It is 11 am in Vancouver. Danya sits at a desk beside a large window that looks out onto tree tops and electrical wires. Rain pools in the gutters and on sidewalks, and everything is shades of grey and green. In Winnipeg, it is 1 pm. Rob is behind his laptop and surrounded by stacks of papers and books. He looks out the window at the bright blue prairie sky, and imagines for a moment that it might be warmer than is possible at this time of year.
Danya and Rob are both medical anthropologists situated within faculties of medicine at Canadian universities. Danya has been doing research with young people who use drugs in Greater Vancouver since late 2007. Since 2006, Rob has been working with sex worker activists confronting HIV epidemics and global health regimes in India and Kenya. Over the years, they have had many conversations about what happens to anthropological modes of thinking and writing when your job requires you to lead and collaborate on numerous large, multidisciplinary research projects aimed at improving health interventions and outcomes.
Rob Lorway (RL): We’ve talked before about the frenetic pace of being involved in so many different health research projects. How does that impact your writing life?
Danya Fast (DF): I recently wrote about the churn of activity that has been generated by the declaration of an overdose public health emergency in British Columbia, and how young people who use drugs can become swept up in this churn. But, of course, I have also been swept up in it: in a churn of meetings and collaborations and grant writing and manuscript writing. Yesterday I was on a call with the Ministry of Mental Health and Addictions, and I was being asked if one of our projects would be wrapped up in time to guide important conversations that are happening in government. As I’m being asked this, in my head I’m trying to calculate how I can accelerate the pace of that writing project, which is being led by one of my Master’s students. Also in my mind is how I am going to keep moving forward with writing my book when situations like this come up again and again, whether we are talking about suddenly getting a paper out more quickly, or suddenly writing a big, multidisciplinary team grant for a health research project that needs to happen now, so that it can have an impact on policy and program decisions.
RL: In our departments, we do have a lot of protected time for research and writing. Our course-based teaching loads tend to be lower. But then there’s this constant pressure to be responsive to the changing policy arenas that we become part of. Our writing lives are powerfully shaped by public health temporalities.
DF: For me, anthropological writing and health sciences writing often seem to have very different temporalities, and different accountabilities. No matter what I am writing or who I am writing for, I, of course, feel accountable to the young people who have shared their stories and aspects of their lives with me. But, when it comes to the multi-authored papers that grow out of big health research projects, there often seems to be much more urgency, and a much more immediate accountability to the members of the research team, who include busy practitioners and program managers and policy makers, epidemiologists who have the ear of government, and young people who are fighting for change in their communities.
RL: This reminds me of some of the literature on humanitarianism and how a continual state of crisis seems to leave us with little time for contemplation. But I’m also struck by how writing under these conditions is an ethnographic journey into science studies. We’re entangled in what you and I have started calling “intervention life.” There’s a liveliness that unfurls around public health problems and interventions, and we are often as caught up in this liveliness as the people who are the targets of these interventions, although the stakes are very different. How does this liveliness make its way into the writing that you do?
DF: When I’m writing big team grants and multi-authored publications, I’m collaborating with practitioners, managers, decision makers, multidisciplinary researchers, young people who use drugs, and others. All of the back and forth that happens around this kind of health sciences writing – all of the emails, drafts with tracked changes, phone conversations, and text messages – is a rich site of fieldwork, and I long ago began saving particular correspondences and edited documents as a part of my fieldnotes, which then get folded into my more anthropological writing. I often think about my anthropological writing and my health sciences writing as being very separate, but they aren’t.
RL: I do find, though, that I need to mark out certain boundaries for my anthropological writing, which gets pushed to the very edges of my time – often too late at night, around ten or eleven until one in the morning. My anthropological writing gets done outside of the writing that is a part of these live health research projects that react to pressures and demands from decision makers and others. Do you find this as disruptive to the kind of careful thinking you need to do in your anthropological writing as I do? [laughter]
DF: [more laughter] In a word, yes.
RL: At the same time, writing health sciences papers and team grants – like for the Canadian Institutes for Health Research (CIHR) – can be very challenging in terms of how I have been trained to think and write as an anthropologist. The first time I attempted a CIHR grant, a very generous colleague looked at my proposal and said with some humour, “Well, you’re a very nice writer, but you have to learn how to write in passive voice and take out the subject.” And then, by the end of composing that proposal, I tried to return to writing an anthropology paper and it felt like I couldn’t get my head around it for a few days. How have you found moving back and forth between health sciences writing and more anthropological writing?
DF: I do hope that I have been able to bring an anthropological sensibility to some of my health sciences grants and publications, but I agree with you that the two styles of writing don’t sit easily alongside one another. Honestly, I find switching between them exhausting, because I never feel like I can fully immerse myself in one or the other. On a very practical level, I find the Pomodoro method, or something close to it, useful for working on many projects throughout the day. I try and start with my most challenging writing project in the morning, even before I check email. Right now, that’s my book. I’ll aim to do three to four rounds of 25-minute writing sessions, with 5-minute breaks in between each session. And then in the afternoon I’m happy if I can squeeze in one to two 25-minute sessions on a grant application or multi-authored publication, just to keep various pieces moving forward.
RL: In our departments, we’re expected to write these large, multidisciplinary team grants as well as “senior authored” papers, which in the health sciences means you’re at the end of a long list of authors. It signals that the publication is produced by the team you lead. How do you find writing with multidisciplinary teams?
DF: The biggest challenge that I am encountering right now with this is integrating very different political commitments into a single grant proposal. Prior to COVID-19, I was leading a hospital-based ethnography of involuntary admissions for young people following an overdose. Collaborating on this work are physicians who are cautiously in favor of these kinds of admissions. They are desperate to be able to do something to save the lives of the youth they encounter in their emergency room. Also collaborating on this work are young people who use drugs, many of whom are vehemently opposed to involuntary admissions to hospital because of multiple negative experiences of institutionalization stretching back into their childhoods. Everyone agrees that the research should happen, and that we need more funding. But how do we write a grant proposal that brings together such divergent politics, in a way that everyone is reasonably happy with and will sign off on? And what kinds of publications will we be able to co-author together, given these divergent politics?
RL: We also do a lot of writing with students.
DF: Each of my students, fellows, and residents is expected to lead at least one small study that is a part of my broader research program. This kind of writing can be really challenging, because I am often walking someone through leading their first manuscript. I find that people are expected to do this much, much earlier in the health sciences than in anthropology. Someone may have no experience with writing research papers, and now they are being asked to write up original research findings for submission to a peer-reviewed academic journal. I think anthropologists working in departments of medicine can find themselves doing a tremendous amount of writing and teaching writing, because we have those skills, whereas someone who is going through medical school may not.
RL: And what about the young people who you work with? How do they shape the writing that you do?
DF: I’m finding that research funders like CIHR increasingly demand that projects start with community engagement and ideas and priorities. And Vancouver, especially, is a setting with a very long history of drug user activism: there is an expectation that young people who use drugs will represent themselves in research and writing and other kinds of forums. My own work is increasingly funded through community-based participatory action research grants. This means that youth are paid members of my research team. They are co-investigators on grants and co-authors on publications. More and more I’m finding that my job is to step back and center and amplify their voices. They will state very explicitly, “This is the project that I’m willing to contribute to, this is the change I want to make in the lives of people like me.” Those demands shape the writing, and also move beyond writing. Many youth are very active in asking, “What happens next, once we have some research findings to share?” And only collaborating on manuscripts is not something that appeals to a lot of them! They want to do things like podcasts and video projects. Of course, anthropologists are also thinking about how to more clearly center the concerns of our interlocutors, and do work that is in the service of the communities we work with. I really like Laurence Ralph’s latest book The Torture Letters in this regard. It inspired me to think about how I can write a book that young people will read and use.
RL: Again, we are talking about the accountabilities and temporalities of these kinds of collaborations, because it sounds like young people are demanding particular kinds of outputs. How does that sit with the timelines of more anthropological knowledge making?
DF: Some of the young people I work with, and in particular those who identify as activists, bring very clear agendas and timelines to our collaborations. They often want us to quickly produce very straightforward narratives about how, for example, involuntary hospitalization following an overdose is bad, so that we can advocate for particular kinds of systemic change. They are less interested in producing research that gets at the contradictions that these kinds of interventions evoke, whereas that is something I am very interested in thinking and writing about over longer time periods. There always is some give and take in terms of our co-authored health sciences publications, because I still want to bring an anthropological sensibility to that work, but, as I said earlier, I am also very committed to centering and amplifying young people’s voices and perspectives.
RL: Do you ever have that nagging sense that you’re not always producing the best quality writing, because it’s done under particular time constraints?
DF: I feel good about getting research out there that is useful and can create positive change. But yes, I also get nervous about publishing findings too quickly, before we’ve had a chance to really think through how dynamics evolve over longer timelines. This longer view is something that many anthropologists do very well. I’m thinking, for example, of Lisa Stevenson’s book Life Beside Itself, which connects responses to the suicide crisis among Inuit youth in Canada’s North to responses to the tuberculosis epidemic many decades earlier. Some things can get lost with the quickened pace of health sciences research and writing, such as how particular moments of public health emergency and intensive intervention are part of much longer histories of care and control.
RL: Yes, and we dread the thought that our work might inadvertently reinforce particular movements of power that further subjugate people. How do you try to write against that?
DF: What I love about anthropology is the space that is held for the uncertain and open-ended quality of everyday life. Eve Tuck (2009: 417) talks about this as the “not yet” and “not anymore” moments in young people’s stories-so-far.1 And at the same time as anthropology has pushed me towards that, the young people who I’ve worked with over the past decade have also pushed me towards that. They’ve asked me again and again to take very seriously their dreams of place in Vancouver, which are often about everything else that is going on in their lives beyond drug use and homelessness. They are constantly articulating all the ways that things have been otherwise and could be otherwise for them. I hope that my more anthropological writing has been able to evoke some of that. In health sciences writing, there is much more of an impetus to pin down what people are doing and thinking and saying, and then to extrapolate from there, “Okay, what are the implications of that for risk, harm, and health outcomes?” That can be limiting, and as you point out, inadvertently reproduce the very movements of power that we are trying to surface and critique.
RL: Given that health sciences departments tend to place greater value on more applied, practical forms of knowledge production, can you say more about your commitment to anthropological writing that doesn’t always or easily fit within the frame of pragmatism?
DF: I’m sure you feel as I do, that leading and collaborating on large health research grants and publications is more than a full-time job. That could be what we do, that’s it. And I’ve sometimes thought about whether I want that. Within my department, I don’t have to write a book. I don’t have to write anthropology publications. It’s much better, from my department’s perspective, to have a senior-authored paper in Addiction or The Lancet. So why are we carving out the time to do this? Why am I carving out that hour or two in the morning? Why are you working into the nights? And I think it’s because we are still medical anthropologists. I want to carve out time to reflect and to think about my field site, which is also my job. I hope that we have something important to say to the disciplines of medical and applied anthropology because of how we are positioned in relation to intervention life. And that’s why we’re moving between periods of anthropological thinking and writing, and periods of working on team grants and publications – and writing all of the emails that come with those collaborations [laughter].
Danya Fast is an Assistant Professor in the Department of Medicine (Division of Social Medicine) at the University of British Columbia. Her current research traces the intimate and institutional trajectories of young people who use drugs in Greater Vancouver, as they navigate multiple systems of care and supervision. She lives and works on the unceded Indigenous territories of the Squamish, Tsleil-Waututh, and Musqueam First Nations. @danya_fast
Robert Lorway is a Professor of medical anthropology and Canada Research Chair at the University of Manitoba. He analyzes forms of intervention life that unfurl around transnationally-mediated attempts to alleviate the suffering of stigmatized people. He has written two books on the subject, Namibia’s Rainbow Project: Gay Rights in an African Nation, and AIDS Activism, Science and Community across Three Continents. @LorwayRobert
1 Tuck, Eve. 2009. “Suspending Damage: A Letter to Communities.” Harvard Educational Review 79 (3): 409-428.
About the series
Writing Life focuses on the craft of writing in the social studies of medicine. Amidst the current challenges to making texts, this series invites scholars in our field to take time to reflect, in conversation with each other, on how to navigate and nurture their craft.
Each post in Writing Life delves into the black boxes of writing life, many exploring the specificities of producing texts about the lives of those entangled in illness, care, pain, diagnosis, experiment, research, suffering, and recovery. The spirit of the contributions is collaborative – an exploration through dialogue. In crafting the posts, authors also explore a research practice central to our fields – interviewing – and the work and art of transcribing and editing other people’s words.
We continue to openly invite further contributions to the series. Please contact series editors Anna Harris (firstname.lastname@example.org) or Denielle Elliott (email@example.com) to express interest.