muscular movement of the neck, forehead, and face (including its expressions); secretions of the lower jaw; tear duct and salivary gland expression; taste; and outer ear sensation. Although the exact cause is often undiagnosed the types of injury commonly understood to produce Bell’s palsy include wounds, blunt force, broken bones in the face, injuries to the brain stem, tumors—specifically acoustic neuroma—and cysts, as well as infection and autoimmune disorders. The lower halves of the faces of those afflicted with Bell’s palsy are usually swollen and one side of their mouth droops down, as if they were smoking an invisible pipe. They have difficulty eating, closing their eyes and mouths, and controlling their facial expressions.
This purportedly universal biomedical description—“biomedical” in that it focuses exclusively on the bodily causes of disease, pathophysiology—belies its origins in specific studies with distinct populations, and erases a potentially heterogeneous set of “biomedical” practices and definitions. This fairly standard description has a wide circulation, and helps many clinicians—in and beyond North America—to identify cases and treatments. I interviewed a doctor in Huehuetenango who repeated this medical definition nearly verbatim. However, this authoritative description elides the experiences and meanings associated with derrame in the rural department of Huehuetenango where I worked. Most cases that I encountered corresponded with intense frustration and emotional trauma, although there were several cases that corresponded with unexpected and uncontained alegria (usually translated as joy or happiness).
I met one young indigenous man who had saved for two years in hopes of migrating to the US with his new bride. When her parents forbade her, their dreams vanished, and his face twisted out of control. His disfigurement covered with a yellow bandana, he explained how he had spent the money instead on a costly regimen of vitamin-B injections. An NGO worker told me that her aunt’s face paralyzed when she was robbed, having just withdrawn 20,000 quetzales (US$3000) from the bank. The value of a life’s work congealed in paper, gone in an instant. An activist friend recounted seeing similar cases among clandestine “communities of populations in resistance” (internally displaced) during the war, indigenous villagers who had fled violence and were living in extreme deprivation and fear, constantly moving through mountains and jungle to evade the army. Sometimes the torsion of expression lingered, and at times became permanent, which many attributed to a lack of treatment.
Facial paralysis befell my long-time friend who was defrauded by a bank. After working for three years in the US, he returned to Guatemala and placed his life savings into BANCAFE. In the early 2000s, the bank’s owners illegally deposited millions into offshore accounts, declared insolvency, and fled the country. Thousands of account holders organized rallies, demanding that the government take action, only to be told that their protests were in vain as it was too late to hold the bank accountable. To punctuate this point, the national police turned water cannons on protestors in Guatemala City. My friend was furious with the crooked bankers and their government accomplices, but couldn’t do anything. When his anger exploded into a brick wall of intransigence, derrame struck.
I began seeing cases everywhere, far more than the North American biomedical accounts might have predicted. When I dug deeper, I was referred to a pharmacy in a small town near the department capital that offered low cost home remedies for this peculiar condition: light electric shocks to the face from a metal wand wired to a hand crank magnetic generator housed in a metal box. The device was invented by a long-deceased doctor, a town founder and Rosicrucian mystic. This I was told by his aging granddaughters who treat a steady stream of cases for over a decade—7-10 each day. They charged 15 quetzales for a session that lasts about 15 minutes, far more affordable than the vitamin or steroid injections prescribed by local physicians. I watched them treat patients, who said that the shocks loosened their muscles and provided temporary relief. Some were cured after several visits. During the extreme counterinsurgency violence of the 1980s, the pharmacists remembered that cases of derrame more than tripled.
Sometimes emotional and bodily stress combined. One poor, middle- aged, disheveled single mother wrapped her head in a black shawl and avoided bright light. She explained that her derrame began when she was lying awake at night worrying about how to pay for her child’s education after his school announced they were raising tuition. Abandoned by her partner and caring for several children, she made a meager living selling tamales on buses, waking up before 5am to cook them, and carrying a heavy basket on her head all day in the hot sun, which gave her a terrible headache. Contrary to the North American understanding, where derrame strikes once and does not recur, this was her third derrame. She recounted a previous case caused by alegria, nineteen years ago, when she gave birth to her first daughter after having four sons. Another woman linked her derrame to susto (fright) and enojos (angers)—to use oversimplified translations—resulting from routine physical abuse by her husband upon whom she and her children were dependent. The pharmacists reported seeing more female than male patients due to domestic abuse and also, they believed, because of reactions to hormonal birth control injections. However, the medical cases were not always correlated to acute misfortune or unexpected happiness; several sufferers I interviewed claimed that there was no precipitating event, although they might not have wanted to reveal such personal or potentially embarrassing information to a gringo holding a camera.
Rather than see all cases as instances of a universal category: ‘Bell’s palsy’, I follow medical anthropologists who examine how meanings, categories, and emotions configure distinct illness experiences, which are further shaped by social, historical, and political contexts. I am also interested in bodily intensities and nervous systems, in the plural, as historical and social artifacts. What might these cases of derrame reveal about how Guatemalan social and political realities congeal in living bodies and affective imaginaries? How does bodily affect blur the line between individual experience and social worlds? I found one clue in that almost everyone I spoke with narrated their derrame as a result of their being forced to tragar (swallow) intense and generally negative emotions that could not find an outlet or satisfaction. This metaphor of ingestion and forcible envelopment dramatizes the interminable labor of absorbing pain and frustration into the body and speaks to the existence of some kind of habitual disposition of defensive girding associated with this process. Derrame only means stroke in the limited context of a brain hemorrhage. It also means to spill out and over: experiences of structural violence that cannot be absorbed or somaticized spills over onto the face, or perhaps in the cases precipitated by alegria, a breaching of the habits and orientations through which subjects shield themselves from the expected harshness of everyday life.
It seemed to me that these sufferers share engrained dispositions and sedimented responses to frustration with endemic poverty, violence, crime, and other forms of victimization and injustice that are systematically and disproportionately inflicted on poor, indigenous, and female bodies in Guatemala in the course of normally extant social relations. The high incidence of derrame was the tip of an iceberg of social suffering; it rendered legible the extent to which violence assaults lives and social worlds in the low hum of the ordinary.
I see in the lived situations surrounding most cases of derrame a distinctive pattern where people struggle against hardship and injustice that they ultimately have to endure and swallow. For those whose derrame was related to euphoria, derrame might be incited by an intense rush of feeling unleashed by the temporary lowering of a rigid barrier routinely held up as protection against expected misfortune and abjection—the “swallowing mechanism”. It is hard to say more without careful and extended observation. But it is hard not to draw parallels to Guatemalan history. In 1954, a CIA-sponsored coup upended a decade-long experiment with democracy driven by peasant hunger for land. Military dictatorship set the stage for the revolution, a spillover of political desire. A vicious counterinsurgency inflicted unspeakable cruelty to vanquish the guerrilla and hope itself. But desire for change persisted, and inspired the 1996 peace accords, which promised more than they delivered. Neoliberal democracy partially accommodates political challenges, even embracing human and indigenous rights, but leaves structural victimization intact and inflicts new injuries.
The experiences of individual sufferers are always in some respect irreducible, but sufferers can also be read as cases to reveal distinctive patterns of embodiment fashioned by the heterogeneous, unbounded, and imbalanced social “nervous systems” of which they form part. The ethnographic challenge is to ponder the distinctive experiences and meanings of alegria, susto, and nervios, which do not translate neatly into the Western conceptions “happiness”, “fright”, or “nerves”, and to understand them as cultural and historical products, distinctive ways of being in the world. I read the similarities between these cases of derrame to index the limits of some Guatemalan’s ability to effectively swallow injustice, exposure, and victimization. I view the epidemic of derrame as a trace of structural violence on the most visible, personal, and emotionally inscribed bodily surface, the face—a jarring sign of the acute frustration that is an ordinary affect in contemporary Guatemala and much of the postcolonial world.
Nicholas Copeland is a cultural anthropologist and assistant professor of American Indian Studies at Virginia Tech. His research in Guatemala examines transformations in Mayan political imaginaries through experiences with revolution, counterinsurgency, development, and neoliberal multicultural democracy.
 Clinicians typically distinguish facial paralysis caused by damage to the central and peripheral nervous systems, the latter being Bell’s Palsy.
 Hauser WA, Karnes WE, Annis J, Kurland LT. Incidence and prognosis of Bell’s palsy in the population of Rochester, Minnesota. Mayo Clin Proc 1971;46:258-64
 Hahn, Robert and Arthur Kleinman. 1983. Biomedical Practice and Anthropological Theory: Frameworks and Directions. Annual Review of Anthropology. 305-333
 Taussig, Michael. 1992. The Nervous System. New York: Routledge.
Here’s comes the second round of what you’ll find ‘In the Journals’ from July. For the Special Issue on HIV Criminalisation and Public Health in the latest edition of Critical Public Health, see this week’s earlier post.
To start us off, the latest issue of Medical Anthropology focuses on ‘exploring bodies in Southern and East Africa.’ In their editorial, Emilie Venables and Lenore Manderson introduce articles that ‘examine how an analytical lens of corporeality can offer new ways to examine and understand linkages and dissonances between migration, violence, and health in the lives of people across the Southern and Eastern African region’.
Elsa Oliveira & Jo Vearey
Many migrants in inner-city Johannesburg survive through unconventional and sometimes criminalized livelihood activities. In this article, we draw on data from a study that applied a participatory visual methodology to work with migrant women who sell sex, and explored the suitability of this approach as a way to engage with a presumed ‘hard to reach’ urban population. The lived experiences of migrant women sex workers were documented by combining participatory visual methods with a more traditional ethnographic approach, and this approach led us to new ways of seeing their worlds. This methodological approach raises important considerations for working with marginalized and criminalized urban groups.
Godfrey Maringira & Lorena Núñez Carrasco
Through military training, soldiers’ bodies are shaped and prepared for war and military-related duties. In the context these former Zimbabwean soldiers find themselves—that of desertion and ‘underground life’ in exile in South Africa—their military-trained bodies and military skills are their only resource. In this article, we explore the ways in which former soldiers maintain and ‘reuse’ their military-trained bodies in South Africa for survival, in a context of high unemployment and a violent, inner-city environment. We look at their social world and practices of soldiering—a term that refers to the specific forms of their social interaction in exile, through which they keep their memories of their military past alive. By attending to their subjectivities and the endurance of their masculine military identities and bodies, we aim to contribute to the discussion on demilitarization, which has largely focused on the failure of models of intervention to assist ex-combatants in postconflict contexts.
In this article, I analyze the role of bodily capital in the daily policing practices of armed response officers, a specific type of private security officers, in Durban, South Africa. Based on 20 months of ethnographic fieldwork, I argue that the masculinized bodily capital of armed response officers is a key source of their sovereign power; it plays a central role in how they acquire and exert authority. Furthermore, I argue that an analysis of bodily capital should not solely analyze the actual flesh of the body, but must include particular equipment (such as bulletproof vests and firearms) that is experienced as a part of the body.
Southern African traditional healers often generalize too broadly from discrete (‘accidental’) instances of success, partly to recruit a clientele, while biomedicine frequently reasons incorrectly from the general to the specific. Both logics are based on empirical observations, but are inversions of each other; these I characterize as ‘magical empiricism.’ ‘Magic’ functions as a metapragmatic discourse to recruit a clientele from a skeptical public that doubts the efficacy of any therapeutic interventions, and it acts in parallel with other practical (and efficacious) healing acts. I introduce the concept of ‘exposed beings’ to describe locally specific constructions of the person as patient and healer. This helps to explain the existence and enduring appeal of many different medical practices and beliefs in South Africa, but I suggest that ‘medical parallelism’ rather than ‘pluralism’ might be more accurate.
Zaheera Jinnah & Lucy Lowe
Female circumcision among Somalis is a deeply personal and subjective practice, framed within traditional norms and cultural practices, but negotiated within contemporary realities to produce a set of processes and practices that are nuanced, differentiated, and undergoing change. Based on ethnographic research among Somali women in Johannesburg and Nairobi, we argue that the context of forced migration provides women with opportunities to renegotiate and reinvent what female circumcision means to them. The complex, subjective, and diverse perceptions and experiences of circumcision as embedded processes, within the context of migration, we argue has been overlooked in the literature, which has tended to be framed within a normative discourse concerned with the medical effects of the practice, or in anthropological studies, counter to the normative discourse based on personal narratives.
In this paper, I demonstrate how autoethnography can be utilized as a methodology to conduct public health research. My argument is structured around an application of Jacques Lacan’s psychoanalytic theory which I see as supporting and extending a critical understanding of the so-called obesity epidemic and related issues. I argue that the body mass index (BMI) measure has achieved an unconscious position as a ‘Sovereign Good’ and, as such, provides the moral and ethical mechanism through which state-sanctioned science, via the wider weight-loss industry, prescribes people into a state of weight anxiety. I conclude that public health practitioners who find themselves promoting weight loss towards the ‘healthy’ range of the BMI are in an unethical position, one that should be entirely rejected. Instead I point to the ethics of desire as an alternative position that might help public health practitioners who are interested in actually improving public health.
Cameron Duff & David Moore
While much has been made of the governmentality evinced in drug policy, its effects on people who use drugs have received less attention. Scholars who have investigated these effects commonly focus on the views and experiences of individuals receiving treatment for their drug use, often reporting an explicit desire among individuals in treatment for a return to a normal, healthy life. Many authors trace this desire to the normalisation inherent in drug policy, and the governmentality involved in the delivery of drug treatment more directly. This article adds to these discussions by shifting focus from the experience of individuals in treatment to those out of treatment settings. In so doing, we aim to develop a more nuanced understanding of how heavy drug users negotiate power, governmentality and the modulations of health and illness in the course of everyday life. We ground our discussion in qualitative research conducted in Melbourne, Australia, with 31 current methamphetamine consumers. We argue that regular methamphetamine consumption involves a complex and ambivalent relationship with the ideas of health and normal life, imposing as well as reflecting a form of estrangement between its consumers and mainstream (or normal) society. This ambivalence has important implications for the delivery of health and social services among methamphetamine consumers, insofar as the restoration of normal health and the reintegration of former drug users into mainstream society are typical health service goals. We address some of these policy implications by way of conclusion.
Kay Aranda and Angie Hart
Recent public health policies have re-endorsed the key role all health and social care professionals have in tackling the social determinants of health inequalities. With inequalities firmly entrenched, and much theorising focused on reproduction rather than transformation, sustaining practitioner commitment and engagement with this work and maintaining confidence in achieving change is challenging. One increasingly popular way to intervene in practice to begin to address inequalities has been the use of resilience, even though resilience is frequently critiqued for its collusion with neoliberal imperatives in favouring individualised rather than socio-political responses. This article examines these concerns through the use of the practice turn and specifically ‘slim-line’ practice theory and ‘tinkering’ to explore the potential for reframing resilience theory and practice. Using an original data set derived from evaluations of resilience-based programmes, held with parents and practitioners between 2008 and 2012, this article re-examines participants’ understandings of resilience. We show how practice theory reveals entangled and emergent meanings, competencies and materials that constitute resilience as a social practice comprised of resilient moves. The implications of this reframing are discussed in relation to ontology, agency and change; but also for resilience theory and practice and public health practices more generally. In conclusion, we argue practice theory’s attention to context as more than mere backdrop to action helps shift inequality theorising beyond the individual and reproduction towards deeper, detailed social understandings of transformation and change.
Noémia Lopes, Telmo Clamote, Elsa Pegado, and Carla Rodrigues
This article analyses performance consumptions among young people. The theme is explored along two main axes. The first concerns the social heterogeneity in this field, considered on two levels: the different purposes for those investments – cognitive/mental and physical performance; and the different social contexts – university and work – where performance practices and dispositions may be fostered. The second axis explores the roles of pharmacological and natural consumptions, and their interrelationship, in the dissemination of these practices. The empirical data for this analysis were drawn from an ongoing research project on performance consumptions among young people (aged 18−29 years) in Portugal, including both university students and young workers without university education. The results correspond to the stage of extensive research, for which a questionnaire was organised at a national level, using non-proportional quota sampling. On the one hand, they show that (a) there is a hierarchy of acceptance of consumptions according to their purposes, with cognitive/mental performance showing higher acceptance and (b) both pharmaceuticals and natural products are consumed for every type of performance investment. On the other, the comparison between students and workers introduces a certain heterogeneity in this general backdrop, both in terms of the purposes for their consumptions and their opting for natural or pharmacological resources. These threads of heterogeneity will prompt a discussion of the dynamics of pharmaceuticalisation within the field of performance, in particular how therapeutic cultures may be changing in terms of the way individuals relate to medications, expanding their uses in social life.
Yorghos Apostolopoulos, Sevil Sönmez, Michael Kenneth Lemke, and Richard B. Rothenberg
This article illustrates how urban inner-city trucking milieux may influence STI/BBI/HIV acquisition and transmission risks for U.S. long-haul truckers, as well as their social and risk relationships. Using mixed methods, we collected ethnoepidemiological and biological data from long-haul truck drivers and their risk contacts in inner-city trucking milieux in Atlanta, Georgia, United States. Key findings indicate that within the risk-endemic environment of distressed inner-city areas, diverse trucking risk milieux can amplify STI/BBI/HIV risk for multiplex networks of truckers. Inner-city neighborhood location, short geographic distance among risk contacts, and trucker concurrency can potentially exacerbate transmission via bridging higher-risk individuals with lower-risk populations at disparate geographic and epidemiological locations.
Yanqing Xu and Fahui Wang
Based on the data from the Behavioral Risk Factor Surveillance System 2012, this study examines the association of neighborhood built environments with individual physical inactivity and obesity in the U.S. Multilevel modeling is used to control for the effects of individual socio-demographic characteristics. Neighborhood variables include built environment, poverty level and urbanicity at the county level. Among the built environment variables, a poorer street connectivity and a more prominent presence of fast-food restaurants are associated with a higher obesity risk (especially for areas of certain urbanicity levels). Analysis of data subsets divided by areas of different urbanicity levels and by gender reveals the variability of effects of independent variables, more so for the neighborhood variables than individual variables. This implies that some obesity risk factors are geographically specific and vary between men and women. The results lend support to the role of built environment in influencing people׳s health behavior and outcome, and promote public policies that need to be geographically adaptable and sensitive to the diversity of demographic groups.
Anna Toma, Mark Hamer and Aparna Shankar
This study examined whether perceived neighborhood factors were associated with positive well-being in older adults using data from the English Longitudinal Study of Ageing. Neighborhood perceptions were assessed at baseline (2006/2007) and three measures of well-being – hedonic, eudaimonic and evaluative – were assessed at baseline and follow-up (2010/2011) for 6134 participants. In cross-sectional and longitudinal analyses, negative neighborhood perceptions were associated with poorer well-being on all three measures. These associations remained significant after adjusting for a range of sociodemographic and health status variables and depressive symptoms.
Julie Brimblecombe, Christel van den Boogaard, Beverley Wood, Selma C Liberato, Jacqui Brown, Adam Barnes, Alison Rogers, John Coveney, Jan Ritchie, and Ross Bailie
Few frameworks exist to assist food system planning, especially for Indigenous Australian remote communities. We developed a Good Food Planning Tool to support stakeholders to collectively plan and take action for local food system improvement. Development occurred over a four-year period through an evolving four phase participatory process that included literature review, several meetings with representatives of various organisations and communities and application of the Tool with multi-sector groups in each of four Indigenous Australian remote communities. A diverse range of 148 stakeholders, 78 of whom were Indigenous, had input to its development. Five food system domains: (i) Leadership and partnerships; (ii) Traditional food and local food production; (iii) Food businesses; (iv) Buildings, public places and transport; (v) Community and services and 28 activity areas form the framework of the Tool. The Good Food Planning Tool provides a useful framework to facilitate collective appraisal of the food system and to identify opportunities for food system improvement in Indigenous Australian remote communities, with potential for adaptation for wider application.
Shawn Renee Hordyk, Jill Hanley and Eric Richard
In this article, we draw on a 2012 Montreal-based study that examined the embodied, every day practices of immigrant children and families in the context of urban greenspaces such as parks, fields, backyards, streetscapes, gardens, forests and rivers. Results suggest that activities in the natural environment serve as a protective factor in the health and well-being of this population, providing emotional and physical nourishment in the face of adversity. Using the Social Determinants of Health model adopted by the World Health Organization (WHO, 1998), we analyze how participants accessed urban nature to minimize the effects of inadequate housing, to strengthen social cohesion and reduce emotional stress. We conclude with a discussion supporting the inclusion of the natural environment in the Social Determinants of Health Model.
Julia McQuoid, Jennifer Welsh, Lyndall Strazdins, Amy L. Griffin, and Cathy Banwell
The upward trend of chronic illness in working age populations calls for better understanding of the difficulties chronically ill people face with workforce participation. Existing research focuses primarily on physical limitations and employer attitudes about chronic illness. Here we use a space-time approach to illuminate the importance of negotiating logistical challenges and embodied rhythms when balancing work and chronic illness. We draw from time geography and rhythmanalysis in analysing interviews from a qualitative case study of 26 individuals living with chronic kidney disease in Australia. Difficulties with paid work arise from: (1) competition for space-time resources by employers and health services; (2) arrhythmias between the body, work and health services; and (3) the absence of workplace rhythms on which to ‘hook’ health activities. Implications for workplaces and health services design are discussed.
Andrea Capstick and Katherine Ludwin
A participatory film-making study carried out in long-term social care with 10 people with Alzheimer-type dementia found that places the participants had known early in life were spontaneously foregrounded. Participants’ memories of such places were well-preserved, particularly when photo-elicitation techniques, using visual images as prompts, were employed. Consistent with previous work on the ‘reminiscence bump’ in dementia, the foregrounded memories belonged in all cases to the period of life between approximately 5 and 30 years. Frequently the remembered places were connected with major life events which continued to have a strong emotional component. The continuing significance of place in the context of long-term dementia care is considered from a psychogeographical perspective.
Marcie Snyder and Kathi Wilson
Urban Indigenous peoples face a disproportionate burden of ill health compared to non-Indigenous populations, and experience more frequent geographic mobility. However, most of what is known about Indigenous health is limited to rural, northern, or in the case of Canada, reserve-based populations. Little is known about the complexities of urban Indigenous health, and the differential impacts of residential mobility and urban migration remain poorly understood. Drawing upon interviews with Aboriginal movers and service providers in Winnipeg, Canada, we apply a critical population health lens, informed by holistic health, to examine these impacts. The results demonstrate mobility is an intergenerational phenomenon, influenced by colonial practices. While migration can contribute to positive health experiences, residential mobility, which is largely involuntary, and linked to stressors such as neighborhood safety, results in negative health effects.
Lee Thompson and Susan Bidwell
Community pharmacies have a complex relationship with the field of health care. This is especially so in countries where pharmaceuticals are dispensed from privately owned retail premises. Using qualitative data and social theoretical concepts, we argue that the time, space and emotional entanglements that take place in and through these sites are far from simple and can be more or less productive in terms of meeting customer needs and fostering professional identity for pharmacists. Unpicking this complexity has the potential to highlight lacunae that result from differential expectations.
Sara Glasgow and Ted Schrecker
The growing prevalence of NCDs in low- and middle-income countries (LMICs) is now recognized as one of the major global health policy issues of the early 21st century. Current official approaches reflect ambivalence about how health policy should approach the social determinants of health identified by the WHO Commission on the topic that released its report in 2008, and in particular the role of macro-scale economic and social processes. Authoritative framing of options for NCD prevention in advance of the September, 2011 UN high-level meeting on NCDs arguably relied on a selective reading of the scientific (including social scientific) evidence, and foregrounded a limited number of risk factors defined in terms of individual behavior: tobacco use, unhealthy diet, alcohol (ab)use and physical inactivity. The effect was to reproduce at a transnational level the individualization of responsibility for health that characterizes most health promotion initiatives in high-income countries, ignoring both the limited control that many people have over their exposure to these risk factors and the contribution of macro-scale processes like trade liberalization and the marketing activities of transnational corporations to the global burden of NCDs. An alternative perspective focuses on “the inequitable distribution of power, money, and resources” described by the WHO Commission, and the ways in which policies that address those inequities can avoid unintentional incorporation of neoliberal constructions of risk and responsibility.
Carolyn J. Dean
This essay explores assumptions that underpin discourses on atrocity photographs, including the idea that images objectify photographed subjects or traumatize viewers. The essay analyzes the unexamined ideas that construct these assumptions, in particular the affective investment in the concept of human dignity as an image of invulnerability. Arguments about atrocity photographs pit important if recent concepts of photography’s ostensibly transformative if vexed political function to “bear witness” against an aversion to the display of violated human dignity whose sources are psychic and cultural.
Jeremy Adelman, Michele Alacevich, Victoria de Grazia, Ira Katznelson and Nadia Urbinati
Albert O. Hirschman (1915–2012) is recognized as one of the most well-rounded and interdisciplinary social scientists of the postwar era. After fleeing Germany as a young opponent of the Nazi regime, he moved across countries, languages, and disciplinary boundaries. He was a pioneer of development economics and other social sciences, to which he contributed with exemplary analyses of the processes and mechanisms of political, economic, and social change. Following Hirschman’s own interdisciplinary approach, Nadia Urbinati, Ira Katznelson, Victoria De Grazia, Jeremy Adelman, and Michele Alacevich will explore the milestones of his incredibly rich intellectual journey.
These pages, excerpted from Gregory Mann’s From Empires to NGOs in the West African Sahel: the Road to Nongovernmentality, offer a succinct overview of its key points. Mann asks how it is that in the years following independence from French colonial rule, in a period when state sovereignty was highly valued, international NGOs took on some of the functions of government in the West African Sahel. He sketches the rise of ambitious and aggressive African governments, the effects of drought and famine, and the emergence of Human Rights campaigns that built on older anti-colonial and labor movements.
Records of drone flights during the Cold War include photographs, engineering documents, commercial pamphlets, and newspaper articles. This series of images photographed pieces of documentation and re-created scenes to consider the anachronism of Cold War target drones in the midst of contemporary “unmanned” warfare. The five triptychs and accompanying essay ask how drone technologies, and the humans who produce and operate them, map onto visible and invisible domestic and international spaces and with what consequences? The pieces underscore the persistence of secrecy and the interplay between soldier, enemy and target, even as the images undo current notions of drone aircraft.
Raising questions about how vulnerable “others” are represented in our mediated culture, and whether such a spectacle of suffering has the power to move us to action, the essay investigates what kinds of aesthetic, ethical, and political challenges are connected with the mediatization of humanitarian space in the neoliberal age. Focusing on the communication techniques used to generate empathy between the spectator and the suffering subject, the paper moves from Lilie Chouliaraki’s The Ironic Spectator: Solidarity in the Age of Post-Humanitarianism and Susie Linfield’s The Cruel Radiance: Photography and Political Violence to explore the complex relationship between the visual media, the needs of victims, and public attention, and unveils the many paradoxes intrinsic to the link between contemporary politics of humanitarianism and the government of human beings.
During the interwar years, 1919–1939, State Department of Health (DOH) laboratories from around the United States provided scientific leadership and dedicated bench work to support the development of standardized laboratory technique. One important focus of the work was syphilis testing. In recent years, historians have explored the heated arguments and international debates surrounding the development of standardized methods. This article adds State Departments of Health to the venues in which scientists performed valuable research aimed at standardizing and improving analytic procedures. I argue that the research conducted in DOH laboratories to provide Progressive Era public health officials with accurate and efficient tools to control syphilis and other infectious diseases required significant innovation, international cooperation, and scientific creativity from scientists deeply engaged in multiple research projects. These endeavors offer an instructive venue for historians to begin to re-envision DOH laboratories as vibrant sites for scientific research, where work on standard methods was an enterprise of discovery and innovation.
Karen D. Ross
In 1923, Thomas Barbour of Harvard announced the creation of a national lay organization, the Society of Friends of Medical Progress (FMP), to defend animal research in the United States against a resurgent antivivisection movement. After decades of successful behind-the-scenes lobbying and avoiding the public spotlight, medical scientists significantly altered their tactics and sought public engagement, at least by proxy. Although the authority of scientific medicine was rising, women’s suffrage, the advent of the ballot initiative, and a growing alliance of antivivisectionists and other groups in opposition to allopathic medicine so altered the political landscape that medical scientists reconsidered formerly rejected ideas such partnering with laymen. Medical scientists, Walter B. Cannon and Simon Flexner chief among them, hoped that the FMP would relieve the scientists of a time-consuming burden and defend against government regulation of medical institutions without the charge of material self-interest. However, financial problems and the frequent conflicts that arose between the lay leadership and Flexner eventually undermined the FMP’s value as a defender of animal experimentation and reveal the distrust of reformers like Flexner who did not believe that laymen could speak for scientific medicine.
The period 1961–76 was one of marked contestation in Britain about how organs should be obtained from recently deceased people’s bodies to transplant into ailing strangers. Most were being removed from hospital patients’ corpses without these people’s prior consent, under a law that enabled hospital authorities to so authorize the use of a body with one caveat: enquiries should first be made to learn whether the dead person had in life objected to this or whether a family member did. Transplant surgeons argued that this requirement severely hampered their enterprise. They pushed for the 1961 Human Tissue Act to be overturned, to enable them to presume that all patients in British hospitals had consented to their organs being removed when they died, with no requirement that relatives’ views be sought first. As a contemporary ethicist noted, this savored more of “conscription than of voluntary service” in the cause.1 The following essay, based on an examination of archival sources, reveals the historical complexity of arguments that continue to be made in favor of presumed consent to organ “donation,” analyzing how early attempts to change the law in that direction failed while revealing the presence of different interests and values in this contest over corpses.
The capacity of individuals to imagine another’s perspective or personal agenda, and our own ability to feel anger, despondency or frustration in response to their pain and distress, has been singled out as something to consider in multiple stories and studies found on the web this month. Is empathy a choice, or something less conscious? Is it always a good thing, or do some situations challenge our empathetic nature? This month’s roundup highlights pieces found around the web in which this question is tackled.
Empathy is normally thought of as being a positive quality to have, however a few stories this month challenge that assumption. The notion of empathy as an unfashionable political emotion is the subject of an article examining recent government policies surrounding cuts to benefits for destitute asylum seekers in the UK, which the article argues ignores the human cost in favor of perpetuating a particular ideology and fiscal responsibilities before the individual lives affected by these policies. This sentiment rings true when thinking about the rise in inequality and its threat to empathy as well, where the less interaction one has with someone unlike themselves, the less empathy one tends to have for them. This is the focus of a piece focusing on the link between empathy and trust, and the need for empathy to ensure the smooth running of a society. The article suggests that the less trust and empathy among a citizenry, the more measures such as policing, regulation and other external enforcements are relied upon. Such propositions highlight a well-researched effect of empathy, in which individuals feel more empathetic to those similar to themselves, thus exacerbating already existing social inequalities. It is this tendency, to use one oft cited example, to view one death as a tragedy and one million as a statistic, which is the focus of an article in the Atlantic highlighting recent research proposing that to be an empathic person doesn’t actually make one a better person. The New York Times conducted a review of recent studies that back up this claim that empathy is actually a choice, and is constrained when it comes to individuals of different races, nationalities or creeds. Citing several recent studies, the article concludes that empathy is in fact a limited resource that cannot be applied to everyone for indefinite periods of time and can sometimes fail when it is most needed.
Recent research from Northwestern University into why some people have more empathy than others suggests that those who have suffered are often times the least compassionate, indicating that those who have gone through difficult experiences tend to be harsher critics of those who are having a hard time themselves. They conclude that a sense of not remembering the difficulty of their own struggles, and viewing them through a lens of having overcome it on their own makes them less charitable in their outlook. The researchers suggest that walking in another’s shoes is sometimes not enough to truly understand another’s struggle.
On a more positive note, novel approaches to addressing this potential inability to truly understand another’s experience is the focus of research from two sources: A Los Angeles based news site called Ryot, and the Virtual Human Interaction lab at Stanford University which were both included in a recent story on NPR. The piece highlighted research in which film and virtual reality are used as a way to change how people feel about certain situations, suggesting that to experience an event as opposed to watching it will create more of a sense of empathy.
Several pieces addressed the need for increased empathy in a world that feels increasingly disconnected, with many looking at empathy as a skill that can be learned, as opposed to a fixed personality trait. The BBC magazine published an article suggesting you can in fact teach empathy by first examining your own empathic tendencies, and following up with making a habit of ‘radical listening’, developing an awareness of the individuals we come into contact with in the day-to-day living of our lives, and as an extension of this, developing and maintaining a curiosity about strangers. Similarly, another story also uses curiosity and listening as a necessary starting point for teaching oneself to become more empathetic.
Finally, putting empathy into practice is the topic of another article focusing on empathy as a necessity in violent environments such as Afghanistan. The piece notes that the Afghan government has made mental healthcare a priority over the last few years in order to make care more affordable and reduce stigma, and is behind an international psychosocial organization training therapists across the country. As a result, local clinics are employing community residents to act as psychosocial counselors to use empathy as a means to help others living amidst abuse, poverty and addiction, using their own position and experience as a means to help others survive psychologically. The increasing need and effectiveness of empathy is also to focus of a story on the importance of teaching empathy to children, the idea being that empathy is the building block for our conscience. The article argues that a lack of conscience is often the trait that history has shown leads to horrific acts including slavery, genocide, rape and murder. Perhaps the founders of an empathy museum (the subject of a recent article in Independent) set to open in the UK later in 2015 are on to something, as in considering how coming into contact with people you might not otherwise meet in your daily life can have a powerful effect on how you approach understanding the position of others on a deeper level.
In her superb exposition of staring, Garland-Thomson (2009) draws attention to Chris Rush’s artistic piece Swim 2 which depicts a woman with Down’s syndrome in a regal pose (figure 1).
The portrait invites us to stare, engrossed perhaps less with the “strangeness” of this woman’s disability and more with the strangeness of witnessing such dignity in a face that marks a life we have learned to imagine as unliveable and unworthy, as the kind of person we routinely detect in advance through medical technology and eliminate from our human community (2009: 83).
Garland-Thomson appears to mark two separate ‘orientations’ (Friedner 2015): one in which Down’s syndrome is afforded a positive social imaginary marked by dignity and worth, and another in which this condition is categorised as an existence without value. Likewise, I see two different and competing ways of enacting Down’s syndrome, that is, as both a negative pregnancy outcome (via prenatal technology) and as joyous and enlightening, and not the misfortune one may initially imagine on receipt of a diagnosis (via parental accounts). I explore these contentions below.
Prenatal Technology: A Troubled Relationship
Down’s syndrome is one of the most common genetic conditions in the world, affecting approximately one to two of every 1,000 live births in England and Wales alone (based on NHS statistics). People with Down’s syndrome are likely to have several symptoms such as learning difficulties, shortened limbs, reduced muscle tone, restricted growth, and a flat facial profile. However, it is by no means a simple or straightforward diagnostic category. Down’s syndrome is often identified in medical discourse as ‘compatible with life’ which translates to people being likely to survive childbirth, although symptoms and prognosis vary considerably in each case. Indeed, its main attribute is the irregularity of its manifestation. Nonetheless, owing to medical advances and an increased knowledge of treatment and care, people with Down’s syndrome can live beyond sixty years.
Down’s syndrome holds a central position in the politics of reproduction within the UK national healthcare system (among others). In my ethnographic study of prenatal screening, I explore how Down’s syndrome is constructed in everyday encounters in the clinic and how both professionals and patients make sense and meaning in their worlds.
In my research, I found, among other things, that a discussion of Down’s syndrome is avoided in prenatal screening consultations. This relative silence is upheld owing to three things: i) the UK public, as a collective group, is construed as knowing what Down’s syndrome is; ii) the everyday organisation of care dictates that a full, or even short, discussion of the condition is difficult and unviable in time-restricted encounters, and; iii) professionals commonly admit to having minimal knowledge of Down’s syndrome, thus highlighting certain healthcare training needs. This absence is supplemented by negative discourses embedded throughout prenatal care categorising the condition as a ‘risk’ or ‘problem’. This plays a crucial role in (re)producing its status as a negative pregnancy outcome. To illustrate this point further, I provide an extract from a consultation that I observed between a midwife and a patient/expectant mother:
Midwife: So the test has changed slightly since your last pregnancy.
Midwife: We check four hormones in the blood now so we use the quadruple test rather than the triple test which you had before. It has a 70% detection rate and, as you know, it tells you whether you’re a high-risk or low-risk. If you’re low-risk, we do nothing else but that doesn’t mean the baby has no chance of having Down’s syndrome.
Midwife: If you’re high-risk, we call you within five working days of the result and we offer you an appointment to discuss your options within twenty-four hours. We offer an amnio[centesis] which tests the fluid around the baby and can say for sure whether your baby has Down’s syndrome or any other problems. But it does have a miscarriage rate of 1%. So would you like to have the initial testing?
Midwife: OK. […] The cut-off is 150 or 151. If it’s anything less than that, it’s a low-risk so 1 in 151 and lower than that and we will let you know what your risk factor is. And so a high-risk would be something like 1 in 145. […] So if you consider that you come back as high-risk, you might consider having an amnio[centesis].
[Midwife walks with patient to another room for the quadruple screen].
This consultation raises several concerns: the one-way traffic of the interaction; the possible undermining of the dominant healthcare principle of non-directiveness (‘So if you consider that you come back as high-risk, you might consider having an amnio[centesis]); the classification of the patient herself as high-risk or low-risk, and; unclear language (the terms ‘screen’ and ‘test’ being used interchangeably despite their different meanings, ‘The cut-off is 150 or 151. If it’s anything less than that, it’s a low-risk so 1 in 151 and lower than that and we will let you know what your risk factor is’, etc.). What is more, the midwife says that an amniocentesis can detect ‘Down’s syndrome and any other problems’. This, in conjunction with the prominence of the risk discourse (a risk, in turn, is to be avoided and implies danger) and the relative absence of Down’s syndrome (that is, a meaningful discussion of the condition) in consultations, frames it as a harmful and damaging pregnancy outcome1. [i] What I argue throughout much of my work is that while Down’s syndrome is a complex and often inconsistent condition (i.e. in relation to prognosis and symptoms), this intricacy and diversity is masked by the universal constitution of it – at least within the medical realm – as a risk, a problem, as abnormal.
Although the consultation cited above is only one example, it is indicative of trends observed throughout my ethnography (as I have demonstrated in complimentary publications). Here, I show how the everyday and banal social practices of the clinic constitute certain (future) bodies as valued or unvalued; certain ways of being in the world are threatened, denied, or enacted as damaging and unwanted. In short, I identify how in the clinic, Down’s syndrome is imbued with negativity; it holds a metonymical status for the abnormal, that is, as something which should be detected and, if a diagnosis is established, something which constitutes a reason for termination of a pregnancy.
This categorisation is vital to prenatal screening – as a process – being continued. In order for screening to endure in its current form, Down’s syndrome must be treated as abnormal and as an inherently negative outcome. [ii] One may argue, then, that parents may not necessarily be given an opportunity to take on the role of ‘moral pioneers’ as Rapp (2000: 3) describes in her seminal ethnography on amniocentesis. That is, the notion of ‘choice’ becomes problematic, if not redundant, once Down’s syndrome is constructed in such a manner. This perhaps contradicts much recent literature on choice, neoliberalism, and liberal eugenics in the clinic. This negative constitution of Down’s syndrome possibly explains – or is at least one component of – the termination statistics for the condition in England and Wales. In 2012, of 1,259 prenatal diagnoses of Down’s syndrome, 90% (n=983) were terminated, 7% (n=76) were live births, and 3% (n=34) were natural miscarriages or stillbirths (the outcome of 166 prenatal diagnoses is unknown). From the first report in 1989 until 2012, the annual rates for termination following a prenatal diagnosis of Down’s syndrome have ranged from 88% to 94%. [iii]
A ‘Down’s Syndrome Public’
The negative configuring of Down’s syndrome in the medical realm exists in tension with the optimistic imaginary reflected in empirical studies (Flaherty and Glidden 2000; Skotko 2005; Van Roper and Choi 2011) and autobiographies of parents with a child who has Down’s syndrome. Focusing on the latter, both mothers (Clark 2008; Groneberg 2008; Lewis 2008; Soper 2009) and fathers (Austin 2014; Bérubé 1996; Daugherty 2015) have recounted their positive experiences of parenting a child with Down’s syndrome, recognising their situation as one which should not always be viewed as unwanted, pitiful, or tragic. Parents, indeed, often detail the joy of raising such a child, albeit while recognising the initial difficulties encountered when coming to terms with this reality and the significant challenges (e.g. medical, social, familial, educational, vocational, political, and economic) they have faced/will face on this journey.
I have encountered similar interpretations both in my personal life (I grew up with Brittany, an ex-neighbour and family friend around my age who has Down’s syndrome) and my research on parents’ experiences of the diagnosis and living with a child who has Down’s syndrome. In an earlier project, I capture how parents – both mothers and fathers – report limited evidence of stigmatisation, on account of their child, in everyday public interactions. Explanations for this include the medical visibility of Down’s syndrome (therefore offering a visual vindication for non-conforming conduct), the infantilisation of children with Down’s syndrome (the young appearance of people with Down’s syndrome means that their misbehaviour is infantilised, i.e. constructed as conduct ‘normal for a child’) [iv], and the public acceptance of Down’s syndrome (i.e. parental perceptions of a greater tolerance toward their children in contemporary society).
In another study, I capture how mothers frame the presence of Down’s syndrome as a source of happiness, strength, and personal growth. [v] While mothers often describe initial negative and rueful reactions after a diagnosis, interpreting Down’s syndrome as a loss of maternal expectations and the ‘death’ of an imagined child, they universally articulate a position of self-acceptance and identify how more positive emotions were experienced later in their child’s life. This move – from a lack of orientation towards their child to feelings of recognition, love, and valorisation – is achieved over time and in several forms, such as drawing on the support of family members, partners, and other parents of children with Down’s syndrome who help them to normalise, and construct a positive acceptance of, their situation. I also explain how mothers construct what I have elsewhere called a ‘courtesy identity’. This is a play on Erving Goffman’s (1963) concept of courtesy stigma to show how parenting a child with Down’s syndrome and being part of this ‘world’, rather having a stigmatising quality, becomes an integral and positive element in a mother’s reframing of self. One mother explains:
[My son] gave me a purpose in life. He brought a different perspective to how life can be and brought out qualities in me that I didn’t know I had. [ . . . ] I’m a mother, teacher, cook, cleaner, therapist, psychologist. I’m his intuition, his middleman, his speaker. I would be lost without him, with so much time to spare and no purpose in life.
Many of the mothers I spoke to describe how they rework their identity-kit and how they become advocates or political activists for their children. What is more, some mothers embrace their status of being, as one mother claims, a ‘Down’s syndrome mother’. This discourse is often supplemented with mothers becoming mother to other children with Down’s syndrome whereby they articulate an inclusive and collective sense of parental responsibility, the restitution of kinship here serving to enlarge what another mother calls the ‘Down’s syndrome family’. Not all mothers explicitly identify themselves along these lines yet they acknowledge their advocacy role, how their child has changed how they see the world, and how they have become better parents because of their child, thus enabling them to transform their lives and orient themselves towards their child and similar others. Thus, a potentially ‘discrediting’ (Goffman 1963) identity is reworked into a crediting one by seeing the child as offering mothers ‘the gift of their own self-knowledge’ (Rapp 1999: xiii).
Such strong identities and positive sentiments have gained greater traction in recent years through various forms of media, including parents’ blogs and social networking websites. As an example, the World Down Syndrome Day page on Facebook (with, at the time of writing, just under 19,000 members) provides parents with an outlet to not only voice concerns and ask questions to ‘wise’ others (Goffman 1963) but also to welcome new members into their community (or the ‘Down’s syndrome family’, if we are to use the term cited above), share amusing and heartening media (poems, photographs, videos, etc.) of and about their children, and celebrate life events such as birthdays, successful surgeries, awards and prizes, prom night, the first day of school, and so on. The World Down Syndrome Day Facebook page, among many others, is also replete with positive news stories. Looking back over the past few months, one can view tales ranging from a marriage proposal to the renaming of a school gym after a cheerleading student with Down’s syndrome, [vi] from a child starring in a TV advert to another being given a national ‘goal of the month’ award after scoring a penalty at half-time during a Scottish football game.
These outputs ignite the formation of what Ginsburg and Rapp (2015) call a ‘disability public’, a term used to ‘call attention to how people with disabilities and their allies are interpellated and materialised through a range of media, across widely distributed networks of people with shared experiences of disability’. For Ginsburg and Rapp, these constitute an emergent form of recognition and a location for alternative engagement. Adopting this concept, I suggest that media and other outputs – books, blogs, websites, social networks (Facebook, Twitter), YouTube clips, art (Judith Scott, Chris Rush, and Josie Webster pieces/exhibitions, Shifting Perspectives, etc.), and documentaries/television and film (e.g. Where Hope Grows, Lauren Potter in Glee), among others – help construct a Down’s syndrome public in which new social imaginaries of human difference are erected and people who have Down’s syndrome, together with their parents, are (re)constructed as occupying ‘inhabitable worlds’, giving them a future as well as a meaningful present.
This imaginary and formation of a Down’s syndrome public – enabling what Ginsburg and Rapp (2015) call an ‘existential repositioning’ – is in tension with the troubled relationship that the condition holds with prenatal technology. What I have shown here, to put it simply, is that there are two competing ways of enacting Down’s syndrome (at least in my own research and observations). Within the medical realm, where discourse shapes how people come to view and experience bodily difference, the condition is configured as a negative outcome. Among parents of those with Down’s syndrome, everyday life is constituted – despite a range of clear and complicated challenges – as celebratory, life-changing (for the better), and not the disaster it was initially believed to be.
While the unborn foetus with the condition is commonly constructed, especially within medical discourse, as problematic, as inherently inhibiting (for both the child and parent), and, ultimately, as disposable, the born child with Down’s syndrome is accepted and often embedded in positive configurings. The existence of two orientations to Down’s syndrome, as outlined in this article, is undoubtedly a simplification of an immensely complex issue and I certainly do not mean to suggest that these are its only two orientations. However, they are two which have appeared in my own work. Thus, by troubling and dissecting the taken-for-granted category of one of the most common yet complex genetic conditions, we can see how ‘Down’s syndrome worlds’ can be made both inhabitable and uninhabitable.
I would like to thank Michele Friedner for inviting me to contribute to the ‘Inhabitable Worlds’ series and for her vital editorial support with this article. I also extend my gratitude to the many fantastic participants who made my research possible and the Economic and Social Research Council (ESRC) for funding a project of great personal and professional interest to me.
[i] Interestingly, many health care professionals in my study were critical of prenatal screening for Down’s syndrome. In addition to being described as inaccurate (depending on which form of screening is undertaken, i.e. nuchal translucency or quadruple screening) and inciting anxiety in pregnant women, screening was defined by some as a ‘eugenic’ practice, with one midwife referring to it as ‘killing another human being because they happen to be a bit different’. This is because several of them that I interacted with viewed Down’s syndrome as compatible with life. Such criticisms, however, were often silenced owing to them, as part of their professional duties, enacting what they viewed as the principles of informed choice and non-directive care. Expanding on this point is outside the scope of this article.
[ii] I build on these ideas in several other publications and my forthcoming monograph Prenatal Testing and the Politics of Reproduction: An Ethnography of Down’s Syndrome Screening (working title) to be published by Routledge.
[iii] It will be very interesting to follow this trend over the next few years given that non-invasive prenatal testing (NIPT), a highly accurate form of screening for Down’s syndrome and other genetic conditions, is currently being trialled in the NHS.
[iv] Admittedly, parents in this study had children with Down’s syndrome who were under the age of 21. If the child was older (i.e. a fully grown adult), this infantilisation would possibly not occur.
[v] In this small-scale study, I focused exclusively on mothers. I made efforts to recruit fathers as well as mothers but this proved to be extremely difficult. The reasons for this are still unclear to me. One guess is that I recruited participants through the UK Down’s Syndrome Association mailing list and Facebook groups for parents of children with Down’s syndrome – spaces which were occupied largely by women. As such, my discussion here is one which, while important, is narrowed by its focus. However, it is clear in the autobiographical accounts of fathers who have a child with Down’s syndrome (e.g. Austin 2014; Bérubé 1996; Daugherty 2015) that a focus on the experiences of men – or fathers and mothers together – would be valuable.
[vi] This story was widely reported in the media after a cheerleader with Down’s syndrome was bullied during a basketball game and, in response, players walked off the court during a time-out to confront the perpetrators.
Austin, P. 2014. Beautiful Eyes: A Father Transformed. New York: W.W. Norton and Company.
Bérubé, M. 1996. Life As We Know It: A Father, a Family, and an Exceptional Child. New York: Pantheon Books.
Clark, B. 2008. A Mother Like Alex. London: Harper True.
Daugherty, P. 2015. An Uncomplicated Life: A Father’s Memoir of His Exceptional Daughter. New York: HarperCollins Publishers.
Flaherty, E.M. and Glidden, L.M. 2000. ‘Positive adjustment in parents rearing children with Down syndrome.’ Early Education and Development 11(4): 407-422.
Friedner, M. 2015. Valuing Deaf Worlds in Urban India. New Brunswick, NJ: Rutgers University Press.
Ginsburg, F. and Rapp, R. 2015. ‘Making disability count: demography, futurity, and the making of disability publics.’ Somatosphere. Available at:
http://somatosphere.net/2015/05/making-disability-count-demography-futurity-and-the-making-of-disability-publics.html [Accessed: 04 Jun 2015].
Goffman, E. 1963. Stigma: Notes on the Management of Spoiled Identity. New York: Simon and Schuster.
Groneberg, J.F. 2008. Road Map to Holland: How I Found My Way Through My Son’s First Two Years With Down’s Syndrome. New York: Penguin Group.
Lewis, S. 2008. Living with Max. London: Vermilion.
Rapp, R. 1999. Forward. In: Layne, L. (ed.). Transformative Motherhood: On Giving and Getting in a Consumer Culture. New York: University Press, pp. xi–xix.
Rapp, R. 2000. Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America. London: Routledge.
Skotko, B.G. 2005. ‘Prenatally diagnosed Down syndrome: mothers who continued their pregnancies evaluate their health care providers.’ American Journal of Obstetrics and Gynaecology 192(3), pp. 670–677.
Soper, K.L. 2009. Gifts: Mothers Reflect on How Children with Down Syndrome Enrich Their Lives. Bethesda, MA: Woodbine House.
Van Riper, M. and Choi, H. 2011. ‘Family-provider interactions surrounding the diagnosis of Down syndrome.’ Genetics in Medicine 13(8), pp. 714–716.
Gareth M. Thomas is a Lecturer in Sociology in the School of Social Sciences at Cardiff University. He is a sociologist who is interested in – among other things – medical encounters, disability, health and illness/wellbeing, genetics and the family, social stigma, risk, health technologies and ethics, interactionism, reproduction, STS, community, and ethnography. He is Co-Convenor of the Medicine, Science and Culture Research Group (MeSC) at Cardiff University and Co-Book Reviews Editor for Sociology of Health and Illness.
Inhabitable Worlds is a series that examines the theoretical tools and approaches that scholars bring to the study of disability in the social sciences and humanities. It is edited by Michele Friedner (Stony Brook University) and Emily Cohen (New York University).
This series aims to get anthropologists and closely-related others talking seriously, and thinking practically, about how to synergize biological and social scientific approaches to human health and well-being, and to what positive ends. In this interview, Bill Dressler responds to questions posed by series organizer Jeffrey G. Snodgrass.
How and why might cultural anthropologists and social scientists interested in health benefit from integrating biological variables/biomarkers into their research and analysis?
Outcomes. What I mean is that anthropological analyses are full of intriguing theoretical and ethnographic models proposing processes that operate at many levels, ranging from the molecular to the symbolic. Very often I find myself reading such analyses, only to get to the end thinking: “and……?” I’m waiting for the other shoe to drop, in the sense of what the implications of those processes might be for health or biological outcomes. That other shoe can be a biological outcome or a biomarker. For example, medical anthropologists are interested in various sorts of social relationships. These could be between a healer and client; among family members coping with a social or economic crisis; within a voluntary association — in short, social relationships that organize persons in any number of of ways and contexts. The epidemiologic literature teaches us that integration into a network of relationships is, generally, associated with better health status, assessed in a variety of ways; the problem is that the epidemiologic literature tends to deal only with social relationships that seem plausible from a generally middle-class, North American orientation. Therefore, much of the potential for understanding in detail how social relationships shape health outcomes in diverse settings is left unrealized. Furthermore, in anthropological analyses, the demonstration of the importance of a particular configuration of social relationships for health are also left unrealized. A focus on potential health outcomes would help to clarify these associations.
How would you respond directly to one potential cultural anthropological or social scientific critique of such an integrative “biocultural” approach?
One critique of such an approach is that it requires that we pay attention to measurement issues. While case-study material is useful for examining in detail the nature of social relationships, a clear demonstration of differences in health outcomes in relation to social relationships requires a more extensive approach to data collection, and especially the ability to differentiate empirically configurations of social relationships, so that these can in turn be compared to health outcomes. A biocultural approach generally requires greater attention to issues of research design and measurement than is encountered in cultural anthropology, and those issues can be regarded skeptically within the field.
What is one potential caution you’d have for cultural anthropologists or social scientists considering a biocultural approach?
Do not become a believer in magic bullets. What I mean is that biological outcomes and biomarkers are themselves often interpreted uncritically. An example is arterial blood pressure, which is something that I’ve studied a good bit. While arterial blood pressure is extraordinarily sensitive to the quality and quantity of social relationships, it is also influenced by a variety of other factors that must also be taken into account if you are going to incorporate blood pressure as a measure into your research. Viewing this the other way around, do not be seduced into thinking that you can treat someone’s self-report of, for example, the quality of social relationships as capturing the features of social relationships in which you are interested. Consciously and verbally expressed thoughts and perceptions cannot be accepted uncritically as measuring what your are trying to measure.
What is one piece of research (ideally your own) that points to the benefits of such an integrative approach?
There has been a great deal of attention focused on the nature of social support in the African American community. Some years ago we found that a reliance on kin versus nonkin for help and assistance in times of felt need had different associations with blood pressure, depending on other contextual factors. (This is a bit of an old paper, but it does a nice job of showing how an issue of theoretical interest in cultural anthropology can be better understood from a biocultural perspective.)
Dressler, William W. and James R. Bindon. (2000) “The health consequences of cultural consonance: cultural dimensions of lifestyle, social support and arterial blood pressure in an African American community.” American Anthropologist 102: 244-260.
What is a good reference that cultural anthropologists or social scientists interested in such an approach could use to get started?
Dressler, William W. (2005) “What’s cultural about biocultural research?” Ethos 33: 20-45.
William Dressler is a medical anthropologist with interests in culture theory, community studies, research methods, and especially the relationship between culture and disease risk. In his earlier work Dressler adapted models of psychosocial stress to examine the association between social and cultural factors and the risk of chronic disease, including cardiovascular disease and dysthymic disorder. His recent work emphasizes concepts and methods for examining the health effects of individual efforts to achieve culturally-defined goals and aspirations. He has developed a new concept, ‘cultural consonance,’ to define this link of culture and the individual theoretically and operationally. This work has necessitated the theoretical integration of cultural constructivist and social structural theoretical orientations, and the development of research methods for linking the cultural, the individual, and the biological. Dressler and colleagues have examined these factors in settings as diverse as urban Great Britain, the Southeast U.S., the West Indies, Mexico, and Samoa.
“Bioculturalism” aims to get anthropologists and closely-related others talking seriously, and thinking practically, about how to synergize biological and social scientific approaches to human health and well-being, and to what positive ends. It is edited by Jeffrey G. Snodgrass.
Introduction: “Bioculturalism: The Why and How of a Promising Medical Anthropological Future” by Jeffrey G. Snodgrass
I’m perplexed by cultural anthropology’s antagonism toward biology, with culture and biology more typically treated as providing alternate and competing, rather than complementary and synergistic, explanations for human functioning. This is particularly strange to me—a practicing cultural anthropologist with a background in molecular biology—when even medical anthropologists fail to account for the role biology plays in shaping human health. Wouldn’t such a consideration enrich our comprehension of the interplay between sociocultural milieus and human bodies?
“Biocultural” anthropologists do now routinely investigate human health and other topics. However, they are a small minority, both within medical anthropology and anthropology more generally. Though small, they are potentially important. To me, this group’s synthetic approach represents one promising future for anthropology, which would be capable of producing more comprehensive explanations for human function (and dysfunction), and in the process bridging divisions both within our discipline and between anthropology and other natural science disciplines.
To sketch a blueprint for such a future, I have invited a group of self-professed “biocultural anthropologists” to address the question, “How might cultural anthropology gain by taking biology more seriously?” Responses to this issue will run in a new series, Bioculturalism, which aims to get anthropologists and closely-related others to talking seriously, and thinking practically, about how this possible anthropological future might unfold, and to what positive ends.
To kick off this series, I respond to this topic myself, which, as you’ll see below, I’ve parsed into five interrelated questions. My response foreshadows themes touched upon by the other contributors. Also today, you’ll hear how Bill Dressler responds to my questions, followed by Emily Mendenhall, Chris Lynn, and Greg Downey every other Monday. This will conclude the first part of this series, with a planned second set of contributions to follow.
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In a recent biocultural study of the well-being of Indigenous Sahariya “conservation refugees” in central India, I assessed these individuals’ stress and health via the salivary analytes cortisol and alpha-amylase, self-reports of psychosomatic stress and emotional experience (utilizing locally validated psychiatric scales), in-depth person-centered interviews, and ethnographic observations. These alternate sources of data told interlocking but somewhat unique stories about the state of these Sahariyas’ bodies and minds. Where the data streams parallel each other, I feel more confident in my conclusions. Where data diverge and even appear contradictory, I am forced to challenge my assumptions, acknowledge ambiguities and limits both in my own knowledge and in prevailing theories, and generally think more deeply about the nature of my findings.
More recently, related to my ongoing studies of distressful online gaming as a form of “addiction” to the Internet, I’m planning a gene-by-environment (GXE) interaction study, where I’ll assess the relative power of genetic as compared to sociocultural resilience/ vulnerability markers to predict compulsive patterns of online play. For the genetics, this will require examining individual gamers’ DNA to determine the extent to which they carry known single nucleotide polymorphisms (SNPs) associated with addiction (related to the body-brain’s stress reactivity and reward circuitry, for example). For the sociocultural variables, I envision assessing gamers’ relative degrees of social distress, e.g. by tracking self-reported early trauma, stressful life events, and also relative “consonance” or “dissonance” with culturally-sanctioned models of the good life (utilizing the “cultural consonance” approach pioneered by Bill Dressler, whom we’ll hear from next). I hypothesize that higher offline social distress—rather than the genetics, and certainly not exclusively the genetics—propel gamers into problematic patterns of online play, as they seek escape and respite from their life’s problems. It is one thing for cultural anthropologists to (rightfully) critique the now culturally and medically dominant “disease model” of addiction, where the roots of behavioral compulsions are located in neurotransmitter imbalances and “broken brains,” with often scant attention paid to how environmental and sociocultural factors might also drive such behavior. It is quite another matter to demonstrate the potentially even superior predictive power of sociocultural factors on such health outcomes (which I expect to find), in studies that statistically model genetic and sociocultural factors (as potentially distal causes) side-by-side in the same sets of equations.
Though challenging, the gains of thinking across biological and cultural levels are multiple. We enrich our theories and understanding of the phenomena at hand—the distress experienced by Indigenous refugees and online gamers in my current research—by building more complete explanations for both their causes and health consequences. Rather than posing at the outset false dichotomies, we are able to identify potential biocultural synergies, like environmentally-driven “epigenetic” patterns of gene expression, which can also be mapped through now known techniques (as I plan to do in my Internet study). Further, we will almost necessarily have to collaborate with people from other fields, expanding our knowledge and horizons in the process. All in all, our research has a better chance of leading to both more valid and also more broadly authoritative results. The latter is not trivial. Relying at least in part on methods and perspectives developed in other fields, our results and subsequent explanations and theories will be framed in ways that can be better appreciated outside of narrower cultural anthropological circles.
Some cultural anthropologists fear that incorporating biology into their studies risks reductionism and even racism and sexism. These are fair concerns, given that our disciplinary history is intertwined complexly with colonialist, racist, and sexist agendas, where biological theorizing has been used to attribute fixed and essential identities to colonized peoples, racial minorities, wo/men, and others. However, contemporary biologists are now exquisitely attuned to the manner that biological structures and processes respond flexibly to their environments, as demonstrated in innumerable examples of human neuro- and corporal “plasticity.” As current biology research amply demonstrates, genetic makeup is often less important than how those genes are epigenetically expressed (and even programmed) in response to environmental cues. Biological systems, it seems, are just as malleable—and indeed just as complex and unpredictable—as sociocultural ones. As such, biology is no longer thought of as necessarily underlying and thus constitutive of psychological, sociocultural, or other systems. Rather, our dual biological and cultural inheritances can be understood as complexly interacting systems that mutually constitute each other. As such, a fear of reductionist thinking is no longer a valid justification for avoiding serious engagement with the biological and other natural sciences, as Maurice Bloch eloquently argues in his recent book, released in 2012, Anthropology and the Cognitive Challenge.
Don’t imagine that incorporating biomarkers into a medical anthropological health study will provide magical solutions to all your analytical and theoretical problems. In fact, the case is more nearly the opposite: you will have more to think about and consequently more problems to solve, as you struggle to make sense of potentially conflicting data. As I suggested above, a biological measure might suggest an alternate health story, but there is no reason to assume a priori that this story should take precedence over one suggested by the sociocultural data.
I would suggest, first, my recent study of stress telomere shortening among central Indian conservation refugees. I do believe that psychosomatic stress, related to an intricate set of overlapping arousal systems, underlies and thus helps to explain innumerable health problems, as masterfully demonstrated by researchers like Robert Sapolsky, as well as by biocultural anthropologists such as Carol Worthman and her students. Likewise, good evidence suggests that telomeres—termini that cap and protect our chromosomes—could serve as human chronometers. Telomeres erode naturally with cell division and aging, leading some to suggest that their length might be a good proxy for overall health and even longevity. Both stress and telomeres, then, would seem to be “master” systems of explanation that could be seen as revealing and even underpinning a variety of human health processes. However, both psychosomatic stress and telomere length are deeply responsive to environmental cues, leading myself and my collaborators to wonder if the extreme stress experienced by the Indigenous Sahariya featuring in our study might manifest itself on the cellular and chromosomal level. We demonstrate this to be the case, pointing to the way that both biological and also politically-driven environmental changes in concern propel health outcomes in this non-Western context.
I’d also suggest a few of my recent online gaming papers. In one, my collaborators and I suggest—rather than empirically demonstrate—that interactions between underlying neurobiological and psychological faculties (such as dissociation) and culturally-produced “technologies of absorption” (like video games) together shape positive and negative online gaming experiences. In others, we explore links between stress, consonance with the culturally-sanctioned good life, and problematically distressful gaming.
Stress and telomere shortening in India:
Zahran, S., Snodgrass, J. G., Maranon, D. G., Upadhyay, C., Granger, D. A., & Bailey, S. M. (2015). Stress and telomere shortening among central Indian conservation refugees. Proceedings of the National Academy of Sciences, 112(9), E928–E936. http://www.pnas.org/content/112/9/E928.abstract
Online Gaming in the U.S.:
Snodgrass, J. G., Lacy, M. G., Dengah II, H. F., Fagan, J., & Most, D. E. (2011). Magical flight and monstrous stress: Technologies of absorption and mental wellness in Azeroth. Culture, Medicine, and Psychiatry, 35(1), 26–62. http://link.springer.com/article/10.1007/s11013-010-9197-4
Snodgrass, J. G., Lacy, M. G., Dengah, H. F., Eisenhauer, S., Batchelder, G., & Cookson, R. J. (2014). A vacation from your mind: Problematic online gaming is a stress response. Computers in Human Behavior, 38, 248–260. http://www.sciencedirect.com/science/article/pii/S0747563214003392
Snodgrass, J. G., Dengah, H. J. F., & Lacy, M. G. (2014). “I Swear to God, I Only Want People Here Who Are Losers!” Cultural Dissonance and the (Problematic) Allure of Azeroth. Medical Anthropology Quarterly, 28(4), 480–501. http://onlinelibrary.wiley.com/doi/10.1111/maq.12116/abstract
How might cultural anthropologists or social scientists interested in such an approach get started?
Just one more piece of advice at this point: Reach out and collaborate with outsiders to cultural anthropology. These biocultural problems are too large to tackle all by our lonesome, indeed, too large for any single discipline to solve. Plus, you’ll have much more fun having at these problems in good company.
Jeffrey G. Snodgrass, Professor of Anthropology at Colorado State University, and member of Somatosphere’s editorial collaborative, has published widely on caste, performance, and religion in India. He is currently working on two projects. First, he is interested to understand how culture-specific absorptive experiences, achievement motivations, and social interactions contribute to virtual worlds’ therapeutic and addictive dimensions. This research has begun with primarily U.S. gamers with plans to extend the project to other parts of the world. Second, in NSF-funded research, he is working to understand how loss of access to forest spaces and resources – for example, through deforestation and displacement from a newly established wildlife preserve in central India – impact indigenous peoples’ health and systems of healing. He hopes empirical results from these and other projects will help him fuse insights from cultural psychiatry and neuroscience into more synthetic “biopsychocultural” accounts of mental health resilience. Follow him on Twitter: @GodfreySnorgyrs