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Science, Medicine, and Anthropology
Mis à jour : il y a 7 heures 23 min

Teaching Medical Anthropology by Thomas A Williamson

19 Janvier 2018 - 8:51pm

I am grateful to those who have shared their medical anthropology syllabi here and thought I would add mine to the mix. There is so much one could cover in a med anthro course! I am always concerned with overwhelming my students, especially those not only new to the subdiscipline but also to anthropology and even to social science (ah, the challenges of a undergraduate liberal arts institution). The more teaching I do, the greater my conviction that less is more.

Readings: I shape a course arc with a point of departure, a few contrasting perspectives, and then a closing attempt at synthesis or consolidation. I like books rather than articles, because a book allows us to linger on an argument and see it develop. A book also helps students to catch up if need be. Articles are wonderful for introducing students to key arguments and crucial contributions, but they take considerable class time to discuss effectively (the articles I assigned by Rose and Hacking, for example, were both pedagogical failures given our brief time to discuss them). Even with my preference for books over articles, I was surprised to count a total of 19 separate articles and book chapters in my syllabus.

I had the students read the Sullivan article before the semester began. I knew it would engage them, and I also wanted to disorient them if they thought medical anthropology would focus on exotica. Van der Kock’s book on trauma was more of an experiment: how would students engage with an argument on such an intimate topic that ranges over so many different domains and shifts in register? They were at once intrigued and yet wary of some of his claims. It also allowed us to ask how a practitioner’s account (van der Kock is a psychiatrist and a leader in the field of trauma research) might be different from that of a social scientist.

We next switched to a critique of the concept of health. Adelson’s ethnography is short and sharp, giving students a taste of anthropological methodology and analysis. It also introduces them to the complex politics of medical anthropology. The Metzl and Kirkland volume raises great questions about the culture of health and the concept’s primacy among the affluent “worried well.” It also pushes students to consider the perspective of gender studies and literature, ones of far less prestige than medicine. How is it, I challenge them, that such (seemingly) marginal viewpoints produce such a powerful critique?

Next, students encounter what they thought the course was going to be about, cross-cultural difference. Langford’s book depicts Ayurveda as more of a question than as a ready-made antithesis of biomedicine. Students consider how we moderns tend to enframe difference, and her arguments about Ayurveda have the effect of making biomedicine appear more elusive than they initially imagined. The students are left to ask how the desires they bring to a medical practitioner shape the healing process.

Finally, we end by considering the politics of medicine. I have often assigned a Paul Farmer book, but replaced that this time with brief readings by and about him. I also assigned an article by Redfield about MSF. Holmes’ book about migrant fruit pickers offers students a sharp, accessible glimpse of inequality and health, the “suffering subject” familiar in anthropology. In addition, this year I tried Malkki’s The Need to Help, and it proved to be a big success. It so happened that our institution had a series of major anti-racist protests this past spring, and reading Malkki’s book as those unfolded helped us to think about politics, the professions, and our engagement with each other. She’s a subtle thinker and writer, which was a valuable counter-rhythm when the campus was full of passionate energy. Students took the opportunity to think about their commitments and motivations, and appreciate what Malkki calls the “mere” of everyday activism. A plurality of students named it their favorite book of the course.

Assignments: The major assignment for the course, of course, was to come to class prepared to discuss the readings. In class I often presented a key concept for 10 or 15 minutes at the beginning of the hour, but most of the time was spent in a mix of large and small group discussion. Conversation continued with the online forum connected to the class. Class sessions went well, though the online forums were mostly a disappointment. I could only occasionally get the students to engage with each other’s ideas rather than write self-contained posts that tended to impress more than respond.

Each unit had a culminating assignment. For the first unit, students created an annotated map of trauma. I purposely underexplained this because I wanted to be surprised by what the students did. Their maps were quite different and engaged effectively with van der Kock’s book. I was surprised though how many of them described trauma as something personal rather than social, which went against what we emphasized in class (no doubt attesting to the power of their preconceptions). I was also astonished that several students used the map assignment to reveal their experience with significant childhood trauma. I was concerned about how they might personally respond to the book and shared that worry multiple times in class. But I didn’t hear much until they turned in their assignments. I found it curious that they would take this mode to share with me intimate aspects of their histories.

For the second unit, students had to use the readings to construct a guide for the campus wellness center. Inspired by Adelson’s book (and the Metzl/Kirkland volume), their project had to address “being alive well at St. Olaf.” Most students either did a pamphlet or a website, while some got even more creative (or in a few cases, too creative!). Although I enjoyed their critique of the biopower cesspool they claim to inhabit at St. Olaf, the best assignments were also able to see how creativity, politics, and solidarity can be antidotes to obsessive healthiness and bodily dysfunction. Those guides offered their fellow students a critical diagnosis but also possible means of healing.

The third assignment was the most difficult one (I find that April is an appropriate time to be cruel). Each student was asked to write an essay describing Ayurveda. The challenge came from Langford’s critique, which questions whether Ayurveda is in fact a thing that can be represented. I enjoyed seeing the students puzzle over the assignment and figure out a way to depict an entity that appears to elude representation. In the process, our earlier work on maps and pamphlets and websites was called into question, as was our ability to understand the human body and to demark discrete healing modalities.

The final assignment was, as is appropriate in May, a straightforward one. Students had to compare the books by Holmes and Malkki and figure out what they show us about the politics of health and medicine. These came together well (I had them do so as an annotated list). Students were also schedule a “doctor’s appointment” with me to talk about their work in the course. This was an off-hand idea that I casually mentioned in class but students took quite seriously. As their interest grew I decided I was going to wear a labcoat and stethoscope for the meetings, but in the end elected to retain what dignity remained. In our conversations some students wanted to talk about their own health situation; others wanted to talk about the mechanics of the final assignment. Most wanted to discuss their general experience of the course. The topic is such an intimate one that it turned out to be appropriate and important to share one-on-one where it left us. That’s the wonderful thing about medical anthropology. Everyone has a body; everyone has the capacity to feel pain and the responsibility to care for others. What an honor to explore this domain with intriguing students.

Download the syllabus

Thomas A. Williamson is Associate Professor in the Department of Sociology and Anthropology at St. Olaf College, where he teaches courses on theory, Southeast Asia, medical anthropology, and globalization.  Much of his work is based on research done in Malaysia over the past 25 years.

Texting Like A State: mHealth and the first thousand days in South Africa by Nanna Schneidermann

17 Janvier 2018 - 6:58pm

What does making a new life look like from the perspective of a mobile phone?

For the phone of a woman using the public health care system in Cape Town, South Africa, in all likelihood involves a series of WhatsApp conversations with a partner, with friends and kin. The phone helps with “Googling” questions about health and childcare, maybe about shopping for things for the baby. Maybe it will take photos of a growing belly and of the preparations for the new family member. Maybe it will take no photos of this at all because the pregnancy remains hidden as long as possible. The phone will make calls and send WhatsApp messages about finding money for transport and maybe about finding childcare and getting time off to go to the clinic for checkups. And when the time comes, for getting to the Midwife Obstetric Unit (MOU) to give birth. There will be WhatsApp’ing though early labor, where the phone is the woman’s only companion in the ward, apart from the other birthing women. The phone might be the only thing that follows the woman into the labour ward, when the time comes to push. When the birth is over and the child is in its mother’s arms, the phone is there to take photos and send WhatsApp messages to let family and friends know that all is well.

In the last few years the mobile phones of pregnant women and new mothers in South Africa have become the site of something else too: the first national mHealth program in Africa. The South African Department of Health established a mobile phone health program aiming to improve maternal and child health in August 2014. The MomConnect program seeks to harness the potential of high rates of mobile phone penetration in South Africa to communicate to patients and build digital infrastructures in the public health care system, to ultimately deliver more efficient and “patient centered” services (Barron and Pillay 2016).

At a recent conference in Stellenbosch on the use of digital technologies for maternal and child health, one presentation seemed to capture the un-blighted optimism about the transformative power of mobile phones in health systems in developing countries with the title: “mHealth – The Promise.” Using digital media technologies and mobile phone networks is considered, by international donors and governments of poor countries alike, a pathway to a more efficient, flexible and cheaper health system (Haas 2016, Vital Wave Consulting 2009), though both researchers and practitioners are more cautious (Donner and Mechael 2012). From a mushrooming of pilot projects, governments are now bringing “mHealth to scale,” investing in national mobile health programs and apps for both patients and health professionals (Haas 2016).

During nine months of fieldwork in Cape Town, I sought to place these grand development promises in the context of everyday media use among pregnant women and new mothers. Paraphrasing James Scott’s famous work on statecraft (1998), the idea of “texting like a state” here gathers thematic fragments from my fieldwork, looking at some connects and disconnects in the intersection between mobile phones and maternal health in the public health system in Cape Town.

 

The Promise

MomConnect is owned by the South African Department of Health, “championed by the Minister of Health,” and run in partnership with over 20 public and private actors. Among these are the American company Johnson & Johnson, the South African Praekelt Foundation, telecommunications companies in South Africa, and an investment of close to eight billion dollars from the United States Agency for International Development. The aim of the program is to improve maternal health by sending informational text messages to pregnant women and new mothers according to their gestational age or the age of their child, and in turn registering them in a national patient database when they sign up for the messages. MomConnect also has an interactive feature through which users can submit questions to a help desk staffed by maternal health professionals. Here I focus on the text-messaging feature of MomConnect.

The promise of mHealth as it appears in MomConnect is about knowledge. The idea is that almost every citizen is within reach via the mobile phone, and that delivery of information changes perceived problematic “behaviors” of individuals, leading to better health outcomes for mothers and children (Barron and Pillay 2016). This theory about how to bring about change is also known as the Knowledge Attitudes Practice Model or Social and Behavior Change Communication Theory among the health professionals working with the program (as described in for instance Lamstein et al 2014 but see Neuhauser and Kreps 2003). These models about communication and knowledge positions the sender – the Department of Health – and the receivers – poor pregnant women and new mothers – in an unequal relation of power, in which the sender is perceived as the holder and giver of “knowledge” and the receiver as without “knowledge”. It further assumes that if receivers are given “knowledge” their attitudes and practices will change regardless of whatever else might be at stake in their lives. To explore further how this envisioned theory of change is enacted from the side of the health system, let us consider the kinds of messages sent to women in the MomConnect program.

 

The Messages

The first message available in MomConnect is in week five: “Congrats on your pregnancy! Your baby is just the size of a small seed but you can help your baby grow. Eat vegetables and fruit, don’t smoke or drink alcohol.” The message initiates a narrative about a welcome and wanted pregnancy, taking for granted the relations of mother-child-dyad as already existing and positive. It also personifies the embryo growing in the woman’s womb as a baby, and prescribes specific courses of actions for “mother” and “baby”. The imagery of an already formed human being the size of a grain, a human being in need of the mother’s help to grow into a full social person runs through the messages of the MomConnect program. Such a text message from the National department of Health suggests a state with a pronatalist political stance, and does not seem to consider the ambivalence and choices that many women (and their partners) face in early pregnancy, somewhat undermining women’s rights to abortion.

Altogether 162 messages of MomConnect (in 2015) are sent during pregnancy, the first year after birth, and in case of miscarriage, stillbirth or the loss of a baby. Fifty-three (one-third) of these messages encourage the reader to go to the clinic, either for regular appointments or if mother or baby are showing signs of illness. Descriptions of the size and abilities of the un-born fetus or born child are the second most prominent theme in the messages, followed by encouragement and information about breastfeeding. Other recurring themes are healthy eating, keeping oneself and the baby clean by washing hands, taking the prescribed medicine from the clinic and avoiding traditional and alternative medicines, and avoiding alcohol, smoking and illegal drugs. Saving money for transport to the hospital and shopping to prepare for the birth of the child are also part of the messages. Throughout the messages, the fetus is articulated as a baby with human features in need of the help, care and safekeeping of the mother: “Your baby is growing fingers! If you feel unwell, have a fever, bleeding or vomiting, go to the clinic to make sure you and your baby are safe” (Week 10 of pregnancy). Many of the messages, like this one, seems to have several concerns in mind: to congratulate the mother on “growing” her “baby” in a friendly way and at the same time managing the “risk” involved with pregnancy with encouragements to go to the clinic.

After birth, messages focus on breastfeeding and feeding, as well as on activities that helps the child develop: “Your baby loves the sound of your voice. She may stop moving when you speak. Talk and sing to her every day. Make eye contact and smile. She will smile back!” (Week 11 after birth). The conclusion of the messages at week 51 after birth instigates a new period of life:

“You have done a great job! Keep being a great mother to your sweet child. If you miss a period, you may be pregnant again. Go to the clinic for pregnancy care”. The baby has now become a child, and the mother has proved herself a capable mother. But motherhood is not without risks; another pregnancy may occur.

MomConnect functions primarily as a broadcast from a national, centralized database in the Department of Health directly to subscribers’ phones. But it also has a feedback option through which subscribers, via text messages, can report problems or abuse and ask questions about their own health and that of their offspring. In project reports based on the self-generated data of MomConnect, this feature has been used to translate messages or call for materials for local clinics.

The promise of mobile technology as envisioned by the public health professionals working by MomConnect, and the theories of change that underpin it, is that it puts the National Department of Health in direct “conversation” with expecting and new mothers all over the country. The 140 characters of the text messages tell subscribers stories about how to bring new life into the world, not merely nudging but hailing pregnant women to act and feel in particular ways towards their pregnancy. The careful crafting of messages to be relevant and meaningful across the cultural and lingual differences in South Africa is reported repeatedly in grey literature on MomConnect, suggesting that the texting state is self-consciously practicing what Stuart Hall would have called “encoding”. Hall conceives of (mass) mediated communication as series of “moments” rather than a causal, linear process (as above) in which “no one moment can fully guarantee the next moment with which it is articulated” (Hall [1973] 1999: 91). Encoding is the moment of production of phenomena into “message form” – something that can be mediated and communicated – with particular meanings and purposes. The encoding of MomConnect would then be a moment of the National Department of Health purposefully seeking to communicate messages whose meaning it thinks will be understood by the receivers. According to Hall, mediated messages are received by audiences in moments of “decoding” though which messages are given meaning within receivers’ life worlds, as well as the power relations framing the communication. That is, the message “sent” and the message “received” is not the same thing: rather communication is a series of relatively autonomous moments of social practice with uncertain outcomes. Hall’s aim to trouble the idea of commination as a “perfectly equivalent circuit” (ibid: 100) may be as relevant today as it was in 1973.

As the MomConnect program was implemented, two related issues seemed to make the promises of mHealth harder to keep. First, the technological infrastructure depends on busy, overworked health care workers to make the actual connection between MomConnect and expecting mothers. Second, those same people seem to define how subscribers understand, or decode, the text messages.

 

The Voice of Technology

To register fully with MomConnect, the pregnant woman must be “diagnosed” as pregnant in the public health system, and she must submit both her own national identification number and the number of the clinic. Because the woman cannot register fully on her own, clinic staff need to help patients with this. Speaking with community nurses and other health workers in Cape Town I learned that not all MOUs had taken up the program, despite public health facilitators presenting and introducing the service to managers and midwives at the clinic. Registration of users in the MomConnect database was experienced as a burden for nurses at some of the understaffed MOUs, and as beyond the scope of their professional duties. “Work is added … (by) this MomConnect. (…) It’s on top of other things,” one nurse reported (Wolf-Piggot and Rivet 2016: 7). Facility managers noted that it was “unfair” to give nurses further tasks, tasks not essential for the health of mother and her unborn child (Wolf-Pigott 2015). At some MOUs the community nurses would seek to enroll women in MomConnect while they were waiting to see a nurse in the antenatal ward. MomConnect depends on the staff at the MOUs to collaborate with the technical infrastructure of the program by “connecting” the phones of patients with the program. For this to happen, they must see the value of time spent registering their patients. This appears to be a challenge in a overburdened health system where nurses are torn between seeing as many patients as possible and correctly monitoring and diagnosing potentially fatal conditions in their patients.

The role of clinic staff in the kinds of connectivities established in MomConnect may be even more complex when it comes to how subscribers make sense of the messages. A central question is that of the “voice” of MomConnect, said one doctor who had worked with the program. When the subscribers read the messages, is the voice they hear in their head a friendly caring voice, or a shrill, patronizing one? The voice of the MomConnect program was essential for effecting behavioral changes in the women, he told me. He differentiated between the “tone” of messages, the wording and intentions put into the messages by the producers, and the “voice” of the messages heard by the receivers. If both the tone and the voice of the messages were not phrased just right, the mothers would not listen, and the messages would not change the behaviors of the mothers. The developers had worked closely with midwives, communication specialists and a range of other professionals to develop a set of messages that would be friendly and encouraging across cultures and languages in South Africa. MomConnect is available in South Africa’s 11 official languages, translated from the original set of English messages. The researchers working within the MomConnect program considered this use of “local knowledge” one of the strengths of MomConnect; it was designed with “local experts to make it compatible with the local South African context” (Sebregts et al 2016).

Yet the researchers discovered that the tone of text itself seemed not to be all that mattered to the receivers. Rather, they read the messages in “the voice” of the nurse who had helped them sign up for the program. The nurses were not only in material terms connecting patients to the infrastructure of the program; their voices became part of the messages themselves. The relationship between patients and caregivers, a relationship placed outside of the control of the carefully crafted MomConnect system, apparently circumscribes the system itself. “We can do everything and design everything, except for the thing that matters!” my friend exclaimed. Nurses and other frontline clinic staff mediate between MomConnect and the mothers the program seeks to connect with in curious ways. They are part of the MomConnect infrastructure, as the program does not function without them, but the owners and makers of the program see them as a difficult and mysterious element, beyond control.

 

Texting It In

Health professionals working with MomConnect noted that in the region of the more urban, cosmopolitan and affluent Western Cape, the program had not been taken up as enthusiastically as for instance in the poorer and rural Eastern Cape. At the local Cape Town office of a national NGO for reproductive health, the manager did not mince words when I asked her if she knew about MomConnect. “Bullshit!” she yelled. “It’s a total bullshit thing! Looks great on paper, looks great in high places and for international donors. But what is the outcome?! Does anyone on the ground even know what it is?” she asked. I wondered the same. I interviewed pregnant women and new mothers about their media habits. They had attended MOUs in areas that were formerly townships reserved for those classified as “Coloured” or “African” . Among the 52 mothers I talked to, one was enrolled in the MomConnect program. She enjoyed receiving the messages and felt they were inspiring. But then she turned to more pressing matters: difficult kin relations, cramped living situations, lack of employment, fear of personal violence. One other mother had tried to register with MomConnect and failed. Some said that they had heard about programs using the phone to support mothers, like WhatsApp groups. Though my study focused on the role of mobile phones in the everyday lives of pregnant women and new mothers, quite a few of the women we met did not have personal mobile phones. I talked to some of the people who had been developing and managing the program in the national Department of Health. One noted that though the market research showed that women were enthusiastic about the program, it appeared that despite the informational qualities of the text messages, there was no measurable change in users’ “knowledge” about pregnancy and childbirth (see also Lau et al 2014).

Placing the MomConnect program within its context of use, the mobile phones of South African women, diffuses the idea of a monolithic state working through a perfectly functioning infrastructure, prescribing how life should be shaped.

Thinking with James Scott’s work on statecraft and the logics of great utopian social engineering schemes, what do grand infrastructural projects of development look like in the 21st century? MomConnect is not a grandiose project in terms of visible, physical structures, but the use of digital media technologies are forms of statecraft, seeking to effect change in the groups of citizens considered at once the most vulnerable and the most valuable – pregnant women and their infant offspring. Examining the intersection between media use and ideals of governance concerning mothers and infants that use the public health sector in Cape Town might help us to better understand the ideas that animate the relationship between social change and digital technologies and infrastructures in contemporary states in Africa.

 

Nanna Schneidermann is an anthropologist and postdoc in the research project MediAfrica at the Oslo and Akershus University College, and an affiliate of “The First Thousand Days” research group at the University of Cape Town. Her current research looks at intersections between digital media technologies and motherhood among poor and marginalized women in Cape Town, trying to understand ideas of change and transformation in the making of new lives, from texting states to WhatsApp’ing mother in laws.

 

References

Barron, P., & Pillay, Y. (2016). Using mobile technology to improve maternal, child and youth health and treatment of HIV patients. SAMJ: South African Medical Journal106(1), 3-4.

Donner, J., & Mechael, P. (Eds.). (2012). mHealth in Practice: Mobile technology for health promotion in the developing world. A&C Black.

Haas, S (2016). mHealth Compendium, Special Edition 2016: Reaching Scale. Arlington, VA: African Strategies for Health, USAID (link: www.africanstrategies4health.org.)

Hall, Stuart ([1973] 1980): ‘Encoding/decoding’. In: During, S. (Ed.). (1999). The cultural studies reader. Psychology Press. (‘Encoding and Decoding in Television Discourse’, 1973).

Lamstein, S.,T. Stillman, P. Koniz-Booher,A.Aakesson, B. Collaiezzi,T.Williams, K. Beall, and M.Anson. (2014). Evidence of Effective Approaches to Social and Behavior Change Communication for Preventing and Reducing Stunting and Anemia: Report from a Systematic Literature Review. Arlington,VA: USAID/ Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project.

Lau, Y. K., Cassidy, T., Hacking, D., Brittain, K., Haricharan, H. J., & Heap, M. (2014). Antenatal health promotion via short message service at a Midwife Obstetrics Unit in South Africa: a mixed methods study. BMC pregnancy and childbirth14(1), 284.

Neuhauser, L., & Kreps, G. L. (2003). Rethinking communication in the e-health era. Journal of Health Psychology8(1), 7-23.

Scott, J. C. (1998). Seeing like a state: How certain schemes to improve the human condition have failed. Yale University Press.

Seebregts, C., Barron, P., Tanna, G., Benjamin, P., & Fogwill, T. (2016). MomConnect: an exemplar implementation of the Health Normative Standards Framework in South Africa. South African Health Review2016(1), 125-135.

Vital Wave Consulting (2009) mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World. Washington, D.C. and Berkshire, UK UN Foundation-Vodafone Foundation Partnership,

Wolff-Piggott, B., & Rivett, U. (2016). An Activity Theory Approach to Affordance Actualisation in mHealth: the Case of Momconnect. ECIS (Research Paper 108).

Wolff-Piggott, B. (2015). Towards an Affordance Perspective on mHealth Usage: A Clinic-Level View. In: Proceedings of SIG GlobDev Eighth Annual Workshop. (Vol. 26). Münster, Germany

Beauty by Lynn M. Thomas

16 Janvier 2018 - 12:12am

In the late 1990s, a group of Japanese researchers set out to investigate whether small-scale gold mining operations near the shores of East Africa’s Lake Victoria were resulting in mercury contamination of local fish and human populations. The group included Dr. Masazumi Harada who began his medical career in the early 1960s by studying the devastating effects of severe mercury poisoning caused by industrial wastewater from the Chisso chemical factory in Minamata, Japan. The effects included serious brain impairment, birth defects, and even death. Harada became one of the world’s foremost authorities on “Minamata disease,” devoting much of his career to identifying outbreaks internationally. Harada and his colleagues set their sights on Lake Victoria’s shoreline because they knew that local artisanal miners there, as in Brazil’s Amazon, were increasingly using a mercury amalgamation technique to recover gold from ore.

Much to their surprise, the Japanese researchers found that it was not Tanzanian and Kenyan gold miners or fishermen who possessed the highest levels of mercury but rather women who used mercury soaps to lighten and clarify their skin. Whereas the miners’ and fishermen’s mean mercury levels were normal, the level for women using mercury soaps significantly exceeded the critical benchmark for Minamata. To scientists more familiar with the use of mercury in industrial processes than cosmetics products, this was an unanticipated finding that directed their attention away from artisanal mining and environmental contaminants and towards women’s bodies and consumer habits.

Mercury pollution is a by-product of everyday beauty routines, not just manufacturing and mining regimes. Through intimate as well as industrial processes, mercury toxins enter bodies and waterways, poisoning the world. The global trade in skin lighteners has continued to grow since the late 1990s. Estimated now at over 15 billion U.S. dollars per year, it stretches from East Asia and into South and Southeast Asia, the Middle East, Africa, Europe, and the Americas. To achieve paler, blemish-free, or more youthful complexions, consumers turn to a range of soaps, creams, and other products. Those available to poor consumers often contain mercury.

The products the Japanese researchers stumbled across in East Africa were packaged as “antiseptic soaps.” When used to lighten skin color, consumers would lather the soap on faces and other body parts, let it dry, and often leave it on overnight. The soaps were manufactured in Europe, most in the United Kingdom. Harada and his colleagues noted that although the Tanzanian and Kenyan government had banned the sale of mercury soaps, they were “unexpectedly . . . . very easily available” (Harada et al., 2001; Harada et al., 1999). Japanese researchers, in their efforts to map Minamata hotspots across the globe, had run headlong into the illicit transnational trade in mercury-containing cosmetics and governments’ half-hearted efforts to stop it.

Image 1: Although banned by the Kenyan and Tanzanian governments, mercury-containing soaps were widely available during the late 1990s when the Japanese researchers stumbled across their use. These three brands were purchased at a market in Mpanda, Tanzania. Reproduced from Christian M. Glahder, Peter W. U. Appel, and Gert Asmund, Mercury in Soap in Tanzania (NERI Technical Report No. 306, National Environmental Research Institute, Denmark, 1999).

Recently, toiletries containing mercury have once again surprised medical researchers in Africa. This time the researchers are not from abroad. Instead, they are South African doctors and scientists seeking to understand and curb the ill effects of skin lightening cosmetics in their own country. In laboratory analysis of products sold in Durban and Cape Town, researchers found that over forty percent contain mercury, often combined with hydroquinone and topical corticosteroids. Although hydroquinone and steroids are also banned for use in cosmetics, they are regularly listed on product labels. Mercury, by contrast, never appears on labels (Dlova et al., 2012; Maneli et al. 2016). A 2010 survey of consumer attitudes towards mercury-containing products in eight countries (including Kenya and Senegal but not South Africa) suggests why it might be omitted: where mercury is a well-known toxin, its appearance on cosmetic labels deters purchase.

These findings are remarkable for a couple of reasons. First, South Africa (1975) – like the United States (1973), the European Economic Union (1976), and Nigeria (1982) – long ago banned mercury from cosmetics. In the years following South Africa’s mercury ban, opposition to skin lighteners rooted in both political and health concerns grew and became a corollary of the anti-apartheid movement. Ultimately, a coalition of Black Consciousness, medical, and consumer activists convinced the apartheid government, during its waning months, to pass the world’s most restrictive, if now frequently flouted, regulations on skin lighteners.

Whereas many countries today ban specific active ingredients, South Africa is the only one that also prohibits cosmetic advertisements from making any claims to “bleach,” “lighten,” or “whiten” the skin. This prohibition bears the anti-racist politics of the broader movement from which it emerged. The South African campaign of the 1980s focused on hydroquinone as the most worrisome active ingredient, situating mercury as a problem of a bygone era. Efforts in the post-apartheid period to raise public awareness about skin lighteners have focused on the harmful effects of products containing hydroquinone and topical steroids. Considered an outmoded ingredient, mercury has rarely been mentioned.

The South African finding that forty percent of skin lighteners contain mercury is also remarkable because it is a much higher portion than that found elsewhere. In recent years, as the international market for skin lightening products has boomed, journalists, regulators, and scientists have sounded the alarm bell about mercury in some products. Within the United States, reports of people using mercury-containing soaps and cosmetics frequently feature poor immigrants from Latin America, the Caribbean, and Africa. The World Health Organization issued a bulletin on the matter in 2011, warning that the health dangers extend beyond users as the mercury they discharge travels through wastewater and into the environment. Three years later, a study of 549 skin-lightening products purchased either on-line or in stores in the United States, Taiwan, Japan, Thailand, and Sri Lanka found that six percent of the products contain mercury (Hamann et al., 2014). Six percent is a small, if significant, portion compared with the forty percent found in the South African studies.

What does this unexpected and uneven resurgence tell us about mercury’s circulation and persistence? And what does it reveal about mercury’s visibility and concealment?

Mercury’s resurgence in soaps and cosmetics demonstrates the tremendous reach of what Michelle Murphy (2013) has termed “chemical infrastructures,” the distributions of industrially produced chemicals as they move across decades, through the atmosphere, landscapes, waterways, commodities, and bodies, and into realms of recognition. Chemical exposure pairs uncertainty with diffusion. Toxins spread while their sources remain unidentified and their deleterious effects appear far downstream. As Murphy (2006) demonstrated in her earlier study of sick building syndrome and Nick Caverly discusses in his contribution to this series, such exposure is notoriously difficult to trace and prove.

The infrastructures that produce the mercury-containing soaps and cosmetics sold in Africa are geographically expansive and congenitally duplicitous. The mercury itself might be mined in Spain, China, Kyrgyzstan, and Algeria or recycled from industrial facilities in Europe. The soaps and cosmetics are manufactured in Cote D’Ivoire, Democratic Republic of the Congo, France, India, Italy, South Africa, Spain, the United Kingdom, and United States. Some products are distributed through the diasporic networks of shopkeepers and traders. Others arrive in stores and markets through the more formal, if no less illicit, distribution chains of cosmetic manufacturers.

For example, the mercury soaps sold in East Africa during the 1990s were legally manufactured in the United Kingdom despite the fact that their sale was illegal there as well as in Kenya and Tanzania. From the start, the UK-based manufacturers had in mind unlawful markets in former colonies and among black and brown immigrant communities in former metropoles, most notably London and Brussels. Only in 2003 did the European Union ban the export of mercury-containing cosmetics.

A key pillar of these chemical infrastructures is mercury’s deep history and relative efficacy as a clarifying and lightening agent. Ancient burials in Asia, South America, and the Mediterranean region suggest that humans long ago recognized mercury, in the form of cinnabar dust, as a formidable anti-bacterial that could forestall decay. Mercury was a coveted ingredient in cosmetics, since at least early modern times, because of its capacity to clear blemishes, reduce uneven coloring, and induce overall lightening. When combined with chlorine and then injected or applied topically, mercury has effectively, if lethally, combatted bacterial infections, ranging from acne to syphilis.

By the early twentieth century, pharmaceutical and medical textbooks recommended ammoniated mercury and other mercury salts for treating skin infections and spots of darker pigmentation while often warning of their harmful effects. Creams containing ammoniated mercury, usually marketed as “freckle removers” or “freckle waxes,” ranked among the period’s most popular cosmetics used by white women (or those in the process of being recognized as white) and some black and brown women in the United Kingdom, the United States, and other imperial outposts.

When the U.S. Congress passed the Food, Drug and Cosmetics Act in 1938, mercury–containing creams were among the first products targeted for regulation. Soon after, government and industry scientists identified mercury’s temporary (generally, as long as the product is used) depigmenting mechanism as two-fold: it inhibits the formation of melanin through rendering inactive the enzyme tyrosinase and it exfoliates the tanned, outer layers of the epidermis through the production of hydrochloric acid. When included in cosmetics, mercury’s effects extend below the surface of the skin, altering appearances by disrupting biochemical processes.

As the negative environmental and health consequences of mercury became ever more apparent in the post-World War II period, including through the devastation at Minamata, the United States and other countries imposed tougher restrictions on mercury, including banning all but trace amounts from cosmetics. Given mercury’s deep history as a relatively effective depigmenting agent combined with growing global demand for skin lighteners and lax enforcement of trade and cosmetic regulations, it was perhaps naïve not to anticipate a resurgence of mercury-containing cosmetics in our times.

The researchers who study these cosmetics are also part of mercury’s expansive infrastructures. Minamata made mercury’s bodily effects painfully visible, causing a group of Japanese medical doctors to become the world’s leading experts on environmental mercury poisoning. This expertise brought them to East Africa, searching for organic mercury that might have passed from gold ore processing through the aquatic food supply and into human bodies in the highly toxic form of methylmercury. Instead, they discerned a new, consumer rather than industrial, starting point for the dispersal of mercury. The inorganic mercury in antiseptic soaps could poison users’ bodies and be made even more lethal as it passed into the ecosystem through bodily waste and greywater, transformed into methylmercury, and returned to human bodies through the consumption of fish. Here was a visceral instance of environmentalist Rachel Carson’s insight (1962) that small, domestic choices were making the world uninhabitable.

For others in East Africa, the poisonous presence of mercury products had been visible for some time. As the Japanese researchers soon learned, the Kenyan and Tanzanian governments had, in fact, banned the soaps in the early 1990s. Moreover, twenty years earlier, medical faculty at Nairobi’s Kenyatta National Hospital published an article in the British Journal of Medicine on an outbreak of nephrotic syndrome or kidney failure among “young sophisticated African women” who used perfumed skin-lightening creams (Barr et al., 1972). This article became one of the most widely-cited studies of the ill health effects of mercury-containing cosmetics. That Harada and his colleagues were initially unaware of it suggests how beauty practices had, until then, fallen outside their research purview.

Mercury’s infrastructures straddle and support geo-political inequities and prejudices. Mercury’s presence or absence and the very forms in which it appears have become a measure of states’ regulatory powers as well as of consumer awareness and wealth. The Japanese researchers’ discovery that mercury soaps were easily available positioned Africa as an unregulated region of the world. Recent South African studies confirm that mercury-containing cosmetics are more common there. And those investigations did not even include antiseptic soaps or homemade skin lightening concoctions sold in informal markets and shops most often patronized by poor immigrants from elsewhere in Africa. Whereas Japanese researchers were surprised by the very existence of mercury-containing toiletries, South African researchers overlooked the diversity of products sold in their own country.

Consumers rely on labels to make mercury visible. Cosmetic manufacturers, in turn, consistently conceal their inclusion of ammoniated mercury by not listing it. This concealment both resonates and contrasts with dynamics that Kristin Peterson (2014) has recently identified in Nigeria’s pharmaceutical industry. Like Nigerian drug markets, South Africa’s skin lightener markets are formed through regional, transnational, and global circuits of capital and commerce. Trade liberalization policies of the past thirty years have made these circuits increasingly difficult to track and regulate. Peterson found that drug manufacturers, to save on production costs, often include smaller amounts of active ingredients than they list on their labels.

At stake with mercury-containing cosmetics is not what is listed but what is left off. The concealment of mercury, when other banned ingredients frequently appear, suggests that skin lightener labels are directed at buyers rather than regulators. Companies are more fearful of discerning consumers than conscientious officials. Mercury’s concealment also illustrates how cosmetic manufacturers, who produce for highly competitive and de facto unregulated markets, are apt to multiply and combine active ingredients, allowing the naming of some to mask the presence of others.

Mercury’s resurgence in soaps and creams demonstrates how innumerable, personal acts contribute to the world’s toxicity. Chemical pollution occurs not only through manufacturing and mining or spectacular disasters like Minamata, Bhopal, and Chernobyl. It also spreads through everyday beauty practices. Highlighting those practices reveals the incredible reach of chemical infrastructures that distribute toxins across the globe, making them visible to some researchers and consumers while concealing them from others.

 

Lynn M. Thomas is a Professor in the Department of History and adjunct in Anthropology and Gender, Women and Sexuality Studies at the University of Washington, Seattle.  She is the author of Politics of the Womb: Women, Reproduction, and the State in Kenya (2003), and co-editor of The Modern Girl Around the World: Consumption, Modernity, and Globalization (2008), and Love in Africa (2009). She has served as a co-editor of the Journal of African History. Currently, Thomas is completing a monograph on the history of skin lighteners that is centered in South Africa and looks out towards the United States and East Africa.

 

Bibliography

Barr, R. D., P. H. Rees, P. E. Cordy, A. Kungu, B. A. Woodger, and H. M. Cameron. 1972. “Nephrotic Syndrome in Adult Africans in Nairobi.” British Medical Journal (15 April): 131-4.

Carson, Rachel. 1962. Silent Spring. New York: Houghton Mifflin Company.

Dlova, Ncoza C., Nicole E. Hendricks, and Bice S. Martincgh. 2012. “Skin-lightening Creams Used in South Africa.” International Journal of Dermatology 51 (Suppl. 1): 51-3.

George, Timothy. 2002. Minamata: Pollution and the Struggle for Democracy in Postwar Japan. Cambridge: Harvard University Press.

Glenn, Evelyn Nakano. 2009. “Consuming Lightness: Segmented Markets and Global Capital in the Skin-Whitening Trade.” In Evelyn Nakano Glenn, ed., Shades of Difference: Why Skin Color Matters, 166-87. Palo Alto: Stanford University Press.

Hamann, Carsten R., Waranya Boonchai, Liping Wen, Emi Nishijima Sakanashi, Chia-Yu Chu, Kylin Hamann, Curtis P Hamann, Kumar Sinniah, and Dathan Hamann. 2014. “Spectrometric Analysis of Mercury Content in 549 Skin-Lightening Products: Is Mercury Toxicity a Hidden Global Health Hazard?” Journal of American Academy of Dermatology 70, 2: 281-6.

Harada, Masazumi, Shigeharu Nakachi, Taketo Cheu, Hirotaka Hamada, Yuko Ono, Toshihide Tsuda, Kohichi Yanagida, Takako Kizaki, and Hideki Ohno. 1999. “Monitoring of Mercury Pollution in Tanzania: Relation between Head Hair Mercury and Health.” The Science of the Total Environment 227: 249-56

Harada, Masazumi, Shigeharu Nakachi, Koa Tasaka, Sakae Sakashita, Kazue Muta, Kohichi Yanagida, Rikuo Doi, Takako Kizaki, and Hideki Ohno. 2001. “Wide Use of Skin-Lightening Soap May Cause Mercury Poisoning in Kenya.” The Science of the Total Environment 269: 183-7.

Maneli, M. H., L. Wiesner, C. Tinguely, L. M. Davids, Z. Spengane, P. Smith, J. C. van Wyk, A. Jardine, and N. P. Khumalo. 2016. “Combinations of Potent Topical Steroids, Mercury and Hydroquinone are Common in Internationally Manufactured Skin-Lightening: A Spectroscopic Study.” Clinical and Experimental Dermatology 41: 196-201.

Murphy, Michelle. 2006. Sick Building Syndrome and the Problem of Uncertainty: Environmental Politics, Technoscience, and Women Workers. Durham: Duke University Press.

Murphy, Michelle. 2013. “Chemical Infrastructures of the St Clair River.” In Soraya Boudia and Nathalie Jas, eds., Toxicants, Health and Regulation since 1945, 103-15. London: Pickering & Chatto.

Peterson, Kristin. 2014. Speculative Markets: Drug Circuits and Derivative Life in Nigeria. Durham: Duke University Press.

Swiderski, Richard. 2008. Quicksilver: A History of the Use, Lore and Effects of Mercury. London: McFarland & Company, Inc., Publishers.

Thomas, Lynn M. 2009. “Skin Lighteners in South Africa: Transnational Entanglements and Technologies of the Self.” In Evelyn Nakano Glenn, ed., Shades of Difference: Why Skin Color Matters, 188-209. Palo Alto: Stanford University Press.

Thomas, Lynn M. 2016. “Historicising Agency.” Gender & History 28, 2: 324-39.

Walker, Brett L. 2010. Toxic Archipelago: A History of Industrial Disease in Japan. Seattle: University of Washington Press.

 

Cover image credit: Ncoza Dlova

Soft Power: The Over-Determined Politicization of Vulnerable in the #CDC7words by Elizabeth Bromley

12 Janvier 2018 - 5:10pm

At first blush, the inclusion of the word vulnerable alongside words like fetus, evidence-based, and diversity in the list of 7 words discouraged for use in budget documents from the Centers for Disease Control (i.e., the #CDC7words) evokes a feeling that ‘one of these things is not like the other.’ Considering the other six words, a critical mind can see the potential for triggering the sensitivities of a polarized polity, even if a budgeteer chooses such words precisely for their neutral technicality. But vulnerable is at once so simple and fungible a word as to seem mostly innocuous, if also somewhat tonally tender for bureaucratese. We might call vulnerable a word about softness, one that denotes susceptibility to attack or a delicacy to being dented or nicked. Yet a tour through the particular health discourses in which the word vulnerable plays a singular role reveals some troubling implications of its inclusion on a list of words in official disfavor.

First, in the field of bioethics, the word vulnerable has dense meanings that respond directly to past research abuses.1 As defined by federal regulations governing research with human subjects including the Belmont Report2 and the Federal Policy for the Protection of Human Subjects (“Federal Policy,” Health and Human Services 45 CFR part 463), vulnerable groups and individuals require extra safeguards in biomedical research contexts. Bioethicists’ concerns center on those with “vulnerability to coercion or undue influence,”4 a characteristic that would compromise the Belmont Report’s principle of respect for persons (i.e., autonomy) according to which individuals should consent to research voluntarily, with full knowledge of its risks and benefits. Other types of vulnerability are also invoked in the Federal Policy, including those vulnerabilities that may undermine the Belmont Report’s principle of justice. The principle of justice stipulates that the selection of research subjects “be scrutinized in order to determine whether some classes (e.g., welfare patients, particular racial and ethnic minorities, or persons confined to institutions) are being systematically selected simply because of their easy availability, their compromised position, or their manipulability, rather than for reasons directly related to the problem being studied.”2 The principle of justice also requires that those who bear the burden of research are not barred from receiving its benefits. In the Federal Policy, pregnant women, fetuses, neonates, children, and prisoners are defined as vulnerable populations; veterans, those with mental disabilities, individuals who are “economically disadvantaged” (who may be coerced with incentives or have no other access to care) or “educationally disadvantaged,” employees and students (who may experience pressure to participate from supervisors), and those with physical disabilities are also named as vulnerable populations. Federal regulations encourage research review boards to consider vulnerability as a propensity that could lead to abuse in research contexts,5 for in addition to these specific groups, federal research oversight agencies “[expect] IRBs to use their judgment when determining if subjects enrolling into particular protocols are considered vulnerable and if additional protections are warranted.”6(p. 4)

Next, in the field of disaster preparedness, the word vulnerable has a specific definition as a designation for groups and individuals that experience disproportionate injury and mortality in disasters and that therefore require special outreach, planning and support. The World Health Organization (WHO) defines vulnerability as “the degree to which a population, individual or organization is unable to anticipate, cope with, resist and recover from the impacts of disasters.”7 The WHO names pregnant women, children, the elderly, and those who are malnourished, immunocompromised or ill as “particularly vulnerable when a disaster strikes, and take a relatively high share of the disease burden associated with emergencies.” In addition, vulnerability applies to those living in “poverty – and its common consequences such as malnutrition, homelessness, poor housing and destitution.” Domestic disaster planning policies echo the WHO’s attention to vulnerability. Guidance from the CDC,8 the Office of the Assistant Secretary for Preparedness and Response,9 and the Federal Emergency Management Agency10 all emphasize enhancing preparedness for vulnerable groups through improved coordination between health and human services and the adoption of an inclusive and proactive approach to disaster preparedness. In an effort to minimize excess injury and death, preparedness professionals implement special services for vulnerable populations including individuals with physical or mental disabilities, renters (with limited ability to control risk circumstances), those living in nursing homes and other residential care facilities, individuals with limited mobility, the elderly living independently, the homeless, and others. Preparedness professionals recognize vulnerability in order to develop and implement plans to support those with less capacity to support themselves before and after disasters strike.

Definitions of the vulnerable from bioethics and disaster preparedness intersect with those used widely in public health, health services research, and clinical practice.11 Here, too, vulnerability is invoked in discourses of relative risk and additive suffering. When I use the word clinically, it is to describe patients who requires extra vigilance and added assistance.12 Health researchers label as vulnerable those groups or individuals susceptible to negative outcomes or confronting combined burdens of illness and social deprivation. Vulnerability is used to mark those whose lives are defined by precarity and by dependence upon a web of formal and informal resources whose disruption brings about catastrophic consequences. In this discourse, the vulnerable are those left behind, on the margins, actively excluded, or multiply disadvantaged. Simultaneously, researchers and clinicians understand the vulnerable to benefit more than others from well-delivered interventions. They experience “beneficial spillovers”13(p. 3) from straightforward health and social service interventions (e.g., nurse home visits for new parents; financial assistance) and they flourish with intensive clinical support.14

In these health contexts, vulnerability is permitted some strategic ambivalence. Defined fluidly as a concatenation of risks and encumbrances faced by individuals and communities – a lack of legal citizenship, disability, discrimination, and so on — vulnerability points to some and all factors at once. We immediately grasp that vulnerability is a signifier for the incontrovertible negative impact of certain assemblages of social factors on health, even where we still know little of the precise mechanics of this impact.15 Moreover, in these flexible deployments, the word vulnerable gains moral valence as an invocation of a responsibility to care for those who are less safe. And, in health discourses, the word vulnerable carries a gentle, if usually silent, political significance because it implies priorities for how resources should best be distributed.

Perhaps especially in its most flexible usages, vulnerable gains its moral traction because of a shared understanding that the word implicates us all. Vulnerability is an inevitable mode of human experience; emotionally, physically, and existentially, vulnerability inheres within us. As Jonathan Lear says, “As finite, non-omnipotent creatures we are constitutively vulnerable in a world over which we have, at best, limited control.”16(p. 679) Vulnerability is a state we see ourselves pass through, or one we perceive waits for us, if we do not feel we live entirely within it. Subjectively experienced and therefore diversely understood and articulated, we become vulnerable who-knows-where: in moments of intimate connection and caring;17 in “the reality of our final dissolution,”18(p. 159) when confronted with our imperfections;19 in “the ravages of emotion” of “intense sorrow, loss, anger, and frustration” that come with bereavement;20(p. 245) when we come to terms with our dependence on disinterested institutions;21 when we are “overwhelmed by [our] duties or responsibilities to others and when [our] own needs go neglected or unfulfilled”22(p. 486) and even in moments of strength and safety. In fact, in our everyday experience, potency and vulnerability are linked not as antitheses but as mirror images, identical except in structure and direction. In other words, as many of my current research interlocutors (mostly female surgeons) tell me, vulnerability is a skill and a distinction: “Being able to admit that I was vulnerable…I don’t think many women doctors can,” one told me. Indeed, it may be particularly those times when we imagine ourselves to be invulnerable that we expose ourselves to injury and isolation. As one physician said to me, commenting on how easily some colleagues come to prefer the predictability of work relationships to the give-and-take of regular ones, “you get into some position of authority…and everybody says, ‘Oh you’re the boss. You have all of the information. What would you like us to do, Doctor? We’ll do that right away. Thank you, Doctor.’… and some part of you says, ‘Oh yeah, I guess I’m really pretty special here.’” The desire to feel pretty special and never vulnerable can render us entirely alone.

Given these definitions, both flexible and specific, both subjugated and statutory, what significance can we take from the official disfavor and distrust of the word vulnerable as indicated by its presence on this odd list of 7 words? I will name two possibilities. First, since by definition the word vulnerable designates an increased risk for death and injury, we can interpret the eschewal of the word as an example of Achille Mbembe’s necropolitics. As Mbembe says, in a necropolitics, the state is active in “the creation of death-worlds, new and unique forms of social existence in which vast populations are subjected to conditions of life conferring upon them the status of living dead.”23(p. 40) If the use of the word vulnerable is first and foremost a form of calling forth protections for those most likely to die, closing off its use allows state power to redirect itself away from the explicit protection of those at highest risk, with certain results. In the process, a necropolitics designates some citizens as disposable and some lives as waste. These are the exercises of state biopower “to make live and let die” that Foucault famously identified,24 and they are the politics that Flavia Dzodan calls “eugenics adjacent”25 for they tolerate not only the proliferation of precarity but also of apathy and of demurrals to do what is required to serve and save. Certain lives are not worth the extension of extra protections. Their special designation of risk and adversity revoked, any approach to health will disadvantage the vulnerable, and perhaps that’s the point.

Yet we can also interpret a censure of the word vulnerable as a form of willful and wishful defensiveness against our own obligatory exposures. Avoiding the word vulnerable can be understood as a form of suppression that reflects a wish to create a world in which we are never frail and forever safe. We may hope that, without the word, we could make ourselves entirely unlike those who live with peril. To hope to never encounter the word vulnerable suggests a purposive blindness to our own condition, a motivated turn away from the real forces (the market, a deity, the climate, our bodies) at whose mercy we live and die. Lear reminds us that illness “gives us direct and immediate insight into who and what we are.”16(p. 678) In the same way, the word vulnerable gives a direct and immediate cognizance of the social reality of our existential defenselessness. As far as I can see, no other word could slot in for it. Without it, we are left with a strange gap in our speech, a sudden silence, like a redacted phrase that leaves a black rectangle behind. Jason Throop asks, “What, as an anthropologist, should one make of gaps in one’s own and other’s consciousness?” We might take caution in the “inherent hubris [of] attempting to make sense of putatively disguised motives … by means of one’s own theoretical assumptions and interpretive commitments.”26(p. 79) Yet what else but hubris could be behind the forced silencing of a word as capacious, moral, and generous as vulnerable? I would not have guessed it, but apparently, the word carries enough soft power that it needs to be muffled. If that’s the case, then living in full recognition of vulnerability27 — our own and others’ — is a form of resistance: to a politics of apathy and death, and to the effacement of our shared humanity.

 

Elizabeth Bromley, M.D., Ph.D., is Associate Professor in the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. She received her M.D. and M.A. in the history of medicine from the University of California, San Francisco and her Ph.D. in anthropology from UCLA. Dr. Bromley completed residency in psychiatry at Columbia University and the New York State Psychiatric Institute. She is an alumna of the VA/UCLA Robert Wood Johnson Clinical Scholars Program.

 

References

  1. Gamble VN. Under the shadow of Tuskegee: African Americans and Health Care. Am Journal of Public Health. 1997;87:1773-1778.
  2. The Belmont Report. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research: Department of Health, Education, and Welfare;1979.
  3. Federal Policy for the Protection of Human Subjects (‘Common Rule’). Health and Human Services, National Institutes of Health, Office for Human Research Protections.
  4. Notice of Proposed Rulemaking: Federal Policy for the Protection of Human Subjects; Proposed Rules. Vol 80. Federal Register 2015:53933-54061.
  5. Geissler PW. Public secrets in public health: Knowing and not knowing while making scientific knowledge. American Ethnologist. 2013;40(1):13-34.
  6. Standard Operating Procedure 14A v3: Research Involving Vulnerable Subjects (General Considerations) Health and Human Services, National Institutes of Health, Office for Human Research Protections 17 Feb 2017.
  7. Environmental health in emergencies: Vulnerable groups. World Health Organization 2017. http://www.who.int/environmental_health_emergencies/vulnerable_groups/en/.
  8. A National Strategic Plan for Public Health Preparedness and Response. Centers for Disease Control and Prevention 2011.
  9. National Health Security Strategy and Implementation Plan, 2015-2018. Health and Human Services 2014.
  10. A Whole Community Approach to Emergency Management: Principles, Themes, and Pathways for Action. Federal Emergency Management Agency 2011.
  11. Siegel B. Improving Quality and Patient Safety for Vulnerable Populations. Improving Quality and Patient Safety for Vulnerable Populations: Institute of Medicine;2013.
  12. Bromley E, Mikesell L, Armstrong NP, Young AS. “You might lose him through the cracks”: Clinicians’ Views on Discharge from Assertive Community Treatment. Administration and Policy in Mental Health and Mental Health Services Research. 2015;42(1):99-110.
  13. Adler NE, Cutler DM, Jonathan JE, et al. Addressing Social Determinants of Health and Health Disparities. Washington, DC: National Academy of Medicine;2016.
  14. Stein LI, Test MA. Alternative to mental hospital treatment: I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry. 1980;37:392-397.
  15. Bayer R, Galea S. Public Health in the Precision-Medicine Era. New England Journal of Medicine. 2015;373(6):499-501.
  16. Lear J. Wisdom won from illness: The psychoanalytic grasp of human being. International Journal of Psychoanalysis 2014;95:677–693.
  17. Brodwin P. Futility in the practice of community psychiatry. Medical Anthropology Quarterly. 2011;25(2):189-208.
  18. Rowe M. Doctors’ responses to medical errors. Critical Reviews in Oncology/Hematology. 2004;52(3):147-163.
  19. Chapple HS. No place for dying: Hospitals and the ideology of rescue. Left Coast Press; 2010.
  20. Boyte WR. The Curtain. Health Affairs. 2002;21(4):242-245.
  21. Bromley E, Kennedy D, Sherbourne C, Miranda J, Wells KB. The Fracture of Relational Space in Depression: Predicaments in Primary Care Help Seeking. Current Anthropology. 2016;57(5):610–631.
  22. Hollan D. Being there: On the imaginative aspects of understanding others and being understood. Ethos. 2008;36(4):475–489.
  23. Mbembe A. Necropolitics. Public Culture. 2003;15(1):11-40.
  24. Foucault M. Society must be defended: Lectures at the Colle`ge de France, 1975–76. New York: Picador; 2002.
  25. Dzodan F. When the personal is necropolitical: On Inauguration Day and alliances of hate. 2017. https://medium.com/this-political-woman/when-the-personal-is-necropolitical-on-inauguration-day-and-alliances-of-hate-55f9ce4eb6e2.
  26. Throop J. On inaccessibility and vulnerability: Some horizons of compatibility between phenomenology and psychoanalysis. Ethos. 2012;40(1):75–96.
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Dust by Nick Caverly

12 Janvier 2018 - 6:45am

The building pictured below sat near Mack Avenue on Detroit’s far east side and, according to the municipal government, was an environmental hazard. Following years of complaints from area residents that the structure smelled of rotting garbage and attracted criminal activity, the building is slated for demolition. In mid-2017, a fifty-five-ton excavator piloted by a human operator knocked down the floors, walls, and other components before loading them into waste haulers bound for area landfills.

Building as environmental hazard. Source: Photo by Author.

By 2020, an estimated 40,000 buildings are scheduled for removal. Such structures are unevenly distributed across Detroit’s landscape, and are the material remainders of racially-motivated population movements in which white property owners and industrial employers have sought to insulate themselves from upwardly mobile people of color throughout the twentieth and early twenty-first centuries (For more, read: Bunge, 2011; Kinney, 2016; Sugrue, 2005; Thomas, 2013). Otherwise put, if Detroit’s vacant buildings are waste to be landfilled, they are the products of racialized systems of property ownership that allowed white families to cash in on moves to the suburbs, while people of color were left to cope with the deleterious effects of increasing vacancy and declining property values.

Demolition has been the standard response to dilapidated buildings in Detroit since at least the 1950s, but the pace of removals has accelerated since the mid-2010s, with more than 10,000 demolitions recorded between 2015 and 2016. Still, the process of bulldozing structures deemed environmental hazards has produced new anxieties, specifically the potential for collapsing buildings to release toxin-laced dust. What follows are moments in which dusty emissions of building removal become matters of concern. Accounts from Southeast Asia, North America, and elsewhere demonstrate how the shifting makeup of air – including scents, chemicals, colors, and other contents – give shape to collective lives (Choy and Zee, 2015; Murphy, 2008; Shapiro, 2015). In this vein, following attempts to control building removal emissions offers a brief glimpse at how racialized inequalities are recast through the organized ‘clean up’ of their material remains.

My first encounter with fears of demolition dust occurred on a hot July morning when Julian, a demolition laborer exclaimed, “We’ve got to find a hydrant around here that works, and soon.” On that morning, Julian was part of a team razing a burned out auto body shop on Detroit’s west side, and his responsibilities included drenching the building before it could be “knocked down and loaded out.” After our first two attempts to crank open corroded fire hydrants yielded only trickles of water, Julian muttered, “If we don’t get water, there’s going to be dust, and if there’s dust it’s my job.” Just days before, one of Julian’s fellow laborers was fired after he failed to locate a sufficient water source. To be sure, Julian’s difficulties locating a working hydrant are not isolated, and a recent audit found as many as half of Detroit’s fire hydrants are inoperable following decades of deferred maintenance. Luckily for Julian, on our third attempt, a hydrant released a torrent of water that traveled through three blocks of leaky fire hose and onto the walls of the auto garage.

Hydrants became a required part of demolition practice in 2014 when the Detroit Building Authority (DBA) took over management of the city government’s demolition fund in what municipal leaders and private-sector executives then described as “An ambitious plan to clean up the City of Detroit.” This announcement underscored how the DBA would set a “gold standard” for building removal using methods deemed to be “fiscally responsible and environmentally safe.” These methods were developed by a panel of demolition contractors, state administrators, and environmental health practitioners, who mandated a “wet-wet method” in which the contents of demolished buildings are soaked down both when they are being flattened by excavators and while they are being scooped into waste haulers. Doing so, according to the panel’s report, would control dust generated through highly mechanized demolition, preventing it from blowing onto adjacent properties.

Non-Functioning Fire Hydrant. Source: Photo by Author

“Dust,” as Melanie, a state economic development officer who advised the panel told me, “is the number one nuisance produced by demolition, and keeping things wet prevents that. We’re trying to clean up the city here, and we don’t want to leave things dirtier than we found them.” Pronouncements by DBA administrators, politicians, property developers, and others treat vacant buildings as waste to be expelled from the city limits. Doing so, they argue, will improve property values, promote public safety, and attract new residents. To use Melanie’s words, “We want to clear away the mess and encourage development.”

Nevertheless, dust kicked up in removing traces of Detroit’s past is more than an aesthetic inconvenience. According to an inspector from the Michigan Occupational Safety and Health Administration (MiOSHA), “This isn’t just dirt blowing around. We’re talking about buildings constructed before the 1970s, so they most likely contain asbestos, PCBs, lead, cadmium, and other contaminants. Those things are usually fine if you don’t touch ‘em, but when you’re demolishing them there is the potential they can become airborne and affect workers, next-door neighbors, and other people. Abatement may remove most of these toxins, but they almost always miss stuff hidden in walls, pipe chases, attics, and the like.” Asbestos siding, PCB insulators, and other materials were state-of-the-art technologies for middle-class homeowners as Detroit’s built environment was constructed over the course of the early twentieth-century. Decades later, materials that once made for safe, warm, and colorful lives are made environmental toxins when they are run through by fifty-five ton excavators.

Asbestos pipe insulation in building to be demolished. Source: Photo by Author

Aerosolized toxins have become a matter of public concern, and local environmental activists are vocal critics of the DBA’s demolition protocol, including “wet-wet” practices. Instead, environmental groups argue that salvageable buildings should be renovated and used to house low-income Detroiters, while necessary removals should proceed slowly and by hand, without the use of heavy machinery that has a propensity to kick-up dust. Such arguments have largely gone unheeded, perhaps in part because contact with chemicals like asbestos, lead, and PCBs is notoriously difficult to trace since these substances only produce deleterious effects years after contact with human tissue (Chen 2012; Murphy 2006; Markowitz and Rosner 2002; Walker 2011). Furthermore, even when there is proof of contact with an environmental toxin, it can be impossible to prove the source of the exposure, especially when that source is a dusty particulate that can be blown or washed away (Hecht 2012; Krupar 2013; Pulido 2000).

Dave, a DBA program officer, chafed at the accusations of environmental activists, telling me “We take the safety of workers and the public very seriously and would never do anything to harm them. Hazardous materials like asbestos are abated pre-knock down, and our wet-wet method is tested to prevent harmful emissions when they can’t be.” That said, dust is kicked up even when water protocols are strictly followed, including at the auto shop that Julian and his coworkers demolished. Despite a thorough soaking, the process produced clouds of dust that enveloped Julian and blew into surrounding yards. When I mentioned my observations of dusty worksites to Dave, he reframed his earlier statement, adding, “We can’t go tenting every house. We need to remove them, and taking them apart by hand takes a lot of time and money. That would be like $100,000 for a single-family [house] and right now our costs are at $15,000 per. The brass tacks financial reality of the situation is that we can’t afford the time and billions of dollars […] As it is, our timeline for cleaning this up is already slowing down […] Do you really want to slow down that progress because of a little dust?”

Marking Asbestos. Source: Photo by Author

In this instance, it is difficult to ignore arguments that ‘unintended consequences’ emerge with panoptic views for progress that obscure local particularities (e.g. Beamish 2002; Holston 1989; Scott 1999). Mono-cropping, highly Taylorized production, and modernist planning may work well in theory, but they come unhinged in practice. While this has been a productive scholarly framework, it is notable that Detroit’s demolition program has been made to fit local circumstances, including what Dave refers to as the “brass tacks financial reality of the situation” where limited funding streams shaped decisions to pursue a cheaper, speedier, and potentially draftier demolition protocol. Still, my intent is not to present an economically determined argument in which all processes are tethered to financial concerns; there are other particularities at work.

For instance, on the day when Julian’s colleague was fired for failing to find an adequate water source, he was working with a team of six people to demolish an entire block of houses in northeast Detroit. Unable to find an operable fire hydrant, the crew continued with a “dry” demolition until an occupational health inspector ordered work stopped at 11:00 am, with the provision that it could resume when a suitable water source was located. According to Julian, the contractor insisted that work resume after the inspector had left the site, even though no working fire hydrant could be located. A regulatory citation states that when the inspector returned forty-five minutes later, they found a large dust cloud with demolition ongoing and no water in use.

Following this citation, only Julian’s fellow laborer was fired, and neither the excavator operator nor the site supervisor received any form of discipline. When I asked Julian how this could have happened he shrugged, replying, “We’re expendable, don’t you see? We’re black and brown. We bust our asses every day, hauling materials, breathing in shit. They’re white and they sit in air conditioned cabs all day with air purifiers.” This statement exemplifies how hierarchies of demolition employment are both racialized and technologized. Contractors, excavator operators, supervisors, and regulators are always better paid, and almost exclusively white, whereas low-wage laborers like Julian are typically people of color. Furthermore, many laborers are migrant workers or part of prison-release programs that make their positions even more precarious.

Marta, whose yard was covered by fine brown dust from the demolished auto body shop extended the sentiment of expendability to the predominantly people of color who live near building demolition sites. In her words, “They don’t need to let us know that they might dump a load of dirt into our lungs or on our yards. They’ve been dumping stuff on us for centuries. [We’re] black, they’re white, and they can act like you don’t even have a right to exist. What’s more is that they’re not demolishing these buildings for us, they’re getting rid of them so that folks who look like you can come and kick us out.”

‘Wet-Wet’ demolition in progress. Source: Photo by Author

Scholars have argued that in instances where wastes and toxic substances exceed spatial and temporal containments they also undermine systems of racialized and classed privilege (Beck, 2006; Rathje and Murphy, 2001; cf. Stoler, 2010). Surplus waste and toxic burden, in this view, becomes a problem for abstract configurations of “the city,” “society,” and “humanity” writ large rather than one of specifically marginalized populations (Melosi, 1981; Rathje and Murphy, 2001; cf. Nixon, 2011). Detroit’s vacant buildings and their dusty emissions offer caution to these conclusions. Waste, including Detroit’s 80,000 vacant buildings and their potentially toxic dust, may appear as emergent phenomena; however, as this brief discussion of building removal has highlighted, waste and its excesses are always historically entailed. Indeed, interactions with wasted materials become valences of already racialized and classed bodies as they are organized through existing formations of residential segregation and precarious labor.

Such a finding is not limited to the caustic histories of racialized exclusion at work in Detroit, Michigan, or the United States. As Gabrielle Hecht argues in her brief from the uranium-laced piles of mining slag on the West Rand, disjunctive temporalities of gold, mercury, water, and human life collide, producing highly uneven anthropocenic realities. This collision generates radioactive water for some, but not nearly all, perpetuating what Hecht has elsewhere termed the slow violence of “molecular colonialism.” Placing Hecht’s terminology in conversation with Detroit suggests that present-day toxic emissions – be they potentially toxin-laden dust or acid mine drainage – both compound and redefine longstanding sociopolitical and economic hierarchies as they leave caustic traces in the bodies of those made to contend with them.

Still, authors in this collection find instances where toxic remains enable new, desirable lives. The smelly spoilage of Nile perch buffers against the growth of pathogens while producing uniquely sought after flavors.  Glimmers of revolutionary consciousness emerge in an industrial valley in Durban. And others still. Jennifer Wenzel calls us to follow waste and remains as sites of latent possibilities for constructing cleaner futures from our contaminated presents. Her hopeful arguments resonate with those of activists growing a prairie and playground from disused industrial land and abandoned tires in Ypsilanti; however, other wasted substances do not provide such eventualities. Asbestos fibers, for instance, cannot be rendered inert. When removed from places like Detroit’s vacant buildings they can only be reshuffled elsewhere, including into landfills and the aerial spaces surrounding demolition sites. Tracing dusty emissions in Detroit, thus, suggests that efforts to muddle through and imbue wasted things with new life must grapple with the possibility that such futures may not always be possible, let alone desirable for all concerned. Indeed, when Detroit’s marginalized places and the bodies of marginalized people who live and work in them become targets for clean up, they are also fashioned into the places where the toxic excesses of wasted built environments will settle as they are dredged up and redistributed by fifty-five ton excavators, fiscal governance, geographic proximity, and the prevailing breeze.

 

Nick Caverly is a PhD candidate in the Department of Anthropology and the Program in Science, Technology, and Society at the University of Michigan. Broadly, his research follows the production and maintenance of spatialized and embodied inequalities at the intersections of land, work, and the environment in the United States. He is currently exploring these themes through a dissertation examining large-scale building demolition projects in Detroit, Michigan as an optic for understanding how people — as neighbors, workers, regulators, and administrators — grapple with the material traces of longstanding racialized and classed inequalities. Within this project he traces how the elimination of vacant buildings produces new things, including emergent forms of techno-political classification, property ownership, precarious labor, and environmental hazard.

 

Works Cited

Beamish, Thomas D. 2002. Silent Spill: The Organization of an Industrial Crisis. Cambridge: MIT Press.

Beck, Ulrich. 2006. “Living in the World Risk Society.” Economy and Society 35 (3): 329–45. doi:10.1080/03085140600844902.

Bunge, William. 2011. Fitzgerald: Geography of a Revolution. Athens: University of Georgia Press.

Chen, Mel Y. 2012. Animacies: Biopolitics, Racial Mattering, and Queer Affect. Durham: Duke University Press.

Choy, Timothy, and Jerry Zee. 2015. “Condition—Suspension.” Cultural Anthropology 30 (2): 210–23. doi:10.14506/ca30.2.04.

Hecht, Gabrielle. 2012. Being Nuclear: Africans and the Global Uranium Trade. xx, 451 p. Cambridge, Mass.: MIT Press. http://hdl.handle.net/2027/.

Holston, James. 1989. The Modernist City: An Anthropological Critique of Brasilia. 1 edition. Chicago: University of Chicago Press.

Kinney, Rebecca J. 2016. Beautiful Wasteland: The Rise of Detroit as America’s Postindustrial Frontier. University Of Minnesota Press.

Krupar, Shiloh R. 2013. Hot Spotter’s Report: Military Fables of Toxic Waste. xv, 366 pages. Minneapolis: University of Minnesota Press. http://hdl.handle.net/2027/.

Markowitz, Gerald E., and David Rosner. 2002. Deceit and Denial: The Deadly Politics of Industrial Pollution. xx, 408 p. Berkeley, CA : New York: University of California Press ; Milbank Memorial Fund. http://hdl.handle.net/2027/.

Melosi, Martin. 1981. Garbage In The Cities: Refuse Reform and the Environment. Revised edition. Pittsburgh: University of Pittsburgh Press.

Murphy, Michelle. 2006. Sick Building Syndrome and the Problem of Uncertainty: Environmental Politics, Technoscience, and Women Workers. Durham: Duke University Press.

———. 2008. “Chemical Regimes of Living.” Environmental History 13 (4): 695–703.

Nixon, Robert. 2011. Slow Violence and the Environmentalism of the Poor. Cambridge: Harvard University Press.

Pulido, Laura. 2000. “Rethinking Environmental Racism: White Privilege and Urban Development in Southern California.” Annals of the Association of American Geographers 90 (1): 12–40. doi:10.1111/0004-5608.00182.

Rathje, William, and Cullen Murphy. 2001. Rubbish!: The Archaeology of Garbage. Tucson: University of Arizona Press.

Scott, James C. 1999. Seeing like a State: How Certain Schemes to Improve the Human Condition Have Failed. New Haven: Yale University Press.

Shapiro, Nicholas. 2015. “ATTUNING TO THE CHEMOSPHERE: Domestic Formaldehyde, Bodily Reasoning, and the Chemical Sublime.” Cultural Anthropology 30 (3): 368–93.

Stoler, Ann Laura. 2010. Along the Archival Grain: Epistemic Anxieties and Colonial Common Sense. Princeton: Princeton University Press.

Sugrue, Thomas J. 2005. The Origins of the Urban Crisis: Race and Inequality in Postwar Detroit. Princeton: Princeton University Press.

Thomas, June Manning. 2013. Redevelopment and Race: Planning a Finer City in Postwar Detroit. Detroit: Wayne State University Press.

Walker, Brett. 2011. Toxic Archipelago: A History of Industrial Disease in Japan. Seattle; London: University of Washington Press.

Residue by Gabrielle Hecht

8 Janvier 2018 - 5:36pm

Waste and toxicity are foundational categories of knowledge for the Anthropocene. Consider how natural scientists approach the topic. Empirically, the “great acceleration” they’ve identified corresponds to a massive increase in human-generated wastes: carbon molecules, toxic chemicals, radioactive particles, plastics, and much more. Measuring molecular concentrations of these materials, and mapping these measurements onto models of earth systems (such as the atmosphere, the biosphere, or the pedosphere), hails certain materials as excessive, residual, and/or toxic. Model-mediated measurements (Edwards, 2010) thus enact ontologies of waste and toxicity, generating evidence for the planetary scale of human terraforming. In important ways, tracking (toxic) wastes is how we know the Anthropocene.

Of course human terraforming is geographically and politically uneven. Communities living in precarious economic and environmental conditions experience it very differently than those living comfortably: the Anthropocene may be planetary, but it is not uniform. And knowing that aspect of the Anthropocene requires a qualitative approach. So how can waste-centered epistemology help humanists and social scientists think about differential histories, presents, and futures in in the Anthropocene? Let’s take mine residues in South Africa as an entry point.

 

Rocky residues

Consider rock. At certain historical moments, production imperatives, industrial needs, and sometimes just plain greed turn rock into rocks. As some rocks acquire value through mining, refining, and chemical extraction, others (actively, dialectically) become waste. Such dynamics were central to the making of modern South Africa.

Industrial gold mining on the Witwatersrand plateau (in today’s Gauteng province) began in 1886. In the ensuing decades, hundreds of thousands of men migrated to the Rand from southern and central Africa to work in the mines, which rapidly became deepest in the world. As miners tunneled in, they extracted millions of tons of rock. Rocks with high gold content got processed. Rock whose gold content couldn’t be profitably extracted at the time of mining piled up around the shafts. By the 1930s, gigantic tailings piles had changed the topography of the Rand – including that of Johannesburg, the urban sprawl birthed by mining.

Workers descend into the Robinson Deep Gold Mine, 1900. Source: http://www.miningartifacts.org/South-African-Mines.html

In production-centered historiographies, histories of mining focus on shaft-sinking, tunneling, descending, collapsing; the absence of air, the falling of rocks, the terrors of the dark. A pivot to waste extends this vertical orientation upward: mining makes mountains, as well as holes. Not that this history is any less wrenching. South African author Peter Abrahams, best known for his novel Mine Boy, which took readers deep underground, also wrote poetry about the mine dumps. Here’s an excerpt from “Fancies idle (iii)”:

Mine dumps of the Rand.
These pyramids speak hands
Torn and bleeding,
Black, hard, rocky,
Like the black earth, wind-swept and touched by time
To leave
Torn nails and twisted thumbs
And missing spaces where the first and third fingers lived.

These pyramids
Scattered over the body of the Rand,
Mighty in their grandeur and aloofness,
Monuments of the Twentieth Century Pharaohs,
Speak the world,
Not thousands of black men,
But millions of toilers,
Welded into a rock of firm aloofness,
Like them, made of the soul of suffering;
These pyramids are the symbol of revolt!

And revolts there were, of course, but those have been thoroughly analyzed by others. Here, I offer Abrahams’s vision as a counterpoint to that of a mining magnate in the 1950s, who in gazing out at the new topography of Johannesburg and its surroundings saw not pyramids of suffering, but gigantic piles of cheap uranium.

The dump at the Crown Gold Mine, 1939. Source: Central Mining-Rand Mines Group.

All rock is a complex conglomerate of elements and molecules. For decades, Rand magnates cared only about gold. But as the Cold War heated up, a previously valueless element suddenly came into view: uranium. And it was readily available in South Africa, embedded in Rand residues. Procurers for the American and British nuclear weapons complexes salivated. Contracts were signed, treatment plants built. The first 10,000 tons of South African uranium came from these mine dumps. After that, the cycle of tunneling and mountain making resumed, extracting both uranium and gold for the rest of the 20th century (Hecht, 2012).

In deep time, water shapes rock. Industrial mining accelerated this process, rescaling it for human time. Extracting gold in South Africa required a vast amount of water, particularly once the cyanide leaching process became the standard means of extracting gold from host rock. Gold mining was accompanied by massive water works: dams, barrages, and pipelines channeled water from the Vaal River to the mines for use in the treatment process. But water also had to be extracted from the mine shafts. By the early 20th century, many shafts had plunged below the water table. So they got flooded. Water had to be pumped out so that miners could work.

Dozens of different companies extracted Rand ore over the years. The mines they worked fell into three geological basins. Within each basin, the shafts were all connected underground. When a mine ceased to produce profit and shut down, the pumping stopped too. This increased the pumping burden on the other mines. By the late 20th century, only a handful of mines in this vast techno-geological assemblage still operated. The onus of pumping ever-increasing amounts of water squeezed profit margins. The now democratically-elected government, no less a promoter of capitalism than its apartheid predecessor, paid pumping subsidies to the remaining mining companies to preserve their profit margins (McCarthy, 2010; Turton et al., 2006; Adler et al., 2007).

 

Residual governance

When yet more mines shut down, the remaining pumps could no longer beat hydrological cycles. Water seeped back in, filling cracks and shafts, reacting with the pyrite in the exposed rock. This chemical reaction acidified the water, rendering it more conducive to the dissolution of elements long trapped in the rock, such as lead, mercury, and arsenic. This toxic soup trickling through tunnels and tailings was known as acid mine drainage (AMD). A new residue had become visible – and with it, new demands for its governance.

Mind you, a small handful of experts, scattered across several government agencies, had long predicted that the acidified waters would rise, “decanting” out of abandoned shafts and into the water table (Förstner and Wittmann, 1976; Rösner and Van Schalkwyk, 2000). For years they had called, in vain, for measures to stop the overflow before it began. But out of sight, out of mind: as long as the water remained in the shafts, it attracted no attention as a potential object of governance. That changed in 2002, when a flood in the Rand’s Western Basin brought AMD, laced with heavy metals, to the surface. (Naicker et al., 2003; Bobbins, 2015).

In short order, acid mine drainage came to constitute one of Gauteng’s gravest environmental health threats. Residents without access to cleaner water sources bathed themselves and their clothes in acidic, metallic water. Contaminated water irrigated crops and quenched the thirst of humans and livestock. Along the way, people, animals, and plants absorbed heavy metals, chemical solvents, and radioactive particles. Of course they got sick; of course they noticed; of course they protested. Dozens, then hundreds of articles appeared in the press. As the decant and its effects increased in scale and visibility, architect Lindsey Bremner argues, it “transformed geology into politics”(Bremner, 2013).

The governance of mine residues remains central to the governance of Gauteng. National and regional government agencies, mining and water companies, civil society organizations, scientists, farmers, residents of informal settlements, and many others continue to battle over how to govern the toxic floods (Humby, 2013). In the Rand’s Western Basin, one constellation of such actors has taken a technopolitical approach to residual governance by building a neutralization plant to raise the pH of the water. But as others point out, this (dis)solution does nothing more than de-acidify the water. It doesn’t make the water safe for humans: heavy metals and other contaminants remain (Bobbins, 2015). This narrowly conceived approach, which isolates a small piece of the problem while ignoring its broader implications, represents residual governance in a second sense: governance as afterthought, governance on the margins.

And then there’s the ongoing problem posed by the pyramids. Although many of the mine dumps have been re-mined or moved (often spreading toxicity yet further), large piles of residues remain (Oosthuizen et al., 2012). When winter winds scream across the Rand, they blow radioactive mine dust over farms and settlements, both formal and informal. Drifting dust enters dwellings, lungs, and eyes, interpellating yet more agencies, experts, and publics (Schonfeld, Winde et al., 2014; Van Eeden, Liefferink, and Durand, 2009).

Tudor Shaft informal settlement with mine dump in the background, 2016. Photo by the author.

Surprisingly visible among these publics: the residents of the Tudor Shaft informal settlement, located both on and downwind from dumps. Some Tudor Shaft residents, such as Mr. Jeffrey Ramoruti, lived there for over two decades. When Mr. Ramoruti first arrived, he and others were promised a short wait time for permanent housing (via the new government’s Reconstruction and Development Programme). Their hopes frustrated again and again, residents pursued many strategies to remedy their plight. Radioactive dust, for example, helped them garner enough media attention to produce several studies that found radiation levels in excess of international norms. Some shacks were marked for demolition, yet they remained standing for years. The National Nuclear Regulator concluded that higher levels of public exposure were acceptable because Tudor Shaft presented an “existing exposure scenario.” In other words, the radioactivity was already present – in contrast, say, to nuclear reactor maintenance, which would count as a “future exposure scenario,” requiring an operations plan to minimize exposure. Studies continued to proliferate, some framing the issue in terms of lifetime cancer risk (Njinga & Tshivase, 2016), others in terms of human rights (Docherty 2016). Meanwhile, the Socio-Economic Rights Institute and the Federation for a Sustainable Environment helped Tudor Shaft residents articulate their right to benefit from democratic South Africa’s basic compact: that the state stop treating people as residues, as waste. In February 2017, twenty-four years after the first residents arrived at Tudor Shaft, 300 families were relocated into RDP housing.

Mr. Jeffrey Ramoruti showing dust from mine dumps, 2016. Photo by the author.

Yet residual governance in this third sense – where people themselves are waste – continues. It continues on Tudor Shaft, where immigrants and others remain, the residues of relocation. And it continues throughout Gauteng, where immigrants from Zimbabwe sift through mine residues and descend into abandoned shafts, hoping to recover a few milligrams of gold to keep them going, hoping that today is not the day that the tunnel collapses, hoping not to get arrested when they sell their soil to merciless brokers.

In the afterlife of extraction, the three registers of residual governance – the governance of residues, governance as afterthought, and governance that treats people as residual – are deeply entwined in a slow, violent dance (Nixon, 2011). The violence seeps through technopolitical entanglements between the time of the human life and the geological time of rocks; between the time of colonized bodies and the time of metallic integrity; between the time of the corporation and the time of radioactive decay; between the time of apartheid and the time of democratic promise.

Such is the violence of the Anthropocene. Is residual governance the only way forward?

 

Gabrielle Hecht is Frank Stanton Foundation Professor of Nuclear Security at Stanford University, where she is affiliated with the Center for International Security and Cooperation (CISAC) and the Department of History.  Before returning to Stanford in 2017, Hecht taught at the University of Michigan for 18 years, where she helped to launch UM’s collaborative project with the Wits Institute for Social and Economic Research (South Africa) on Joining Theory and Empiricism in the remaking of the African Humanities. Hecht has written two award-winning books about nuclear things: Being Nuclear: Africans and the Global Uranium Trade (2012) and The Radiance of France: Nuclear Power and National Identity (1998 & 2009). She is currently beginning a book on technology and power in Africa (under contract with Cambridge University Press), as well as a series of essays on radioactive and other forms of waste, tentatively titled Toxic Tales from the African Anthropocene.

Sources

Abrahams, Peter. 1973. “Fancies Idle iii,” in Paul Breman, ed., You Better Believe It: Black Verse in English. Penguin Press.

Adler, Rebecca A., Marius Claassen, Linda Godfrey, Anthony R. Turton, and others. 2007. “Water, Mining and Waste: An Historical and Economic Perspective on Conflict Management in South Africa.” The Economics of Peace and Security Journal 2 (2): 32–41.

Bobbins, Kerry. 2015. “Acid Mine Drainage and Its Governance in the Gauteng City-Region.” http://wiredspace.wits.ac.za/handle/10539/18835.

Bremner, Lindsay. 2013. “The Political Life of Rising Acid Mine Water.” Urban Forum 24 (4): 463–83.

Docherty, Bonnie. 2016. The Cost of Gold. Harvard International Human Rights Clinic.

Edwards, Paul. 2010. A Vast Machine: Computer Models, Climate Data, and the Politics of Global Warming. MIT Press.

Förstner, U., and G.T.W. Wittmann. 1976. “Metal Accumulations in Acidic Waters from Gold Mines in South Africa.” Geoforum 7 (1): 41–49.

Hecht, Gabrielle. 2012. Being Nuclear: Africans and the Global Uranium Trade. MIT Press.

Humby, Tracy-Lynn. 2013.“Environmental Justice and Human Rights on the Mining Wastelands of the Witwatersrand Gold Fields.” Revue Générale de Droit 43: 67–112.

McCarthy, Terence. 2010. “The Decanting of Acid Mine Water in the Gauteng City-Region: Analysis, Prognosis and Solutions.” http://wiredspace.wits.ac.za/handle/10539/17323.

Naicker, K., E. Cukrowska, and T. S. McCarthy. 2003. “Acid Mine Drainage Arising from Gold Mining Activity in Johannesburg, South Africa and Environs.” Environmental Pollution 122 (1): 29–40.

Njinga, Raymond L., and Victor M. Tshivhase. 2016. “Lifetime Cancer Risk due to Gamma Radioactivity in Soils from Tudor Shaft Mine Environs, South Africa.” Journal of Radiation Research and Applied Sciences 9 (3): 310–15.

Nixon, Rob. 2011. Slow Violence and the Environmentalism of the Poor. Harvard University Press.

Oosthuizen, R., M. Matooane, C. Wright, and N. Phala. 2012. “It’s Not All about Acid Mine Drainage (AMD) on the West Rand-There Is Dust Too.” http://researchspace.csir.co.za/dspace/handle/10204/6281.

Rösner, T., and A. Van Schalkwyk. 2000. “The Environmental Impact of Gold Mine Tailings Footprints in the Johannesburg Region, South Africa.” Bulletin of Engineering Geology and the Environment 59 (2): 137–48.

Schonfeld, S.J., F. Winde, C. Albrecht, D. Kielkowski, M. Liefferink, M. Patel, V. Sewram, L. Stoch, C. Whitaker, and J. Schüz. 2014. “Health Effects in Populations Living around the Uraniferous Gold Mine Tailings in South Africa: Gaps and Opportunities for Research.” Cancer Epidemiology 38 (5): 628–32.

Turton, Anthony, Craig Schultz, Hannes Buckle, Mapule Kgomongoe, Tinyiko Malungani, and Mikael Drackner. 2006. “Gold, Scorched Earth and Water: The Hydropolitics of Johannesburg.” International Journal of Water Resources Development 22 (2): 313–35.

Van Eeden, Elize S., M. Liefferink, and J. F. Durand. 2009. “Legal Issues Concerning Mine Closure and Social Responsibility on the West Rand.” http://dspace.nwu.ac.za/handle/10394/3961.

Public health politicised: A response to the politics of CDC language and implications for global health, wellbeing and inequalities by Ben Kasstan

7 Janvier 2018 - 11:36pm

In this response we address how the recent language controversy surrounding the Center for Disease Control and Prevention (CDC) must be considered as part of a broader politicisation of public health services used by women and minority groups in the US context, which has international implications given the influential position of the CDC in global health governance. Our individual areas of expertise in medical anthropology (BK), public health and policy (MG), and sociolinguistics (JK) inform our collective position on this issue.

 

Politics of public health language

On 15 December 2017 The Washington Post[1] reported that the US Department of Health and Human Services, which includes the CDC, were being prevented from using specific terms in documents by the Trump administration. These documents would apparently be circulated at the federal government level in relation to the Trump administration’s 2018 budget, and the terms in question included:

  • Foetus
  • Transgender
  • Evidence-based
  • Science-based
  • Vulnerable
  • Entitlement
  • Diversity

The CDC Director, Brenda Fitzgerald, flatly denied this report in a series of Tweets and stated ‘there are no banned words at CDC.’ Whilst the above terms may not have been banned per se, the CDC may have been advised to ‘reconsider’ the language it uses when engaging with politicians and policy-makers.[2] It is important to stress that these politicians would include socially-conservative Republicans, some of whom direct economic decision-making by virtue of their dominant party position in both the Senate and the House of Representatives. It is also in the public interest to highlight that some of these individuals maintain oppressive positions on women’s sexual and reproductive health and rights, especially when it comes to restrictive access to abortion care. It is no surprise then that accommodating socially conservative values (prevalent among Republicans) within public health language has resulted in verbal hygiene, that is, attempts at ‘cleaning up’ language to make its use more acceptable from the perspective of the dominant group. Practicing verbal hygiene might result from different motivations, but in the context of sexual and reproductive health and rights, it reflects opposing positions on abortion that are rooted in deeper socio-political and moral anxieties. Our concern is the implications of verbal hygiene for sexual and reproductive health and rights, which are increasingly under threat in the US context and internationally.

Verbal hygiene has been employed here as a strategy to render these specific CDC outputs more palatable to Republicans responsible for making budgetary decisions. Yet the suggestion that the CDC should revise (or conceal) its language is serious because it would cultivate a public health infrastructure that is embedded in socially conservative values that infringe on human rights. Moreover, it would legitimise the damaging actions that have already been implemented across the US and specifically by the Trump administration in the context of women’s health and welfare at the global level.

Our point of departure in this response is the fact that public health and language share a commonality in the way they are political and politicised, and the interaction of which can be seen clearly in restrictions enforced over sexual and reproductive health and rights.

Let us take the term ‘foetus’ as one example, and let us imagine that the CDC acted upon cautions to instead use ‘unborn child’ in documents submitted to politicians and policy-makers. The consequences of using ‘unborn child’ might, at first glance, be glossed over by many people who are not active in sexual and reproductive health and rights-based issues. It might even be interpreted to some as a pragmatic step to obtain necessary funding for the CDC’s research into the Zika virus, which is known to cause birth defects (and has primarily affected areas with dangerously restrictive abortion legislations).

Closer attention, however, illustrates how using the term ‘unborn child’ in CDC outputs would tread further down a dangerous path for women’s health and rights. Using the term ‘unborn child’ in place of ‘foetus’ is not a synonym: it carries a very different semantic value. Adopting (or suggesting as an alternative) ‘unborn child’ would be part of a systematic, intentional and politictised attempt to restrict access to abortion care and target the sexual and reproductive health and rights of women. The term ‘unborn child’ is prolific in anti-abortion discourse, both in the US and the UK, and its use attempts to shift the conceptual focus away from the welfare, health and rights of a pregnant women.

Women in certain US states, for instance, are compelled to undergo ultrasound screening in order to access abortion care as part of an abhorrent attempt to dissuade women from making sexual and reproductive health decisions under the guise of ‘informed consent.’[3] Texas recently attempted to enforce laws that would see aborted foetal tissues and remains treated as deceased people and legally entitled to a funeral (e.g. burial or cremation), which would bestow the foetus with social personhood and political rights.[4] None of these interventions are informed by evidence-based and science-based research that might benefit women accessing abortion care, but only to serve the political interests of the anti-abortion lobby. Little wonder then that such lexical items are clustered together and discouraged by a US administration that has already deliberately dismissed empirical research holding inconvenient truths for its policy making (e.g. climatology, climate change, and the politicisation of the Paris Climate Accord during the 2016 election campaign).

Earlier in January 2017 the President of the United States made the regrettable decision to reinstate and widen the Mexico City Policy (also termed ‘global gag rule’), which withholds funding from NGOs in low- and middle-income countries which actively perform or promote abortion care as part of sexual and reproductive health and rights programmes. It is worth noting that restricting access to safe abortion care does not deter women from needing abortions, and only forces women to seek out unsafe abortions at great risk to their lives and health. Reducing abortion rates is complex, and requires structural, social, and political changes surrounding reproductive rights and gender equity. The World Health Organization, for instance, estimates that up to twenty million women will have to resort to unsafe abortions, and almost fifty thousand of those women will die as a result of complications.[5] So, if CDC outputs frame the foetus as an ‘unborn child’, it supports, like the Mexico City Policy, a discourse and a culture that designates rights to a foetus, while subverting women’s reproductive rights.

We can further consider any attempt to avoid using the term ‘transgender in CDC outputs within a deeper social and political history concerning how people identifying as (or identified as) LGBT were stigmatised through the politicisation of public health language. The emergence of the HIV/AIDS epidemic in the 1980s brought tremors to the CDC at a time when healthcare professionals, policy-makers, and politicians struggled to grasp the enormity of a disease that had never been encountered before. Public health ‘facts’ conditioned HIV/AIDS as an exclusively ‘gay disease’ in the early 1980s, which were, in reality, not built on evidence but on misinformation, and institutionalised homophobia. Recognising the specific and diverse health needs of transgender and LGBT people entails recognising them as people, and this is fundamentally achieved through language.

Our position on the politicisation of public language is clear and unequivocal. Public health bodies such as the CDC are mandated to meet the needs of all people, in all their diversity. Access to quality healthcare services and the enablers of health is the entitlement of everybody, and public health language is the basic mechanism through which inequalities and inequities are made visible and addressed. The type of socially-conservative language ideology that is being conveyed by the Trump administration serves only to intentionally erase realities that stand in opposition to Republican worldviews and political agendas. All persons can use language to support and shape culture, and with greater awareness of the power language has we can all more actively participate in creating the kind of world we want.

 

Restoring public confidence: Our recommendations

In light of recent events we recommend the following actions to restore international confidence and credibility in the important work of the CDC and its public health outputs, which may have been undermined by the language controversy:

  1. The CDC should unequivocally and transparently state whether it was advised to review or reconsider the language it uses, and to clarify whether it intends to act accordingly.
  2. If the CDC confirms it will be reconsidering the language used in documents submitted to politicians and policy-makers then this should be made public knowledge.
    • The CDC should conduct a review into the possibly unintended consequences of revising the specific language used in documents that are submitted to politicians and policy-makers.
    • If said language is reconsidered, then the CDC should make it clear that public health bodies in low- and middle-income countries should not adopt the revisions in kind, particularly at a time when global sexual and reproductive rights are under attack.
  1. The CDC should meet with leading NGOs and stakeholder groups to offer reassurance that public health policies and guidelines will continue to be designed in consultation with the intended beneficiaries, especially those groups concerned with gender, equality, and diversity.
  2. The CDC will continue to ensure that its work is grounded in research- and science-based evidence, including qualitative research, to ensure its policies are informed by a full range of academic interfaces.

 

Ben Kasstan is a Research Fellow in the Department of Anthropology at the University of Sussex (UK). Ben combines research and activism in all areas of sexual and reproductive health and rights, and has specific research interests in family health and family-making dynamics among ethnic and religious minority groups.

Meghann Gregg is a PhD Researcher at the London School of Hygiene and Tropical Medicine. Her work encompasses community development and health research, with current projects focussing on improving maternal health with complexity theory and participatory research. 

Jonathan Kasstan is a Leverhulme Early Career Fellow in the Department of Linguistics at Queen Mary University of London (UK). He holds a PhD from the University of Kent, and an MPhil from the University of Cambridge. 

 

Notes

[1] The Washington Post, 15 December 2017. https://www.washingtonpost.com/national/health-science/cdc-gets-list-of-forbidden-words-fetus-transgender-diversity/2017/12/15/f503837a-e1cf-11e7-89e8-edec16379010_story.html?utm_term=.926d414288ef

[2] The Guardian, 17 December 2017. https://www.theguardian.com/us-news/2017/dec/17/health-leaders-report-fetus-transgender-cdc-banned-words

[3] Rewire, 20 April 2017. https://rewire.news/legislative-tracker/law-topic/forced-ultrasound/

[4] New York Times, 30 Nov 2016. https://www.nytimes.com/2016/11/30/us/texas-burial-aborted-fetuses.html

[5] World Health Organization, no date. http://www.who.int/reproductivehealth/topics/unsafe_abortion/hrpwork/en/

Beyond “Banned Words”: The CDC, Trump’s Anti-Science, and Anthropological Outrage by Charles L. Briggs

5 Janvier 2018 - 8:10am

I am delighted that anthropologists joined the debate unleashed by a story published in the Washington Post on 15 December 2017, in which health reporter Lena Sun and politics correspondent Juliet Eilperin suggested that “The Trump administration is prohibiting officials at the nation’s top public health agency from using a list of seven words or phrases … in official documents being prepared for next year’s budget.” While the brouhaha has provided anthropologists with an opportunity to weigh in on the anti-science politics of the Trump administration, we have fallen short—I argue here—in grasping the broader and more deeply-rooted issues the story raises and its potential for challenging anthropological boundaries and analytics.

That the debate can point to new conceptual perspectives is suggested by its prominence on listservs of both the Society for Linguistic Anthropology and the Society for Medical Anthropology (and perhaps others as well). At the same time, anthropology’s subdisciplining isolated these parallel discussions: the participants did not overlap, and the issues raised were distinct. The absence of dialogue is not surprising, given that boundary-work generally confines linguistic anthropologists interested in health and medical anthropologists who write about narrative, translation, and medical registers to separate universes, blissfully unaware of the critical insights that lie just over the border.

Framing the debate as one of whether seven words—“vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based”—were banned, discouraged, or strategically avoided at the Centers for Disease Control and Prevention (CDC) involved two key reifications. One is a core component of language ideologies of modernity since the seventeenth century: the reduction of complex issues of poetics, politics, rhetoric, and meaning to a focus on individual words. Lost in this move is broader awareness of how knowledge and ignorance are produced in medicine and public health, how some people become authoritative speakers while others are muted, their perspectives becoming unspeakable or judged to provide evidence of the ignorance that health communication must eradicate. Overlooking the complex positionality of journalists and understanding them as having simply lifted the veil on political interference in science and medicine ignores insights emerging from the anthropology of media and journalism, which itself overlooks health and medicine as important sites of mediatization. So, rather than registering commonsense cries of indignation, let’s stop for a moment, slow down, and think more deeply—as anthropologists—about what is going on here and how we might respond.

My reading of the controversy is mediated by a couple of decades of watching how discourse circulates in national, state, and local public health agencies in various countries, particularly the United States and Venezuela. Vincanne Adams (2016) has recently documented the migration of “evidence-based” modes of validating knowledge production from clinical medicine to public health. Rather than being framed as efforts to boost the health of a particular population, public health funding must be based on “evidence,” especially numbers produced in what seem to be quasi-experimental interventions intent on maximizing the potential scalability (Tsing 2015) of a particular strategy. In interviews, national, state, county, and local public officials extended this logic to what are framed as issues of “communication,” claiming that how they attempt “to reach the public” is based on quantitative epidemiological and communicative investigations.

Nevertheless, my ethnographic work suggests that notions of evidence fall far short of adequately explaining how discourse circulates in public health agencies. Control over discourse circulation in these agencies is quite akin to military organizations, such that only top officials and individuals they designate can issue reports or statements that might reach beyond the agency’s borders. The securitization of health—which has been characterized as a shift from population management to emergency preparedness (Lakoff 2017)—has rationalized even tighter controls: “the public” might prove to be more dangerous than pathogens if it becomes “panicked” or “alarmed” in a biosecurity “crisis.” Public health officials—who are generally appointed by elected officials—are extremely sensitive to their bosses’ fury when a communicative misstep suggests that their agency is endangering public health or wasting state resources. Even as their professional ideologies lead public health officials to project a sharp boundary between science/medicine and politics, their struggles to maintain allocations and grants lead them to grapple daily with the precarity of their boundary-work. Indeed, the focus of the CDC meeting described in the Post was not on producing epidemiological reports but on what we might call econoscience, documents that would draw together public health, bureaucratic, and political networks and discourses—inviting the same move by reporters Sun and Eilperin! Projecting a chasm between the health sciences versus journalism and communication limits awareness of the extent to which “communication” is a key site in which public health hierarchies are structured and relations between what are defined as health and political entities are constituted.

How, then, did two Post reporters learn what transpired at a closed-door CDC meeting? We might suggest that “the CDC analyst” believed that administration officials had damaged the science/politics boundary so profoundly that s/he felt justified in crossing it him/herself by violating these restrictions, speaking to reporters “on the condition of anonymity because the person was not authorized to speak publicly.” Stopping here, however, would leave anthropologists in a second reductionist trap, imagining reporters as searching medical and public health sectors for “facts” that journalistic techniques empower them to turn into stories.  When they draw on news stories—as much in their labor of research as in their daily reading and viewing—anthropologists often extract referential content rather than ask how making news might constitute a crucial part of making the event reported. This short-circuit forecloses valuable insights into how bodies, diseases, epidemics, cures, and forms of care get made—not simply “represented.” Overlooking the power of journalism to turn a routine bureaucratic meeting into a major political event fails to explore how a really “big story”—one that generated 7,545 comments (as of 12/23/17), additional articles in the Post and other news outlets, a social media explosion, the SMA and SLA listserv flurries, and this Somatoshere post—came into being. If we step back a bit, the story might prompt us to wonder a bit more about why there is such a proliferation of health news stories in the first place, even as many other media “beats” are shrinking.

Here we need to question our own assimilation of another form of boundary-work, one that springs from journalists’ professional ideologies and their self-construction as standing outside of the arenas they report. Even as journalists and health professionals constantly project a boundary between them, health is now just as mediatized as health reporting is medicalized. US medical and public health organizations—from small clinics and public health offices to the CDC with its vast Office of the Associate Director for Communication—employ individuals trained as journalists and outsource media consultation. “Messaging” (Lempert and Silverstein 2012) is as much a part of the daily labor of health officials as of politicians. Many health journalists have scientific training, and all U.S. national news networks and CNN employ physician-journalists who speak as reporter, doctor, and public health commentator, often in the same broadcast. In larger venues like the Post, health issues are split between political reporters like Eilperin, who generally write stories on governmental policies and political battles, like efforts to repeal the Affordable Care Act. They draw largely on the reporting conventions used for partisan political battles and on their networks of politicians and officials. Health reporters get deeply entangled in networks consisting of leading clinicians, researchers, health officials, scientific bloggers, and pharmaceutical and biotech companies. The Post article is a rare hybrid in which journalists from both “beats” combined their networks and reporting conventions.

The illusion of distinct media and medical arenas is sustained by the content of stories—like the one on banned words—which projects journalists as boundary-workers whose watchdog role enables them to expose illegal crossings. Such stories emerged from a broader process that I have referred to in work with media studies scholar Daniel Hallin as biomediatization (Briggs and Hallin 2016). Carried out in laboratories, clinics, public health offices, and living rooms as much as newsrooms, biomediatization involves the co-production of medical subjects and objects through collaborations that entangle what are envisioned as distinct professional ideologies and practices. Two examples must suffice. Along with marketers (Dumit 2012), media consultants for biotech and pharmaceutical corporations do not simply issue press releases when new products are announced but rather collaborate with scientists and clinicians from the start in constructing a new disease, identifying target molecules, designing and carrying out clinical trials, recruiting medical writers, placing articles in professional journals, and building dialogues between biotech journalists and scientists throughout the process. Thus, new drugs and devices are mediatized from the start.

Similarly, if preparedness is, as Lakoff suggests, a new episteme, then it is largely the constant barrage of stories about possible pandemics that transforms health into a security issue and creates infectious affective economies outside the walls of medical and public health organizations. Extensive ethnographic and textual research on the emergence of H1N1 (“swine flu”) suggests how securitization and biomediatization converged in recent decades. On 23 April 2009, NBC and the New York Times presented minor stories about seven cases of an unusual strain of H1N1 in California and Texas. Just 24 hours later, “the swine flu epidemic” had become the lead story. How did journalists construct a narrative that sustained most of its dominant elements over months, worried laypersons as much as health professionals, and diverted public health funds on the basis of virtually no clinical or epidemiological evidence? Starting long before 9/11, the CDC played a leading role in disseminating techniques of “emergency risk communication.” The CDC (2002) published a Crisis and Emergency Risk Communication manual, as well as one adapted specifically for pandemic influenza, and offered public health officials and others an associated online course that standardized ways of speaking to “the public.” The CDC has spent millions on “exercises” or “scenarios” in which first-responders, security and health officials, journalists employed by media outlets and state agencies, politicians, and others simulate biosecurity “events” sparked by bioterrorism or novel pathogens. Constituting one of the most massively funded and widely dispersed rehearsal processes on the planet—perhaps only surpassed by “civil defense” preparations for nuclear war (Gusterson 1996; Masco 2006)—these “exercises” socialize health and media professionals and politicians in standardized biosecurity discursive practices and create biomediatization networks. The news stories covering these faux “events” enable them to shape everyday lay affects and discourse, particularly as they replay visual and auditory tropes from germ thrillers like Outbreak and Contagion. In short, the 24 April 2009 stories had already been devised in countless encounters between media, health, and Homeland Security professionals and audiences and then assembled—details modified to fit “pig flu” rather than the expected “bird flu” virus—in 24 hours.

Please don’t get me wrong: Trump’s attacks on science are deeply troubling. But I hope that scrutinizing the commonsense reifications that generally shape how anthropologists read and respond to science and health news stories can foster greater awareness of the context in which such attempts to regulate scientific discourse emerge. The production of knowledge about health in the CDC and other public health organizations was deeply enmeshed in the politics of communication long before January 2017; attempting to regulate the use of particular words thus forms a tiny canary in the mineshaft of highly regimented and hierarchicalized discursive practices. The boundary-work that sustains it renders us reliant on complex processes of biomediatization whose surface form is news articles: we seldom learn about what goes on inside the CDC except when journalists outside its walls “break” stories or those inside launch “media campaigns.”

More adequate identification of political stakes and issues involves going beyond repeating the referential content of a particular story to think about how the seemingly proper boundaries of science and communication produce particular sorts of health subjects and objects and render others unspeakable. Expressing outrage and attempting to intervene are certainly valuable responses, but failing to anticipate how they will become enmeshed in the same biomediatization logics and practices naively fails to benefit from available anthropological insights. Participants in the listserv discussions suggested that the SMA should ask the American Anthropological Association to denounce the “ban,” meaning that AAA leadership should direct the office of Communications and Public Affairs to place a statement on the AAA website and transmit it to “the media.” Another contributor recommended publishing a letter in the New York Times. My goal is not to criticize such inventions but to indicate how deeply our possibilities for political action are ensnared in forms of mediatization.

In short, our cries of outrage are likely to generate more impact if they are articulated in critical anthropological voices, shaped by perspectives that challenge subdisciplinary boundaries and look ethnographically beyond commonsense binaries.

 

Charles L. Briggs is the Alan Dundes Distinguished Professor in the Department of Anthropology of the University of California, Berkeley, where he teaches social/cultural, medical, and linguistic anthropology and folkloristics. He received his PhD from the University of Chicago. His books include The Wood Carvers of Córdova, New Mexico; Learning How to Ask; Voices of Modernity (with Richard Bauman); Competence in performance; Stories in the Time of Cholera (with Clara Mantini-Briggs); Making Health Public (with Daniel Hallin); and Tell Me Why My Children Died (with Clara Mantini-Briggs). He has received such honors as the James Mooney Award, the Chicago Folklore Prize, Edward Sapir Book Prize, the J. I. Staley Prize, the Américo Paredes Prize, the New Millennium Book Award, the Cultural Horizons Prize, and fellowships from the John Simon Guggenheim Memorial Foundation, the National Endowment for the Humanities, the Lichtenberg-Kolleg, and the Center for Advanced Studies in the Behavioral Sciences.

 

References

Adams, Vincanne, ed. 2016. Metrics: What Counts in Global Health. Durham, NC: Duke University Press.

Briggs, Charles L., and Daniel C. Hallin. 2016. Making Health Public: How News Coverage Is Remaking Media, Medicine, and Contemporary Life. London: Routledge.

Centers for Disease Control and Prevention. 2002. Crisis Emergency and Risk Communication. Atlanta: CDC.

Dumit, Joseph. 2012. Drugs for Life: How Pharmaceutical Companies Define Our Health. Durham, NC: Duke University Press.

Gusterson, Hugh. 1996. Nuclear Rites: A Weapons Laboratory at the End of the Cold War. Berkeley: University of California Press.

Lakoff, Andrew. 2017. Unprepared: Global Health in a Time of Emergency. Oakland: University of California Press.

Lempert, Michael, and Michael Silverstein. 2012. Creatures of Politics: Media, Message, and the American Presidency. Bloomington & London: Indiana University Press.

Masco, Joseph. 2006. The Nuclear Borderlands: The Manhattan Project in Post-Cold War New Mexico. Princeton: Princeton University Press.

Tsing, Anna Lowenhaupt. 2015. The Mushroom at the End of the World: On the possibility of Life in Capitalist Ruins. Princeton, NJ: Princeton University Press.

Somatosphere in 2017 by Eugene Raikhel

4 Janvier 2018 - 9:22am

As 2018 begins we pause to briefly look back at the posts that appeared in the past year on Somatosphere. Last year we were happy to publish a number of excellent series, including “Toxicity, Waste, and Detritus in the Global South: Africa and Beyond,” edited by Gabrielle Hecht and Pamila Gupta, “Critical Histories, Activist Futures,” edited by Tess Lanzarotta and Sarah M. Pickman, “The First 1,000 Days of Life,” edited by Michelle Pentecost and Fiona C. Ross, and “Speculative Health,” edited by Matthew Wolf-Meyer, as well as a raft of other book reviews, book forums, and other pieces.

A huge thanks to all of the entire editorial team, our contributors, and to our readers! We’re very excited for 2018. In the coming days we’ll have a series responding to the recent #7wordsCDC story; we’ll also be continuing our numerous series and publishing forums on recent books by Alondra Nelson, Des Fitzgerald and Fernando Vidal and Francisco Ortega. And later in the year we celebrate the 10th anniversary of the site…. so there’s a lot to look forward to!

 

Toxicity, Waste, and Detritus in the Global South: Africa and Beyond

Edited by Gabrielle Hecht and Pamila Gupta

Short adventures into our planet’s toxic sensorium, by Africanists and some of their scholarly kin.

 

Critical Histories, Activist Futures

Edited by Tess Lanzarotta and Sarah Pickman

This series is our attempt to capture some of the insights, suggestions, critiques and experiences from a conference entitled “Critical Histories, Activist Futures: Science, Medicine and Racial Violence.”

 

Aftermath

A series examining the consequences of recent nationalist political turns throughout the world, including the US election.

 

First 1,000 Days of Life

Edited by Michelle Pentecost and Fiona C. Ross

Exploring “the ways that a global health initiative driven by new findings in epigenetics and neuroscience and by a reframing of theories about health and disease in terms of developmental origins shape ideas about (global) health and population futures, invigorate campaigns, and take form and settle in localized contexts.”

 

Speculative Health

Edited by Matthew Wolf-Meyer

Examining “how speculation makes particular kinds of persons and social forms possible; to think though other models and modes of speculation about the body, health, and disease — in film, literature, and mass media; to consider how particular technologies and techniques create futures.”

 

Experiments with pedagogy

Edited by Hannah Kienzler

 

Top of the heap

 

Features

 

Book forums

 

 

 

 

Book reviews and essays

Edited by Seth Messinger

 

Web Roudups

Edited by Lily Shapiro

 

In the Journals

Edited by Anna Zogas

 

In the Journals – December 2017 by Anna Zogas

3 Janvier 2018 - 12:50am

Happy new year! This post rounds off Somatosphere’s 2017 “In the Journals,” with articles published in December. Enjoy!

Medical Anthropology Quarterly

(In)Visibility Online: The Benefits of Online Patient Forums for People with a Hidden Illness: The Case of Multiple Chemical Sensitivity (MCS)
Tarrryn Phillips, Tyson Rees

Sufferers of medically unexplained conditions that are not observable in the clinic can experience multiple layers of invisibility: a lack of biomedical diagnosis; legal skepticism; political disinterest; and a loss of their prior social identity. For those with environmental sensitivities, this is compounded by literal hiddenness due to often being housebound. Drawing on an online survey of people with multiple chemical sensitivity, this article examines how the everyday experience of invisibility is mitigated by engaging with other patients online. Respondents used online forums to undertake various forms of “visibility work,” including attempts to crystallize their suffering into something recognizable medically, legally, and politically, and to reconstruct an identity considered valid and deserving—although the therapeutic potential of online support was contingent on intra-group politics. This study demonstrates that online forums allow biomedicine’s “invisible others” to struggle for alternative forms of recognition beyond the clinical gaze.

Corporate Mortality Files and Late Industrial Necropolitics
Peter C. Little

This article critically examines the corporate production, archival politics, and socio–legal dimensions of corporate mortality files (CMFs), the largest corporate archive developed by IBM to systematically document industrial exposures and occupational health outcomes for electronics workers. I first provide a history of IBM’s CMF project, which amounts to a comprehensive mortality record for IBM employees over the past 40 years. Next, I explore a recent case in Endicott, New York, birthplace of IBM, where the U.S. National Institute for Occupational Safety and Health studied IBM’s CMFs for workers at IBM’s former Endicott plant. Tracking the production of the IBM CMF, the strategic avoidance of this source of big data as evidence for determining a recent legal settlement, alongside local critiques of the IBM CMF project, the article develops what I call “late industrial necropolitics.”

Efficacious Holidays: The Therapeutic Dimensions of Pleasure and Discipline in Czech Respiratory Spas
Susanna Trnka

As evidence-based medicine has increasingly become the standard for assessing the efficacy of health care, the Czech Republic finds itself in a dilemma, with centuries of sanatorium-style spa treatments resisting easy categorization. Despite some critics’ contentions that spas are “pointless holidays” and reductions in government funding of health spas, in 2014 Czech courts affirmed every Czech citizen’s right to spa treatments if their health status merits it. Drawing on research in two children’s respiratory spas, this article considers the experiences of patients aged 2–15 and their accompanying parents or guardians (mainly mothers) to suggest that in addition to the range of therapeutic procedures highlighted within spa cures, more amorphous aspects—such as pleasure and discipline—may be just as central to spas’ successes. Indeed, as some spa physicians contend, spas may be considered a “package deal,” to which EBM criteria is not easily applied.

To Keep this Disease from Killing You: Cultural Competence, Consonance, and Health among HIV-positive Women in Kenya
Toni Copeland

The HIV/AIDS crisis continues in sub-Saharan Africa, where nearly 70% of infections are found. Despite recent efforts to supply antiretroviral therapy to those infected, most are not receiving medication and are forced to rely on self-management to remain healthy. In Kenya, many of those infected are women living in extreme poverty. This article presents the findings of research among poor women in Nairobi that examined the relationship between knowledge of a cultural model of self-managing HIV/AIDS, cultural consonance, and health. This biocultural study expands on earlier findings showing that knowledge of the model (competence) is a significant predictor of health by examining here how behavior consistent with that knowledge (consonance) affects health outcomes, as measured by CD4 counts, perceived stress, depressive symptoms, and recent illnesses.

Pregnant Metaphors and Surrogate Meanings: Bringing the Ethnography of Pregnancy and Surrogacy into Conversation in Israel and Beyond
Tsipy Ivry, Elly Teman

This article explores the way that surrogacy and normal pregnancy share cultural assumptions about pregnancy. Through a juxtaposition of our ethnographic studies of two groups of Jewish–Israeli women—women who have undergone “normal,” low-risk pregnancies and women who have given birth as gestational surrogates—we argue that surrogacy and pregnancy emerge as potent metaphors for one another. Both pregnant women and surrogates divided their bodies into two separate realms: fetus and maternal pregnant body. Both trivialized the effect of gestational influence on fetal health, making the fetus seem detached from gestational capacities of the mother. We argue for closer scrutiny of the way local cultural priorities and experiences of pregnancy shape surrogacy and for bringing the scholarship on pregnancy and on surrogacy into deeper conversation.

Living the Social Determinants of Health: Assemblages in a Remote Aboriginal Community
Richard D. Chenhall, Kate Senior

This article provides a critical discussion of the social determinants of health framework and compares it with theoretical perspectives, such as that offered by assemblage theory, offering an alternative view of the complex interplay between human relationships and the structures around us. We offer an ethnographic perspective, discussing the lived experiences of the social determinants in an Indigenous community in a remote part of northern Australia.

Only Near Is Dear? Doing Elderly Care with Everyday ICTs in Indian Transnational Families
Tanja Ahlin

In Kerala, South India, young people, especially women, are encouraged to become nurses in order to migrate abroad for work and thereby improve the financial status of their family. Meanwhile, many of their parents remain in India by themselves. This is occurring in the context of a strong popular discourse of elder abandonment, related to the local norms of intergenerational co-habitation. Based on fieldwork in Kerala and one of the nurses’ destination countries, Oman, I present evidence that complicates this discourse by showing how: (1) migration is a form of elder care practice in itself; and (2) care for the elderly continues across countries and continents with the help of information and communication technologies (ICTs). Using the theoretical approaches of science and technology studies, I analyze ICTs as key members of care collectives and argue that ICTs have a significant role in reshaping care relations at a distance.

Care in the Context of a Chronic Epidemic: Caring for Diabetes in Chicago’s Native Community
Margaret Pollak

American Indians have some of the highest rates of diabetes worldwide, and they are disproportionately affected by the secondary complications of the disease. While most research on Native populations focuses on reservations, this study investigates diabetes care in Chicago’s Native community. People living with diabetes manage blood sugar levels to prevent the development of secondary complications. As with many diabetics, the majority of their health care work is completed outside of the biomedical setting. In this article, I explore how, in a community facing epidemic rates of disease, care is enmeshed in the everyday lives of not just those living with the disease but also significant others. As care in this context is accomplished across multiple spheres, from inside individual households to community-wide considerations, Chicago’s intertribal community ties are strengthened. Care, in this sense, becomes a (perhaps tragic) means of Native American community building tied to cultural identity.

Anthropology & Medicine

A critique of medicalisation: three instances
Sonia Ryang

By briefly exploring three different examples where the existence of mental illness and developmental delay has been presumed, this paper sheds light on the way what Foucault calls the emergence of a regime of truth, i.e. where something that does not exist is made to exist through the construction of a system of truth around it. The first example concerns the direct marketing of pharmaceutical products to consumers in the US, the second the use of psychology in semi-post-Cold War Korea, and the third the persisting authority of psychology in the treatment of the developmentally delayed. While these instances are not innately connected, looking at these as part of the process by which the authoritative knowledge is established will help us understand, albeit partially, the mechanism by which mental illness penetrates our lives as truth, and how this regime of truth is supported by the authority of psychology, psychiatry and psychoanalysis, what Foucault calls the ‘psy-function,’ reinforcing the medicalisation of our lives.

From distress to disease: a critique of the medicalisation of possession in DSM-5
Divya Padmanabhan

This paper critiques the category of possession-form dissociative identity disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) published in 2013 by the American Psychiatric Association (APA). The DSM as an index of psychiatry pathologises possession by categorising it as a form of dissociative identity disorder. Drawing upon ethnographic fieldwork, this paper argues that such a pathologisation medicalises possession, which is understood as a non-pathological condition in other contexts such as by those individuals who manifest possession at a temple in Kerala, South India. Through medicalising and further by creating distinctions between acceptable and pathological possession, the DSM converts a form of distress into a disease. This has both conceptual and pragmatic implications. The temple therefore becomes reduced to a culturally acceptable site for the manifestation of a mental illness in a form that is culturally available and possession is explained solely through a biomedical framework, denying alternative conceptualisations and theories which inform possession. By focussing on the DSM-5 classification of possession and the limitations of such a classification, this paper seeks to posit an alternative conceptualisation of possession by engaging with three primary areas which are significant in the DSM categorisation of possession: the DSM’s conceptualisation of self in the singular, the distinction between pathological and non-pathological forms of possession, and the limitations of the DSM’s equation of the condition of possession with the manifestation of possession. Finally, the paper briefly highlights alternative conceptualisations of possession, which emerged from the perspective of those seeking to heal possession at the Chottanikkara temple.

Of sacraments, sacramentals and anthropology: is anthropological explanation sacramental?
Harish Naraindas

This paper suggests that what is usually called a cultural misunderstanding of biomedical disease categories may be construed as a biomedical and anthropological misunderstanding of cultural categories. This is premised on the fact that anthropology often functions as an intimate double and handmaiden of biomedicine, in so far as it refuses to countenance the possibility of theurgic aetiologies in the realm of what is called ‘mental illness’. Such a refusal displaces native explanations of divine or demonic agency to human agency. This is best elucidated by examining the unexamined religious beliefs of Anglo-European anthropology, which appears to be the terra firma of its emic explanatory categories. The paper attempts to demonstrate this by proposing that while native explanations are akin to the sacraments, anthropological explanations are akin to sacramentals (holy water, the cross, the scapular, verbal blessings). While the sacraments, like divine agency, operate ex opere operato, the sacramentals are dependent on the disposition of the recipient and on the good offices of the church, as they operate ex opere operantis ecclesiae (from the work of the working church), as well as ex opere operantis (from the work of the working one). If the sacraments are efficacious as it is work done by Christ alone, and akin to work done by the possessing agent, sacramentals are efficacious as they are also dependent on human agency. In other words, anthropological explanations are, at best, ‘sacramental’ as they replace emic theurgic explanations by etic ones, where human agency in the form of the priest, the institution of the church, and the lay person who is the recipient of divine dispensation, also have a role to play; or, as is often the case, the only role to play.

Humanitarian quarantine in practice: medicine, religion and leprosy in New Caledonia
Ingrid J. Sykes

Medicine and religion worked in close synchronisation during the leprosy outbreak of New Caledonia (1890–1950). Once isolation of leprosy-affected people became mandatory doctors and missionaries came together to promote a particular form of medical practice that tied charitable zeal with cutting-edge medical research, developing a sophisticated set of medical practices that catered for the soul as well as the body. Such practices went hand-in-hand with ideas developed by doctors in the earlier stages of the epidemic about the way in which the disease had entered the Kanak (local Melanesian) population. Doctors and missionaries admitted that immoral colonial channels had upset the delicate balance of local social and biological rhythms. Yet they also believed that the highly contagious nature of the outbreak was linked to the inferior state of Kanak. This paper aims to highlight the way in which the leprosaria system in New Caledonia represented a double-edged moral high-ground within the French medical colonial narrative. It tracks the complex way in which emotionally charged arguments about contagion, science and spirituality constructed an ideology of humanitarian quarantine which was used to justify a highly aggressive form of medical biocontrol.

Hospitals as factories of medical garbage
Sarah Hodges

Over the course of the twentieth century, as hospitals cleaned up, they came to produce more and more rubbish. Beginning in the 1970s and gaining pace in the 1980s and 1990s, single-use plastic items (syringes, blood bags, tubing) saturated everyday medical practice across the globe. This essay brings the question of plastic to bear upon the longer history of twentieth century sanitary science. The widespread adoption of single-use disposable medical plastics consolidated a century’s worth of changes in medical hygiene. As strange as it may seem today, the initial uptake of medical plastics was not driven primarily by concerns about hygiene. Plastic began as a mid-century technology of convenience and durability. It was not until the end of the twentieth century that it morphed into a powerful symbol and instrument of medical hygiene. Today, both patients and practitioners have embraced plastic as an indispensable technology of clean medicine. The procession of single-use medical plastics through everyday medicine now comprises a constant, if disposable, infrastructure of medical hygiene. This new processional infrastructure of disposable hygiene has produced another, albeit unintended, consequence. This new regime has exponentially increased hospitals’ material outputs. In so doing, plastic has refigured the ecologies of everyday medicine. Plastic hygiene has rendered hospitals factories of medical garbage.

Performing piety in sexual health research: gender, health and evangelical Christianities in a Mexican human papillomavirus (HPV) study
Emily Wentzell

Recent research suggests that health surveillance experiences like clinical trial participation might have unanticipated social consequences. I investigate how evangelical Christians participating in longitudinal, observational sexual health research incorporate that long-term medical surveillance into their religious practice. This exploratory research focuses on Mexican Cristianos’ participation in the Cuernavaca arm of the multinational ‘Human Papillomavirus in Men’ (‘HIM’) study, which tested men for the common and usually asymptomatic sexually transmitted infection human papillomavirus (HPV) over time. I draw on interviews with heterosexual male research participants and their female partners throughout their medical research involvement, and data from church-based participant observation, to understand how couples framed the HIM study as an arena for performing piety. I argue that evangelical understandings of piety as moral practice encouraged participants to view long-term sexual health surveillance as assistance for living out the health, gender, and marital behaviors promoted by their congregations. This finding suggests that health research designers and ethics committees should consider the health and social outcomes of research participants’ agentive incorporation of religious observance into study protocols.

Living into death: a case for an iterative, fortified and cross-sector approach to advance care planning
Rebecca Llewellyn, Chrystal Jaye, Richard Egan, Wayne Cunningham, Jessica Young & Peter Radue

Advance care planning (ACP) has been framed as best practice for quality palliative care, yet a growing body of literature affirms the need for an early iterative ACP process to begin when people are young and healthy. A significant gap appears to exist in the literature regarding the utility of death conversations outside the end-of-life context. Could ‘death conversations’ early in life be an effective tool by which doctor and patient can co-construct a more healthful way of life, and realistic relationship with death? And what variables must be taken into account for these conversations to proceed successfully? This paper provides a narrative exploration of the value of death conversations in the clinical context in New Zealand. Five exemplars are discussed, drawn from a sample of 21 semi-structured interviews with young older adults (54–65 years old) not receiving palliative care or diagnosed with a terminal illness. Together, these narratives indicate that further community consultation is required to determine culturally appropriate ways to initiate productive conversations around aging, death and dying and how to build patient/practitioner/family relationships which allow these conversations to happen safely. There is a need to acknowledge the important factor of culture related to age, generation, sex, faith and ethnicity when engaging in conversations about aging, death and dying. By doing so, health professionals will be best equipped to assist their patients to live well into death.

Medical Humanities

Shame, stigma and medicine (open access)
Barry Lyons, Luna Dolezal

[excerpt] The Shame and Medicine Project evolved from a conversation between the two editors of this Special Issue of Medical Humanities about the politics of shame and humiliation within healthcare. One is a philosopher with an academic focus in the phenomenology of the body, the other a clinician with an interest in medical training and regulation. Over the 2 years the project has run thus far, we have had the pleasure of hearing from scholars and practitioners from over 20 distinct and diverse disciplines—from theology and history to plastic surgery and contemporary visual culture. It has been a truly interdisciplinary engagement and one that has reflected shame’s role as a commonplace social emotion, frequently ‘underground’ or hidden, but which has affected, and continues to impact on, many health-related interactions between individuals and society, patients and doctors, clinicians and regulators. Shame is the primary ‘emotion of politics and conformity’ particularly, as Myra Mendible points out in American Shame, ‘for those who have the ‘wrong’ bodies or the ‘wrong’ desires’. Those who deviate from entrenched social norms are frequently subjected to stigma—‘a social process, experienced or anticipated, characterised by exclusion, rejection, blame or devaluation that results from experience, perception or reasonable anticipation of an adverse social judgement about a person or group’. Stigma, as many of the articles in this Special Issue demonstrate, is intimately bound up with shame. In moments of stigma, Goffman famously noted, ‘shame becomes a central possibility’. Stigma is a social, emotional, political and clinical issue of enormous significance—the impact of social exclusion contributes substantially to the burden of illness, perhaps to the extent that in highly stigmatised disorders the suffering brought on by the disease process may be outweighed by the impact of stigma-induced social rejection.

Shame and the vulnerable self in medical contexts: the compassionate solution
Paul Gilbert

Shame is a powerful experience that plays a vital role in a whole range of aspects of the clinical encounter. Shame experiences can have an impact on our psychological and physiological state and on how we experience ourselves, others and our relationships. The medical encounter is an obvious arena for shame because we are presenting (aspects of) our bodies and minds that can be seen as unattractive and undesirable, diseased, decayed and injured with the various excretions that typically might invite disgust. In contrast, experiences of compassion of acceptance, validation and kindness and can increase approach, openness and preparedness to engage with painful difficult scenarios. While shame is an experience that separates, segregates, marginalises and disengages people, caring and compassion facilitate integration, (re)connection and support. Given the potential opposite impacts of these different types of social experience, this paper will outline their evolutionary origins and compare and contrast them with particular reference to the medical context.

A dirty little secret: stigma, shame and hepatitis C in the health setting
Jane Megan Northrop

While recent medical innovation shows great promise in treating hepatitis C (HCV), it remains a condition associated with profound stigma. HCV is a bloodborne virus (BBV) most commonly transmitted in high-income countries by injecting drug use, and it is the stigmatising association between the two which is deeply problematic for those with HCV. A qualitative study undertaken in 2002 found that disclosure in health settings places those with HCV in positions of pronounced vulnerability. Disclosure is a primal scene, an interface, where the stigma of HCV, replete with connotations of disease and deviance, potentially transforms those affected into shamed subjects. Standard precautions protect health workers and minimise the transmission of contagion, measures which, in theory, also mitigate the requirement of those with BBVs to unnecessarily disclose their blood status. However, questions on pre-employment health checks, concerns that health treatments might adversely affect the liver and an ethical need to pre-emptively inform healthcare professionals undertaking exposure prone procedures are occasions when those with HCV confront the decision to disclose their blood status. This paper employs Goffman’s model of actual and virtual social identities, along with Douglas’ notion of dirt and pollution, to examine the dilemmas around disclosure those with HCV negotiate within the health setting. Discriminatory responses by healthcare professionals elucidate the stigmatising potential HCV carries. The subsequent reticence by those with HCV to disclose their blood status risks less than optimum healthcare. Recent studies indicate that stigma occurring in health settings remains a perennial concern for those with HCV.

Shame, stigma, HIV: philosophical reflections (open access)
Phil Hutchinson, Rageshri Dhairyawan

It is a distinctive feature of HIV that its pathology cannot be adequately grasped separate from a number of psychosocial factors, and stigma is widely seen as the most prominent. We argue that it is equally important to have an adequate understanding of shame, as the emotional response to stigma. We have identified five ways shame might negatively impact upon attempts to combat and treat HIV, which emerge from the stigma HIV carries and STI-stigma in general. In this paper, we draw out four insights from philosophical work on emotions and shame which we propose will improve understanding of shame and stigma. We conclude by briefly discussing how these insights might shed light on the negative role shame can play for a person living with HIV engaging with, or being retained in, care. We conclude by proposing further study.

Pain, objectivity and history: understanding pain stigma (open access)
Daniel S Goldberg

The primary claim of this paper is that understanding the stigma so commonly endured by chronic pain sufferers today in the USA and the UK is unlikely without proper appreciation of the history of pain. Ameliorating such stigma is an ethical imperative, and yet most approaches eschew even an attempt to trace connections between historical attitudes, practices and beliefs towards pain and the stigmatisation so many pain sufferers currently endure. The manuscript aims to help fill this gap by framing pain in the modern era in context of two crucial intellectual schemes that waxed in the 19th and 20th centuries: mechanical objectivity and somaticism. The analysis explains these frameworks and applies them to exploration of primary sources connected to contested pain conditions such as railway spine. By properly situating the historical roots of what it means to cite the ‘subjectivity’ of pain as a problem, the modern roots of stigmatising attitudes and practices towards chronic pain sufferers become much clearer. The manuscript concludes by suggesting that interventions expressly intended to target the root causes of such stigma are much more likely to be successful than approaches that proceed in ignorance of the historical forces shaping and driving pain stigma in the present.

The medical reshaping of disabled bodies as a response to stigma and a route to normality (open access)
Janice McLaughlin

Disabled people are said to experience stigma because their embodied presence in the world does not fit with how others interact and use their bodies to be social participants. In response they can turn to medical procedures, such as surgery or physiotherapy, in order to reshape their bodies to more closely approximate norms of social interaction and embodiment. This paper explores how medicine plays a role in attempts to be recognised by others as normal and acceptable by minimising disability. It will do so via a focus on disabled young people, in order to explore how their emerging identities and aspirations for the future influence how they think about their bodies, what normality means and their participation in multiple activities that work on their bodies. The paper draws from an Economic and Social Research Council (ESRC) project that used a range of qualitative research methods with a group of disabled young people. The project explored ways in which participants actively worked on their bodies to be more normal and examined the disciplinary and agency dynamics involved in this work.

On shame and voice-hearing
Angela Woods

Hearing voices in the absence of another speaker—what psychiatry terms an auditory verbal hallucination—is often associated with a wide range of negative emotions. Mainstream clinical research addressing the emotional dimensions of voice-hearing has tended to treat these as self-evident, undifferentiated and so effectively interchangeable. But what happens when a richer, more nuanced understanding of specific emotions is brought to bear on the analysis of distressing voices? This article draws findings from the ‘What is it like to hear voices’ study conducted as part of the interdisciplinary Hearing the Voice project into conversation with philosopher Dan Zahavi’s Self and Other: Exploring Subjectivity, Empathy and Shame to consider how a focus on shame can open up new questions about the experience of hearing voices. A higher-order emotion of social cognition, shame directs our attention to aspects of voice-hearing which are understudied and elusive, particularly as they concern the status of voices as other and the constitution and conceptualisation of the self.

Current Anthropology

The Pharmaceutical Assemblage: Rethinking Sowa Rigpa and the Herbal Pharmaceutical Industry in Asia (open access)
Stephan Kloos

Cutting-edge anthropological research on pharmaceuticals aims to trace the connections that link our health and subjectivity, via the drugs we ingest, to contemporary forms of science, governance, and market practice. Yet this research is mostly limited to biomedical pharmaceuticals, ignoring the vast and rapidly growing “traditional” pharmaceutical industry, which connects contemporary forms of culture, capitalism, and politics in arguably even more interesting ways. Addressing this gap, this programmatic essay proposes the concept of the “pharmaceutical assemblage” as a way to assess the traditional pharmaceutical industry as part of Asia’s growing knowledge industry sector and the global pharmaceutical nexus. Taking the emerging Sowa Rigpa (also known as Tibetan medicine) industry as a particularly illustrative example, the article outlines an interdisciplinary approach to study this industry as a larger, transnational entity with its own role and dynamics. Identifying and discussing four major domains of the Sowa Rigpa industry—raw materials, drug-manufacturing processes, the market, and intellectual property rights—this article argues that the concept of the pharmaceutical assemblage can generate a much-needed bigger picture of traditional medicine and a fresh perspective on the confluences of culture, health, economy, governance, and the environment in contemporary Asia.

BioSocieties

Parent perspectives on brain scans and genetic tests for OCD: Talking of difficult presents, desired pasts, and imagined futures
Louise Whiteley, Emily Borgelt, S. Evelyn Stewart, Judy Illes

This paper investigates parent perspectives on potential future applications of neuroimaging and genetic research in the OCD clinical setting. Grounded in qualitative interviews with parents whose children had participated in an OCD neuroimaging and genetic research study in the United States, we situate parent discussions of imagined futures in their projections from difficult presents and into desired pasts. Parents reported apparently high receptivity to potential future neuroimaging and genetic tests. Yet when they responded, ‘yes, anything that helps’, uncertainty, caution, and resistance were expressed in implicit negotiations over what it means to ‘help’. We situate the discussion of future technologies in the wider context of how a biological approach figures in parents’ understandings of OCD. A biological perspective was prioritised when it facilitated a journey towards understanding-as-acting; the intense gathering of knowledge judged likely to lead to better outcomes. When biological knowledge did not seem likely to lead to or itself constitute action, parents were often reluctant to even discuss it. The perspectives of those who may encounter future technologies are relevant to shaping their development, but gathering and interpreting such perspectives presents methodological, conceptual, and normative difficulties. These difficulties with time-travelling talk are discussed throughout the paper.

“Let’s pull these technologies out of the ivory tower”: The politics, ethos, and ironies of participant-driven genomic research (open access)
Michelle L. McGowan, Suparna Choudhury, Eric T. Juengst, Marcie Lambrix, Richard A. Settersten Jr., Jennifer R. Fishman

This paper investigates how groups of ‘citizen scientists’ in non-traditional settings and primarily online networks claim to be challenging conventional genomic research processes and norms. Although these groups are highly diverse, they all distinguish their efforts from traditional university- or industry-based genomic research as being ‘participant-driven’ in one way or another. Participant-driven genomic research (PDGR) groups often work from ‘labs’ that consist of servers and computing devices as much as wet lab apparatus, relying on information-processing software for data-driven, discovery-based analysis rather than hypothesis-driven experimentation. We interviewed individuals from a variety of efforts across the expanding ecosystem of PDGR, including academic groups, start-ups, activists, hobbyists, and hackers, in order to compare and contrast how they relate their stated objectives, practices, and political and moral stances to institutions of expert scientific knowledge production. Results reveal that these groups, despite their diversity, share commitments to promoting alternative modes of housing, conducting, and funding genomic research and, ultimately, sharing knowledge. In doing so, PDGR discourses challenge existing approaches to research governance as well, especially the regulation, ethics, and oversight of human genomic information management. Interestingly, the reaction of the traditional genomics research community to this revolutionary challenge has not been negative: in fact, the community seems to be embracing the ethos espoused by PDGR, at the highest levels of science policy. As conventional genomic research assimilates the ethos of PDGR, the movement’s ‘democratizing’ views on research governance are likely to become normalized as well, creating new tensions for science policy and research ethics.

Mapping Global Health: A network analysis of a heterogeneous publication domain
George Weisz, Alberto Cambrosio, Jean-Philippe Cointet

This paper examines one of the most visible but oddly neglected aspects of the rapidly expanding Global Health (GH) enterprise: its vast literature. Basing our data on the PubMed MeSH term “World Health” (changed to “Global Health” in 2015) and utilizing the citation and funding metadata provided by Web of Science, we analyze nearly 20,000 articles using the software platform CorTexT for the automatic processing of large text corpora. We perform several types of scientometric network analyses, and provide maps displaying inter-citations among journals publishing GH articles, co-authorship among the 292 authors who published 12 or more papers, co-citation analysis of works (articles, books, and reports) cited at least 30 times by the papers in our database, and funding sources since 2008. The maps display the social, cognitive, and funding substructure of the GH publication field. We suggest that this somewhat fragmented and fuzzy domain is held together by (1) a core group of authors who have for some time been co-authoring numerous papers and reports with one another; (2) several central journals, most notably the Lancet, addressing wider audiences and transcending the narrow specialization characteristic of scientific and biomedical fields; and (3) a growing body of large-data metrics, most prominently the Global Burden of Disease, which has become a rhetorical resource for numerous groups with different agendas.

Morally accounting for sex selection online in Turkey
Burcu Mutlu

The Internet, beyond providing opportunities for advertising reproductive services, offers people an anonymous social space to exchange information, support, and personal stories regarding their reproductive goals and to enact reproductive moral reasoning regarding controversial biotechnologies in complex ways. Focusing on the online discussion forum of the Turkish web portal Women’s Club, this article examines the moral negotiations of sex selection by women seeking to legitimize or delegitimize it through rhetorical appeal to a mix of science, religion, gender, ignorance, propitiousness, and modernity. By doing so, it will reveal the ways in which women forum members work to craft not only moral selves and technologies but also a shared space for moral reflection. By examining the discursive content of Turkish women’s postings concerning sex selection, I argue that online forums offer these women an anonymous moral space to discuss their reproductive goals, although some family secrets do not escape the moral scrutiny of others even within these forums. The heterogeneity and complexity of women’s moral engagements with reproductive technologies on the Internet demonstrates that reproductive issues are moral issues directly related to the expectations for women as gendered beings, as individuals, family members, and as citizens, and also serve to reproduce social relations, including patriarchal inequalities.

“I don’t have to know why it snows, I just have to shovel it!”: Addiction recovery, genetic frameworks, and biological citizenship
Molly J. Dingel, Jenny Ostergren, Kathleen Heaney, Barbara A. Koenig, Jennifer McCormick

The gene has infiltrated the way citizens perceive themselves and their health. However, there is scant research that explores the ways genetic conceptions infiltrate individuals’ understanding of their own health as it relates to a behavioral trait such as addiction. Do people seeking treatment for addiction ground their self-perception in biology in a way that shapes their experiences? We interviewed 63 participants in addiction treatment programs, asking how they make meaning of a genetic understanding of addiction in the context of their recovery, and in dealing with the stigma of addiction. About two-thirds of people in our sample did not find a genetic conception of addiction personally useful to them in treatment, instead believing that the cause was irrelevant to their daily struggle to remain abstinent. One-third of respondents believed that an individualized confirmation of a genetic predisposition to addiction would facilitate their dealing with feelings of shame and accept treatment. The vast majority of our sample believed that a genetic understanding of addiction would reduce the stigma associated with addiction, which demonstrates the perceived power of genetic explanations in U.S. society. Our results indicate that respondents (unevenly) ground their self-perception of themselves as an addicted individual in biology.

Young brains at risk: Co-constituting youth and addiction in neuroscience-informed Australian drug education
Adrian Farrugia, Suzanne Fraser

This article explores the developing relationship between neuroscientific understandings of ‘addiction’ and ‘youth’. Drawing on science and technology studies theory and social scientific analyses of both these concepts, it identifies a co-constitutive relationship between notions of addiction as a brain disease and of youth as a stage of brain development. These two concepts are then tracked in a series of drug education documents concerned with alcohol and other drug (AOD) use and addiction among young people, and their implications and effects and analysed together. The aim is to investigate the impact on drug education of neuroscientific approaches to youth and addiction. Are new concepts and directions for harm reduction created in the encounters between neuroscience, youth and addiction, or do they simply reinstate and reinforce existing assumptions and judgments? Is drug education shaped by these concepts likely to achieve its aim, that is, to increase young people’s sensitivity to harm and safety? The article begins by introducing neuroscientific accounts of youth and addiction, arguing that the two concepts share three key assumptions. First, both emphasise biology and sideline social context in the making of drug use practices and outcomes. Second, both reproduce uncritical treatments of brain scans (PET and fMRI images) as windows into minds and subjects. Third, both understand the brain as ontologically separate from its environment. These assumptions and their implications are then tracked through an analysis of Australian drug education resources, focusing on how drug education constitutes youthfulness and addiction as pathological disorders. In its reliance on neuroscientific understandings of youth and addiction, we conclude, drug education is unlikely to achieve its goal of reducing drug-related harm.

Failing, hacking, passing: Autism, entanglement, and the ethics of transformation
Gregory Hollin

One of the most notable recent changes in autism science is the belief that autism is a heterogeneous condition with no singular essence. I argue that this notion of ‘autistic heterogeneity’ can be conceived as an ‘agential cut’ and traced to uncertainty work conducted by cognitive psychologists during the early 1990s. Researchers at this time overcame uncertainty in scientific theory by locating it within autism itself: epistemological uncertainty was interwoven with ontological indeterminacy and autism became heterogeneous and chance like, a condition determined by indeterminacy. This paper considers not only the conceptual significance of this move but also the impact upon forms of subjectivity. This analysis is undertaken by integrating the agential realism of Karen Barad with the historical ontology of Michel Foucault. I argue that these two approaches are, firstly, concerned with ontologies of emergence and, secondly, foreground the inherently ethical nature of change. As such these theories can be used to articulate an ‘ethics of transformation’. I argue that the agential cut which brought about autistic heterogeneity is potentially problematic within an ethics of transformation, limiting the possibility of future change in subjectivity by imagining difference and resistance as properties of autism rather than the individual.

Body & Society

Exploring the Ineffable in Women’s Experiences of Relationality with their Stored IVF Embryos
Jenni Millbank

This article contributes to a more nuanced and contextual approach to women’s decision-making concerning their stored IVF (in vitro fertilisation) embryos through attempting to craft a space for the expression of the complex, and contradictory, emotions attached to these decisions, unhooked from any notion of abstract moral status inhering in the embryo itself. Women struggle to express the confounding nature of the relationship to the stored IVF embryo as something of-the-body but not within the body, neither self nor other, person nor thing. In order to try to address this sense of the ineffable, I draw in this article upon a series of images by German-born American artist, Kiki Smith. The article explores three major themes, each alongside one of Smith’s artworks connecting to an experience of discomfort or confounding unease.

Culture, Medicine & Psychiatry

Medical Disease or Moral Defect? Stigma Attribution and Cultural Models of Addiction Causality in a University Population
Nicole L. Henderson, William W. Dressler

This study examines the knowledge individuals use to make judgments about persons with substance use disorder. First, we show that there is a cultural model of addiction causality that is both shared and contested. Second, we examine how individuals’ understanding of that model is associated with stigma attribution. Research was conducted among undergraduate students at the University of Alabama. College students in the 18–25 age range are especially at risk for developing substance use disorder, and they are, perhaps more than any other population group, intensely targeted by drug education. The elicited cultural model includes different types of causes distributed across five distinct themes: Biological, Self-Medication, Familial, Social, and Hedonistic. Though there was cultural consensus among respondents overall, residual agreement analysis showed that the cultural model of addiction causality is a multicentric domain. Two centers of the model, the moral and the medical, were discovered. Differing adherence to these centers is associated with the level of stigma attributed towards individuals with substance use disorder. The results suggest that current approaches to substance use education could contribute to stigma attribution, which may or may not be inadvertent. The significance of these results for both theory and the treatment of addiction are discussed.

Family Life and Social Medicine: Discourses and Discontents Surrounding Puebla’s Psychiatric Care
Kathryn Law Hale

Drawing on clinical data from 15 months of on-site participant observation in the only public psychiatric hospital in the state of Puebla, Mexico, this article advances our understanding of globalization in relation to psychiatry. I challenge the construction of psychiatry as only treating the individual patient and provide grounded doctor-patient-family member interaction in a Mexican psychiatric clinic in order to review what happens when doctors cannot interact with patients as atomized individuals even though in theory they are trained to think of patients that way. Challenged by severe structural constraints and bolstered by lessons from other nations’ efforts at deinstitutionalization, psychiatrists in Puebla push to keep patients out of the inpatient wards and in their respective communities. To this end, psychiatrists call upon co-present kin who are identified both as the customer and part of the caretaking system outside the clinic. This modification to the visit structure changes the dynamic and content of clinical visits while doctors seamlessly respond to unspoken beliefs and values that are central to local life, ultimately showing that efforts to define a “global psychiatry” informed by global policy will fail because it cannot exist in a uniform way—interpersonal interaction and personal experience matters.

Seeing a Brain Through an Other: The Informant’s Share in the Diagnosis of Dementia
Laurence Anne Tessier

This article takes up the neuroscientific assumption of our brains as “solitary” and contrasts this understanding with the description of actual clinical practices. Drawing on observations of clinical consultations and team meetings in a world famous US center for the diagnosis of dementia, I examine how the “informant”, a member of the patient’s family, participates in the diagnosis process. Based on specific situations in which the informant is judged to be a “bad” one, I inquire as to how clinicians use what they understand of the affective relationships between the patient and the bad informant in order to make a diagnosis. The diagnosis of dementia in an individual is shown to draw on relational dimensions in the patient’s life, made visible and enunciable only when problematic. This inquiry therefore brings out how these neurologists, even though they are engaged in a neuroscientific paradigm that conceives the brain as a self-sufficient cognitive machinery, nevertheless do consider what links us to the brains sharing our lives, in order to make sense of our networks of neurons.

Class-Based Chronicities of Suffering and Seeking Help: Comparing Addiction Treatment Programs in Uganda
Julia Vorhölter

Based on ethnographic fieldwork, this article looks at changing discourses and practices in the field of mental health care in Uganda. In particular, it analyzes two psychotherapeutic institutions designed to treat drug- and alcohol-addiction, and their accessibility and affordability for people from different class backgrounds. The first center is a high-class residential facility near Kampala which offers state-of-the-art addiction therapy, but is affordable only for the rich. The second center, a church-funded organization in Northern Uganda, cares mainly for people from poor, rural families who cannot afford exp/tensive treatment. Comparing the two centers provides important insights not only into the temporalities of mental illness, substance abuse and mental health care, but also into broader socio-economic dynamics and understandings of suffering in contemporary Uganda. The term ‘class-based chronicities’ refers to the way both the urgency with which people seek treatment (when has someone suffered enough?) and the length of treatment they receive (when is someone considered ‘recovered’?) are highly class-dependent. On a theoretical level, the article shows how psychotherapeutic models operate as philosophical systems which not only impact on treatment practices, but also produce different addiction entities and addiction-related subjectivities. As such, it contributes to an emerging anthropology of addiction.

Insuring Care: Paperwork, Insurance Rules, and Clinical Labor at a U.S. Transgender Clinic
Marieke van Eijk

What is a clinician to do when people needing medical care do not have access to consistent or sufficient health insurance coverage and cannot pay for care privately? Analyzing ethnographically how clinicians at a university-based transgender clinic in the United States responded to this challenge, I examine the U.S. health insurance system, insurance paperwork, and administrative procedures that shape transgender care delivery. To buffer the impact of the system’s failure to provide sufficient health insurance coverage for transgender care, clinicians blended administrative routines with psychological therapy, counseled people’s minds and finances, and leveraged the prestige of their clinic in attempts to create space for gender nonconforming embodiments in gender conservative insurance policies. My analysis demonstrates that in a market-based health insurance system with multiple payers and gender binary insurance rules, health care may be unaffordable, or remain financially challenging, even for transgender people with health insurance. Moreover, insurance carriers’ “reliance” on clinicians’ insurance-related labor is problematic as it exacerbates existing insurance barriers to the accessibility and affordability of transgender care and obscures the workings of a financial payment model that prioritizes economic expediency over gender nonconforming health.

Global Mental Health and Adolescent Anxiety: Kin, Care and Struggle in New Mexico
Janis H. Jenkins, Annika Stone

While recent developments within the field of global mental health have illuminated the reality of serious mental health difficulties worldwide, particularly in low-income settings, research that focuses on children and adolescents remains underdeveloped. This is especially the case with respect to ethnographic studies of lived experience of adolescents diagnosed with serious mental health conditions. Drawing from an interdisciplinary study of adolescents in New Mexico who were afflicted with a broad range of disorders according to contemporary research diagnostic criteria, this article focuses on anxiety-related conditions with respect to subjective experience and social–ecological contexts of living with such conditions. We offer preliminary observations regarding the value of linking ethnographic and research diagnostic data to address questions of resilience, endurance, capacity and struggle. These observations are intended as the basis for the formulation of more precise hypotheses about adolescent anxiety, kin, and care under conditions of structural violence marked by psychological, residential, and intergenerational adversity.

East Asian Science, Technology and Society

Postcolonial Biotech: Taiwanese Conundrums and Subimperial Desires (open access)
Jennifer A. Liu

Where most accounts of biotech in Taiwan—indeed, globally—focus on its economic potential and its potential to heal various ills, a postcolonial and subimperial framing insists on attention to often underexamined aspects, for example, how biotech practices reflect specific nationalist desires and rely on forms of exploitation. A postcolonial and subimperial framing insists on the inclusion of other stories. Drawing Taiwan’s nanxiang (southward) policies and Indigenous rights into a biotech frame, I suggest that such policies and desires create potential contradictions that are not easily resolved. For example, hard-won policies preventing the collection of Indigenous genetic samples may foreclose studies that might address pronounced health disparities. And the scope of a national biobank project aimed toward a global Chinese ethnic community is limited by competing claims of Taiwanese genetic uniqueness. One possible resolution envisions Taiwan biotech as a site for imagining possible futures outside enduring colonial influences and subimperial desires.

Ethos

Dinámicas Ocultas: Culture and Psy-Sociality in Mexican Family Constellations Therapy
Whitney L. Duncan

This article takes the ethnographic case of Family Constellations therapy in Oaxaca, Mexico, to demonstrate how a nonnative therapeutic practice articulates with local cultural frameworks to foster novel forms of therapeutic experience and sociality. Family Constellations in Oaxaca promotes particular forms of what I call “psy-sociality,” or sociality generated by globalizing psy concepts, diagnoses, and practices, which produce new sites for self-work and subject-formation, but also for jointly processing social suffering, familial conflict, and psychological distress in culturally salient ways. First, participants socialize in a structured way that promotes embodied connection to others. Second, participants are socialized into gendered ways of speaking, knowing, interpreting, and acting upon the self and the family. Finally, participants are also given explicit guidance for how to confront current sociofamilial conflicts with which they are grappling. In the process, participants localize this foreign therapy according to the context of present-day Mexico.

Journal of the Royal Anthropological Institute

‘Black’ and ‘white’ death: burials in a time of Ebola in Freetown, Sierra Leone
Jonah Lipton

The article examines experiences of the 2014-15 Ebola crisis in Freetown, Sierra Leone, through an analysis of the performance of burials. While most of the city’s residents had no contact with the virus, ‘Ebola’ was inescapable, owing to the onerous state of emergency regulations imposed by national and international authorities. All burials, regardless of the cause of death, were to be performed by newly established official teams operating according to unfamiliar biomedical and bureaucratic protocols. Burials became emblematic of the crisis through presenting a conflict between local practices and novel procedures, which was coded locally in a complex racial language of ‘black’ and ‘white’, recalling a long regional history of violent integration into the Atlantic World. Building on long-standing anthropological discussion on the relationship between ‘good’ death and social order, the article explores how burials became sites around which opposing ‘orders’ were experienced, negotiated, and reconciled in locally meaningful ways.

Medicine Anthropology Theory (Open Access)

Anthropological approaches to medical humanitarianism
Isabel Beshar, Darryl Stellmach

Despite broadly shared interest in the welfare of ‘precarious lives’, medical anthropology and medical humanitarianism are too often in tension. In this survey, we sketch a history of the two disciplines, then track three major patterns through which anthropologists approach the analysis of medical humanitarian efforts. Our three patterns frame medical anthropology as: 1) a critique of medical humanitarianism and its ties to colonialism and globalization, 2) a translation of medical humanitarianism and its associated lexicon, 3) and a reform of medical humanitarianism from the inside out. In highlighting the individual strengths of these three approaches, we argue for the value of medical anthropology – as both a mindset and a method – in health and humanitarian emergencies.

The program is perfect: Narcotics Anonymous and the managing of the American addict
Paul Christensen

This article examines Narcotics Anonymous (NA) membership in two ways: how blame for failure is displaced from the ‘perfect’ organizational program and onto the individual addict working to remain sober and how this displacement is accompanied by notions of individual responsibility and work. These discourses illustrate the influence of a neoliberal outlook on the life course among ‘clean’ NA members, particularly as the social safety net in the United States has been systematically reduced and replaced by a system that focuses attention on personal responsibility. I show how NA’s ideological approach blinds group members and the larger public to the complexity of addiction, turning addicts who struggle with recovery into failures, through internalized ideological trajectories that root responsibility in the self while discounting context.

In search of trust and efficacy: Tibetan medicine in multiethnic Rebgong, Qinghai, China
Nianggajia, Heidi Fjeld

This article describes how Tibetan medicine, traditionally an ethnomedicine indigenous to Tibetan areas, travels across cultural boundaries in a multiethnic region, presenting empirical findings from Rebgong (Ch. Tongren) in Qinghai province, People’s Republic of China. Focusing on Muslim Hui and Han Chinese citizens, we describe how these patients smoothly engage with Tibetan medicine. This, we argue, is enabled by a strong sense of trust in distinguished Tibetan doctors, or ‘lineage doctors’, and their privately produced Tibetan medicines, and by shared understandings of the patient role. Contemporary medical pluralism in Rebgong invites us to revisit classic themes in medical anthropology as it brings the study of ethnomedicine into the context of a reconfigured instrumentalized public health system and ethnic relations, in which trust is a rare and treasured quality.

Pathways, intersections, and hotspots: Multisited fieldwork and the South African HIV/AIDS policy process
Theodore Powers

Since the late apartheid era, the South African HIV/AIDS movement has mobilized infected and affected communities and cultivated alliances to establish and expand a national HIV/AIDS response that is based on human rights. In doing so, HIV/AIDS activists have actively engaged with political dynamics across the institutional domains of the state. Participant observation research with South African HIV/AIDS activists and analyses of the South African HIV/AIDS policy process therefore necessitate following the movement of research participants across many sites. Bringing together existing approaches to multisited research, the concepts of pathways, intersections, and hot spots are utilized to represent the social and spatial experiences of HIV/AIDS activists, state health administrators, and other policy actors within a unified conceptual framework.

Photo Essay: Diabetes in Senegal
Steven Rubin, Rhonda BeLue

Saharan Africa is faced with a significant and increasing burden of noncommunicable diseases, including type 2 diabetes mellitus. The incidence of diabetes is growing; however, insufficient resources are available for prevention efforts and disease management. Diabetes affects people living with the disease, their families and communities, and the multiple health care systems with which they interface.

The prevention and management of diabetes extend well beyond the walls of health care facilities; they are embedded within and influenced by family, community, cultural, and economic contexts. Adopting a socioecological lens (Hill et al. 2013), we use photography to explore diabetes-related behaviors such as diet and physical activity in the context of family, community, and other emplaced interactions. Our images make visible the management and effects of diabetes within the intimate daily lives and spaces of people living with the disease in the Thiès region of Senegal.

Photography as a tool of ethnographic research can exacerbate power differentials between observer and observed, particularly when used with vulnerable populations. However, the creation and dissemination of images also provide an opportunity to make visible a noncommunicable disease like diabetes, which continues to be dangerously underfunded internationally (Bloomberg 2017). Diabetes in sub-Saharan Africa, in particular, remains insufficiently researched and scarcely represented, rendering invisible both the people (patients and health care providers) and places involved in the prevention and management of the disease.

Social Science & Medicine

Justification and authority in institutional review board decision letters (open access)
Justin T. Clapp, Katharine A. Gleason, Steven Joffe

While ethnographic study has described the discussions that occur during human subjects research ethics review, investigators have minimal access to the interactions of ethics oversight committees. They instead receive letters stipulating changes to their proposed studies. Ethics committee letters are central to the practice of research ethics: they change the nature of research, alter the knowledge it produces, and in doing so construct what ethical research is and how it is pursued. However, these letters have rarely been objects of analysis. Accordingly, we conducted a qualitative analysis of letters written by American institutional review boards (IRBs) overseeing biomedical and health behavioral research. We sought to clarify how IRBs exercise their authority by assessing the frequency with which they provided reasons for their stipulations as well as the nature of these reasons. We found that IRBs frequently do not justify their stipulations; rather, they often leave ethical or regulatory concerns implicit or frame their comments as boilerplate language replacements, procedural instructions, or demands for missing information. When they do provide justifications, their rationales exhibit substantial variability in explicitness and clarity. These rhetorical tendencies indicate that the authority of IRBs is grounded primarily in their role as bureaucratic gatekeepers. We conclude by suggesting that greater attention to justification could help shift the basis of the IRB-researcher relationship from compliance to mutual accountability.

The oughtness of care: Fear, stress, and caregiving during the 2000–2001 Ebola outbreak in Gulu, Uganda
Sung-Joon Park, Grace Akello

In this article we introduce the term oughtness of care to show how caring for sick relatives was experienced in the context of the Ebola outbreak in Gulu, Uganda, in 2000–2001. We conducted fieldwork over a nine month period from July 2016 to March 2017 in the suburbs of Lacor, Bardege, Pece Lukung, Kasubi, Limu, and Kanyagoga Koro Layibi, Rwot Obilo, all of which were epicenters for Ebola. In addition, we conducted interviews in the districts of Amuru, Kitgum, and Lamwo, where some interlocutors had resettled following the end of the war that was affecting Gulu at the time of the Ebola outbreak. Of the 198 interlocutors in the focus group discussions, we followed up on 98 for further group and individual interviews. Our analysis principally provides a retrospective ethnographic study of caregivers’ moral experiences of the need to care for sick relatives during the outbreak. In our study, respondents argued that they would rather respond to the compelling need to offer care for intimate others at home or in a healthcare institution, rather than listen to sensitization messages not to touch sick patients. We introduce the term oughtness of care to enable us to understand how caregiving, which caregivers experienced as a moral logic draws its justification from the specific situation of radical insecurity which they were thrown into. We argue that this caregiving has its own logic, which is insufficiently captured by conventional public health approaches to containing Ebola outbreaks. Caregivers are, in consequence, not recognized as ethical subjects by such public health interventions. By providing an understanding of the moral experience of caregiving and the distinct logic of care, our analysis contributes to the development of relevant and effective public health responses to Ebola epidemics.

Medical egg freezing and cancer patients’ hopes: Fertility preservation at the intersection of life and death
Marcia C. Inhorn, Daphna Birenbaum-Carmeli, Pasquale Patrizio

Egg freezing (i.e., oocyte cryopreservation) is a new reproductive technology that allows women’s eggs to be frozen and stored for future use. Over the past five years, so-called “medical egg freezing” (MEF) has begun to play a major role as a form of fertility preservation for young women with cancer and other fertility-threatening medical conditions. Indeed, women who are candidates for MEF are often facing the “double jeopardy” of fertility loss and potential death. In this article, we examine the experiences of the first generation of women to use MEF in the United States and Israel, two countries where experimental use of MEF began early, and where MEF is now offered clinically in many in vitro fertilization (IVF) clinics. Through an ethnographic, interview-based study carried out between June 2014 and August 2016 with 45 women (33 American, 12 Israeli) who had completed at least one cycle of MEF, we highlight women’s reflections on their egg freezing experiences, and their considerable hopes for future recovery and motherhood. However, MEF is a Janus-faced new “hope technology.” On the one hand, it holds out the promise of life in terms of recovery and future childbearing. As such, women’s reflections on MEF reveal hope and gratitude for the technology’s existence. However, as with IVF itself, future motherhood can never be guaranteed. This is especially true for women facing death from advanced or aggressive forms of cancers. Three ethnographic case studies of cancer patients, two from the US and one from Israel, highlight how MEF offers hope for life among women confronted with a deadly disease.

What if the baby doesn’t survive? Health-care decision making for ill newborns in Ethiopia
Kristine Husøy Onarheim, Mitike Molla Sisay, Muluken Gizaw, Karen Marie Moland, Ingrid Miljeteig

Despite efforts to improve access to and quality of care for newborns, the first month after birth remains the most dangerous period of life. Given high neonatal mortality in low-income countries, saving newborn lives is a key priority for global and national health policy agendas. However, little is known about how these policies resonate with local understandings, experiences and household priorities. In this qualitative study we examined families’ decision making and health-care-seeking in Butajira, Ethiopia. Data were collected through observation in hospital, in-depth interviews (41), and focus group discussions (7) with family members, health-care workers, and community members (October–November 2015). Transcripts and field notes were analyzed inductively using qualitative content analysis. Findings indicate that newborn health was not always the family’s priority. Local perceptions of newborns as not yet useful members of the household alongside costly health-care services delayed decision making and care-seeking. While sickness was recognized as dangerous for the ill newborn, seeking health-care could be harmful for the economic survival of the family. In a resource-constrained setting, families’ focused on productive assets in order to minimize long-term risks, and waited before seeking newborn health-care services. Until the baby had survived the first vulnerable weeks and months of life, the unknown newborn was not yet seen as a social person by the community. Personhood evolved progressively as the baby became a part of the family. A newborn death was surrounded by silence, and families received minimal support from traditional financial associations, iddirs. Decisions regarding health-care were contingent upon families’ understandings of newborns and their resource-constrained circumstances. Improving newborn health involves recognizing why families choose to (not) seek health-care, and their actual opportunities and constraints in making such decisions. The everyday realities of vulnerable newborns must be at the center of global and national policy discussions and local implementation.

Catalyst: Feminism, Theory, Technoscience (Open Access)

Toxic Shock Syndrome, Tampon Absorbency, and Feminist Science (open access)
Sharra Vostral

Tampon-associated toxic shock syndrome (TSS) has disproportionately affected women, and specifically, menstruators. By 1980, the Centers for Disease Control recommended that women limit their use of superabsorbent tampons since the risk for TSS increased with greater levels of absorption. However, women had no way of following this advice since products did not have consistent absorbency labels. A standard to set absorptive capacity as well as nomenclature was required, and the consensus process to do so was governed by ASTM (American Society for Testing and Materials). Esther Rome from the Boston Women’s Health Book Collective participated as a consumer representative, and solicited feminist scientist Nancy Reame to help generate data on their behalf. Importantly, they rejected the use of blue saline and “blue goo” as a menstrual fluid in the syngyna—the synthetic vagina simulacrum lab instrument—to test tampon absorbency, and insisted upon heparinized blood instead. They challenged the process by which a standard is established, the method by which variables are controlled, and the erasure of menstrual fluid from tests about tampon absorbency. The feminist science yielded both usable and valid outcomes, with results that challenged the design of the experiment upon which standards were to be based.

Philosophy, Psychiatry, & Psychology 

Liberal Individualism and Deleuzean Relationality in Intellectual Disability
Jennifer Clegg, Elizabeth Murphy, Kathryn Almack

Successful critiques of health policies for people with impaired cognition identify a need for alternatives that go beyond individualism. ‘Choice’ policy was examined as young people with severe intellectual disabilities moved from special schools to adult services. We draw on three cases from a longitudinal cohort study to examine the way decisions with and for these young people were made and accounted for. It was not a simple matter of parents and transition workers hearing about these young people’s choices and facilitating what they wanted. The data raise questions about discourses of choice in ID when referring to people with severe intellectual disabilities: few ‘choices’ could be considered informed nor made by young people with capacity to make them and many decisions were informed by other ethics. Findings were interpreted through a Deleuzean ethical–relational lens. We identify implications for theory and practice to show how Deleuzean thinking can reinvigorate intellectual disability.

Health, Risk & Society

Responsible use to responsible harm: illicit drug use and peer harm reduction in a darknet cryptomarket
Angus Bancroft

Sale of illicit drugs through online ‘cryptomarkets’ is a notable innovation in the illicit drug market. Cryptomarkets present new ways of configuring risk and harm in relation to drug use. I examine the kinds of knowledge and discourses users employed to do this. I argue that the lay/expert divide that creates a hierarchy of knowledge around drug use and harms is increasingly undermined by the creation of knowledge communities by drug users who make drug use work effectively for them. I draw on the discussion forum of a now defunct English language focused cryptomarket, anonymised as ‘Merkat’, collected between 2015 and 2016. Typically, vendors in the major cryptomarkets are based in the USA, UK, China, the Netherlands and Australia. Buyers were mainly located in the USA, UK, Australia and Western Europe. I scraped the market forum threads and coded on emergent themes. I found that risk worked along four axes, cultural normalisation/pathologisation, chemical potency, legal/policy and market, each of which required a set of practices and orientations to manage successfully. Users indicated that they had adapted many harm reduction practices, while also promoting a ‘responsible harm’ orientation where they sought to own and take charge of harm. The support infrastructure drew on knowledge from drug users, vendors and interested professionals. I conclude that cryptomarkets can provide a community infrastructure that supports the exchange of drugs and configures them as risky but manageable objects.

Risk as a relational phenomenon: a cross-cultural analysis of parents’ understandings of child food allergy and risk management
Marie-Louise Stjerna, Allison Worth, Jeni Harden & Sonja Olin Lauritzen

Western culture can be seen as permeated by risk-consciousness. In particular, parents are under scrutiny in their roles as risk managers. In this article, we address parental experiences of children more at risk than other children, children with food allergy, and the management of allergy risk in everyday life. Drawing on a notion of risk as ‘situated’ in local everyday life, we argue that a further exploration of parental understandings of child food allergy risk would benefit from an analysis of studies across different local contexts. In this article, we draw on a secondary qualitative cross-cultural analysis of interview data from several studies of parents in Sweden and Scotland through 2006–2010, which focused on parents’ understandings of the nature of food allergy and the children’s management of the allergy risk. We found some common themes in the different data sets. First, parents depicted food allergy as life-threatening, a ‘death risk’ lurking in the background, more or less constantly present in different everyday situations, amounting to an existential condition in parenting. Second, they talked about food allergy risk as a relational phenomenon, meaning that the risk emerged in the encounter between the young person’s individual competence to manage allergy risk and the understandings of allergy risk in others – thus depending on contexts and interaction between several actors. Finally, the analysis showed that unpredictability and risk in constant flux are the prominent aspects of living with food allergy. We also discussed the ways risk and trust are related, as well as how the involvement of others can be seen as both a risk and a safeguard.

‘You don’t know what’s going on in there’: a discursive analysis of midwifery hospital consultations
Danielle Ferndale, Renata F.I Meuter, Bernadette Watson & Cindy Gallois

In contemporary Western society, the concept of risk is mostly linked related to negative or undesirable outcomes and used to explain unusual or abnormal events that have harmful consequences. Working in a poststructuralist framework, in this article we examine how risk shapes interactions between midwives and pregnant women in the context of public hospitals in Australia. We draw on data from an observational study of clinical encounters in three Australian hospitals between October 2014 and July 2015. The research teams recorded 83 health encounters and in this paper we draw on data from the recordings of 10 clinical consultations between 8 midwives and 10 pregnant women at various stages of gestation. We used these data to explore how a discourse of risk was mobilised through rhetorical strategies and practices of ‘hunting’ for the abnormal and attempts to control the body. Our findings demonstrate how a discourse of pregnancy and birth as risky operates within public hospital midwifery consultations. We found that in the midwifery consultations we recorded, pregnancy was constructed as a period of vulnerability and unpredictability. It was normalised through discursive practices of hunting for the abnormal and rhetorical strategies of attempting to control the body. Within this discourse, midwives occupied conflicting positions. They asserted that women, with the right support, were capable of spontaneous and intervention-free (pregnancy and) birth. Yet, they acted to enable medical professionals to assess a woman’s ability to give birth (un)assisted, or the potential for an adverse event. The women, while positioned as passive within the public health system, were positioned as active in surveilling themselves and responsible for taking steps to mitigate against adverse events.

Web Roundup: Gender and Health by Cinzia Greco

27 Décembre 2017 - 9:55pm

Nothing seems to be more self-evident than gender differences, and yet when we have to establish what these differences are, things seem to become complicated. Is it the reproductive system that clearly determines if we love pink or blue? Perhaps it is the endocrine system? Or is it the genes that are different?

Feminist research started decades ago to build a trail through the forest of myths and symbols surrounding gender differences, and has shown how biological differences between women and men are not so simple to identify. As the social sciences have demonstrated well, many differences between men and women, including some in the field of health outcomes, are attributable to social rather than to biological factors.

A recent special issue of Scientific American presents some of these reflections. Although most of the articles are behind a paywall, the Introduction sets the tone for an interesting series of articles that aim to show the complex ways in which gender and biology connect. The Conversation has also started an interesting series of articles on gender and medicine.

Other research highlights new ways in which gender can play a role when it comes to health. An analysis on blood transfusions performed in the Netherlands has showed a higher risk of rejection in cases in which a blood donor and recipient are not of the same gender. These results are not conclusive and further studies should be conducted to understand if and how matching blood donors and patients by gender can have a role in improving survival rates in transfusions. However, these results already sparked a debate in the medical community about whether blood should be sex-matched, and some clinicians are inclined to avoid risks and are willing to include this element in the current blood transfusions practices.

For a long time, cardiac conditions have been considered a prerogative of men and thus cardiac symptoms have been underestimated in women. Recent research has not only shown that this cultural bias can be a risk factor for women, but also that physiological elements of female anatomy should be taken into consideration when diagnosing and treating cardiac conditions in women. Physiological factors can also explain why women are more prone to some inflammatory diseases, in particular autoimmune ones. In this regard, an article in an Italian newspaper describes how the endocrine system can be one of reasons why women and men respond differently to anti-inflammatory therapies. This can be true also for psychological conditions. Hormonal variations in women are considered to be among the possible causes of a stronger predisposition to disorders such as depression or anxiety. However, social factors that influence mental well-being should also be taken into consideration. Indeed, the ways in which women are educated and the expectations that society has of women can make them more vulnerable and prone to depression or anxiety. Social and cultural factors can also explain women’s exposure to violent medical treatment. An interesting article published in the French newspaper Le Monde reminds us that women were indeed the main victims of the lobotomy, when this practice was still considered valid.

Women’s financial vulnerability can also play a role in health decisions. In discussing new end-of-life legislation in Australia, an article published in The Conversation argues that older women might be driven by their greater social and economic fragility to resort to assisted suicide more often than men do.

Medical knowledge of the human body has been for a long time based on the study of the male body, with women considered as “small men”. This approach is gradually losing ground and more nuanced studies are giving a more significant role to women in medical research and clinical trials. These are, of course, important steps toward the production of a more inclusive and accurate biomedical knowledge. However, the recognition of gender specificities within medical research are strongly focused on physiological dimensions. A greater interdisciplinary understanding of gender would help medical research to take into consideration the social dimensions of the gender system and help to avoid the risk of biological essentialism.

Cinzia Greco obtained her PhD from the École des hautes études en sciences sociales and the CERMES3 laboratory, with a Cancéropôle Île-de-France scholarship. For her dissertation, focused on the experience of postmastectomy breast reconstruction, she was awarded the Barbara Rosenblum Dissertation Scholarship for the Study of Women and Cancer. Cinzia is currently a Newton International Fellow at the Centre for the History of Science, Technology and Medicine of the University of Manchester where she is working on the recent history of metastatic breast cancer.

Top of the heap: Nayantara Sheoran by Hannah Gibson

21 Décembre 2017 - 4:25pm

For this installment of the Top of the Heap series, I spoke with Nayantara Sheoran Appleton, who is a medical anthropologist and lecturer in the Cultural Anthropology program at Victoria University of Wellington, New Zealand.

 

Reading in the Antipodean Summer

In May, as the winter winds whipped through Wellington, Aotearoa New Zealand, I ordered a few books from Duke University Press, induced by its half-price sale. A number of them were new releases that immediately made it on to my “must read now” list. But life intervened. It seemed like an impossible task to get to them as I settled into my first year of teaching in a new programme in the Antipodes. Over the past few months, I have longingly looked at my stack of new books while grading papers, replying to administrative emails, or working through a few revisions on articles. As Christmas and New Year descend upon us, marking the official summer holiday season here, I have moved my reading pile from the office to my home. Progress!!!

One of the first books I intend to read is Kaushik Sunder Rajan’s Pharmocracy: Value, Politics, and Knowledge in Global Biomedicine (Rajan 2017). It addresses some of the issues I tackle in my latest project on stem cell research and therapy in India. Rajan’s previous work, including Biocapital: The Constitution of Postgenomic Life (Rajan 2006), was instrumental for my doctoral research on emergency contraception in India, and I can only imagine the valuable insights I will be able to draw on from this follow-up.

Pharmocracy looks at international pharmaceutical regimens and how they work within a democracy to create structures (through regulatory frameworks and neoliberal health policies) that are detrimental to the interests of India’s citizens. Playing on the word democracy, he used “pharmaocracy” to denote the way democratic institutions and democracies (like India) are subsumed to the global capitalistic interests of the pharmaceutical industry. This gels with an argument I have been developing in my own current research project, as I think through stem cell research and therapies in India and the political-economy of bioethics as they are mobilized in service to global biocapital (Appleton and Bharadwaj 2017a; Appleton and Bharadwaj 2017b). Pharmocracy, as a first read of the summer, will allow me to reimagine my field sites in India and set me up for some good writing in the New Year.

The next book on the list is Karine Chemla and Evelyn Fox Keller’s edited collection titled Cultures without Culturalism: The Making of Scientific Knowledge (Chemla and Keller 2017). It is a timely intervention on how ‘culture’ has been mobilized within social scientific scholarship to engage with science and scientific knowledge. Science studies scholars have seen the tools they devised to critique science, with the aim of improving it, co-opted by science deniers. An edited volume like this allows us to re-examine our earlier critiques and re-imagine what the next turn in science studies will look like. Careful not to raise alarm bells (I have browsed the introduction), this collection promises to be an engaging read that will generate ideas on how to continue to hold science and scientific knowledge accountable, whilst being careful not to allow that critique to collapse into essentialist readings of how culture and science interact. In particular, as an anthropologist who looks at medico-scientific spaces, this edited volume will be vital reading as I start next year on my writing project on stem cells.

Two other edited volumes, while contributing to my research, will also be important reads for more prosaic reasons. Crumpled Paper Boat: Experiments in Ethnographic Writing by Anand Pandian and Stuart McLean (Pandian and McLean 2017) promises to be a delight based on some of the reviews I have read. Between methods and writing, it appears as a generative space for theoretical engagements that are willing and able to upend static boundaries and allow space for creative expressions in anthropology. For somebody who enjoys writing ethnographically but also feels constrained by the expectations of academic writing, I am hoping this creative experimental edited volume serves as a gentle reminder that writing anthropologically can take many shapes and forms.

The other edited volume on my list is Critically Sovereign: Indigenous Gender, Sexuality, and Feminist Studies by Joanne Barker (Barker 2017). This promises to be vital as I prepare a new course on Gender, Sexuality, and Kinship in the cultural anthropology programme at Victoria University of Wellington. It will also allow me to read in an area that brings together two of my academic and teaching interests: gender & sexuality and indigeneity. While gender and sexuality and feminist theories have been an instrumental part of my academic life for a long time, issues around indigeneity have become more important to me recently as I (an immigrant) have moved to Aotearoa, New Zealand and live on the lands of and under the hospitality of indigenous communities. Through academic texts like Critically Sovereign, I hope to continue to engage more personally with the politically charged and socially important conversations on the rights of indigenous communities in settler societies.

Finally, the fifth book on my list is also an edited volume, by Rhonda Shaw titled Bioethics Beyond Altruism: Donating and Transforming Human Biological Materials (Shaw 2017)[1]. While I have a chapter in the book, I have not had the opportunity to read the other chapters in it. Some of the chapters are directly related to my work, but others not so much – helping me read more broadly in the area of bioethics (and in my case, beyond stem cells). Sometimes edited volumes emerge from collaborative projects and similar intellectual conversations. At other times, they are a collection of divergent conversations on similar topics that an editor brings together in order to facilitate a conversation. This edited volume is of the latter sort, with Shaw deftly curating interdisciplinary conversations via engaging chapters on the bioethics of donating, sharing, transforming biological material – ranging from human organs and gametes to breastmilk and stem cells. Reading this book, and thinking about my own contribution to this conversation on bioethics, should be a good way to wrap up the summer of reading and preparing for the upcoming academic year.

With luscious red summer blooms of the pohutukawa tree blowing gently in the breeze and barbeque smells wafting in the air, I am being coaxed away from my computer and invited to start on this reading stack that’s been waiting for way too long. Happy holidays (and reading)!!!

Dr Nayantara Sheoran Appleton’s research and teaching interests are in the following areas: Feminist Medical Anthropology and Science and Technology Studies (STS); Cultural Studies and Media; Reproductive and Contraceptive Justice; Critical Kinship; Ethics and Governance; Regenerative Medicine; and Ethnographic Research.

 

Images:

Stack of books: Sheoran Appleton.

Pohutukawa Tree: https://nzhistory.govt.nz/media/photo/pohutukawa-flowers

 

Bibliography

Appleton, Nayantara Sheoran, and Aditya Bharadwaj
2017a On the Everyday Ethics of Stem Cell Therapies in India. In Bioethics Beyond Altruism. Rhonda Shaw, ed. Pp. 89–112. Palgrave Macmillan. https://link.springer.com/chapter/10.1007/978-3-319-55532-4_4.

2017b Biocrossing Heterotopia: Revisiting Contemporary Stem Cell Research and Therapy in India. In Global Perspectives on Stem Cell Technologies. Aditya Bharadwaj, ed. Pp. 195–214. Palgrave Macmillan, Cham. https://link.springer.com/chapter/10.1007/978-3-319-63787-7_9.

Barker, Joanne, ed.
2017   Critically Sovereign: Indigenous Gender, Sexuality, and Feminist Studies. Durham, NC: Duke University Press.

Chemla, Karine, and Evelyn Fox Keller, eds.
2017   Cultures without Culturalism: The Making of Scientific Knowledge. Durham: Duke University Press Books.

Pandian, Anand, and Stuart McLean, eds.
2017   Crumpled Paper Boat: Experiments in Ethnographic Writing. Durham: Duke University Press Books.

Rajan, Kaushik Sunder
2006   Biocapital: The Constitution of Postgenomic Life. Duke University Press.

2017   Pharmocracy: Value, Politics, and Knowledge in Global Biomedicine. Experimental Futures : Technological Lives, Scientific Arts, Anthropological Voices. Durham, NC: Duke University Press.

Shaw, Rhonda M., ed.
2017   Bioethics Beyond Altruism: Donating and Transforming Human Biological Materials. 1st ed. 2017 edition. New York, NY: Palgrave Macmillan.

 

[1] Not a Duke University Press publication

Justice, Science, and Pedagogy by Myrna Perez Sheldon

15 Décembre 2017 - 6:09pm

As we consider the role of justice in pedagogy and scholarship, I want to ask a simple but difficult question:

What is our ethical task?

Do we desire to be right? Do we desire to be powerful? Do we desire to be empathetic and other-oriented?

Earlier in my academic career, I understood my pedagogical task to be equipping students to see science as a social activity, and perhaps even to recognize how science is complicit in social power and oppressions. I’m no longer able to think of my task solely in those terms, partly because I am jointly appointed in two departments, neither of which are the history of science or medicine. But also because this no longer is enough for me. The time that I’ve spent in feminist and anti-racist spaces has emboldened me, and stripped the shyness I once had in thinking of my work as an ethical task, of seeing my work as necessarily and unapologetically political. And I also learned of my own deep ignorance;  of the decades of thought and debate over the relationship between theory and activism in fields that take on feminist and critical-race methodologies, and who claim, as Michel Foucault has expressed, that theory should not, prompt “the kind of curiosity that seeks to assimilate what it is proper for one to know, but rather that which enables one to get free of oneself.

In the past few years, I have found some moral clarity in reading Gayatri Spivak; the postcolonial theorist and feminist writer. What I find intoxicating about Spivak is her articulation of the value of humanistic learning that is not primarily concerned with rebuking science. Spivak, is after all, a literary theorist. In a 2014 collection of essays titled Readings, she describes what she believes is the deep value in literary reading:

This is what training in literary reading offers beyond the conventional definition of literature— a painstaking learning of the language of others. This training can also come through cultural rearing, often compromised by gender and class. In other words, only women and servants must think of others, the colonists and their children think of themselves, and the queer generally remain in hiding. This is a general description as I move through India. It is amazing to see in my own class how different the treatment of women and servants is, to observe how the children and the colonists behave. 

Literary reading can, if given the chance, undo this, and not just in India… A literary education can direct one to noticing these otherwise ignored details…

By a literary education Spivak has far more in mind than the simple mechanics of comprehension, grammar and composition. Reading literature, in her view, is a way of training the imagination to consider and care for the needs, perspectives, and troubles of those distant from us in terms of geography, worldview, class, race, religion, and gender. This is a necessary feature of social justice, one which is far harder to ingrain than we might imagine. Yet Spivak does not believe we can forcibly instill this in anyone—rather, we can only craft the conditions this other-orientedness needs to arise on its own.

Spivak’s is a beautiful and terrifying vision of the ethical project. It’s a vision in which we cannot control the outcome; if we attempt to control it, we destroy any possibility of social justice. In seeking power, particularly when we fervently believe ourselves to be right, we destroy what was good about our moral system in the first place. Much of the evil in the world was committed by people who urgently believed in the righteousness of their cause. As Spivak explains, “everything that is medicine can turn to poison if the person or the collectivity who is using it is not trained to know how much to use, when, and how.” Reading, literary reading, can give us a “training of the imagination that makes revolutions last.”

Spivak has prompted me to think about “making revolutionists last” in the design of my courses—and to ask, what is it in particular can the history of science and medicine do— in my case, in a feminist classroom— to train the imagination? I’ll just give a brief example from a graduate course I taught last fall, titled “Feminism and Eugenics”: in the Women’s, Gender and Sexuality Studies Program at Ohio University. In the course, I ask WGSS graduate students to engage with the history of hereditary and evolutionary science, and to ask how this scholarship differently illuminates our understanding of feminist theory and activism. The students came to the course with little or no background in the natural or medical sciences, and quite frankly, limited initial interest in the history of science. But over the course of the semester, through reading primary and theoretical texts on the intersections between population control and feminist reform, our course confronted the relentless logic that held together American reform movements and white supremacy.

For example, we studied first-wave feminist activists such as Charlotte Perkins Gilman who argued for women’s reproductive rights on the basis of white women’s ability to whiten America’s racial future. Gilman believed that white women and white men shared a bond that transcended their gender divide, and enabled them to be partners in the reproductive progress of their race. As historian Gail Bederman has argued, that although contemporary scholars “find Gilman’s racism suprisingly inconsistent with her gender egalitarianism, Gilman herself would have seen no inconsistency. Her feminism was inextricably rooted in the white supremacy of ‘civilization.’”

For students in a feminist classroom, the history of eugenics is challenging reality to face. Because we see the impulses of first wave American feminism as not merely complicit with structural racism, but productive of it. But concentrating on the hereditarian logic that entangled eugenics and feminism helps us to confront with humility this history as well as our own contemporary vocabulary on women’s health, reproductive rights, and bodily normalcy.

Engaging with this history of science also pointed our course to moments of resistance. For instance, we examined works by black women on their refusal to procreate in a world where their sons were lynched. In our analysis of authors such as Nella Larsen, we ask how the reality of lynching reshaped modes of sexuality, sexual reproduction and motherhood for black women. Nella Larsen, perhaps most famous for her novel Passing, which has been analyzed by Judith Butler and others for the complex entanglement between raced and queered passing; wrote several novels that explored the fluidity and violence of racial categories in Progressive era America.

In her first novel Quicksand from 1928, Larsen tells the story of a mixed-race woman Crane, and her attempts to find existential fulfillment and racial identity in a marriage partner. American studies scholar Daylanne English has analyzed this novel for what it reveals regarding the refusals of black women in Jim Crow America to reproduce in a world with the spectre of lynching. English first points to the confidence that male leaders in the African American community had in the promise of eugenics to uplift their community; as English argues, figures such as WEB Dubois and other African-American men were trying to set an agenda for black reproduction and to establish control over modern black women’s fertility.

English takes this history to her reading of Larsen’s Quicksand, when one of the black female character laments, when asked if she will ever marry:

“Someday, perhaps, I don’t know. Marriage- that means children to men. And why add more suffering to the world? Why add any more unwanted tortured Negros to America?”

For English, this moment in Larsen’s book speaks to a refusal- a refusal on the part of black women to play the reproductive role set out for them. As she argues,

“Here lies the deep structural link between lynching and black women’s reproductive lives. If the essence of racial and gender oppression for African American men is the lynching cycle, for black women the essence of their oppression is the cycle of repeated childbirth within a racist and lynching nation.”

For my course, these readings prompted us to several questions: How is kinship differently configured by new scientific understandings of heredity as well as persistence forms of violence? How do we understand the cultural influence of “natural” and “sexual” selection for women whose selective capacities are robbed from them by lynching? Ultimately, the toolkit of the history of science opened up a different set of questions in this feminist and anti-racist context.

By the end of the course, I do not desire most that the students fully understand and discipline themselves in intersectional feminist theory. Nor do I desire most that they recognize and identify their own privileges, or the privileges of those around them. No, what I desire for them, is what I desire for myself: is that history and theory, might help us to get away from ourselves-in this case, as contemporary feminists, to see clearly and humbly the history of racial supremacy at the heart of early American feminism. And I might even suggest that this might embolden us to set aside our desire for security and power and rightness— most especially when we have come into the world, or moved through the world in such a way to gain some measure of these temptations— and to “dig down deep” and use our securities to address the precarities and violences in our lives and the lives of our neighbors.

And as I say this, it terrifies me. Because I am confronted with an ethical task that requires a willingness to sacrifice much of what I hold dear. I’m not sure what my world looks like in which I train my imagination to consider the refusal to bear children in a world of lynching. But I am convinced it is a thing I must try to imagine, because in a nation where racial violence is daily, structural and state-sanctioned, it is the world I already live in.

 

Myrna Perez Sheldon is Assistant Professor of Gender and American Religion, jointly appointed in two departments, Classics & World Religions and Women’s, Gender, & Sexuality Studies, at Ohio University. She earned her Ph.D. in the History of Science from Harvard University in 2014 and was a Postdoctoral Fellow in the Center for Women, Gender, and Sexuality Studies at Rice University. She is a faculty affiliate of the Program for Science, Religion, and Culture at Harvard Divinity School and is the editor of Cosmologics Magazine. She has published in Signs: Journal of Women in Culture and Society, Endeavour, Studies in the History and Philosophy of Biological and Biomedical Sciences, and the Routledge Companion to Religion and Ecology. Dr. Sheldon’s dissertation, on the public career of Harvard evolutionary biologist and public intellectual Stephen Jay Gould, was the sole runner up for the Allan Nevins Prize in American History. 

Critical Histories, Activist Futures” is a series edited by Tess Lanzarotta and Sarah M. Pickman.

Selections of this piece were taken from “What do the Humanities Have to Offer for Social Justice” Cosmologics Magazine, Spring 2015.

Drift by Charne Lavery

14 Décembre 2017 - 5:27pm

The ocean has long been considered the ideal location for the disposal of waste—including, among many other things, treated and untreated sewage poured easily into the sea, the vast quantities of sand and earth displaced into continental margins by harbor dredging, and the irredeemable byproducts of nuclear reactions secretly sunk. The ocean’s vastness, viscerally encountered and culturally reproduced, has seemed a guarantee of disappearance. But that sublime image—wild, limitless, outside—is pockmarked by reminders of both past and distant disposals. Most famously, the now familiar plastic island in the Pacific, made up of vast quantities of slowly broken-down plastic collected in an ocean gyre, so large as to be visible from space. And, a recent scan of the floor of the Pacific Ocean which revealed that even the deepest parts of the ocean, up to four miles down, are littered with humanity’s detritus.

It is often very difficult to adequately represent environmental destruction, because it happens so slowly and anonymously—and the ability to imaginatively represent is politically important, linked to abilities to prevent and prosecute (Nixon 2011). As Nick Caverly writes in this series, the toxic impacts of dust are lagged and uncertain because it can so easily be blown or washed away; Michelle Murphey (2016) vividly describes the way in which chemical pollution is displaced not only spatially but temporally, ‘such that accountabilities exceed the scope of individual lives, bioaccumulating or persisting over time, across regulatory regimes, beyond research grants and into the conjectural future.” One way of doing the difficult work of imagining environmental destruction—so often delayed, anonymous and dispersed—that I would like to explore here, is through the idea of oceanic drift.

Drift, as a slow, fluid movement along lateral and three-dimensional currents; a languorous and unpredictable move from one place to another; a spatial and temporal lag. And oceanic because the ocean is both familiar and strange: easy to picture but also far larger than the human scale and spatially foreign in its three-dimensionality. This is captured by the word ‘pelagic’, which refers to open seas, water that is not close either to the bottom or to the shore. These are the regimes of the sea—the deep and distant ocean—in which plankton and plastic continually drift. As Jatin Dua notes in this series, the elemental difference between land and sea has a long legal and imaginative history, must of which revolves around the inhospitability and strangeness of the ocean. However, it is important to not just give in to sea-blindness, or replace it only with ‘fluid ontologies’. Rather, he suggests that we trace some sense through stories of things that land up on shore—alongside which I offer stories of those that drift out at sea.

The pelagic zone is the zone of open water in contact neither with the bottom nor the shore. Source: K. Aainsqatsi at en.wikipedia – https://commons.wikimedia.org/w/index.php?curid=3251432

The following then are three cases—real stories that may speak to the imagination—which point to ways in which drifting operates in very distant and very deep parts of the ocean (primarily here the pelagic Indian Ocean) in relation to unusual forms of disposal.

 

Drift away

The first case is one of unintended consequences, an industrial fishing technique that is premised on natural drifting, intersects with pelagic fish life, and finally results in dangerous detritus.

Schools of fish in the open ocean tend to congregate around natural floating objects, such as a log washed down from a river in Kenya and carried by currents or the monsoon into the wide Indian Ocean. These objects make valuable fish such as tuna much easier to find and catch. But while the advantages of fishing around floating objects have long been obvious to captains, opportunities to do so were limited by the number of natural floating objects in the ocean—just not quite enough flood-born logs to meet the global tuna demand. In the 1980s, however, purpose-built objects began to be constructed, known as drifting fish aggregating devices (FADs).

Fish aggregating device, copyright Greenpeace/Paul Hilton http://www.greenpeace.org/australia/en/photosandvideos/photos/slideshows/Whats-in-your-can-of-tuna-/A-Fish-Aggregating-Device-FAD/

This drifting-device method is so successful that it has reshaped fishing particularly in the Indian Ocean, leading to worries that it might, if left unchecked, “exacerbate issues of overcapacity” (Davies et al 2014).

But a stranger impact emerges from the fact that the devices are often lost—sinking, drifting away into areas with poor fishing prospects, being commandeered by other fishing boats—such that fishermen constantly deploy new devices. As FADs have proliferated and been repeatedly misplaced, they have effectively created a perpetual artificial floating object habitat across, for instance, much of the northwest Indian Ocean. The consequences of this proliferation are largely unknown, because little is known about why these devices work at all. One hypothesis is they act as indicators of good hunting grounds; another, that they facilitate social interaction among fish, acting as drifting meeting points in an otherwise unmarked sea. In other words, here we have a man-made device that is modeled on natural, drifting detritus—the FAD drifts and fish congregate around it, and sometimes are thereby caught. But FADs also drift away and are lost, so that the mock-log begins to function again just like a log, a meeting point for fish.

Like the important distinction between flotsam and jetsam there is similarly in this case a sort of doubled drift—both the objects themselves, drifting sometimes aimlessly and sometimes effectively around the ocean, and their meaning and use, from detritus to device and back again. Except for the artificially accelerated proliferation, with its unpredictable, likely ominous, consequences for fish life.

 

Drift across

This all troubles the image of the ocean as a space into which it is possible to throw anything away, while at the same time, paradoxically, confirming our still immense ignorance about the pelagic sea. Against constructions of the ocean as limitless and beyond human affairs are thrown these uncomfortable reminders of its vulnerability and finitude; and yet, in the other direction again, evidence of impact rests uneasily against indications of ignorance.

Both are highlighted by the search for the lost Malaysian Airlines flight MH370, whose continued, baffling failure can be explained not only by the particularly little-known nature of the southern Indian Ocean, but also by its surprising pollutedness. The search has been so prolonged and wildly expensive partly because that part of the ocean is so distant from human affairs and almost entirely unmapped, but also, in apparent contradiction, because it turned out to be full of distracting debris. The surprisingly numerous patches of debris identified by satellite imaging and flyovers—raising hopes of the plane’s discovery and repeatedly dashing them—turned out instead to be “abandoned fishing equipment, the carcass of a dead whale or other pieces of marine trash” (Bremner, 2015).

Those few bits of plane debris that have been recovered have been picked up very far from the original site of the crash. Different pieces have drifted across almost the entire expanse of the Indian Ocean, turning up in South Africa, Mozambique, Tanzania, Réunion and Mauritius. The likely dispersal pattern is captured in the video below, which projects from the proposed crash site to drift patterns over the course of a year.

Debris like this, as well as ghost ships, toy ducks and other recognizable flotsam, are employed by oceanographers to test models used to try to understand the notoriously complicated, little-understood movements of ocean currents. This is in addition to the many floatation markers intentionally set adrift upon the sea. But the scientific markers are expensive and therefore supplemented by these this other more contingent debris—known by the picturesque terms “passive tracer” or “Lagrangian drifter”.

They also include this list of objects that were washed offshore by the 2011 Japanese tsunami and which drifted all the way across the Pacific to arrive on North American shores, including a fishing dock, a radioactive tuna, and a Harley Davidson. But in both cases—the planecrash and the tsunami—the horrible fact is that some of the human detritus in the oceans are the humans themselves, many lives lost. A forensic pathologist in Japan interviewed five years after the tsunami described what happens to a body that gets taken out to sea:

“If a body is taken into the ocean and disappears,” Takagi told me, “it’s hard to say what happens to it. No one ever really knows how the sea moves or flows. If a body is pulled down to a certain depth, it stays there. If it catches in fishing equipment, it might float across the Pacific and turn up in Hawaii. A body in the sea will mostly become soft as cheese, so that if you touch it, the skin falls apart. In other cases the body may become encased in a substance called grave wax that makes it turn hard like plaster.”

The same aimlessness, and anonymizing effect, of oceanic drifting gains then a more intimate, tragic aspect when applied to the human body.

The anonymity yet pervasiveness of human impact on the ocean, embodied by these images of drift and dispersion, sits uneasily with a level of unmappedness which allows us to still lose in it whole tankers, planewrecks, and people.

 

Drift in, and conclusion

From the intimate scale of the body to the scale of the planet, is the vertiginous scalar elasticity required by thinking about the Anthropocene or climate change. A final, short example of drifting, in this case on a planetary scale but with perilous human consequences, is a vast energetic flow of heat into the Indian Ocean. In a report published in Nature Geoscience last year, the authors found that a large amount of atmospheric heat is being taken up by the Pacific Ocean, which, confusingly, does not show a correlated increase in temperature. Instead, the Pacific appears to be transferring much of its extra heat to the Indian Ocean, which now holds more than 70% of all the heat absorbed by the upper ocean since 2003. The Indian Ocean is therefore acting as a global air conditioner, causing a perceptible hiatus in the rise of global atmospheric temperature. And, like the ancient trades in spices, opium and indentured labour, almost all the warmer water is flowing from the Pacific into the Indian Ocean through the Indonesian islands, particularly the Makassar Strait (Sang-Ki Lee et al, 2015).

Warm ocean water can, in the time of anthropogenic climate change, be considered a kind of waste or toxicity, one which seems to be drifting uncontrollably into the Indian Ocean. It is certainly toxic on the local level, as so far the warming has been associated with a 20% decrease in the quantity of microscopic marine life (Roxy et al 2015). But also on a planetary level, associated with the unpredictable, unintended consequences of global climate change. This can possibly be best imagined through the idea that the over-warmed water is not only drifting from one ocean to another, but also sinking into the deep ocean. These regions are largely unknown—as both the search for MH370 and the uncertain pelagic itineraries of drifting fishing devices reveals—which means the effects of that warming will be too.

Floating logs and fishing devices drift into and out of species-specific usefulness; plane parts, plastic and bodies float across vast ocean basins to sometimes land on distant shores; warm water flows inexorably from one ocean to another, and from the surface to the deep. These are stories of ignorance coming up against impact, of small techniques and events spanning immense scalar shifts from intimate to oceanic, and of unknown unknowns—exemplifying, but maybe also going some way towards meeting, the representational challenge with which we began.

Charne Lavery is a lecturer in the Department of English Language and Literature at the University of Cape Town, South Africa, as well as an affiliated researcher at Environmental Humanities South and the Wits Institute of Social and Economic Research. She has a DPhil from the University of Oxford, and is co-editor of a Palgrave series, Maritime Literature and Culture. Her research is in oceanic literary studies, particularly literary and cultural representations of the Indian and Southern Oceans, in relation to the global South. 

Selected references

Bremner, Lindsay. “Fluid ontologies in the search for MH370.” Journal of the Indian Ocean Region 11.1 (2015): 8-29.

Davies, Tim K., Chris C. Mees, and E. J. Milner-Gulland. “The past, present and future use of drifting fish aggregating devices (FADs) in the Indian Ocean.” Marine policy 45 (2014): 163-170.

Lee, Sang-Ki, et al. “Pacific origin of the abrupt increase in Indian Ocean heat content during the warming hiatus.” Nature Geoscience 8.6 (2015): 445-449.

Murphy, Michelle. “Chemical Infrastructures of the St. Clair River.” Souriaya Boudia and Natalie Jas (eds) Toxicants, health and regulation since 1945. Routledge, 2016.

Nixon, Rob. Slow Violence and the Environmentalism of the Poor. Harvard University Press, 2011.

Roxy, Mathew Koll, et al. “A reduction in marine primary productivity driven by rapid warming over the tropical Indian Ocean.” Geophysical Research Letters 43.2 (2016): 826-833.

In the Journals – November 2017 by Anna Zogas

13 Décembre 2017 - 5:08pm

Here’s a selection of articles of interest published last month. Enjoy!

Anthropology Now

I Feel, Therefore I Matter: Emotional Rhetoric and Autism Self-Advocacy
Ben Belek

How do people who have been labeled “autistic” negotiate the meaning of this label? How, in other words, do autistic people understand and subsequently work to shape the fluid and unstable — but at the same time undeniably significant — concept of autism? To try to answer this question, I carried out a 12-month period of ethnographic fieldwork among several small communities of autistic adults from various parts of England. These groups’ activities consisted of weekly, biweekly or monthly social gatherings, as well as the occasional political demonstration, support group session or film screening, to name just a few examples. I was fortunate to have been welcomed to attend these activities as a participant-observer and to have met with most members of these groups for in-depth interviews.

In addition to their regular social meetings, many of my interlocutors were active in online spaces. They would author blogs, upload videos, design websites, post in forum discussions, engage in chat-room conversations, participate in social network sites, share art, play games and reside in virtual worlds. Online environments serve as a particularly accommodating platform for the construction of new appreciations of autism because they afford styles of communication where the typical challenges of interacting socially become less pronounced. The popularity of such activities among my interlocutors highlighted the need for a holistic approach to ethnographic fieldwork that would integrate the online and the offline, such as was suggested by Miller and Horst, for example. A combined ethnography of this sort — that is, actual as well as virtual —not only would enable a wide array of methods, but can be especially useful in demarginalizing the voices of members of socially marginalized groups.

This article draws primarily from the online portion of my project. However, making sense of this material involved shifting back and forth between notes from my online and offline field sites to foreground the “inter-indexical” relationship between the two. Here, I am especially interested in one common theme that seemed to underscore and accentuate the accounts of many of my autistic interlocutors, in both spheres. Namely, their frequent use of a rhetoric of emotions, which plays an important role in their claiming of the autism label.

Contemporary Drug Problems 

November’s issue of Contemporary Drug Problems is a Special Issue: Gender and Critical Drug Studies. 

Gender and Critical Drug Studies: An Introduction and an Invitation
Nancy D. Campbell, David Herzberg

This introduction to conjoined special issues of Contemporary Drug Problems and Social History of Alcohol and Drugs, the journal of the Alcohol and Drugs History Society, began with a 2015 symposium at the Baldy Center for Law and Social Policy at the University at Buffalo (SUNY), organized by co-editors Nancy D. Campbell and David Herzberg. The symposium called for incorporating gender analysis into the rapidly developing scholarship on drug use, drug trade, drug science, drug treatment, and drug policy in the United States. The special issues showcase articles that are part of a vibrant body of historical, sociological, and anthropological scholarship that explores the differential effects of drug policy, focusing on how gender—in dynamic relationship to race, class, and sexuality—is integral to virtually every aspect of drug crises including (but not limited to) the relationship between drug policy, drug treatment, and the development of mass incarceration. Gender matters at every level from the intimate and highly personalized to the broad cultural and political forces that disparately apportion vulnerability within drug commerce and the U.S. prison–industrial complex.

The Intersectional Origins of Women’s “Substance Abuse” Treatment: Learning From Detroit’s WOMAN Center, 1970–1985
Trysh Travis

The WOMAN Center was a women’s drug treatment program focused on heroin that existed in Detroit’s Cass Corridor neighborhood between 1971 and 1985. During this period, successful advocacy by the Modern Alcoholism Movement was establishing the “disease model” as the norm in the expanding alcoholism treatment realm; therapeutic communities and methadone maintenance vied for similar prominence in the world of drug treatment. The WOMAN Center approached drug dependence quite differently. Its founders’ allegiance to ideas about grassroots organizing led them to see drug use and related problems as predictable responses to community chaos and blight. Their treatment program hinged on linking individual and community empowerment, achieved through drug cessation but also through consciousness-raising and leadership training. This theory was difficult to operationalize and the WOMAN Center’s tenure was short-lived. This article argues that it is nevertheless an important moment in the theorization of women’s alcohol and other drug problems: WOMAN’s intersectional analysis of gender, which drew special attention to the ways that capitalism and racism affect women’s decisions to use drugs, is a road not taken for women’s treatment. Attention to such a politicized vision of recovery is important as the U.S. grapples with the present wave of narcotics use in rural and rust-belt communities.

The Second Coming: Gender, Race, and the Privatization of Carceral Drug Treatment
Jill McCorkel

Over the course of the last two decades, drug treatment programming has become increasingly privatized in the U.S. correctional system. Drug treatment and related rehabilitative and reentry services are a multibillion dollar (USD) a year industry. In this article, I trace the origin of this transformation to an unlikely source: women’s prisons during the War on Drugs. Correctional facilities for women provided a useful testing ground for new models of carceral drug treatment at a time when rehabilitation was otherwise rejected by policy makers as too “soft” a response to crime and drug use. Gendered assumptions about punishment, rehabilitation, and addiction coupled with racial hierarchies governing punishment policies paved the way for private vendors to develop, market, and ultimately expand carceral drug treatment to a broad array of correctional venues and populations. To make this case, I analyze ethnographic data collected from one such private vendor and demonstrate how they utilized assumptions about gender and race to upend more traditional models of prison profiteering and pioneered the means through which rehabilitation could operate in service of profit.

Women on the Edge: Opioids, Benzodiazepines, and the Social Anxieties Surrounding Women’s Reproduction in the U.S. “Opioid Epidemic”
Kelly R. Knight

The current “opioid epidemic” provides an opportunity to identify age-old social anxieties about drug use while opening up new lines of inquiry about how and why drug use epidemics become gendered. This paper reflects on the intertwined phenomena of opioid and benzodiazepine prescribing to U.S. women to examine how gender, race, and class inform social anxieties about reproduction and parenting. Multiple discourses abound about the relationship between women and the “opioid epidemic.” Epidemiological reports attribute premature death among White women to the deadly combination of opioids and antianxiety medications. The National Institute on Drug Abuse reports that “every 25 minutes a baby is born suffering from opioid withdrawal,” leading to costly hospital stays for infants and the potential for mother–child separation and other forms of family adjudication postpartum. Primary care providers are reluctant to distinguish diagnoses of chronic noncancer pain from anxiety among their female patients. Taken together, these discourses beg the question: What exactly are we worried about? I compare and contrast the narratives of two anxious women on opioids to raise larger structural questions about pregnancy, parenting, and drug use and to interrogate the public narrative that women on opioids threaten the American family and thwart the American Dream.

Assisted Technologies of Social Reproduction: Pharmaceutical Prosthesis for Gender, Race, and Class in the White Opioid “Crisis”
Helena Hansen

This article examines the symbolic work of gender as it intersects with race and class in popular media and in local community discourses surrounding the “suburban opioid epidemic,” in which national drug policies, and White futures, are thought to be at stake. The study starts with an analysis of the White, middle-class, female “new face of addiction” that has been cultivated by national press coverage of prescription opioid-cum-heroin overdoses in the U.S. and then turns to interviews with community physicians in the front line of a clinical response to the “epidemic” in Staten Island, a White suburban enclave within New York City that is experiencing 3–4 times the opioid overdose rate of any other City borough. Physicians use the language of family membership to indicate identification with their opioid addiction patients, and many go to lengths to provide holistic care and to incorporate family support for their patients despite lack of insurance reimbursement. White, educated patients describe buprenorphine as a way to maintain their professional identities, while low-income Black and Latino patients describe pharmaceutical maintenance as a socially alienating arm of the criminal justice system. Together, media and clinical responses make up strategies of White racial rescue from threatened social reproduction in an era of substance-induced White downward mobility.

Annals of Anthropological Practice

Family and Social Context Contributes to the Interplay of Economic Insecurity, Food Insecurity, and Health
Robin T. Higashi, et al.

In this study, we show how household health, economic instability, and food insecurity are inextricably linked and how disruptions in individual health or income create cumulative and interdependent challenges faced by multiple household members. Drawing upon semistructured focus groups with English- and Spanish-speaking clients of an urban food pantry, we demonstrate: (1) the impact of economic scarcity on health, (2) the impact of one household member’s health on the health and food security of all household members, and (3) food-sharing behaviors among family and social networks, including multigenerational families and nonkin individuals. We identify the gap in the literature between household-level assessments of food insecurity and individual-level health reports, which may obscure poor health among other household members. Understanding the social and family context of health and food insecurity may inform future interventions that address the interrelated challenges of diverse and disadvantaged households and communities.

Women’s Evolving Roles in Drug Trafficking in the United States: New Conceptualizations Needed for 21st-Century Markets
Tammy L. Anderson, Philip R. Kavanaugh

Drugs and crime research and theory in the United States originated after President Nixon declared the first War on Drugs in 1971. This research agenda promised to reveal the scope, dynamics, and impact of the drugs–crime relationship, thus promising solutions for the country’s drug problems. The initial focus was on drug trade violence and, as a result, produced scholarship mostly on men’s involvement in drug distribution, purchasing, and related crimes. It paid little attention to women’s involvement and failed to consider how gender might shape the drugs–crime relationship. By the early 1980s, however, studies began to appear on women’s experiences and addressed the role of gender in U.S. street-based illegal markets for crack cocaine and heroin. These studies revealed women’s relative powerlessness or supporting roles to domineering males in illegal, street-based drug markets. Today, drugs of concern in the U.S. originate and are sold and purchased through both legal and illegal channels that often work in tandem. This interplay requires us to rethink the drugs–crime relationship. Our article seeks to provoke new thinking and research on how 21st-century drug trends might reshape the gendered nature of drug selling across both legal and illegal markets and the gray area in between. In specific terms, we review the nature of women’s involvement in newer drug markets and consider how their involvement differs from that of men and how theory and research might move forward in addressing these changes. Our conclusions, and those reached by others in this issue, speak to the centrality of gender scholarship in research and policy on drugs and crime currently and into the future.

Feminist Autoethnography, Gender, and Drug Use: “Feeling About” Empathy While “Storying the I”
Elizabeth Ettorre

This article explores autoethnography as one way of doing feminist research in the drugs field. By telling my story during my 40 years experience as a feminist researcher in the drugs field, I aim to help those practicing critical drug scholarship to become familiar with this methodology as a viable way of employing a gender analysis, an employment that is the focus of this special issue. This paper is divided into five related discussions. First, I explain what feminist autoethnography is. Second, I look at how doing feminist “drugs” autoethnography helps to develop empathy. Third, I describe the methods and use of data employed in this paper. Fourth, I tell my story chronologically from 1972 to the present time. Lastly, as with many autoethnographies, my analysis of my “story as data” is left to last and I discuss the political implications of my experiences, while “feeling about” empathy as resonance with the other.

American Ethnologist

Never too late for pleasure: Aging, neoliberalism, and the politics of potentiality in Denmark
Henrik Hvenegaard Mikkelsen

Health promotion in the Danish welfare state increasingly consists of helping people to identify and realize their inner potential for health and happiness. Such a “politics of potentiality” might seem to reflect the widespread neoliberal economic deregulation and austerity policies that have in recent decades marked public health sectors throughout the industrialized world. But in the encounter between the Danish state and its aging citizens, all moral demands converge on the imperative of identifying how citizens may become subjects who live up to certain definitions of what constitutes pleasure and self-realization. This represents an instantiation of neoliberal health promotion that targets the sense of loss that people associate with their unactualized potentials—their unlived lives.

Cultural Anthropology (Open Access)

Chemo-Ethnography: An Introduction (open access)
Nicholas Shapiro and Eben Kirksey

Chemicals have seeped into the ethnographic imaginary. Anthropologists have long been tracing the material, toxicological, and neurological valences of molecular dreamworlds, growing pharmaceutical markets, and landscapes haunted by industrial capitalism (e.g., Fortun 2001; Hayden 2003; Murphy 2006; Dumit 2012; Jain 2013). Sensing technologies and collaborations with allies in other disciplines are also allowing ethnographers to study chemical species in water, soil, air, human bodies, and emergent ecological assemblages. Theoretical and empirical research is focusing on technoscientific environmental constructs, civic public forms, noninnocent optimism, state abdication, and capital despoilment. Processes like sublimation and combustion are informing nascent approaches to writing culture in the Anthropocene (Shapiro 2015; Povinelli 2017). Chemicals are becoming increasingly useful linking figures as ethnographers follow complex, multisited, and multiscalar phenomena (Bond 2013; Hardon, Idrus, and Hymans 2013; Myers 2015; Romero et al. 2017; Sunder Rajan 2017; Murphy 2017).

Chemical ethnography, or chemo-ethnography, owes intellectual debts to Lochlann Jain (2013, 24), who has ushered “cancer and its identities out of the closet and into a space not of comfort, or righteous anger, but of mourning, a space where the material humanity of suffering and death informs communicative and collective action.” The stomach-wrenching experience of chemotherapy offers a suitably complex inroads to other encounters with the pharmakon—a poison that doubles as a cure (Stengers 2011). Scaling up Jain’s call for communicative and collective action, we are concerned with a broader suite of chemicals that create possibilities for life while simultaneously enfeebling bodies or multispecies worlds (cf. Roberts 2010). Chemo-ethnographers are starting to conduct research on economic, personal, political, and sentimental relationships that have emerged with modern chemistry (e.g., Chen 2012; Agard-Jones 2013; Graeter 2017; Feser, forthcoming).

What Gets Inside: Violent Entanglements and Toxic Boundaries in Mexico City (open access)
Elizabeth F. S. Roberts

Entanglement is a key concept in contemporary anthropology and science and technology studies. By tracing the contingent and uncertain relations that endow objects with seemingly stable boundaries, entanglement allows us to see how such boundaries restrict our ability to know the world better. This article examines the concept of entanglement in the context of contemporary life in a working-class Mexico City neighborhood, Colonia Periférico, and a longitudinal environmental health project that studies the neighborhood’s residents. While entanglement has its uses, the entanglement of working-class bodies with globalizing processes like NAFTA and the ongoing War on Drugs shows that the concept has its limits. For working-class residents, life is already deeply entangled with chronic economic and political instability shaped through the violent ravages of transnational capital. Instead, I trace how residents in Colonia Periférico secure stability through toxic boundaries that protectively keep out the disruptive effects of police and public health surveillance. Colonia Periférico’s boundaries, which include a sewage-filled dam, cement dust, and freeway exhaust, are clearly entangled with residents’ bodies. They get inside. These entanglements are the price paid for a remarkable stability, in which children can play on the streets and attentive care for drug-addicted and disabled residents is part of everyday life. With the goal of knowing the world better, then, we might complicate celebratory calls for the uncertainty of entanglement by taking into account both the practices that make boundaries and what boundaries have to offer.

Health & Place

Care farms as a space of wellbeing for people with a learning disability in the United Kingdom  (open access)
Suzanne Rotheram, Sarah McGarrol, Francine Watkins

People with a learning disability in the UK are increasingly choosing to spend their time on ‘care farms’ but there is limited research examining these spaces from their perspective. A qualitative research design was used to ask eighteen of these clients how care farms contributed to their health and wellbeing. For these participants care farms can be understood, using Fleuret and Atkinson’s (2007) framework, as a ‘space of wellbeing’ and as a positive and life-enhancing space. Positive language was used by participants to describe the farms contrasting with ne gative language describing other spaces and activities. Farms were identified as contributing positively to mental and social wellbeing.

Medical Anthropology

Breaking Binaries? Biomedicine and Serostatus Borderlands among Couples with Mixed HIV Status
Asha Persson, Christy E. Newman & Jeanne Ellard

With recent breakthroughs in HIV treatment and prevention, the meanings of HIV-positivity and HIV-negativity are changing at biomedical and community levels. We explore how binary constructions of HIV serostatus identities are giving way to something more complex that brings both welcome possibilities and potential concerns. We draw on research with couples with mixed HIV status to argue that, in the context of lived experiences, serostatus identities have always been more ambiguous than allowed for in HIV discourse. However, their supposed dichotomous quality seems even more dubious now in view of contemporary biomedical technologies. Invoking the anthropological concept of “borderlands,” we consider how biomedicine is generating more diverse serostatus identities, widening the options for how to live with HIV, and eroding the stigmatizing serostatus binary that has haunted the epidemic. But we also ask whether this emerging borderland, and its “normalizing” tendencies, is concomitantly giving rise to new and troubling binaries.

Moral Adherence: HIV Treatment, Undetectability, and Stigmatized Viral Loads among Haitians in South Florida
Chelsea Cormier McSwiggin

In the United States, HIV is rendered a chronic condition, and viral transmission is minimized through strict adherence to pharmaceutical treatment. Treatment reduces viral loads to untraceable levels in the blood, a status known as “undetectable,” as determined by laboratory testing. For Haitians living with HIV in South Florida, “undetectable” has become more than a viral status; it is a means to know and govern themselves as moral actors and to survey and stigmatize others who remain “detectable.” The ethnographic evidence I present here suggests that Haitians adopt novel forms of subjectivity based on undetectability, producing identities entangled in biotechnical categorizations and dominant narratives of responsibility, morality, and health. Haitians’ experiences with these processes reveal the persistence of HIV stigmatization and the centrality of biomedical morality in mediating perceptions of inclusion, value, and worth of people living with HIV.

Affect and the “Really Real”: The Politics of HIV/AIDS Framing in South African Theater
Jessica S. Ruthven

Funding in South Africa privileges HIV prevention campaigns underpinned by individual behavior change goals, despite over two decades of intervention but little reduction in national HIV prevalence. In response, civil society has begun calling for innovative interventions and ways of speaking about the epidemic. Employing framing theory, I analyze differences in how HIV/AIDS is characterized in public media and interrogate the knowledge politics underpinning a group of artists’ emerging attention to the nexus of affect, intersubjectivity, and epidemics within performance. I suggest this focus challenges but also complements dominant HIV intervention models by destabilizing common content, relations of power, and hierarchies of knowledge that shape normative health discourse and practice. Simultaneously, such performances reveal deep disparities between the neoliberal principles undergirding most global public health ideology, South Africa’s current political economy of HIV intervention, and the dynamic concerns of its HIV-affected constituents.

Respectable Gentlemen and Street-Savvy Men: HIV Vulnerability in Sri Lanka
Sandya Hewamanne

In this article, I investigate how particular discourses surrounding class specific understandings of sexual behavior and female morality shape awareness and views of the disease and personal vulnerability. Although both groups belong to the working class, those employed by the transportation board consider themselves government servants and, therefore, “respectable gentlemen.” Construction workers identify easily with their class position, recognizing and sometimes trying to live up to the stereotypes of free sexuality. These different perceptions directly affect their concern and awareness of risk factors for sexually transmissible infections and safe-sex practices. While the “respectable gentlemen” consider themselves invulnerable, the “street-savvy men” learned about risks and took precautions to prevent STIs.

Careful Words: Nursing, Language, and Emotion in Papua New Guinea
Barbara Andersen

Papua New Guinean nurses work in a sociomedical system in which cultural and linguistic diversity are matters of pressing concern. Using data drawn from ethnographic research with PNG nursing students, I show how nursing education socializes nurses to take stances toward language and communication that impact their care practices. I argue that nurses’ use of language is shaped by their ethical commitments as educated Christians and indigenous concerns about the links between language, emotion, and health. In a resource-poor setting where health workers risk blame for structural inequalities, this “ethical metapragmatics” is an important but neglected facet of care work.

The Limits of Autonomy: Ideals in Care for People with Learning Disabilities (open access)
Jeannette Pols, Brigitte Althoff & Els Bransen

In the Netherlands, autonomy is a key ideal in visions of care for people with learning disability. This ideal can lead to tension when clients, in the opinion of their caregivers, overuse alcohol or drugs. In this article, we analyze how professional caregivers understand the ideal of autonomy in care for people with learning disability, and articulate the tacit attempts of caregivers to provide “good care,” which can be understood as care for relationships. This relational view includes caregivers, care recipients, and their networks and infrastructures in the vision of care.

Social Theory and Health

Incorrigible conduct and incorrigible diagnoses: the case of personality disorder
David Pilgrim

A critical realist analysis is offered of a particular unresolved contention in modern psychiatric knowledge about the diagnosis of personality disorder (PD). With the publication of the most recent edition of the Diagnostic and Statistical Manual from the American Psychiatric Association in 2013, this diagnosis stood out as a point of reticence in a document, noted by its critics, for its diagnostic expansionism. Resources from critical realism are used to examine the weakness of the diagnosis and the real enough conduct that the medical codification subsumes. It is concluded that the psychiatric jurisdiction over those with a PD diagnosis now lacks credibility. However, the socio-ethical challenges that lay beneath the diagnosis and beyond its associated medical jurisdiction are not only real but are thrown into sharp relief by the critique offered, raising socio-ethical questions for all citizens.

Beyond ubiquity: Unravelling medicalisation within the frame of health insurance and health-policy making
Sarah Van den Bogaert, Ricardo A. Ayala, Piet Bracke

Besides being extensively studied by health sociologists, medicalisation has also become a term that frequently appears in mainstream discourses on health and illness. Recently, scholars started to acknowledge a greater complexity within medicalisation. This article is situated within this research tradition and draws on three recurring critiques on the validity of medicalisation; critique on the construct validity, internal validity and external validity. By examining the interests and network of health-policy stakeholders, this article attempts to unravel different mechanisms of medicalisation and demedicalisation within a social health insurance system. The empirical data for this article derive from 30 elite interviews with key informants from 18 organisations in Belgium. Key representatives of these organisations provided us with in-depth information about their political intentions and interests. This study provides empirical evidence that both medicalisation and demedicalisation are different processes that can occur simultaneously. Furthermore, in order to facilitate studies on medicalisation in an institutional context, this article proposes some indicators for medicalisation and demedicalisation.

Science, Technology and Society

Policy Challenges and Ethical Issues with the Breakthrough Technology: The Case of Synthetic Biology
Samuel Pang, Sam Youl Lee, Ji Yung Seul

Synthetic biology is an exciting field which has enormous potentials for solving various problems human beings are facing up such as genetic disease, food shortage and global warming. Many countries such as the United States, the United Kingdom and China have invested heavily in this field but the negative aspect of such scientific breakthrough draws little attention. Since the harms synthetic biology can cause is not certain, it is neither safe nor proper to leave it to the hands of only experts. Currently researches on synthetic biology are being conducted without proper public discourse and consideration. One of the reasons for the lack of public discussion on synthetic biology is the speed of the development in the field. The field is innovating so fast that people have little chance to digest the consequence of such advances. Also the confusion on the definition of synthetic biology contributes to the lack of proper public discussion on the issue. This article provides a new typology for definition of synthetic biology conceptualised by the authors and analyses the current state of synthetic biology in major countries. In addition, ethical issues associated with synthetic biology are discussed. Scientific transparency and participatory process are suggested as policy options to deal with them.

Sociology of Health & Illness

The everyday risk work of Dutch child-healthcare professionals: inferring ‘safe’ and ‘good’ parenting through trust, as mediated by a lens of gender and class
Gerlieke Veltkamp, Patrick Brown

Amidst intensifying policy concerns with children’s wellbeing and development, healthcare professionals are required not only to assess risk of abuse and neglect, but to manage risk of ‘poor parenting’ more broadly. Drawing on 15 in-depth interviews and non-participant observations of 61 professional-family interactions, across four preventative public health services for children in the Netherlands, we explored how professionals accomplished such risk work amid intractable uncertainties. Building inferences from brief encounters with families, professionals gauged the extent to which they trusted parents to care ‘appropriately’. This trust developed most readily with parents experienced as ‘familiar’ by the largely middle-class female professionals. Harnessing Schutzian phenomenology, we analyse the related manifestations of social structure within the interactional-dynamics and lifeworlds of risk assessment. We argue that social structures of gender, class and ethnicity can be seen as influential both through the differing potential for ‘we-relationships’ to be formed and via the generalising and stereotyped knowledge applied in their absence.

Now or never: smoking cessation discussions in the face of serious illness
Clara Iversen

Sociological research on medical discussions of lifestyle suggests that smoking patients may be seen as knowingly causing their medical problems. Therefore, it may be interactionally problematic for doctors to raise the issue of smoking cessation in relation to patients’ serious health problems. While a serious illness can be expected to bring to the fore the relevance of smoking cessation advice, it may also give rise to questions about patients’ right to treatment. This study uses conversation analysis to explicate how patients and doctors manage issues of responsibility in smoking cessation discussions in the face of a serious medical problem that strongly correlates with smoking. The findings show that whilst ill health can be referred to in a confrontational manner, it can also give smoking cessation a ‘now or never’ status that downplays patients’ responsibility for not having quit before. Based on these findings, the paper concludes that for warranting further smoking cessation advice, how doctors and patients verbalise the link between smoking and a serious medical problem matters more than whether they do so.

Contingent maternities? Maternal claims-making in third party reproduction
Katherine M. Johnson

The new reproductive technologies have significantly impacted definitions of motherhood. Historically, mothers were defined through the act of giving birth, but egg donation, embryo donation, and surrogacy disrupt this. Now multiple women can potentially claim maternity through gestational, genetic, legal, and social ties. Although there is some legal precedent for designating parentage, there is no simple solution to identify the ‘true’ mother. I address maternal claims-making in third party reproduction via a content analysis of US patient literature for infertile women. Major tensions arise over which link to privilege, especially regarding genetic versus gestational ties in egg donation versus surrogacy; however, adding embryo donation to the analysis illuminates another crucial dimension previously overlooked – that heterosexual women’s maternal claims are supported by their partner’s paternity claims. Ultimately, I argue that although reproductive organisational discourse carefully constructs credible options for maternal claims-making, contemporary reproductive medicine does not define maternity through assisted reproduction as a truly autonomous connection. Rather, maternity is highly contingent and thus potentially discreditable.

Dynamics between doctors and managers in the Italian National Health Care System
Giovanna M. Vicarelli, Emmanuele Pavolini

This article focuses on the changes in the Italian NHS by concentrating on patterns in the managerialisation of doctors. It addresses a series of shortcomings in studies on the response by doctors to managerialisation. The first is a shortcoming of theoretical and analytical nature. It is necessary to adopt a broader perspective whereby analysis considers not only the interaction between doctors and managers, but also the public control and regulation agencies that operate in that field. The second shortcoming is a methodological one. The literature on managerialisation is more theoretical than applied. It is necessary to adopt a strategy based on a plurality of methodologies and sources in order to focus attention on a national case (Italy in the present study), discussing the changes over time (from the beginning of managerialisation until today) and considering different groups within the medical profession. The outcome is a complex picture of the dynamics between doctors and managers which foregrounds the managerial co-optation processes of a small group of national health service doctors, the transition from strategic adaptation to forms of resistance against managerialisation by the majority of Italian NHS doctors, and the emergence of restratification processes among self-employed doctors working with the NHS.

The gas that fuels the engine: Individuals’ motivations for medicalisation
Ann V. Bell

It is well established that the drivers of medicalisation have shifted alongside changes in the institution of medicine. The process of medicalisation is no longer incited by macro processes of institutional prestige or control; rather, individual patients/consumers are pushing the process forward. The present study complicates this neat transition and examines the relationship between structure and agency using the case of assisted reproductive technology (ART), specifically the medicalisation of lesbian reproduction in the US. I explore individuals’ influence on and motivations towards medicalisation through 24 in-depth interviews with women in same-sex relationships who had ever attempted to become pregnant. In centring on their experiences, I find that while individual consumers may now propel medicalisation forward, oftentimes consumers’ motivations for doing so reside in the prestige and control of medicine. In other words, consumers now seek medicalisation precisely because of the process’s previous institutional drivers. In exploring what fuels the engine of medicalisation, the findings reveal its nuance and complexity.

Navigating the new, transplanted self: how recipients manage the cognitive risks of organ transplantation
Nicholas R. Cormier, Selina R. Gallo-Cruz, Renee L. Beard

The physiological risks of organ transplantation are well documented, but more poorly understood are the sociological ways in which organ recipients redefine themselves in reaction to physiological risks and social changes accompanying transplantation. This article analyses transplantation as a procedure that is not only physiologically risky but also poses risk to the social identity of the recipient, and explores how transplant recipients cognitively navigate transplantation surgery from waiting for to recovering after a transplant. It builds on previous sociological exploration of risk as a socially constructed process mediating experiences of health and illness with a focused contribution on explaining how individuals navigate risks posed to their social identities by major biophysical transformations. This article pointedly analyses narratives of fourteen organ recipients and the four dominant phases of identity management that emerged to create what we have coined as the new ‘transplanted self’, indicating the varied ways the individual social self emerges in response to the social risks of transplantation. We conclude that a better understanding of the recipient experience will contribute to improved care in the transplantation field.

The Actionability of Exome sequencing testing results
Tanya Stivers, Stefan Timmermans

Genomic tests such as exome sequencing have recently become an option for diagnosing patients. The tests allow clinical geneticists to sequence the majority of patients’ disease causing genetic variants. As a new technology, exome sequencing confronts the question of what the benefit is of this increased genetic information. Against a narrow perspective of clinical utility that emphasises tangible improvements in a patient’s disease management, professional organisations have argued that genomic sequencing should be considered beneficial if it helps families and society. Based on video-recorded observations of the return of exome sequencing results to parents of a child with disabilities in the clinic and in-depth interviews with these parents, we examine how genomic test results become actionable in the clinical encounter. We find that parents and clinicians marshal exome results beyond biomedical diagnostic and management goals to address questions about guilt for causing the disabilities and to secure access to disability-related services. We argue that genomic actionability rests on the interaction between the biological characteristics of genetic results and the predicaments facing parents of children with disabilities.

Social Science & Medicine

What is not, but might be: The disnarrated in parents’ stories of their child’s cancer treatment
Cecilia Vindrola-Padros, Eugenia Brage

The study of illness narratives is based on the premise that stories are told for a reason and storytellers make narrative decisions on what to include and leave out of a story, the style of narration, the place where the story is told and the audience. Through this narrative work, they situate themselves in particular ways and make sense of the illness and the world around them. In this article, we explore the disnarrated, a style of narration that features events that do not happen, but are nonetheless referred to in the story. The aim of the article is to illustrate the additional layers of meaning that can be uncovered from illness stories when attention is paid to what did not happen, but, yet, is still part of the story. We draw from a qualitative study carried out with 17 parents whose children were diagnosed with cancer and were receiving medical care in Argentina. We carried out narrative interviews with the parents and participant-observation in hospital areas and the hotels where they resided during treatment. The analysis of the interview transcripts was carried out using a holistic understanding of the narratives and focusing on the identification of themes that appeared disnarrated. The fieldnotes from the observations were used to contextualize the narrative analysis. The disnarrated, in its many manifestations, produced a layer of analysis of parents’ stories of treatment patterned by parents’ desires, hopes and fears. The disnarrated was used by parents to discuss alternative care trajectories and express fears regarding what the future would bring for the child and family. The disnarrated is a useful analytical tool for examining illness stories as it points to storytellers’ views of what is acceptable or desirable in their world and their hopes and preferences for alternative realities.

Pastoral power in HIV prevention: Converging rationalities of care in Christian and medical practices in Papua New Guinea
P. Shih, H. Worth, J. Travaglia, A. Kelly-Hanku

In his conceptualisation of pastoral power, Michel Foucault argues that modern healthcare practices derive a specific power technique from pastors of the early Christian church. As experts in a position of authority, pastors practise the care of others through implicitly guiding them towards thoughts and actions that effect self-care, and towards a predefined realm of acceptable conduct, thus having a regulatory effect. This qualitative study of healthcare workers from two Christian faith-based organisations in Papua New Guinea examines the pastoral rationalities of HIV prevention practices which draw together globally circulated modern medical knowledge and Christian teachings in sexual morality for implicit social regulation. Community-based HIV awareness education, voluntary counselling and testing services, mobile outreach, and economic empowerment programs are standardised by promoting behavioural choice and individual responsibility for health. Through pastoral rationalities of care, healthcare practices become part of the social production of negative differences, and condemn those who become ill due to perceived immorality. This emphasis assumes that all individuals are equal in their ability to make behavioural choices, and downplays social inequality and structural drivers of HIV risk that are outside individual control. Given healthcare workers’ recognition of the structural drivers of HIV, yet the lack of language and practical strategies to address these issues, political commitment is needed to enhance structural competency among HIV prevention programs and healthcare workers.

“What’s the right thing to do?” Correctional healthcare providers’ knowledge, attitudes and experiences caring for transgender inmates
Kirsty A. Clark, Jaclyn M. White Hughto, John E. Pachankis

Rationale
Incarcerated transgender individuals may need to access physical and mental health services to meet their general and gender-affirming (e.g., hormones, surgery) medical needs while incarcerated.

Objective
This study sought to examine correctional healthcare providers’ knowledge of, attitudes toward, and experiences providing care to transgender inmates.

Method
In 2016, 20 correctional healthcare providers (e.g., physicians, social workers, psychologists, mental health counselors) from New England participated in in-depth, semi-structured interviews examining their experiences caring for transgender inmates. The interview guide drew on healthcare-related interviews with recently incarcerated transgender women and key informant interviews with correctional healthcare providers and administrators. Data were analyzed using a modified grounded theory framework and thematic analysis.

Results
Findings revealed that transgender inmates do not consistently receive adequate or gender-affirming care while incarcerated. Factors at the structural level (i.e., lack of training, restrictive healthcare policies, limited budget, and an unsupportive prison culture); interpersonal level (i.e., custody staff bias); and individual level (i.e., lack of transgender cultural and clinical competence) impede correctional healthcare providers’ ability to provide gender-affirming care to transgender patients. These factors result in negative health consequences for incarcerated transgender patients.

Conclusions
Results call for transgender-specific healthcare policy changes and the implementation of transgender competency trainings for both correctional healthcare providers and custody staff (e.g., officers, lieutenants, wardens).

Building addiction recovery capital through online participation in a recovery community
Ana-Maria Bliuc, David Best, Muhammad Iqbal, Katie Upton

Rationale
This study examines how online participation in a community of recovery contributes to personal journeys of recovery. It investigates whether recovery capital building – as indicated by increased levels and quality of online social interactions – and markers of positive identity development predict retention in a recovery program designed around fostering community involvement for early stage recovery addicts.

Hypotheses
It was predicted that online participation on the group’s Facebook page and positive identity development are associated to retention in the program.

Methods
To map how participants interact online, social network analysis (SNA) based on naturally occurring online data (N = 609) on the Facebook page of a recovery community was conducted. Computerised linguistic analyses evaluated sentiment of the textual data (capturing social identity markers). Linear regression analyses evaluated whether indicators of recovery capital predict program retention. To illustrate the findings in the context of the specific recovery community, presented are two case studies of key participants who moved from the periphery to the centre of the social network. By conducting in-depth interviews with these participants, personal experiences of engagement in the online community of group members who have undergone the most significant changes since joining the community are explored.

Results
Retention in the program was determined by a) the number of comment ‘likes’ and all ‘likes’ received on the Facebook page; b) position in the social network (degree of centrality); and c) linguistic content around group identity and achievement.

Conclusion
Positive online interactions between members of recovery communities support the recovery process through helping participants to develop recovery capital that binds them to groups supportive of positive change.

Minerals by Robyn d’Avignon

11 Décembre 2017 - 11:09pm

Mining is a toxic business and gold mining is particularly noxious. Mercury and cyanide pollute river-ways and sentient bodies. The large-scale evacuation of earth often acidifies water tables, literally “lying waste” to land by making it unusable for agriculture and pastoralism. Elsewhere in this series, Claudia Gastrow, Jennifer Wenzel, and Lynn Thomas describe the political architecture of latent toxicities and their eruption in illness, ecological destruction, and ruin. This essay argues that discourses and accusations of waste—like material toxicities—also accumulate in places, lying dormant for future incorporation in political and economic claims making.

Red and blue tarps shelter so-called “artisanal” miners as they dig for gold with hand picks, dynamite, and mortar pickers in Kedougou, Senegal. Today, most artisanal miners operate within the research permits of junior exploration companies (Photo by author, 2013).

Consider the potent vocabulary of waste in Francophone West Africa’s gold mining sector.

It is a scorching hot day in March 2013 in the remote region of Kedougou in southeastern Senegal. Mamadou, a Senegalese geologist working for an Australian junior gold company, navigates a white Land Rover across the dusty plains where he coordinates mineral exploration within a 500 square kilometer research permit. In the early 2000s Kedougou emerged as a frontier for global gold mining capital. Similar to neighboring regions of Guinea and Mali, residents of Kedougou have mined gold dust and ore with hand tools for over a millennium. Today, villages of so-called “artisanal” gold miners dot the interior of exploration permits held by private mining companies and increasingly compete with staff geologists and security forces for access to gold deposits.

Mamadou gestures to a vibrant strip of red and blue tarps on the horizon, sheltering artisanal miners from the sun as they dig tunnels into the crust of the earth. “It’s a waste!” cries Mamadou. “They take the top layer and destroy the land. If the state does not stop this, we will not be able to mine the deposit. The gold will go to waste.” Mamadou’s frustration as a professional geologist is understandable. He scopes economically viable deposits for mining companies that generate formal employment and pay taxes to the state. He also maintains respectful working relationships with resident artisanal miners and employs local youth as geological aids. Yet Mamadou’s invocation of local miners as wasteful is an old argument, with a toxic past.

Beginning in the 17th century, French prospectors who traveled to goldfields formerly controlled by the medieval empires of Ghana, Mali, and Songhai accused African miners of wasting gold with “primitive” tools and “inefficient” labor practices (Curtin 1974). By the late 19th century, administrators of the nascent colonial state declared it was morally incumbent on the French to exploit the region’s minerals with modern, industrial methods. Idioms of waste became integral to a colonial lexicon of dispossession and the facilitation of imperial enclosure under the sign of “improving” African resources (Davis 2007; Mavhunga 2014; Neuman 1998; Mackenzie 1998).

But the colonial dream of transforming native mines into modern ones proved elusive. European mining equipment was poorly adapted to West African geological conditions. French miners rarely prospected for fresh gold deposits: they installed on mines already exploited by Africans, incurring violent conflicts. Even then French mining outfits were not economical and, by the 1910s, French miners had largely abandoned West Africa. Mining by Africans, however, expanded to unprecedented scales, comprising 95% of the federation’s exports. Concerns over mineral waste persisted in colonial circles. In the 1930s, young French geologists opened mining research stations across the goldfields of West Africa with the goal of locating ways to reduce the golden waste left behind by the techniques of African miners. When even these modest improvement efforts failed, colonial geologists conceded that African mining methods were better suited to regional geology than previously recognized. Despite this admission, French administrators and scientists continued to accuse African miners of wasting imperial patrimony by only partially exploiting ore bodies. Plans were elaborated to supplant native mines with European enterprises as soon as gold prices and infrastructural provision allowed.

Mineral waste was not solely the concern of Europeans in colonial French West Africa. Waste, reuse, and reserves also saturate the oral histories and praxis of multi-generational African gold miners. Their concerns were articulated in regional idioms of subterranean value and divergent regimes of value (see Guyer 2004). For African gold miners, mineral waste indexes a ritual relationship with the unseen world—with Nininkala. This mystical serpent slithers underground, consuming ferruginous soils and excreting gold veins in its wake. To safely mine Nininkala’s golden excrement requires making sacrifices to this spirit. Failure to do so incurs the wrath of Nininkala; miners suffocate underground. Regional oral traditions underscore the value of reproducing human and nonhuman inhabitants dependent on mineral wealth, rather than depleting the earth entirely of its mineral resources. At times, African miners abandoned goldfields before full depletion: this “waste” constituted a mineral reserve for future generations.

Colonial geologists puzzled over how to render African gold processing methods more efficient. But they failed to recognize that leaving gold in discarded sands was an intentional design, to distribute wealth across genders and generations. Gold mining is highly gendered in savannah West Africa: men dig vertical mining shafts with iron picks, while women hoist excavated rock to the surface with a calabash tied to rope. Women then wash the rock, mechanically separating gold particles from sand and silt. The first wash belongs to men; the second to women; and subsequent washes to children and the elderly. Attention to the cultural and intellectual history of gold mining in this region reveals the conditions under which the value of gold shifts from the hands of spirits to those of humans. For West Africans, leaving a portion of gold underground—and in mine tailings at the earth’s surface—redistributed the potential for wealth creation.

Waste is always unstable and relational. It is contingent on subject position and the available uses and reuses of a given substance in local and long-distance markets. In the extractive industry, new technologies, shifting markets, and the expansion of global logistics can re-value rocks and silts discarded by earlier generations of miners. Just as landfills are commodities for pickers and gleaners (Fredericks, forthcoming; Reno 2015), brownfields and superfund sites are investment frontiers for environmental remediation companies (Dillon 2014). Accusations of waste also produce value for mining industries. By criminalizing local mining, and dispossessing the “wasteful” of mineral rights, states and private companies in West Africa have claimed new territories and fresh extractive frontiers. Arguments rooted in colonial ambitions of expanding private property regimes have retained appeal in the post-colony. At decolonization leaders of independent West African states abolished the rights of agrarian households to mine gold, declaring it anathema to ambitions for developing national industries in which new citizens would labor as skilled technicians. Low commodity prices and global interest in industrial metals such as bauxite and phosphates consigned West Africa’s gold reserves to “shelf projects” until the marked rise of gold prices in the 1990s. The revaluation of the region’s goldfields inspired a legal and military crackdown on artisanal miners to pave the way for industrial enterprises.

As a geologist trained to work in the modern mineral industry, Mamadou has spent more than two decades studying the geology of southeastern Senegal. Trained in Dakar and in Paris, Mamadou has worked for companies based in Sydney, Johannesburg, and Toronto. His working life is evidence that no facile distinction can be drawn between artisanal and industrial mining or European and African vernaculars of efficiency and waste. Mamadou is rooted both in the local world of extraction and in the logics of global mining capital and expertise. He is a powerful reminder that idioms and accusations of waste—similar to the toxic chemicals used by gold miners in Kedougou—seep across social domains and temporalities, emerging in unlikely places.

 

Robyn d’Avignon is an Assistant Professor of History at New York University. Her research focuses on extractive economies, scientific research, and state formation in West Africa. Her first book manuscript, Shadow Geology: The Search for Subterranean Knowledge in West Africa, is a historical ethnography of gold exploration and contests over mineral discoveries in Senegal, Guinea, and Mali.

Opening photo credit: Aliou Bakhoum (2014)

 

References

Philip Curtin, “The Lure of Bambuk Gold,” Journal of African History 14: 4 (1973): 623-32.

Diana K. Davis, Resurrecting the Granary of Rome: Environmental History and French Colonial Expansion in North Africa (Ohio, 2007)

Lindsey Dillon, “Waste, Race, and Space: Brownfield Redevelopment and Environmental Justice at the Hunters Point Shipyard,” Antipode 46:5 (2014): 1205-1221.

Rosalind Fredericks, Garbage Citizenship: Vibrant Infrastructures of Labor in Dakar, Senegal (Duke, forthcoming).

Jane Guyer, Marginal Gains: Monetary Transactions in Atlantic Africa (Chicago, 2004)

Fiona MacKenzie, Land, Ecology, and Resistance in Kenya, 1880-1952 (Edinburgh, 1998)

Clapperton Chakanetsa Mavhunga, Transient Workspaces: Technologies of Everyday Innovation in Zimbabwe (MIT, 2014).

Joshua Reno, Waste Away: Working and Living with a North American Landfill (California, 2015)

Roderick Neumann, Imposing Wilderness: Struggles over Livelihood and Nature Preservation in Africa (California, 1998)

Fish by Jennifer Lee Johnson

8 Décembre 2017 - 10:43pm

If you’ve seen Hubert Sauper’s (2004) documentary film Darwin’s Nightmare you may remember the stark contrast he draws between the sterile disassembly line of a factory producing Nile perch fillets for export to Europe and the seething, smoky, maggoty miasma where Tanzanian women, men, and children work to dry and fry fish carcasses. You may also recall your own sense of disgust, even horror, when presented with the sights, sounds, and imagined smells of lives made turning rotting flesh and bones into food that Sauper tells us “a few million Africans eat.”

Figure 1: Fish factory in Uganda. Photo by author in 2011.

Figure 2: Fish carcasses in Kenya. Photo by author in 2007.

Readers who haven’t seen the film need not stop here – I’ll recount one of the most moving scenes now:

Walking between seemingly endless rows of wooden drying racks, Sauper stops to show the hands of a woman picking up freshly delivered Nile perch carcasses from the ground three at a time. These carcasses — the heads, tails, and meager flesh still clinging to bones — are the remains of once whole fish whose sides have already been carved out and trimmed into fillets for sale on global whitefish markets. Before we see the face of Sauper’s interlocutor, we see the heads of these carcasses wedged between rows of vertical wood and hear the buzzing of flies circling the whole scene. Sauper’s lens zooms in on a single fish head adorned with a crown of worms feasting on its sun-softened flesh. A single maggot inches towards the juicy pit where this fish’s eye once had been. It then slips on the slick slime of their own mutual decomposition and falls off and out of view.

Sauper’s translator asks the woman in Kiswahili to whom these laboring hands belong to “say something.” We finally see her face. She smiles as she tells us she is alone. Her husband fell sick and left to find help. “My life is now good,” she says. Because she earns cash every day working with carcasses, Sauper’s interlocutor says she is better off now than when she was a “normal farmer.” Even before her boss tells her to stop talking and return to work, she continues bending down, picking up fresh piles of rotting carcass, and hanging them to dry. Sauper’s camera follows her movements, panning down and zooming into black mud that seethes with fly larvae and squishes up between her toes. Another single maggot inches up and onto her foot searching for something more to digest.

Next we encounter a woman carrying an empty woven tray on her head. Her right eye is covered with the drab green cloth of a zippered canvas hood that was likely once attached to a complete rain jacket. “I should go to the hospital for an operation,” she says before swiftly pulling off her hood to reveal smooth brown skin that now covers the space where her right eye once had been. When asked to describe her working conditions, she opens her pursed lips to speak of stomach pains and diarrhea caused by the bitter ammoniac gasses produced by the decomposing flesh she works to carry. Because we’re told these gasses sting the eyes, viewers intuit that they also may lead to the loss of them. “It’s worse when it rains,” she says.

Viewers shudder to feel our own toes squishing into the mud as we imagine the tickle of maggots crawling across our skin, eyes watering from the sting of ammonitic gas, and intestines rumbling from the imaginary toxins rushing through our digestive system. The smell of the whole scene must be unbearable; the taste of what’s produced there abominable. It becomes impossible for viewers to believe – let alone remember – that a woman who moves visibly decaying fish carcasses for a living says her “life is good.” Certainly she must be soothing herself with a false consciousness, rather than the daily cash she earns. Certainly farming, even in a drought prone region like Northern Tanzania, must be a better option than lives made where eyes might disappear to toxic fumes.

There’s a sensorial empathy generated through Sauper’s account of carcasses and of fishing sites more generally that frames much of what the latest generation of Euro-American trained researchers and policy-professionals working on Lake Victoria’s fisheries know about this lake, its fisheries, and its fishworkers. This sensorial empathy – while likely well intentioned – is metaphorically toxic. It taints the sensibilities of individuals and institutions tasked with designing a sustainable future for Lake Victoria’s fisheries by sympathetically rendering fish products produced outside of seemingly sterile factory settings as unsanitary and unsafe – whether or not they actually are.

Given the strength of Sauper’s message, it strikes me as strange that I never fell sick from the great quantities of fresh, dried, smoked, and fried fish that I’ve eaten in mainland and island fishing camps in and around Lake Victoria since 2007, most gluttonously from 2011-2012, and most recently in 2016. After all, these are the most classically “underdeveloped” and “unhygienic” places in the region. Indeed, given Sauper’s focus on carcasses, I was initially surprised to find whole fish being produced and consumed there at all, let alone regularly.

The only cases of fishborne illness that I’ve encountered seem caused by fish contaminated through industrial means. My first and most personally moving experience followed an exceptionally delicious dinner served at the elite Tilapia Hotel in Mwanza, Tanzania (the very same town where Darwin’s Nightmare was filmed). That night two dishes of tilapia curry poisoned two-thirds of a research team I was leading – rendering us, not unironically, unable to collect a day’s worth of data on the socio-economic determinates of waterborne diseases because we were busy managing our own diarrhea and vomiting. The hotel’s refrigeration, we assumed, had been less than consistent. Later, I was treated to an account from a Ugandan colleague who spent several days suffering from “throwing out, loose motions, and delirium” after he ate a bag of dried sardine-like fish now abundant in Lake Victoria that he had purchased from one of Uganda’s finest foreign-owned grocery stores. Although he enjoyed the taste of these fish, given their explosive and mind altering effects, he vowed never to eat them again.

It’s not just viewers of Darwin’s Nightmare who are repulsed by images of Lake Victoria’s fisheries. Even eastern Africans who perhaps should know better fear invisible toxic agents, hidden within the flesh of locally produced fish and the water within which they live. A Ugandan Fisheries Officer once confessed to me that she almost did not survive her month of fieldwork in an island fishing camp required for her Bachelor of Science in Fisheries and Aquaculture. She didn’t trust the water where she was posted, nor anything cooked with it – especially fish, even though she knew that potentially dangerous pathogens in the water could be boiled out of existence. So, for thirty days she spent her meager stipend on pre-packaged sugary biscuits and drank nothing but Fanta and Coke. She was so constantly thirsty and hungry that she regularly fantasized about jumping into a boat and heading back to the mainland. Her personal experiences of revulsion and deprivation confirmed what she had already learned from her coursework – fishworkers are poor, hungry, and backwards, their fishing camps are unsanitary and unpleasant, and they both should be developed along industrial lines.

Figure 3: A perfectly safe and delicious meal for two served (and eaten) on island in Uganda. Photo by author in 2012.

The metaphorical toxicity that sensorial empathy engenders does more than simply taint the experiences of experts and concerned outsiders and the solutions they pose for Lake Victoria’s fisheries crisis. It pathologically promotes the material ruination of fishworkers and the local and regional markets they serve. In the decade that followed the release of Darwin’s Nightmare, fisheries experts promoted development of managerial practices and physical infrastructures designed to further “modernize” Lake Victoria’s fisheries. These included seizures of “illegal, unreported, and unregulated” whole Nile perch destined for local and regional markets; confiscating and burning “undersized” fishing nets; building more ice-plants and cement loading docks at fish collection sites to serve industrial processing plants; and redirecting the sale of “byproducts” from filleting plants to other factories that make fishmeal for fertilizers and animal feeds. All were designed to improve the conditions of Lake Victoria’s fisheries by decreasing quantities of fish available for local processing, and local and regional sale and consumption.

Figure 4: “Illegal” fish for sale at a Ugandan market. Although these particular fish were purchased and consumed, they could legally be confiscated at any time. Photo by author in 2012.

Figure 5: Confiscated fishing nets soon to be set ablaze in Uganda. Photo by Bakaaki Robert in 2015 and reproduced here with his permission.

Figure 6: Industrial fish landing site on a Ugandan Island. Built with unknown quantities of donor and government funds. Completed in 2008, and as of March 2017, never opened. Photo by author in 2012.

Despite the virulence of sensorial empathy’s toxic effects, multiple species and forms of fish, including whole Nile perch, continue to be safely produced and consumed in places and by methods that experts deem dangerous (Johnson 2016, 2017). In July 2016, after spending two years away from “the field,” I returned to an island fishing camp in Ugandan waters with Akello Florence, a woman who has worked with fish and with me since 2007. This camp was one we had lived and worked in alongside women and men who fish, process, and sell fish for a living. Although my friends and colleagues there noted that fish were still scarce, we were treated to multiple meals of fresh and smoked Nile perch, tilapia, and several species of fish without English names. These were prepared by and eaten with fishworkers in the usual way – boiled in water from the lake, served in ceramic and plastic bowls alongside large plates of steamed bananas, sweet potatoes, cassava, and stiff maize porridge (often without forks or spoons), and savored while seated on the ground atop thatched papyrus mats. None of these meals made us sick. The industrially processed Nile perch “fish fingers” that I ate alone that same month as part of a lavish breakfast buffet served at one of the more expensive hotels on the Ugandan mainland, however, resulted in a much more unpleasant digestive experience. The hotel’s freshly starched white table cloths and fine cutlery could only conceal encounters with the actual toxicity of these factory produced fish products for so long.

Figure 7: Akello Florence enjoying a meal of smoked fish in groundnut sauce with plantains and pumpkin on a Ugandan island. Photo by author in 2016 and used here with Akello’s permission.

 

Jennifer Lee Johnson is an Assistant Professor in the Department of Anthropology at Purdue University. She holds a PhD from the University of Michigan and completed a postdoctoral fellowship with the Program in Agrarian Studies at Yale University. Johnson’s research is historically rooted, ethnographically engaged, and focused at the confluence of gender, illegality, and the ontological politics of sustainability in and around Africa’s largest body of freshwater where she has conducted long-term field research since 2007. Her most recent publications have appeared in the journals Comparative Studies of South Asia, Africa and the Middle East and Aquatic Ecosystem Health and Management, and in the edited volumes Subsistence under Capitalism: Historical and Contemporary Perspectives (McGill-Queen’s, 2016) and Landscape, Environment and Technology in Colonial and Postcolonial Africa (Routledge, 2012). Johnson’s current book project examines how stories about the past shape and are shaped by contemporary environmental policy debates, and how alternative – but no less accurate – accounts of linked transformations in social and ecological life may inspire more livable futures.

 

References

Sauper, Hubert. 2004. Darwin’s Nightmare. Mille et une Productions. Film.

Johnson, Jennifer Lee, and Bakaaki Robert. 2016. “Working with Fish in the Shadows of Sustainability.” In Subsistence under Capitalism: Historical and Contemporary Perspectives, edited by James Ernest Murton, Dean Bavington, and Carly A. Dokis, 195–233. Rural, Wildland, and Resource Studies Series 4. Montreal, Quebec: McGill-Queen’s University Press.

Johnson, Jennifer Lee. 2017. “Eating and Existence on an Island in Southern Uganda.” Comparative Studies of South Asia, Africa and the Middle East 37 (1): 2–23.

Lake by Muchaparara Musemwa

5 Décembre 2017 - 4:47am

Introduction

Urban man-made bodies of water such as lakes can be sources of aesthetic beauty and leisure and can boost a city’s economy and tourism industry. They satisfy what Alex Loftus has called the ‘sensuous human activity that fulfils particular historically defined social needs’ (Loftus, 2007: 43). But the same human activity and the intensification of urbanization have also transformed such urban waterscapes into toxic dumps often sited near peoples’ homes. What this prompts, as Loftus has further argued, is the need for us to direct our attention on ‘the particular historical relationships through which people and natures have been brought into tense, differentiated unities’. Loftus extensively cites Neil Smith’s Uneven Development (1984), in which he implores scholars to analyze the disparities that are engendered as a result of these interactions and to also examine ‘struggles for justice within politicized environments’ (Loftus, 2007: 43). This essay examines the consequences of the reimagining and reinvention of a particular urban landscape on the Eastside of Johannesburg, once a sewage disposal site, into a scenic landscape of leisure and consumption by constructing and artificial waterfront – Bruma Lake in 1989. The essay unfolds the triple narrative of the physical and ecological transformation of Bruma Lake and how it morphed from a wastescape to a waterscape and ended up becoming a parkland (landscape). Finally, it seeks to demonstrate how this man-made engineering feat gradually turned into an environmental menace for the residents of Bruma and nearby suburbs as well as businesses in and around the complex in just less than two decades of its existence, prompting protests by local residents and business owners when the lake ceased to be the once idyllic place of leisure. The consequential ecological degradation of the lake built on the pollution-prone Jukskei River and the protests compelled the City of Johannesburg, after several and costly corrective measures, to embark on a process that resulted, once again, in reshaping this part of the city’s built environment into a park.

When it was built, Bruma Lake, situated about 7 kilometers east of Johannesburg, covered an area of about 30 hectares, and was intersected by the Jukskei River, which stretches from west to east across it, and was bounded by Broadway to the south; Queen Street to the west; and Marcia to the north and east. This area had previously been a sewage disposal area located in what was considered, then, a distant outer area, deemed unlikely to create any ‘nuisance’ for the eastern suburbs. However, as urbanization proceeded apace and more suburbs on the eastern fringe of the city encroached on lands such as these, there was a need to rehabilitate the land and change its wastescape identity. Thus, from 1989 these major sewage works that had serviced Johannesburg’s eastern suburbs gave way to the construction of Bruma Lake.

A Portion of the Picturesque Bruma Lake. Picture taken by author, 2003.

The lake was constructed mid-stream on the Jukskei River, thus blocking the natural watercourse. Without an environmental impact assessment having been conducted, Jukskei River would become the lake’s imminent source of environmental hazard and toxicity, leading to its eventual unmaking in 2015 when, yet again, for the third time, the area was subjected to a different type of land use when it was converted to a recreation park. The environmental engineering of this space is strikingly comparable to the history of ‘urban wastelands’ that have undergone ephemeral transformations elsewhere. For example, Martin V. Melosi’s study on Fresh Kills Landfill in Staten Island, New York, demonstrates how this gigantic ‘human-engineered’ waste-scape was eventually turned into a sprawling parkland. Before acquiring this new identity, Fresh Kills had had a checkered but transient history: from salt marsh to landfill, to cemetery and lastly to future park (Melosi, 2016). Similarly, focusing on the re-creation of Bottle Lake in New Christchurch, New Zealand, Katie Pickles has traced, ‘the haphazard environmental history of an area of land’ (Pickles, 2003, 419) and examined ‘the changing environmental qualities of place over time as a chain of discourses that have formed, re-formed, cross-fertilized – each influencing a new land-use or perception of the area as wasteland, playground, wetland, and site of rehabilitation and recreation’ (Pickles, 419). In much the same way as Melosi and Pickles, Jane Carruthers provides a historical analysis of how the once imposing Delta Sewage Disposal Works in Johannesburg were converted from ‘sewage sludge to pleasant park’, between 1934-1963 (Carruthers). What is common among all three case studies from the US, New Zealand and South Africa is that these were all ‘landscape(s) in perpetual makeover. More broadly, these studies constitute what Lawrence Buell has framed as ‘toxic discourse’, which emphasizes defining the forms, origins, uses, and critical implications of toxic rhetoric’ (Buell, 1998: 639).

This essay aims to contribute to and illuminate on these emerging ‘toxic discourse(s) charted by these environmental historians. Just as Melosi exhorts us to think broadly about the significance of such places as Fresh Kills instead of merely seeing them in physical terms, Bruma Lake needs to be equally recognized as ‘both site and symbol’ by removing it from the ‘realm of the tangible’ and elevating it ‘into a world of ideas and perceptions’ (Melosi, 2016: 64).

 

Renewal of Johannesburg and the Making of Bruma Lake

The construction of Bruma Lake as the central focus of the new infrastructural development was inextricably intertwined with the renewal of the Johannesburg inner city which was started in the 1980s so that ‘it could take up its rightful place within the major global economy and become an all-inclusive city’ (Bremner, 2000: 185-193). One way of fulfilling this sense of global recognition was to create the foremost thing Johannesburg has lacked since it was founded in 1886. As Turton, et. al. (2006) have observed, it is a historical fact that:

… the city of Johannesburg is one of the few cities of the world that is not located on a river, a lake or a seashore. In fact Johannesburg straddles a major watershed, known as the Witwatersrand (translated literally as ‘Ridge of White Waters’), which divided the continent of Africa into rivers that flow into the Indian Ocean to the east, and rivers that flow into the Atlantic Ocean in the west. Located in the headwaters of the two major international basins, the Orange river and the Limpopo river, water supply challenges and water quality issues are but two of the major obstacles that confront the staff of Rand Water, the institution that is responsible for supplying the water that sustains, what is, in effect the economic engine of Africa.

I would argue that part of this new initiative involved the construction of a number of artificial waterfronts meant to compensate for the city’s lack of abundant natural water sources and provide its citizens with the kind of leisure experienced at leisure and sites of consumption such as Cape Town’s Victoria and Alfred Waterfront, ‘a real waterfront that overlooks Cape Town Harbour’ (Mania, 2013: 218). Thus Bruma Lake was to become the first one of these waterscapes to provide a gateway into the City of Johannesburg. It was to be followed in 1996 by the Randburg Waterfront and many others (Mania, 2013: 218).

The Bruma Lake complex comprised luxury offices, apartments and townhouses overlooking the lake. Buildings that sprang up had names connoting their proximity to the lake namely, Waterview, Lakeside Two, Lakeside Manor, The Fisherman’s Village, and so on. The Fisherman’s Village, made up of a quayside restaurant and a range of food shops and boutiques, was advertised as the main attraction complementing the Lake. Straddling the lake was a suspension bridge – itself a miniature replica of the San Francisco’s Golden Gate Bridge. Finally, this new body of water was also designed for canoeing, windsurfing and sailing activities. Both the City Council and the Department of Water Affairs ensured the development of waterways and walkways at the Lake. These designs were later to win the 1992 Corobrik Awards for excellence in paving. A judge of the competition lavishly commended the new structure thus: ‘No matter where the eye falls, the sense of resolution is complete … it is this kind of detail which adds to the friendliness of the place’ (Building, 28, Feb. 1991: 26).

Opened to the public on 1 November 1989 with much fanfare, this new waterscape was acclaimed as compensating for Johannesburg’s unique position of being ‘one of the few major cities not located on the sea or river’ (The Star, 23 November 1989). One more newspaper headline confirmed the symbolism of this new body of water: ‘A touch of the “seaside” comes to our landlocked Jo’burg’. (The Star, 23 November 1989). For quite a number of years, Bruma Lake would remain a popular destination with many local and international visitors coming to pass time there. But, for all its celebrated luxuriant and picturesque ambience, the lake began to experience the dystopian downside of progress, with the dramatic transformation and the accumulation of toxic waste.

When the ground on which the lake was to be constructed was unearthed, there were initial challenges. The Jukskei River incessantly brought trash which tended to undermine the drainage process. In September 1989, there were complaints that the lake had already become a ‘cesspool of rotting debris emitting a terrible stench’ (The Star, 30 September 1989). Immediately after the massive opening of the lake, the authorities were forced to drain the water in order to repair some filters (Vladislavic, 2006). Thereafter the lake did not have major problems until the end of the 1990s and early 2000s when residents in the adjoining suburbs and business people increasingly began to complain about the pungent smells that regularly saturated the air around the Bruma business complex. The lake had continued to take up all the discharge from the inner city which flowed from the Jukskei River. In fact the lake ‘was the first point where the water comes to a standstill, and […] therefore acts as a big sedimentation trap’ (Gamer).

In response, businesses that had once thrived here began to move out from the late 1990s and during the 2000s. For example, The Don, an upmarket hotel, built on the lake’s banks, closed shop following incessant complaints from its guests regarding the powerful smell. In December 2000, The Citizen newspaper reported how ‘Bruma Boardwalk Centre, once buzzing with life, (now) exists as a ghost area following the closure of almost all its stores over the past three years’ (The Citizen, 2000). The last straw was the discovery of four bodies in the lake, dumped by serial killers roaming in the eastern suburbs adjoining Bruma, leading the City Council to order that it be drained to enable the police to look for evidence (Vladislavić, 2006: 94). The draining of the lake each time there was a toxicity problem has led South African literary scholar Ivan Vladislavić to mockingly observe that ‘this was a salutary reminder that the lake was artificial, that it was nothing but a reservoir lined with plastic’ (Vladislavić, 2006: 94). The discovery of dead bodies simply scared people away. In the absence of firm solutions to this continuously evolving environmental hazard, civil society organisations, such as Lake Property Owners Association and the Jukskei River Catchment Area Management Forum, individually and collectively threatened to take civil action in order to compel the City Council to clean up the heavily polluted Lake. Scientific tests conducted by a Wits University ecologist in 2011 revealed that the smell – which residents and businesses attributed to their sickness — was a toxic and flammable gas that is registered as an asphixiant. With such confirmed toxicity one can only imagine the broader detrimental effects this was having on other elements of the ecosystem, given that water from the lake fed the Jukskei River whose waters, in turn, flowed into the Hartbeesport Dam which served as a source of water supply for the City of Pretoria.

Mounting pressure from residents and businesses between 2004 and 2012 compelled the City of Johannesburg to start addressing the problem in conjunction with environmentalists. A whole range of technical, chemical and biological solutions to reduce the toxic levels of the lake and to prevent environmental disaster from spreading were implemented, but to no avail. At one point, in 2010, the year South Africa hosted the Soccer World Cup, R1.5 million was spent on a precipitation plant and the expensive litter trap ceased to function due to a storm (The Star, 18 June 2014). In 2012, attempts to rehabilitate the lake by, among other things reducing the sludge and improve the air failed because of lack of funding from the City of Johannesburg (The Star, 7 December 2012). After millions of Rands had been sunk into the rehabilitation of Bruma Lake to deal with issues relating to silt, litter and pollution, and at some point draining the entire lake to enable the police to ‘search for bodies and serial murder clues’ (Kruger, 2013: 192), the City Council was eventually compelled to take one more radical solution – namely, the creation of a recreational park and the conversion of the lake into a river.

Announcing the arrival of the ‘New Bruma’ Recreation Park. Picture taken by author.

 On Becoming a Recreational Park

Following wide-ranging consultations with several organisations and residents linked to Bruma, the City Council finally decided to restore the lake and its surroundings to its ‘natural state’ and ‘let nature take its course by filling the lake and reinstating the pre-existing stream by reshaping the lake basin’ (The Star, 15 Jan. 2015). In addition, it also planned to recreate an altered vegetated waterway, improve access for cleaning debris, minimize sediment accretion, resuscitate the ecological nexus between upstream and downstream areas, and retention of the bridge, among other things. Completed at the end of 2015, at a cost of R60 million, the re-engineered former waterscape has been turned back into a landscape with a sprawling lush green park with a river full of water flowing freely thereby assuming a new and refreshing identity. The body of water that had been a site of entertainment and wonderment had now been converted to a park and the odors once produced by the stagnant toxic waters disappeared.

Bruma Lake gave way to Bruma Lake. Picture taken by author.

New walkway built on ground that used to Bruma Lake. Picture taken by author.

A plaque marking the opening of Bruma Lake Park. Picture taken by author.

What can we make of the transformation of this place from one form of land-use to another? Both cases involve the re-engineering of, first, the wastescape, which was turned into a waterscape, and then finally back again into a landscape. Creating a vast body of water – Bruma Lake – to satiate consumptive desires meant altering the flows of water and controlling nature. This was done without ensuring that the state of the entire ecosystem around the lake suited the new uses. Hence, a toxic lake. In the second instance, the waterscape was re-engineered into a landscape in the name of restoring it back to nature. However, in both cases, there was not much focus on rehabilitating the areas whence the toxic waste was generated. This gives empirical expression to what Edelstein once called an ‘engineering fallacy, which involves the assumption that problems can be solved in isolation, away from the complicating factors and uncertainties of the real world’ (Edelstein: 1988). Paul Fairall, a wetlands expert who did much to try and purify the Bruma Lake, makes this point even more vividly when commenting about the new park: ‘The ghastly smell has gone, but I am still a bit worried about the amount of sewage coming in from the city and the fact that there is no litter grid on the Observatory’ (The Star, 15 January 2015). But this leads us to another question, also posed by Melosi: what exactly does ‘ecological restoration’, i.e. ‘resurrecting the site from its sordid past’ mean? (Melosi, 2016: 64). Can humans who initially presided over the alteration of nature to suit their wants also successfully preside over the process of restoring such sites back to their natural order without incurring more ecological costs in the process? Flora Mokgohloa, Director: Environmental Planning and Management in the City of Johannesburg, provides a salutary answer: ‘engineering the environment (canalization, channelization of rivers and waterfronts) should never get a town planner’s stamp of approval’. (Urban Green). The toxification of Bruma Lake was the result of humans and their activities. Finally, Martin Melosi poses a question which resonates with this study: ‘Is there a way to reconcile the human and the natural in this restored landscape?’ (Melosi, 2016: 65). Taking a cue from Buell (1998), I would say “YES”, for he has argued that: ‘more and more it may become second nature to everyone’s environmental imagination to visualize humanity in relation to the environment, not as solitary escapees or consumers, but as collectivities with no alternative but to cooperate in acknowledgement of their necessary, like-it-or-not interdependence’ (Buell, 1998: 665). Implicit in such assertions is the idea that ‘toxic discourse calls for a way of imagining physical environments that fuses a social constructivist with an environmental restorationist perspective’(Buell, 1998:656).

 

Muchaparara Musemwa is an Associate Professor in the Department of History and is currently Head of the School of Social Sciences, at the University of the Witwatersrand. He is the author of a monograph: Water, History and Politics in Zimbabwe: Bulawayo’s Struggles with the Environment, 1894-2008 (Trenton NJ: Africa World Press, 2014). He has published widely in journals such as, Journal of Southern African Studies and Environment & History. His latest publications are: ‘Sic utere tu out alienam non laedas: From Wanton Destruction of Timber Forests to Environmentalism: The rise of colonial environmental practices in Southern Rhodesia, 1938-1961’. Environment and History, Number 4. (Nov. 2016), pp. 521-559; and ‘Narratives of Scarcity: Colonial State Responses to Water Scarcity in Southern Rhodesia, 1890-1965’, Cristina J. de Melo, Estelita Vaz and Ligia M. Costa Pinto (eds.), Environmental History in the Making (Springer, 2017) pp. 263-290.

 

References

Bremner, Lindsay (2000), ‘Reinventing the Johannesburg Inner City’, Cities, vol. 17, no. 3: 185-193.

Buell, Lawrence (1998) ‘Toxic Discourse’, Critical Inquiry: 639??

Carruthers, Jane, ‘From Sewage Sludge to Pleasant Park: The Story of the Delta’s Disposal Works, 1934 to 1963’. Source: http:www.deltaenviro.org.za/deltahis.html. Accessed: 31 January 2016.

Edelstein, Michael, R. (1988), Contaminated Communities: Coping with Residual Toxic Exposure (Westview Press).

Editorial: ‘Detail in the Urban Landscape: Bruma’ Building, 28, Feb. 1991

Gerald Garner, ‘Urban Rivers ad Wetlands Threatened’, Urban Green (http://www.urbangreen.co.za/2_3.htm)

Kruger, Loren (2013), Imagining the Edgy City: Writing, Performing, and Building Johannesburg (Oxford: Oxford University Press).

Loftus, Alex (2007). ‘Working the Socio-Natural Relations of the Urban Waterscape in South Africa’, International Journal of Urban and Regional Research, volume 31, no. 1: 41-59.

Mania, Kirby (2013). “On the Brink of the Mundane”: Post-apartheid Literary Representations of Johannesburg in the Work of Ivan Vladislavić, (unpublished PhD Thesis in English Literature), University of the Witwatersrand.

Melosi, Martin, V. (2016). ‘Fresh Kills: The Making and Unmaking of a Wastescape’, Christof Mauch (ed.) Out of Sight, Out of Mind: The Politics of Waste (RCC Perspectives: Transformations in Environment and Society, 1: 59-65.

Pickles, Katie (2003), ‘The Re-Creation of Bottle Lake: From Site of Discard to Environmental Playground’, Environment and History 9: 419-434.

Turton, Anthony.Schultz, Craig. Buckle, Hannes. Kgomongoe, Mapule. Malungani, Tinyiko. & Drackner, Mikael (2006). ‘Gold, Scorched Earth and Water: Hydropolitics of Johannesburg’, Water Resources Development, 22. 2: 313-335

Vladislavic, Ivan (2006). Portrait of Keys (Umuzi: Houghton, SA).

Newspapers:

The Citizen, 2000

The Star, 30 September 1989

The Star, 23 November 1989

The Star, 7 December 2012

The Star, 18 June 2014

The Star, 15 January 2015

Art by Mehita Iqani

1 Décembre 2017 - 5:59pm

Cape Mongo is a multimedia installation that focuses on consumer waste as medium and subject. It is a complex artwork, comprising sculpture using found materials (mostly what viewers would consider waste or trash), performance, and video work. The main narrative feature of the work is a series of fantastical-looking creatures made from either glass, cardboard, tin cans, plastic, VHS tapes or discarded cellphones, all called ‘Mongo’, which is slang for an object thrown away and then recovered, who interact with different urban landscapes and places in various ways. In the installation for the 2015 National Arts Festival in Grahamstown, each of the “creatures” – essentially elaborate hand constructed suits that were worn by the artist in performative engagements with public space – were installed in the gallery as sculptures. The creature suits are human-sized and they were positioned on raised plinths that made them seem even larger than life. The various iterations of Mongo were carefully lit, which gave them an imposing air. The video work was screened on one of the gallery walls.

The video component of the artwork is extremely important. A short film was made “for” each of the Mongo characters. These films serve both as a documentation of the performance aspect of the work – Knoetze donning one of the suits and interacting with urban space and people reacting to the character – and as a multimedia commentary on each character and performance. The latter function was achieved by interlacing and editing a variety of popular culture references and found footage texts into the footage of “Mongo” exploring some section of Cape Town. The short films were screened together in large projection on to a white wall, while viewers stood or sat on the floor. The video element of the artwork was especially powerful in the setting in which the actual sculptural outfits were present. Viewers could see how the now-still, now-silent, sculptures turned into a kind of living character once they were worn and moved in, and in turn a number of fascinating reference points were introduced into the texture of the work through video editing, adding sometimes odd, sometimes surprising elements: a 1990s game of cricket here, a snippet of animation there.

We spoke for almost an hour one autumn afternoon over Skype. We weren’t able to record the interview, so Mehita made notes while we spoke. This short “conversation” is reconstructed from those notes, which Francois reviewed and contributed to before publication.

MI: Where did you source the material that you made the creatures from? Did you collect your own trash, or find it elsewhere?

FK: Even though I’m not very good at recycling, I do hoard some items. I sometimes kept a certain tin can or bottle aside to help finish off a piece. But I sourced most of the materials that I used to make the creatures from a place on Landsdowne Road in Cape Town, called Oasis Recycling. It’s where the opening scene of Cape Mongo: Glass was shot. There is a huge recycling operation there. They wash and sort a lot of materials, and I could just call them up to let them know what I needed, and then I would be able to buy it from them for a very reasonable price. A lot of my work stems from finding items in what often feels like a treasure hunt, in markets or second hand stores, or recycling centres. I’m interested in thinking about where a thing comes from, what system it formed a part of, and what it can be turned in to. I am interested in how objects relate to human systems and cultures. I am interested in the links between materials and humanity. Mongo is a slang word that I came across; I think it was used in 1960s New York to describe reclaimed or reused materials. So I reclaimed that word to describe the things that I was making out of found materials.

Figure 1: Cape Mongo, Metal. Francois Knoetze, 2015

 

Figure 2: Cape Mongo, Paper. Francois Knoetze, 2015

MI: You’re right. One person’s trash is another’s treasure. Once our “garbage” is taken to a recycling centre, and washed and sorted, it actually becomes a commodity again. Something with value that can be bought and sold. The recycling industry is interesting because it re-creates value in materials that others have decided no longer have value. Can we talk a little more about the links between the material and the human that you’re exploring?

FK: Plastic is an interesting example. It’s even becoming incorporated into human DNA. I don’t know the exact science of it, but the narrative is like this: there is all this microplastic waste that is discarded in the ocean, and a lot of it ends up in the bellies of fish and other sea creatures…Then humans catch those fish and consume plastic-associated chemicals, and by eating it those microscopic traces of plastic become a part of our own being. So plastic is becoming part of the human condition in a very bodily, material way, its no longer just material for packaging our lives and lifestyles.

MI: How interesting. Plastic is the most “man-made” of all the substances that you work with. Glass, paper, and tin can all be traced back to some kind of extraction from the earth. But plastic is produced through chemical processes, it is made in a lab, it was invented by us rather than extracted and processed by us. It is quite compelling to imagine it now shaping us, at the molecular level, in turn through a long process of waste and ingestion. Can we talk a bit more about the plastic Mongo? I found this character – the colorful “big bird” – the most friendly, almost cheerful of the five. Can you tell me more about your experiences in creating it?

FK: So as you know each of the characters was an “outfit” that I specially made with the intention of wearing it and interacting with a specific part of Cape Town. Even though the plastic one looked the most cheerful and friendly, it was the most uncomfortable one to wear. It was constructed with all the plastic items, bottles and bottle tops, around a frame of chicken wire, and the wire would pinch and scratch me with every flap of my wings. It was really unpleasant to wear and move in.

MI: It’s like there was this dark awkwardness at the heart of this cheerful friendly-seeming creature. Can you tell me about the location that you chose for filming that performance?

Figure 3: Cape Mongo, Plastic. Francois Knoetze, 2015

FK: For all the performances, I wanted to show the creatures interacting with spaces that were somehow relevant to the objects or materials that they were made from, and to the themes explored in the films. I wanted the viewer to see the creatures from different perspectives, and also to see how people in those spaces sometimes interacted with the creatures. I also wanted the creatures to reveal or expose different vantage points on the city. The plastic Mongo video was filmed at the V&A Waterfront, at one of the piers right at the edge of the complex. The Waterfront is the piece of coastline closest to Robben Island, and so it has a particular kind of resonance in post-apartheid, being the place from which Nelson Mandela came when he was released. There was something powerful for me in thinking about the movement from the sea to the land as a passage of freedom. In the video I edited in a clip of Mandela reading one of Ingrid Jonker’s poems. It was important to me that the plastic Mongo was shown interacting at a coastal space. The oceanic aspect was important for the plastic creature. Although a lot of trash ends up in the ocean, plastic is most visible because it floats. Paper gets soaked and disintegrates and sinks, metal rusts, and glass could break into pieces on rocks. But plastic just floats, and it disintegrates much more slowly than any other substance.

MI: There is something interesting in how you are linking the movement from the sea to the land, Mandela’s return – as symbolic of a particular moment of rainbow nationhood – to the move from the land to the sea, human waste – as symbolic of a particular kind of influence that humanity is having on the environment. It’s not really a fair trade, is it? Mandela comes “from” the sea, and a ton of trash goes “back”. I’m learning that there are many more layers to your work, a lot of which are hinted at in the videos, than merely the politics of trash. Though some people looking at the work would read it as an environmental piece. Some are currently writing about the evocative relationship between waste and the ocean as well the beach as a complex cultural site of detritus. How would you respond?

FK: I get that many people will see the work as a commentary on the environment and how people are messing up the planet, and I am happy to let that be. People will read into the work whatever they wish. It’s important for there to be a space for interpretation. In Cape Mongo I wanted to explore a number of themes. One of them was thinking about the city of Cape Town and its spatial politics, both historical and contemporary. So yes, the work is about the environment but I interpret the environmental broadly, it doesn’t stop at the edge of the city, it includes human systems of production and consumption in general. I see the city as a biosphere, where human processes and natural processes are deeply interconnected. The ways humans interact with nature are also closely related to historical systems of oppression. There are different hierarchies at play, and different environmental issues are linked with colonial capitalist expansion. Subsistence and the sharing of land were violently replaced with capitalism and a culture of producing excess. So yes, my work is about the environment and ecology but I really wanted to link it also with the politics and history of colonialism and capitalism, which is why it was so important that these Mongo creatures were shown interacting with various politically important geographical spaces in Cape Town.

MI: Yes, that is precisely why I was interested in your artwork, because of the commentary that it made on capitalism and consumer culture. I’ve written about the links between consumer culture and the media, and the complex meanings of consumption in the global south. I think an important area of future research, to which I hope to contribute in the years ahead, will be studies that continue to politicize consumption by turning attention to what is left behind after consumption has taken place. In the context of rapidly dwindling natural resources, growing populations and the many ways in which consumption has been centred in narratives of development and the “good life”, it is increasingly important to consider the “other” side of consumption: the material formations of waste, garbage and trash that accrue once human actors have accessed, enjoyed and disposed of the many commodities that they want and need in their lives. Cape Mongo was one of the references points that has gotten me started on thinking about these issues. Waste interjects not only into our material spaces and experiences, but also into our mediated lives and representational space. Waste comes into the public imagination through a number of media forms and genres, usually closely linked with particularly moralizing discussions about ethical consumption and the sustainability of the planet. And all of these issues require further critical analysis and thinking.

 

Mehita Iqani is a Senior Lecturer in Media Studies. Prior to joining Wits, she taught in the Creative and Cultural Industries MA programme at King’s College London, as well as in the Media and Communications MSc programme at the London School of Economics and Political Science (which is also where she completed her PhD in 2009). Mehita is the Founding Editor of an online/offline creative magazine recently adopted by the School of Literature, Language and Media, which publishes new writing and visual work, ITCH Magazine. ITCH has been running since 2003 in one form or another. Before becoming a career academic, Mehita worked in the media and communications sector in South Africa for five years.

Born in Cape Town in 1989, Francois Knoetze is a performance artist, sculptor and filmmaker. He holds a BA Fine Arts degree from Rhodes University and an MFA from Michaelis School of Fine Art, UCT. Knoetze retraces the life cycles of discarded objects and explores junctures between material and social histories. In his Mongo* sculptural suits, the synthetic is welded to the human – bringing focus to the objectification of persons, through the personification of objects. In 2015 Knoetze featured as one of Mail & Guardian’s ‘Top 200 Young South Africans’. His series Cape Mongo formed part of the Grahamstown National Arts Festival Main Programme in 2015 and the Global Graduate Programme at Design Indaba 2016. He has participated in group exhibitions, such as U/Tropia at the Wiener Festwochen in Germany (2015), Slow Violence at the University of Stellenbosch Art Gallery (2015) and Designing Futures at the Lagos Photo Festival (2015).

Anomie and aftermath: the historical residue of Flemish nationalism in present-day debates on refugees in Belgium by Hunter Keys

22 Novembre 2017 - 8:09pm

I. ‘Everything is the same level as the ground’

As protests against Assad morphed into slaughter, Khalid[i] did his best to avoid fighting. At the time, he was a law student, but the advent of war meant he was no longer exempt from military service. Once the government stooges came around, yanking young men off the streets, forcing them into the fight, he knew his time was running out. ‘I don’t mind the idea of dying, but I don’t want to kill anybody,’ so $1,000 later he was on a crowded raft, taking on water in the nighttime darkness, before washing up on the shores of Greece.

‘Why do you come here?’ the authorities badgered him.

‘Why else? To visit the Acropolis and enjoy Greek food.’

He shows me his phone. A picture of him on a pebbled beach, wrapped in an emergency blanket, his eyes down, pale.

Weeks before the 2016 U.S. Presidential election, Khalid and I are standing outside the Taalencentrum, the Ghent university language center, where we are enrolled together in Level 1 Dutch. We are on class break. A fine, cold mist hangs in the air. Khalid rolls himself a cigarette. He sought asylum in Belgium because his older brother was already here, but not by choice: after getting robbed of all his money and paperwork in the Brussels Metro, his brother turned himself into the Belgian police. By law, he had to apply here, rather than Sweden, where he had hoped to go. Khalid followed some time later, passing through a refugee center in Namur and eventually coming to Ghent. Having obtained asylum, he is now committed to learn Dutch, take an ‘integration class,’ and find a job. He later tells me that because I am an American, he thought I was in the CIA.

Across the street from us is the Vooruit building — vooruit means ‘forward’ in Dutch, and it was the name of Ghent’s socialist cooperative and newspaper in the late 1880s. Ghent was ground-zero for Belgium’s socialist movement during the Belle Époque (1871-1914), a time of optimism and relative peace that witnessed verzuiling (‘pillarization’), the formation of ideologically-based ‘pillars’ such as unions, mutual aid groups, and sports and leisure clubs that later formed the basis of the welfare state.[ii], [iii] Pillarization has been understood as both an emancipatory movement against economic exploitation as well as a means to control the masses by pillar elites.[iv]

The Belle Époque was marked by intense poverty and class struggle. In Ghent, textile and other industry workers formed pillars to push back against appalling living and working conditions.[v] Those conditions are brought to life in Stefan Hertmans’ novel War and Turpentine, which draws on the memoirs of Hertmans’ grandfather, who grew up poor in Ghent at the turn of the century. The grandfather’s childhood reads like a tale from Dickens — working in an iron foundry at age 13, begging for coal so that his mother, exhausted from working for a bourgeois family, ‘would be delighted to see that they could heat the house and eat a cooked meal that evening.’[vi]

The ornate Vooruit building became the Festivities Hall for socialist gatherings. On the eve of the First World War, a photo shows men in work shirts next to women and young girls, holding ladles in giant vats of soup to feed striking factory workers.

Soup distribution for striking factory workers, Ghent, 1913. Photo from Deneckere, G. and Pieters, H., “Een showcase voor het socialisme. ‘Vooruit’ in de vitrine van de wereld.”

Today, the Vooruit building is a cultural arts center with a café, complete with vegetarian dishes. Khalid sits across from me. A song from Nirvana’s Unplugged in New York plays overhead. People nearby drink Maes beer and eat tapas.

‘Some things I can’t forget, and other details I can’t remember,’ he says, almost surprised at himself. His recollections come in bursts, not always chronological: his father tries visiting the family farm, which had fallen under the control of the Nusra Front. He is kidnapped and taken to an ‘Islamic Superior Court.’ There, they interrogate him over his presumed allegiance to Assad. Fortunately, the family has enough money for his release, but his mother ‘lost her control.’ Khalid hints at some sort of mental breakdown.

Upon his release, his father tries replacing his identity cards at the local government clerical office, since the Nusra Front had confiscated all his papers. The government, suspicious of anyone who had hung out long enough with opposition militias — whatever their calling — immediately detains him in a secret jail. He undergoes various forms of torture, enough for any 65-year-old man to endure. His mother — Khalid’s grandmother — is called a whore. He is beaten. He is locked in a two-by-two-meter room with 15 people. Given the lack of space, they take turns in allowing one person to sleep while the rest stand upright. To secure his release (yet again), the family sells the rest of the business. ‘If you don’t pay money, they kill you, government or religious people,’ he says simply. When released, his father’s skin is red and peeling. On Google Maps, Khalid wants to show me his old neighborhood. He zooms in; Arabic names appear on the streets. He switches to satellite mode. Brown mountains fill the screen; more zooming in. ‘It’s updated,’ he says. There is only rubble. ‘Everything is the same level as the ground now.’

 

II. ‘Our People First:’ Flemish nationalism and the rise of the Belgian Far-Right

Ghent is located in Flanders, the Dutch-speaking northern half of Belgium. Since Belgium’s founding in 1830, the rich-poor divide fell mostly along linguistic lines. The majority-Flemish were subordinate to the French-speaking bourgeoisie, whose wealth was tied up in the coal mines of Wallonia, Belgium’s French-speaking southern half.[vii] A property-based suffrage system consolidated the power of the bourgeoisie.

Poor Flemish bore most of the military sacrifice of the First World War. Anecdotes describe lower-class, Flemish soldiers dying senselessly from orders they could not understand, since French-speaking officers commanded them.[viii] Until the 1930s, French was the official language of the Belgian army, parliament, courts, and central administration.[ix] The Belgian Constitution was not available in Flemish until 1967.[x] A year later, the country’s oldest and most venerated university, the Catholic University of Leuven, split into separate French and Dutch-language campuses to satisfy student unrest over courses taught only in French.

However, while language was a clear marker of class, all working-class Flemish did not flock to socialism. Working-class Catholics in particular were skeptical.[xi] Catholic priests railed against ‘the Reds’ as ‘common people who had forgotten their place in the world […] instead of humbly doing their jobs.’[xii] Hertmans describes this rift: his Catholic grandfather would ‘fulminate against the “riffraff” from the back alleys — even though he came from the same place.’[xiii]

Keeping within Catholic pillars, Flemish nationalists focused on the lower-class status of Flemish.[xiv] The movement gained strength after the Second World War, as the Belgian state became increasingly centralized and its largely francophone capital, Brussels, crept further into the Flemish countryside.[xv]

In the post-war period, Flemish nationalism had to reconcile an unsavory legacy while contending with contemporary social and political change. During both world wars, some Flemish nationalists, who had collaborated with the Germans, tried to re-enter the larger pro-Flemish movement. To do so, they downplayed their war-time collaboration as a strategic attempt to gain autonomy from the French bourgeoisie.[xvi] By granting entry to extreme right-wing elements, Flemish nationalism was forced to deal with an extreme faction whose fascist notions contradicted an original, emancipatory agenda.[xvii]

Concurrent to these internal debates within the Flemish movement, Belgium contracted with Southern European and North African countries as well as Turkey to supply a cheap workforce. In Belgium, these foreign-born laborers enjoyed rights to housing, healthcare, and social security but were excluded from political citizenship.[xviii] As economic crises in the 1970s took hold, the foreign-born population were cast as a threat to Belgium’s welfare programs.

In this way, certain cultural and ethnic groups — broadly lumped under the general term vreemdelingen, or ‘foreigners,’ were seen as theoretically equal but in practice so different that their integration into Western society was impossible. Not only that, their very presence entailed a drain on the country’s economic solvency. This discourse penetrated all political parties through the 1970s.[xix]

No party took up the explicit rejection of immigration more stridently than Vlaams Blok (‘Flemish Bloc’), formed among the tightly-knit network of extremists with fascist roots. Founded in 1978 from disgust at coalition compromises by the Volksunie, the prevailing Flemish nationalist party of the time, Vlaams Blok fashioned itself as a populist, anti-establishment party — its slogan going into the 1991 elections was ‘We say what you think!’[xx] and later Eigen Volk Eerst (Our Nation/People First). The phrase ‘Our People’ went back to the early days of Dutch-speaking solidarity,[xxi] but it became reactivated by Vlaams Blok to mark a native ‘us’ from an immigrant ‘them.’

‘How stark the contrast,’ reflects Hertmans, between the ‘humanist movement’ of Flemish nationalism’s early days and when it became ‘infested with neo-Nazis’ in the early 1980s.[xxii] Vlaams Blok framed the rejection of immigrants as a defense of Flanders,[xxiii] and made gains in every general election since 1981.[xxiv] In 1991, the party picked up 10 additional seats in the Belgian Chamber of Representatives, etched into the country’s collective memory as ‘Black Sunday.’

Anomie is a term that Durkheim used to refer to a breakdown in solidarity and sense of loss due to economic change, which marked much of the Belle Époque, when Durkheim was working on these ideas. [xxv] His insight provides a useful analytic frame to consider who voted for Vlaams Blok, and why, during the party’s startling rise. Studies of electoral change showed that nearly one-fifth of Vlaams Blok voters were former Socialists[xxvi] — those in unstable job sectors. Further statistical analyses uncovered a ‘content-related preference’ for the Vlaams Blok platform: the strongest attitudinal disposition for voting for Vlaams Blok was anti-immigrant sentiment, while a smaller fraction appeared to vote for Vlaams Blok as an expression of protest or feelings of isolation, meaninglessness, and fear of the future, encapsulated by anomie.[xxvii]

Regardless of the party’s electoral wins, all Belgian political parties refused to form coalitions with Vlaams Blok, isolating it within a parliamentary cordon sanitaire, akin to a ‘political quarantine’ that prevented the party from enacting its platform.[xxviii] But Vlaams Blok came to relish its pariah status. Critics charge that the cordon sanitaire freed the party from moderating its position, furthering its ends by grabbing the media’s attention through inflammatory rhetoric.[xxix] In 2004, a court decision found that its propaganda violated the country’s anti-racist laws, forcing Vlaams Blok to re-establish as Vlaams Belang (‘Flemish Interest’), veiling its anti-immigrant discourse, but retaining the core features of Vlaams Blok. [xxx] Critics have charged that the Court’s decision, like the cordon sanitaire and the larger role of the media in covering the party, only bolstered its image as anti-establishment.[xxxi]

Sign outside Vlaams Belang political office, Antwerp, March, 2017. Message adjacent to crossed-out Islamic star and crescent: ‘Antwerp remains ours’.

 

III. Baking Speculaas

Shortly after Trump is declared the winner of the 2016 U.S. Presidential election, on a frigid morning in December, a group of us meets at a bakery in Ghent’s city center. We are the first shift of volunteers baking Speculaas, gingerbread-style cookies in the guise of Sinterklaas, the iconic, gift-bearing old man with a white beard. Each Speculaas cookie will sell for a few euros, money raised to support a small affiliate of Hand-in-Hand, a non-profit organization that helps refugees and undocumented persons find work, housing, and erkenning — recognition.

Speculaas are a tradition in Belgium (and so too in the Netherlands, where they are called Speculoos). On the morning of December 6th, kids awake to find Speculaas cookies and other gifts left by Sinterklaas. The legend goes back to Saint Nicholas, a Christian bishop who lived 300 years after Christ in a small coastal village in present-day Turkey. Aside from mystical acts of raising the dead and patronage of sailors, Saint Nicholas was renowned for his charity and gift-giving.

Anne, the volunteer coordinator, opens the sliding garage door, and we step inside. Paul, himself a refugee from Cameroon, is emptying boxes of sugar into a large mixer. There are steel countertops for kneading dough. In the cold, our breath fogs in front of us.

I learn about Hand-in-Hand on a separate occasion, when Anne and her partner invite me to their home. We drink coffee in their kitchen. A school teacher most of her life, Anne spent her last 15 years in the workforce teaching the Dutch language to newly arrived immigrants and asylum-seekers. ‘The parents consulted me not just about their kids, but about their asylum problems, and that’s how I got more involved in legislation and rules regarding refugees.’

Hand-in-Hand was founded in Antwerp in 1992. ‘It was because of Black Sunday, the elections in November, 1991, when Vlaams Blok shocked everyone by winning more than we expected,’ Anne tells me. Antwerp and Brussels saw massive, anti-racist protests shortly thereafter, sparking a movement across Flanders that emphasized tolerance of minorities. The affiliate in Ghent helps those in precarious legal circumstances and holds cultural events that try to, as she says, ‘decolonize minds.’

Baking Speculaas is the annual fundraising event for Hand-in-Hand, held every Christmas season. There are upwards of 500 Speculaas to bake today, calling for a real bakery, one whose owner could kindly loan the facility to Hand-in-Hand this morning. People rotate in and out all day. In addition to Paul, there is Akram, who left Afghanistan a few years ago with his wife, Haleema, and their children. They belong to a minority Shia ethnic group. Because she refused to wear a burka, Haleema was attacked by the Taliban.

Akram puts on a baker’s apron. He sinks his hands into the dough, forms a ball, presses it into the wooden template with the engraved Sinterklaas figure, quickly turns the template upside down and smacks it onto the metal table, then gently picks it up and allows the newly formed Speculaas to slide off, scoops it up with a spatula, and places it on the baking sheet. Over four hundred more to go. A few weeks ago, the mosque in his neighborhood in Afghanistan was bombed.

Akram and his family left Afghanistan through smugglers networks: ‘They always made us run; if you can’t keep up, they leave you behind.’ At night, awaiting their turn on the shores of Turkey, the smugglers said that the men would have to wait, since there was only enough room for women and children. Akram became separated from his wife and children in the melee. They had no phone or way of contacting each other, yet they reunited later in Belgium: awaiting a decision on her asylum application, Haleema and her children went to a mosque to honor Ashura, the Shia day of mourning. Her son recognized their father in the crowd.

In the bakery, there is soft chatter. We each find our rhythm. Paul places the racks of Speculaas in the oven and afterwards stacks them in a push-trolley to cool off.

Suddenly, there is a crash of metal: the racks have fallen out of the trolley as Paul was pushing it towards the wall. Freshly baked Speculaas scatter and break all over the floor — about one hour’s worth of work among five people, a sizeable loss. Akram looks up at us from the table, wrinkles at the corners of his eyes, grinning. ‘All that work for nothing!’ he says with a chuckle, his hands covered in flour, and goes back to placing more batter into his wooden template.

 

IV. ‘A dangerous precedent’

Vlaams Belang is not the biggest threat, Anne remarks in our earlier conversation. It is the N-VA, the Nieuwe-Vlaamse Alliantie (New Flemish Alliance), which presents a nicer sheen to the far-right. N-VA is an alliance of an older conservative wing and the Flemish Christian Democrats (CD&V). Like other mainstream Flemish parties, the N-VA has felt compelled to incorporate aspects of the far-right agenda.[xxxii] As a ‘moderately populist’ party,[xxxiii] it emphasizes the disconnect between Flemish interests and a ruling francophone elite in Brussels. As such, it embraces the traditional emancipatory roots of Flemish nationalism. What concerns Anne, however, is how the N-VA ‘still focuses on fear. They’ll say that Islam is a threat, and people without any contact with other people believe it.’

And any additional contact has been dramatically curtailed: Theo Francken, current Secretary of Asylum and Migration and leading figure in the N-VA, was recently vindicated by the EU Court of Justice for his refusal to grant humanitarian visas to a Syrian family from Aleppo. Francken argued that issuing visas would set ‘a dangerous precedent’ that would cause Belgium to lose ‘control of its borders.’[xxxiv]

Applying for asylum in Belgium is a separate bureaucratic procedure than seeking a humanitarian visa (as opposed to a work or travel visa). Asylum applications are filed once in the new country; visas are sought at that country’s embassies (the Syrian family had applied at the Belgian embassy in Beirut). The court case centered on whether obtaining a visa on humanitarian grounds is a right held by the applicant or a favor granted by the other country.

Mr. Francken’s point was that framing the visa as a right would inevitably ‘open the door to thousands of people.’ The EU Court’s ruling proclaimed that no EU member country can be forced to issue a humanitarian visa, regardless of the danger faced by the applicant. Thus, even if all EU countries are required to allow people onto their territory to apply for protection, ‘none are obliged to help them in the first place.’[xxxv] The smugglers who brought Akram and his family here, as well as Khalid and his brother, can rest assured that their business model will stay intact.

Carnival float mocking Theo Francken. Rough translation: ‘Theo Francken dog shelter’ with play-of-words ‘Asiel’ doubling as both ‘dog shelter’ and ‘asylum.’ Literally, ‘Wir blaffen das’ in German means ‘We bark that,’ a jab at Merkel’s famous (and criticized) phrase, ‘Wir schaffen das’ (we will handle it) in response to the refugee influx. Phrases in local dialect above kennels, clockwise from top left: ‘Sent back’, [above pigs] ‘No Halal’, ‘Down-and-out’, ‘Aleppo Terrier’, ‘Dirty dog.’ Red placard: ‘File rejected.’ Aalst, Belgium, 2017.

The irony of Francken’s position — and mostly forgotten by the general population — is that during the First World War, one in seven Belgian civilians was a refugee.[xxxvi] Most fled across the border to the Netherlands, prompting the German army to erect an electrified fence that would claim thousands of lives.[xxxvii] In the United Kingdom, sympathy for Belgian refugees ran thin. A London diarist confided:

[T]he Belgians are not grateful. They won’t do a stroke of work and grumble at everything[,] and their morals …! … save us from the Belgians![xxxviii]

Political cartoon by Dutch socialist Albert Hahn, which appeared in the Dutch
weekly ‘De Notekraker,’ 1915. The original caption read: ‘From the Belgian
border: again a Belgian, who tried to flee over the border to Holland, was caught in the electric barbed wire and was killed by the high voltage.’[xxxix]

V. Anomie and aftermath

Durkheim first elaborated on anomie in The Division of Labor (1893), which describes how specialized occupational roles lead to an interdependent society. For Durkheim, solidarity depends on both structures that encourage social interactions across roles as well as moral norms, together comprising a ‘nomic process’ contributing to solidarity. A central concern for Durkheim were the ‘disruptive tendencies’ that social change brought upon solidarity.[xl] Anomie helps to explain the rise of Socialist pillars during the days of Hertmans’ grandfather, or the electoral loss of those very same Socialists to the Vlaams Blok decades later, when the Belgian economy began to favor cheap, imported labor.

Economic change links these historical points together, and as such some scholars contend that anomie is but the result of ‘an unfettered striving for success in a capitalist society.’[xli] If social values hinge on greater accumulation of wealth, then those who do not (or cannot) abide by those norms in turn become (and feel) devalued.[xlii]

A much-discussed topic after the 2016 U.S. Presidential election was the proportion of white, working-class voters — previously a bastion of Democratic strength — that went solidly for Trump.[xliii] Similarly, the industrial towns of France’s northern region, once deeply Socialist but plagued by high unemployment, went to Marine Le Pen in the first-round of the French election.[xliv] The pattern holds in Belgium, where the rise of the far-right was made possible by appealing to the working-class. In a landscape of rapid change, many of these voters no doubt struggle with, in Bourdieu’s words, ‘“a sense of one’s place” but also “a sense of the place of others”’.[xlv] Perhaps what is most at stake is erkenning — recognition.

And anomie — a sense of isolation and meaninglessness — surely extends to the refugee-volunteers gathered at the bakery in Ghent that day. In Belgium, as anywhere, there are new expectations and norms to manage. For example, when he is with his Syrian friend in public, Khalid tries to speak only in his new-found, broken Dutch, rather than his native Arabic, to avoid creating discomfort among passers-by. Akram and Haleema are scolded by their conservative Muslim neighbors, who tell them that it is sinful to work with Hand-in-Hand.

Solidarity and recognition are transnational ideas but also idioms that are ‘invoked, debated, advanced, and resisted’[xlvi] by local activists, organization participants, and electorates.[xlvii] Groups like Hand-in-Hand attempt to fill the gaps created by policies like Francken’s, yet solidarity and recognition are just as readily invoked — and exploited by — a far-right party to appeal to a left-behind working-class.

Well, if the old argument goes that the refugees gathered in the bakery in Ghent that day are a drain on society, what better way to prove their usefulness than by fashioning wildly popular cookies to raise money? Speculaas, made from dough kneaded by black African and Muslim hands, shaped into the guise of a Christian mystic renowned for acts of charity and protection of sea-going travelers. The little sticker on the packaging tells the kind-enough buyer: ‘Hand-in-Hand thanks you for your support.’ The zuilen, or pillars of turn-of-the-century Ghent, were split along ideological or secular lines but in their own way followed the guideposts of solidarity and recognition. So it goes for groups like Hand-in-Hand: social pillars, rising out of yesterday’s aftermath to shape a possible future.

 

Hunter Keys is a PhD candidate in the Department of Anthropology at the University of Amsterdam.

Koen Peeters Grietens is Professor and Director of the Medical Anthropology Unit at the Institute of Tropical Medicine in Antwerp, Belgium.

Acknowledgements: The authors thank Khalid, Anne, and others who offered their time in granting interviews, as well as Gert Verschraegen, Mark Hann, Emily Yates-Doerr and Megan Raschig for comments on earlier versions of this piece.

 

Notes

[i] All personal names, aside from politicians, are pseudonyms.

[ii] Van Ginderachter, M. and Kamphuis, M. 2012. The transnational dimensions of the early Socialist pillars in Belgium and the Netherlands, c. 1885-1914: an exploratory essay. Revue Belge de philologie de d’histoire 90(4): 1321-1337; see also recent editorial

[iii] Magnette, P. 1999. ‘Racism and the Belgian State.’ In Westin, C. (ed.). Racism and Xenophobia and the Academic Response: European Perspectives. CEIFO, Stockholm University.

[iv] Pennings, P. 1993. ‘Verzuiling: consensus en controverse’, in Becker, U., ed., Nederlandse politiek in historisch en vergelijkend perspectief. Amsterdam: Het Spinhuis, pp. 97-120, 110-112; quoted in Van Ginderachter, M. and Kamphuis, M. 2012. The transnational dimensions of the early Socialist pillars in Belgium and the Netherlands, c. 1885-1914: an exploratory essay. Revue Belge de philologie de d’histoire 90(4): 1321-1337.

[v] ‘About Vooruit,’ available at https://vooruit.be/en/overvooruit/

[vi] Hertmans, S. [McKay, D., trans.]. 2016. War and Turpentine. New York: Pantheon Books, p. 18.

[vii] Mughan, A. 1979. Modernization and ethnic conflict in Belgium. Political Studies 27(1): 21-37.

[viii] Magnette, P. 1999. ‘Racism and the Belgian State.’ In Westin, C. (ed.). Racism and Xenophobia and the Academic Response: European Perspectives. CEIFO, Stockholm University.

[ix] Mughan, A. 1979. Modernization and ethnic conflict in Belgium. Political Studies 27(1): 21-37.

[x] Lorwin, V. 1970. Linguistic pluralism and political tension in Belgium. Canadian Journal of History 5(1).

[xi] Ibid.

[xii] Hertmans, S. [McKay, D., trans.]. 2016. War and Turpentine. New York: Pantheon Books, p. 64.

[xiii] Ibid., p. 66.

[xiv] Mughan, A. 1979. Modernization and ethnic conflict in Belgium. Political Studies 27(1): 21-37.

[xv] De Witte, H., and Klandermans, B. 2000. Political racism in Flanders and the Netherlands: explaining differences in the electoral success of extreme right-wing parties. Journal of Ethnic and Migration Studies 26(4): 699-717.

[xvi] Ibid.

[xvii] Magnette, P. 1999. ‘Racism and the Belgian State.’ In Westin, C. (ed.). Racism and Xenophobia and the Academic Response: European Perspectives. CEIFO, Stockholm University.

[xviii] Ibid.

[xix] Magnette, P. 1999. ‘Racism and the Belgian State.’ In Westin, C. (ed.). Racism and Xenophobia and the Academic Response: European Perspectives. CEIFO, Stockholm University.

[xx] Billiet, J. and Witte, H. 1995. Attitudinal dispositions to vote for a ‘new’ extreme right-wing party: the case of ‘Vlaams Blok’. European Journal of Political Research 27: 181-202.

[xxi] Lorwin, V. 1970. Linguistic pluralism and political tension in Belgium. Canadian Journal of History 5

[xxii] Hertmans, S. [McKay, D., trans.]. 2016. War and Turpentine. New York: Pantheon Books, p. 243.

[xxiii] Cambré, B., De Witte, H., and Billiet, J. 1999. ’The attitude towards foreigners in Belgium.’ In Westin, C. (ed.). Racism and Xenophobia and the Academic Response: European Perspectives. CEIFO, Stockholm University.

[xxiv] Walgrave, S. and De Swert, K. 2004. The making of the (issues of the) Vlaams Blok. Political Communication 21(4): 479-500.

[xxv] Billiet, J. and De Witte, H. 2008. Everyday racism as a predictor of political racism in Flemish Belgium. Journal of Social Issues 64(2): 252-267, p. 264.

[xxvi] Billiet, J. and Witte, H. 1995. Attitudinal dispositions to vote for a ‘new’ extreme right-wing party: the case of ‘Vlaams Blok’. European Journal of Political Research 27: 181-202.

[xxvii] Ibid.

[xxviii] Walgrave, S. and De Swert, K. 2004. The making of the (issues of the) Vlaams Blok. Political Communication 21(4): 479-500.

[xxix] Erk, J. 2005. From Vlaams Blok to Vlaams Belang: The Belgian far-right renames itself. West European Politics 28(3): 493-502.

[xxx] Ibid.

[xxxi] Walgrave, S. and De Swert, K. 2004. The making of the (issues of the) Vlaams Blok. Political Communication 21(4): 479-500.

[xxxii] Erk, J. 2005. From Vlaams Blok to Vlaams Belang: The Belgian far-right renames itself. West European Politics 28(3): 493-502.

[xxxiii] Pauwels, T. 2011. Measuring populism: a quantitative text analysis of party literature in Belgium. Journal of Elections, Public Opinion and Parties 21(1): 97-119, p. 110.

[xxxiv] www.flandreinfo.be ‘Francken refuse toujours des visas à une famille syrienne’, 20 dec 2016.

[xxxv] http://www.economist.com/news/europe/21718543-providing-humanitarian-visas-still-option-not-obligation-european-court-justice ‘The European Court of Justice declines to upend asylum rules’, 10 March, 2017.

[xxxvi] Gatrell, P. 2008. Refugees and forced migrants during the First World War. Immigrants and Minorities 26 (1-2): 82-110.

[xxxvii] Vanneste, A. 2017. ‘High Voltage Fence (The Netherlands and Belgium).’ In: International Encyclopedia of the First World War, ed. by Daniel, U., et al. Issued by Freie Universität Berlin, Berlin 2014-10-08.

[xxxviii] Coules, Miss, quoted in Purseigle, P. 2007. ‘A wave on to our shores’: the exile and resettlement of refugees from the Western Front, 1914-1918. Contemporary European History 16(4): 427-444, p. 441.

[xxxix] http://www.greatwar.nl/frames/default-fence.html ‘A Deadly Fence’.

[xl] Bernberg, J. G. 2002. Anomie, social change and crime. British Journal of Criminology 42: 729-742, p. 729.

[xli] Hövermann, A., Groß, E., Zick, A., and Messner, S. 2015. Understanding the devaluation of vulnerable groups: a novel application of Institutional Anomie Theory. Social Science Research 52: 408-421, p. 409.

[xlii] Ibid, p. 418.

[xliii] https://www.nytimes.com/2016/11/10/upshot/why-trump-won-working-class-whites.html?_r=0 ‘Why Trump Won: Working-Class Whites’, 9 Nov, 2016.

[xliv] https://www.nytimes.com/interactive/2017/04/23/world/europe/french-election-results-maps.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news&_r=0 ‘How the Election Split France’, 23 April, 2017.

[xlv] Bourdieu, P. 1989. Social space and symbolic power. Sociological Theory 7(1): 14-25, p. 19.

[xlvi] Willen, S. 2011. Do ‘Illegal’ Im/migrants have a right to health? Engaging ethical theory as social practice at a Tel Aviv open clinic. Medical Anthropology Quarterly 25(3): 303-330, p. 306.

[xlvii] Merry, S. 2006. Transnational human rights and local activism: mapping the middle. American Anthropologist 108(1): 38-51.

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