It’s an extraordinary privilege to read these responses to Fatal Isolation from five scholars whose work I’ve long admired. They constitute an ideal field of critics — three anthropologists and two historians who study issues such as humanitarianism, disaster and advocacy, citizenship, the environment, and the welfare state and marginality in contemporary France — interests that intersect with the central problems I explore in the book. Fatal Isolation engages with a particular disaster. But in doing so it explores the role of the state and citizenship in producing vulnerability and resilience; with the ecological particularities of Paris and its micro-environment of risks; and with the historical shaping of a hazardous landscape, a population at risk, and the social imagination of marginality.

A glance at the death toll of the 2003 heat wave indicated it was an extreme event by any measure. Producing nearly 15,000 deaths in less than three weeks, it ranks as the worst natural disaster in contemporary France. The disaster also struck powerfully unevenly, with the elderly (and elderly women in particular) as well as urban populations bearing the brunt of the mortality burden. While there are so-called natural factors that explain these disparities, a growing literature on disaster indicates that social factors are at least as important in understanding such inequality. Disasters, like epidemics, expose social fault lines at least as much as they reveal trends of nature.

The population I study in the book illustrates these fractures with stunning clarity. I quickly came to focus on a particular subset of those who died: the roughly one hundred “forgotten” victims of the disaster, those whose bodies remained unclaimed by friends or family after their deaths, and who were buried at public expense in a cemetery outside Paris in September 2003. They represented one in ten of those who died in Paris during the heat wave, and their stories reveal a tragic lapse in citizenship, social solidarity, the welfare state, and the social ecology of contemporary France. They were those who lived and died alone, mostly in desperate poverty, and with a host of other burdens that left them isolated and vulnerable to the particular agency of the heat. The “forgotten” constitute a biased sample — they were by definition marginal, with little family and few social contacts. But by focusing on a marginal population who lived every day of their lives in a state of extremity, I learned a great deal about the uneven burdens of extreme circumstances on different social groups.

Peter Redfield, Camille Robcis, Sara Pritchard, Kim Fortun, and Miriam Ticktin have each hit upon critical elements of what I attempted to achieve in Fatal Isolation, and I thank them for their close readings of the book. Redfield and Robcis focus on the intersections of security and the social in contemporary France. Redfield signals exactly what gripped so many French in the immediate aftermath of the disaster: a sense of betrayal at the notion that such a humanitarian disaster was possible in a place whose very identity rests on a notion of itself as the birthplace of human rights and humanitarianism. He raises the question, “when has life not been precarious?” And this is of course the case: life, especially for those on the margins of society, has always been fragile — it is merely our expectations that have changed. This is especially the case in a place like Paris, whose extensive “artifice and infrastructure,” as Redfield notes, has offered a near-perfect technology for regulating the environment and its arbitrary powers. Yet it was precisely the built environment of contemporary Paris that was a principal mechanism of vulnerability during a disaster that stripped a population “to its skin” as it sought an elusive refuge from the heat. While those who died during the heat wave lived lives that were precarious by any measure, it was the particular agency of a heat disaster that exploited this urban social and architectural ecology to deadly effect.

Robcis also focuses on the question of the social. As she argues, the deaths of marginal figures during the heat wave “seem to expose, once again, the failures of the republican social model to integrate its citizens.” The hand-wringing that surrounded the heat wave is in many ways unsurprising. Those whom the heat struck down were those who had in many ways failed to integrate into the republic. The homeless, the mentally ill, the disabled, and the elderly (and in particular, the unmarried elderly women who died in droves in 2003) fail to be more broadly representative of the republic, calling attention to difference rather than fraternity in much the same way that, as Robcis has argued herself in her marvelous book, The Law of Kinship (Cornell, 2013), alternatives to the heterosexual couple have threatened to disrupt the very foundation of the social. These factors were, I think, critical in shaping the political and social responses to the canicule.

Robcis also wonders about the effectiveness of employing Agamben’s notion of bare life to the heat wave, arguing that the centrality of the Holocaust to Agamben’s theoretical frame is inescapable. This shadow is ever-present in Agamben, but I think that parts of his argument can extend beyond that limited scope. One of the essential components of Agamben’s argument in Homo Sacer is that a prior and near-total rhetorical dehumanization was an essential precondition of genocide. As I argue in chapter 4 of Fatal Isolation, a powerful rhetorical dehumanization of the elderly unfolded over the decades that preceded the heat wave, allowing not for their extermination, to be sure, but at least to a general indifference to many of their lives and deaths in isolation and poverty, at the margins of citizenship. My intention couldn’t be further from blurring the lines between genocide and disaster; it is rather that I find the rhetorical components of dehumanization a compelling notion that can illuminate dramatically different categories of marginalization and suffering.

Given the influence of Kim Fortun’s work on Bhopal, I’m deeply honored by her generous response to the book. She and Redfield share an important insight into the intersection of late-industrial social forms and new vulnerabilities — the precarious lives betrayed in an era that promises social security — and signals the need for new methods to understand the emerging hazards of the contemporary world. Much as Kai Erikson noted in his essay collection, A New Species of Trouble (Norton, 1995), new political economies are colliding with environmental change in unpredictable ways, often leaving the world’s least resilient populations reeling. The extraordinarily rich work of demographers and epidemiologists in the aftermath of the heat wave has produced a portrait of the aggregate nature of these risks for an aging, poor, and often isolated French population. As Fortun notes, I attempted in Fatal Isolation to build on their work by illustrating through ethnographic and historical methods the gaps that such aggregationist work necessarily produces. But such work is often dependent on a rich quantitative foundation: what I’m arguing (to paraphrase Arthur Kleinman) is not that we need less “science” in epidemiology, but instead that we need to think more inclusively about what kinds of science are relevant to the production of epidemiological knowledge.

If there was one thing besides disparity that marked the 2003 disaster, it was its long-term making. Miriam Ticktin seizes on this issue of temporality in her comments. The catalyst for this overwhelming death toll was the extreme heat of August 2003, but the foundations for such a catastrophe had been building for decades. One can make the same case for many disasters: while it is easy to pinpoint a disaster in meteorological terms, it is far more difficult to identify its social ends and beginnings. And indeed, it is the social component that most clearly defines a disaster. One can argue that Hurricane Katrina formed on 23 August 2005, and that it dissipated eight days later. Yet the social foundations of vulnerability — poor housing stock, the concentration of poverty in the Lower 9th Ward, a politics of mistrust — developed over the course of at least a century, and, as Anne Lovell has demonstrated, casualties of the disaster continue to mount, but do not figure in any official death toll: those displaced by the disaster who may turn to suicide years later as a function of deracination, or the chronically ill whose care regimes are disrupted by displacement and who die prematurely as a result. The landscape of Parisian vulnerability, the dehumanization of the elderly, and the discounting of marginal life formed over the long term, and a true accounting of the disaster that restores legitimacy to those deaths — rather than merely attributing them to a “harvesting effect” that pushed the already frail to a slightly earlier death — must incorporate this broader temporal frame.

Finally, Sara Pritchard takes from her reading of the book the centrality of the anecdote. She offers a poignant series of anecdotes of her own, indicating the ways in which the disaster may well have registered for its survivors. She produces a heart-rending narrative of an elderly woman in her neighborhood, a woman who struggled to carry her groceries down the street, much less up the stairs to her apartment. Although Pritchard did not know her or where she lived, she thought about her and her fate in the aftermath of the heat wave. Pritchard was not alone in this response: many of the memories I collected in my fieldwork are similar, as neighbors and shopkeepers recollected their witnessing of this kind of daily suffering in telling the stories of the anonymous deaths of 2003. Where aggregation serves a critical purpose in establishing the broad, population-level trends that mark public health, the anecdote has a capacity to rehumanize and to individuate the faceless nature of epidemiological bookkeeping.

Pritchard also reminds us of the ways in which our personal memories can affect our recollection of entire periods. She writes that a close friend of hers — a colleague and fellow historian of France — had died just before the heat wave, and that this death became enmeshed with a more general sense of loss in that summer, as well as with her own experience of the heat in France. This was also a colleague and friend of mine. For me as well, her death lingers in a sea of memory that configures that time and place. It is perhaps as a result of this entanglement that I found the anecdote such a compelling medium through which to tell the story of the heat wave: one rich with the possibility of encapsulating the links between individual life and loss amid the broad sweep of historical experience.


Richard C. Keller is Professor of Medical History and Bioethics at the University of Wisconsin-Madison, where he is also Associate Dean in the International Division. He is the author of Colonial Madness: Psychiatry in French North Africa (Chicago, 2007) and is the editor, with Warwick Anderson and Deborah Jenson, of Unconscious Dominions: Psychoanalysis, Colonial Trauma, and Global Sovereignties (Duke, 2011).


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