April brings many special issues! We’ve already highlighted themed issues on insurance and digitized health, and here are two more themed issues to know about: this month’s História, Ciências, Saúde-Manguinhos is on The Biomedicalization of Brazilian Bodies: Anthropological Perspectives, and the current South Atlantic Quarterly is about Life After Biopolitics. Enjoy!
The Biomedicalization of Brazilian Bodies: Anthropological Perspectives (open access)
Ilana Löwy, Emilia Sanabria
This special issue brings together work on the “biomedicalization” of Brazilian bodies, examining the way biomedical techniques are taken up across the divergent structural constraints afforded by private and public health in Brazil. Biomedicalization – or “technoscientific interventions in biomedical diagnostics, treatments, practices, and health to exert more and faster transformations of bodies, selves, and lives” – forms an assemblage that is both global and highly local. Our aim is to interrogate this phenomenon from Brazil.
The authors, writing from Brazil, Europe, and North America, share a long-standing commitment to analyzing the specific local biologies – and local politics – of Brazilian approaches to health and the body. They probe the incursion of biomedical technologies within richly depicted social worlds, revealing quotidian violence (particularly where women’s bodies are concerned), exceptional forms of care within conditions of precarity, and the intersections of kinship, class, work, and the symbolic capital afforded by biomedical consumption in Brazil. They share a commitment to critically engaging with biomedical conceptions of disease and illness, destabilizing the body as a stable referent (implicitly grounded in a biomedical ontology), analyzing health as a deeply relational, situated, and political process.
The articles draw on critical theory and science and technology studies, departing from a practice of medical anthropology subservient to biomedical concerns. They reveal the vitality of Brazilian anthropology of medicine and anthropological studies of medicine in Brazil. We believe that the main obstacle to the wider circulation of Brazilian studies in medical anthropology seems less the product of an epistemic and methodological incommensurability and more the result of an uneven circulation of our Brazilian colleagues’ work beyond Brazil, due to the paucity of structures that facilitate collaborations and the hegemony of the English language in international publications. One of the goals of this special issue is to showcase the prolific circulations that constitute the field and provide a forum for productive exchange between anthropologists, sociologists, historians, epidemiologists, and public health experts interested in the biomedicalization of Brazilian bodies.
The texts in this special issue examine the elusive and fluid careers of abortive drugs as they travel through legal regimes; the contingencies of psycho-pharmaceuticalization, beyond the resistance or bioreductionist polarization; the stratification of obstetrical ultrasound use; the rich social worlds within which genetic technologies are taken up and made sense of; and the blurring of enhancement and health and the redefinition of what caring is.
The biomedicalisation of illegal abortion: the double life of misoprostol in Brazil (open access)
Silvia De Zordo
This paper examines the double life of misoprostol in Brazil, where it is illegally used by women as an abortifacient and legally used in obstetric hospital wards. Based on my doctoral and post-doctoral anthropological research on contraception and abortion in Salvador, Bahia, this paper initially traces the “conversion” of misoprostol from a drug to treat ulcers to a self-administered abortifacient in Latin America, and its later conversion to aneclectic global obstetric tool. It then shows how, while reducing maternal mortality, its use as an illegal abortifacient has reinforced the double reproductive citizenship regime existing in countries with restrictive abortion laws and poor post-abortion care services, where poor women using it illegally are stigmatised, discriminated against and exposed to potentially severe health risks.
The dilemma of a practice: experiences of abortion in a public maternity hospital in the city of Salvador, Bahia (open acess)
Cecilia McCallum, Greice Menezes, Ana Paula dos Reis
The article discusses abortion and miscarriage from the perspective of women admitted to a public maternity hospital in Salvador (BA), Brazil. Based on qualitative and quantitative research, it draws on participant observation of everyday hospital life. Taking an ethnographic approach, it addresses the hospital experiences of women who had miscarriages or induced abortions, also presenting the views of health professionals. It argues that the way the institution structures care for abortion and miscarriage involves symbolic processes that profoundly affect women’s experiences. The discrimination against women who have had abortions/miscarriages is an integral part of the structure, organization and culture of these institutions, and does not derive solely from the individual actions of healthcare personnel.
“Holy scan” or “picture of the baby?” Biomedicalization and stratification in the use of obstetric ultrasound in Rio de Janeiro (open access)
Lilian Krakowski Chazan and Livi F.T. Faro
Based on ethnographic studies conducted at public and private healthcare facilities in Rio de Janeiro, we argue that the dissemination of (bio)medicalization varies in accordance with the social stratum of the expectant mothers, thereby producing thoroughly distinct fetal and pregnant bodies, as well as different gestational processes. Starting from the basic premise that biomedicalization represents a transformation in the process of medicalization, characterized by the growing incorporation of technoscience into biomedicine, the observed universes displayed different stages in this transformation, consonant with the social stratification of the women who underwent the scans.
Low-complexity biotechnology and everyday aspects of “care:” neonatal testing and sickle cell diagnosis in Brazil (open access)
The article discusses the link between the use of low-complexity biotechnologies and the diverse notions of “care” involved in the process of diagnosing sickle cell disease. It analyses the stories of four different patients and their families, all collected during ethnographic fieldwork, that illustrate several aspects of the experience of living with the condition. These stories demonstrate the presence of what Mol called the “logic of care,” showing how the everyday use of diagnostic technology is set within life flows that relate to other realms of experience with biomedicine, kinship groups and community networks.
This article examines how cancer genetics has emerged as a focus for research and healthcare in Cuba and Brazil. Drawing on ethnographic research undertaken in community genetics clinics and cancer genetics services, the article examines how the knowledge and technologies associated with this novel area of healthcare are translated and put to work by researchers, health professionals, patients and their families in these two contexts. It illuminates the comparative similarities and differences in how cancer genetics is emerging in relation to transnational research priorities, the history and contemporary politics of public health and embodied vulnerability to cancer that reconfigures the scope and meaning of genomics as “personalised” medicine.
Madness and crime: Zefinha, the longest confined woman in Brazil (open access)
Debora Diniz and Luciana Brito
Living in a forensic hospital for the last 38 years, Josefa da Silva is the longest female inhabitant surviving the penal and psychiatric regime in Brazil. This paper analyses dossier, judicial proceedings, interviews and photographs about her. The psychiatric report is the key component of the medical and penal doubling of criminal insanity. Twelve psychiatric reports illustrate three time frames of the court files: abnormality, danger, and abandonment. The psychiatric authority over confinement has moved from discipline to security, and from disciplinary security to social assistance. In the arrangement between the penal and psychiatric powers, the judge recognizes the medical authority over the truth of insanity. It is the medicine of the reasons for Zefinha’s internment that altered over the decades.
Psychiatry, bio-epistemes and the making of adolescence in southern Brazil (open access)
Dominique Pareja Béhague
Drawing on an ethnographic study in southern Brazil, this paper explores how therapists’ attempts to “resist bioreductionist” pharmaceutical use both succeed and crumble. Using a comparative framing, I show that pharmaceuticalization can become an anesthetizing “lid” that interacts with young people’s polarizing micro-politics and is an outgrowth of multi-generational medico-political family histories. This lid, however, is not air-tight and exceptionalities are born out of these very same histories. I argue that both pharmaceuticalization and exceptions to it emerge not through “resistance” to biopsychiatric logics but from the transformative possibilities that the patterned co-production of social, political, and psychiatric life affords.
Cesarean sections, perfecting the technique and standardizing the practice: an analysis of the book Obstetrícia, by Jorge de Rezende (open access)
Andreza Rodrigues Nakano, Claudia Bonan, Luiz Antonio Teixeira
This article discusses the development of techniques for cesarean sections by doctors in Brazil, during the 20th century, by analyzing the title “Operação Cesárea” (Cesarean Section), of three editions of the textbook Obstetrícia, by Jorge de Rezende. His prominence as an author in obstetrics and his particular style of working, created the groundwork for the normalization of the practice of cesarean sections. The networks of meaning practiced within this scientific community included a “provision for feeling and for action” (Fleck) which established the C-section as a “normal” delivery: showing standards that exclude unpredictability, chaos, and dangers associated with the physiology of childbirth, meeting the demand for control, discipline and safety, qualities associated with practices, techniques and technologies of biomedicine.
Legal remedies: therapeutic markets and the judicialization of the right to health (open access, in Portuguese)
João Biehl and Adriana Petryna
This study draw on the struggle of parents of children with mucopolysacchar idosis to access expensive drugs in the name of universal right to health. The work explores how, in Brazil, right-to-health litigation became an alternative pathway to access health care and shows that several public and private stakeholders dispute the judicialization of health. Biotechnology is, therefore, understood to remake human and social worlds as it opens up new spaces of ethical problematization, desire, and political belonging.
Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil (open access, in Portuguese)
Alexander Edmonds and Emilia Sanabria
This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazil’s regulatory context and societal expectations placed on medicine as a means for managing women’s reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of women’s health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.
On the history of medicine in the United States, theory, health insurance, and psychiatry: an interview with Charles Rosenberg (open access)
Charles Rosenberg and Rafael Mantovani
An interview with Charles Rosenberg conducted by Rafael Mantovani in November 2013 that addressed four topics. It first focused on the way in which Rosenberg perceived trends and directions in historical research on medicine in the United States during the second half of the twentieth century. The second focus was on his experience with other important historians who wrote about public health. Thirdly, he discussed his impressions about the current debate on health policy in his country. Finally, the last part explores some themes related to psychiatry and behavior control that have appeared in a number of his articles.
Life after Biopolitics (open access)
Sara Guyer and Richard C. Keller
[excerpt] We are convinced that biopolitics has not outlived its usefulness. Hailing from the fields of literary criticism and history, we find a number of ways in which the biopolitical is an important frame with an enduring influence. Yet the study of life in the humanities and the qualitative social sciences has developed such that biopolitics alone is no longer sufficient. As the essays in this issue demonstrate, we live and think in an era that is after biopolitics: one in which the idea of biopolitics will remain a part of meditations about life, but which will call for other frames for conceptualizing life. To capture this understanding, we want to suggest that biopolitics not only survives these shifts but also that survival inheres in biopolitics, that there is no concept of life in biopolitics that is not, at the same time, a notion of survival. For this reason, among others, the “after” of this volume’s title can be heard to resonate with the sur of survival and the history of thinking about living as living on among those who have and have not reflected on biopolitics by name.
Scholars of biopolitics widely assume that the life addressed by power = human life, with a reassuring unconsciousness of having left anything at all out of the equation. Recent research contends that animals are at least as much as human beings subject to varied techniques for managing life. Such “zoopolitical” arguments are, however, likely to be effectively defused, given that theories of biopolitics and politics alike assume that human beings are the real subjects of politics and nonhumans are excluded from the possibility of justice. This essay argues that such an assumption overestimates our ability to answer the question, who are the real political animals? Through a reading of Hannah Arendt’s critique of human rights, the essay argues that the traditional assumption that political status is available only to human beings relies on the totalizing power of metaphor to confuse human life and politics. It offers an account of the challenge posed to this metaphor in a brief scene from the 2011 film Rise of the Planet of the Apes. Rather than a recognition of political status based on the nature of animals, what such a challenge amounts to is the apprehension by the viewer of his own stupidity.
Catastrophes now are part of our daily lives, as though the apocalypse could hit us each morning. Yet this crazy relation to the world is a sane response to postmodern society. A new form of governance that I call the biopolitics of catastrophe has come into being in the attempt to metabolize this new relation to the world, this new sensitivity to potential disasters. Biopolitics of catastrophe has two modes: (1) an averting mode, whose goal is to avert events in advance, and (2) a regulating mode, whose function is to erase events after the fact. Grounded on this perverted temporality, this new form of governance blocks the advent of an ecopolitics that could act on the causes rather than the effects of the environmental damages that we are already suffering.
Reconsidering Mimesis: Freedom and Acquiescence in the Anthropocene
Elizabeth R. Johnson
In 1993 Michael Taussig’s Mimesis and Alterity revitalized the power of the mimetic faculty to craft a vision of nature that was neither the alienated subject of modern science nor the passively malleable medium of late twentieth-century social constructivism. Taussig drew explicitly on a tradition of earlier twentieth-century scholarship—Walter Benjamin, Roger Caillois, and Max Horkheimer and Theodor W. Adorno—that located in the mimetic faculty a way out of a techno-fetishized social milieu. This essay explores how mimesis has once again been endowed with revolutionary potential in the contemporary moment through the growing field of biomimicry. I show how mimesis promises a way toward a future free from human hubris and ecological catastrophe—and a way out of the conditions that have created the Anthropocene. I explore how this works in biomimetics, with a detailed look at one of the most celebrated examples of the biomimetic paradigm: the gecko’s foot. But, I ultimately suggest that what has been so seductive about mimesis throughout history is that it offers a “way out” of political confrontation. In doing so, I argue mimesis too easily serves as a double mirror—rather than transform production, nonhuman life at the level of biology becomes a force for production.
Gender Abolition and Ecotone War
Joshua Clover and Juliana Spahr
This essay begins with two examples where certain precapitalist material entanglements were taken up and transformed by capital. One is the Hawaiian creation chant, the Kumulipo, and the complicated ecotones that define that poem. The other is gender. Neither ecotones nor the gender distinction arise with capitalism, but capitalism has been spectacularly successful in using both toward its own ends. From there the essay argues that the ecological crisis is a single crisis of capitalist accumulation that develops over time and appears differently in different moments, and any opposition to crisis capitalism (which is to say, capitalism tout court) must turn to synthesize the problematics of ecology and feminism at the level of the whole. The particular transformation in which we are interested concerns the remaking of an aggregate arrangement, various and elaborated and tending toward a whole, into a systematic differential purpose-built to accumulate capital. We argue that the tracing of this history will lead us not merely toward a useful sense of how we date the Anthropocene but toward a politics adequate to the present and an idea of where to intervene.
The Biopolitics of Dignity
My essay traces the genealogy of the notion of human dignity in modern French law. My goal is to explain how and why dignity has come to be associated with national belonging and public order, as evidenced by the 2010 law banning “face coverings” in public spaces or by the recent pleas to revive “national indignity” after the attacks on the offices of Charlie Hebdo. I argue that the definition of dignity circulating in French law since the 1990s is a corporatist one. Rather than promote abstract individual freedom, human rights, and democratic inclusion, this understanding of dignity (theoretically much closer to that of political Catholicism and personalism than to the Kantian or liberal understanding of dignity seen in American law) insists on the obligations that the individual has toward the community, toward the social, and, in its most recent formulations, toward France. I propose that human dignity in the French context be considered less as a value intrinsic to a person than as a project of biopolitical rule.
During France’s Third Republic, a wide-ranging discourse about animal societies offered a particularly powerful way to redefine the ideological underpinnings of human association in the republican national state. Drawing on precedents in comparative anatomy and physiology, Alfred Espinas drafted his pioneering work Animal Societies (1877) in the wake of a period of pronounced national failure. In what was widely recognized as the “first chapter” in French sociology, Espinas’s work signaled a growing struggle in the French university that echoed a larger struggle in the early Third Republic between different elements of the national bourgeoisie. Biology was critical to this struggle because it offered conceptual resources that the largely liberal terms of French academic philosophy did not possess for conceptualizing the differentiation and interdependence of social elements. Organicism thus provided a strong set of ideological tools for regulating hierarchical social relations between classes in a period of working-class agitation and organization. At the same time, the prestige of biology allowed a newly emergent element of the lower middle classes to pursue its social ambitions in the university field at the expense of an established academic elite.
The Poisonous Ingenuity of Time
Drawing on ethnographic work with one family in Baltimore that began over a decade ago, I consider how time, symptom, and forms of vulnerability and precarity come to shape polypathia (comorbidity). First, I attempt to demonstrate how life with concurrent and recurring illness has a character more dense than interwoven disease etiologies or a general pattern of symptomatology. Chronic illness in its plural form offers terms of life and living that are contingent, disruptive, and dissolving—not so much situated in time as out of step with its familiar cadence. Second, I consider time through the lenses of return, loss, and repair. Ethnography, like illness, has a rhythm, and it is this shared, distorted meter that the essay follows. Life—filling up and emptying out between past and present—is precisely the object here. Chronic illness acts as a temporal threshold through which life finds new ground or is set adrift.
Biopolitics and Population Aesthetics
This essay employs the concept of population to articulate the logic of a dominant style of contemporary thought, practice, and affect. This style, which underwrites cultural productions as diverse as reality TV, para-scholarly endeavors such as Wikipedia, and biomedical initiatives such as personalized medicine, hinges upon locating individual idiosyncrasies within large populations. The essay’s first two sections draw on Michel Foucault’s account of the historical emergence of biopolitics to illuminate the metaphysical assumptions that underwrite the modern concept of population. The third section proposes that these assumptions allow us to see the concept of population as an implicit media theory (i.e., populations are media that capture individual variations) and provides as an early twentieth-century example Leland Stanford’s interest in applying horse trotter breeding techniques to human populations. Sections four and five sketch the expansion of population logic in the post-WWII period in areas such as the US higher educational system, personalized health, and the neoliberal concept of “the market.” The sixth section proposes that these developments eventuate in “population aesthetics,” as the logic of population becomes the enabling frame for judgments concerning what is beautiful and ugly, as well as for our intuitive sense of the relationships between individuals and collectives.