Hurricane Sandy relief

The concept of hurricane relief and recovery, viewed from the medical anthropology perspective, serves to disguise structural inequalities that in part produce the patterning of hurricane devastation. Medical anthropologists have documented the ways in which valences of disaster compound social violence, and that humanitarian relief creates its own moral conundrums (Briggs 2003; Lakoff 2010; Lovell 2011).

A vibrant discourse has emerged in the popular media following hurricane Sandy regarding the uneven level of damage across neighborhoods of New York City. While low-income areas like Redhook and Rockaway were ravaged by the storm, wealthy neighborhoods and areas of importance to global capital, the Upper East Side and Wall Street, were spared. The long process of utility reconnection and rebuilding in these outer borough neighborhoods were in thrown in stark relief by a rapid return to normalcy in Mahattan. As electricity, transport, and aid efforts were launched, the Occupy moniker was applied to grassroots volunteer efforts to organize on-the-ground solutions in hard-hit communities. The Staten Island mayor prominently decried the American Red Cross for failing to respond to the disaster effectively, and FEMA complaints were logged; a dialogue emerged criticizing bureaucratic humanitarian enterprise.

As the national conversation turns to future storm protection, possible designs to protect the city from rising water may continue to, or even worsen, the tendency to disproportionally direct flood-waters to poor neighborhoods. As the concept of building dikes or sea gates for New York City increasingly becomes an idea worth entertaining, the New York Times hosts a discussion on the subject. Contributors wonder if a sea gate project would be “treating the symptoms, but not the cause,” identifying as global warming and rising sea levels as the factor causing the observed devastation.

Meanwhile, US news outlets unevenly covered the storm damage. Focus remained largely on urban American sites in New York City and New Jersey, with minimal coverage of storm after-effects in rural areas in the region, and even more glaringly, in the regions of the Caribbean affected by the same storm. Short news clippings referred to fears that the storms effects in Haiti might cause a resurgence of existing epidemics; yet these epidemics continue to be represented as caused by “natural” disasters, rather than by structural violence.

In other Sandy-Anthropology intersections, colonial-era human remains were unearthed in Connecticut, and anthropologists literally called in to the scene; two posts on transportation habitus disruption and the storm at Savage Minds; and great photoblogging of the hard-hit neighborhoods at humans of new york.

Marijuana legalization

One of the many outcomes of the 2012 voting season – outside of the presidential politics tango – was a significant change in the legal status of marijuana in several states.

While Massachusetts joined numerous other states in legalizing medical marijuana, Colorado and Washington registered historic firsts, when, in separate ballot initiatives, voters approved measures to legalize recreational use of marijuana. Eventually, opinions columnists argue, Massachusetts may follow suit and legalize pot altogether.

Largely absent from the popular media coverage of the event is a critical reflection on how marijuana became illegal in the first place in the United States, and, relatedly, how plant-based ritual and healing substances came to be regulated and adjudicated under the aegis of a medicalized nation state. Medical anthropology, meanwhile, recognizing the temporal and cultural contingency of various healing practices (e.g. Young 1995; Cohen 1998), is well prepared to encounter marijuana as a plant-based medicine (Good 2006).

The criminalization of marijuana over the 21st century has had profound consequences: “in less than the lifetime of one old man, cannabis has moved from being a mainstay in the world’s medical pharmacopeia to a major cause for incarceration.” (Ellis 2008)

Meanwhile, the pharmaceuticalization of American healing practices is left in sharp contrast. I once watched my PhD advisor deliver a lecture to a room full of undergraduates about the ways that the medical profession gained primacy over herbalist healers amongst the US population in the 19th century. A palpable sense of disbelief circulated, as students reckoned with the realization that the noun “medicine” has not always referred to something manufactured and dispensed in an orange plastic bottle.

Now, following the election, in one more state we have the prospect of acquiring a plant-based medicine in a plastic bottle. Massachusetts officials in the state’s Department of Public Health are stuck with the logistics – they must figure out how to enact the ballot measure. They have the experience of 17 other states and the District of Colombia where medical use of marijuana is already legal to draw on (according to the New York Times).

A dissertation by Thomas Heddleston (UC Santa Cruz 2012) on medical marijuana legalization movements takes an ethnographic look at the concept of prohibition, and the way that medical marijuana in California shifted from a movement to an industry. A Boston Globe article on the subject (linked above) closes with a quote on a similar note: ‘‘it’s a billion-dollar industry that we just opened the door to here in Massachusetts. They are going to come in and capitalize on anyone in pain and our young people.’’

And, as Jon Stewart points out with characteristic comedic sass, all this legalization will mean that the national conversation about marijuana will have to move beyond stoners-with-the-munchies jokes, and toward a real consideration of the powerful ritual and social role this plant substance carries. On a popular Massachusetts website, comments abound and passions fly.

The legalization votes all contribute to the conundrum of American confederacy: as the new state laws are in direct contradiction to federal laws, solutions must be brokered. In this sense the cannabis plant and its conscious-altering properties become a pivot for the intersection of bodies, cognition, and the authority of the state. The state-federal conundrum unveiled in this process points to the precarity of structures of political authority, and their intimate connection with the so-called medical.  And institutions face a similar dilemma: The Chronicle of Higher Education points out that the recreational use legalization vote in Washington and Colorado creates a conundrum for university policy.

Other items from around the web:

• aspiring anthropologist (on mars?) and popular neurologist Oliver Sacks was biografied in New York Magazine
• the debate rages on over the bioethics of obamacare (so many links! start here and here)
• John Franklin Stephens’s open letter to Ann Coulter, following her callous and careless use of the word “retard” in a tweet, became an international rallying point for conversations about cognitive difference
• even after the election, Obama myths abound still – and misinformation is sticky according to a post at cognition and culture
• linguistic anthropologists take issue with the “neutrality” of the term “illegal immigrant”
• a video on doctors without borders/ MSF’s World Food Day in October
• a college student in GB chooses anthropology over medicine as a major and blogs about it
• a dengue fever epidemic in India is under-reported due to Sandy coverage
• a new pop science take on human cognition, reviewed at the New Yorker

Academic Works Cited:

Briggs, Charles. 2003. Stories in the Time of Cholera Racial Profiling During a Medical Nightmare. Berkeley: University of California Press.

Cohen, Lawrence. 1998. No Aging in India: Alzheimer’s, the Bad Family, and Other Modern Things. Berkeley: University of California Press.

Ellis, Bernard. 2008. Review of Dying to Get High: Marijuana as Medicine by Wendy Chapkis and Richard J. Webb in Contemporary Sociology 38(5)).

Good, B. 2006. Medicine, Rationality, and Experience: An Anthropological Perspective. Cambridge: Cambridge University Press.

Lakoff, Andrew. 2010. “Two Regimes of Global Health.” Humanity: An International Journal of Human Rights, Humanitarianism, and Development, 1 (1): 59–79.

Lovell, Anne M. 2011. “Debating Life After Disaster: Charity Hospital Babies and Bioscientific Futures in Post-Katrina New Orleans.” Medical Anthropology Quarterly 25 (2): 254–277.

Young, Allan. 1995. The Harmony of Illusions: Inventing Post-traumatic Stress Disorder. Princeton  N.J.: Princeton University Press.

“Overwhelming” was the common descriptor for AIDS 2012 from delegates who I encountered, as well as those reflecting upon the conference on-line.  With 23-25,000 attendees, and between the events, constituencies, protests, networking, and the literature and other material passed out, it proved difficult to find anchors at this five-day gathering.  Despite this, there were particular ideas and initiatives promoted in the lead up, during, and immediately following the Conference. The topics are boosted through the high-profile status of the AIDS Conference, and by the popular media access afforded to those who gathered.

I track the issues in the usual on-line sleuthing, and add in coverage by the International AIDS Society as well as my attendance during the first days.

1.         Before the Themes, a Picture of Conference Happenings:

Who was there? A better question might be, who was noted not to be?  While the Washington DC location was celebrated for signaling the lifting of the US travel ban for people with HIV, it was not lifted on sex workers and drug users. As a result, non-American members of these groups were excluded from attendance.  As KFF summarized based on coverage in the Science Speaks blog, the exclusion set off a petition, conference protests, and the staging of alternative conference events in Kiev, Russia, and Kolkata, India.  Melissa Grant also documented these issues on 7/22 and 7/24 for The Nation. In addition, Mia Milan writes for South Africa’s Mail and Guardian of the low presence of nonwestern journalists.  She notes sitting on a media panel of 10 as the lone African representative. She contrasts this, however, with the increased number of “African voices” on Conference panels.

Descriptions of conference proceedings mention the following spaces. On the below-ground floor at one end of the convention center was the ‘Global Village,’ the only area free and open to access and called the ‘grassroots zone’ by a video journalist for The Body.  These halls consisted of colorful civil society booths, some of which sold crafts to fundraise for their organizations.  Large screens broadcasted presentations from the closed sessions, and various events were held around the halls.

On the Conference’s opposite end were the exhibition halls featuring corporate, government, and large philanthropic organization booths.  Rather than raising money, they gave items away – mostly snacks, from what I could tell. The Chevron booth generated buzz, as one of the Global Fund’s first corporate partners who continues to be giving away large amounts of money to Fund-related initiatives.

Between these zones were poster and panel sessions where members of the HIV/AIDS community and other prominent voices (celebrity, politician, and other) presented their work.  Presentation summaries are now circulating (see UCSF blog), as well as clips of note-worthy sessions; e-health chose to highlight Stephen Lewis on treatment for HIV positive 0-3 year olds, a session on nutrition, on the uptake of HIV home-testing kits, and the South African Deputy President’s remarks.

Traveling between the sessions were opportunities to view art installations and performance groups, and drink lots of Starbucks coffee.

2.         Measuring Activism

A topic recently taken up on Transcriptions, the Conference also explicitly raised the topic of activism.  A blog post at Health Affairs commented that the conference offered spaces where power could be ‘contested.’  Indeed, one post notes various marches and protests (see this photo on the Global Fund website) throughout the week.  An anti-circumcision group camped out across from the center’s main entrance.  And protestors interrupted Hillary Clinton’s address calling attention to US trade negotiations to limit generic drug production (the issue is described in the Health Affairs blog).

Yet, waning activism is also of concern in the days following.  “Clinton at the AIDS Conference: ‘we have to deliver’” on the Gates Blog cites to a posting in the New Republic observing that the conference was less fired up than in previous years (note that comments posted to that article take issue with it).

Another sighting of activism is found in the speeches by global health players who used their addresses to figure them as central to HIV/AIDS history.  Newly appointed World Bank President Jim Kim said in his address that the HIV activists “led the way – putting pressure on politicians and drug companies to act,” and UNAIDS’ Michael Sidibe echoed Dr. Kim.  In a noteworthy move, Hillary Clinton used the protest that started up during her talk as a way to also sign-post the importance of activists to the HIV/AIDS response.

These moves may reveal a strategy playing out to co-opt activist discourse and infuse it with support for state-sponsored campaigns like the AIDS-Free Generation heavily promoted by the US State Department.  Drawing on the prominence of the activists may be an attempt to counter what may be (or is imagined to be) the setting-in of ‘HIV/AIDS fatigue,’ as was hinted at in a PBS AIDS 2012 wrap-up interview, posted at Insite.  A prominent editor from the science journals states that a current “challenge” in the movement is to maintain enthusiasm and, in turn, funding levels.  In view of this admission, even the ramped-up language  of ‘cure!’, ‘End AIDS!’, and ‘AIDS Free Generation!’ finds a new valence,  one that uses these labels to connote not only what’s possible, but attempts to inspire feelings about them, which will lead to particular forms of action.

A future Broadsheet will attend to the circulation of these new terms, but we can already identify traction in the establishment (spoiler: see language adopted by the AIDS Alliance).

3.         Beyond Partnership

Taking ‘partnership’ language a step further, African countries were praised throughout the week for “putting away money” towards healthcare, as reported by PlusNews.  Celebrating African leaders for coming up with their own strategies to fund HIV/AIDS interventions is a position that’s been promoted by the UNAIDS for awhile; just before the Conference began, Huff Post ran an op-ed (7/17) by UNAIDS’ Michael Sidibé stating, “Astute African leaders are striving to ensure … a new paradigm of partnership for sustainable health development — a partnership that is led by Africa, for Africans, through African-sourced solutions.” At AIDS 2012, other prominent speakers like Bill Clinton joined and perhaps bolstered UNAIDS’ position.

4.         Special Populations: Women and Children

Framing HIV/AIDS in terms of populations of risk, vulnerability, and equity is nothing new, but take note of the particular headliners from this Conference: women and children.  Those working on serving these populations were ‘energized’ at AIDS 2012, as reported in the UCSF blog.  AIDS Map links to coverage about this group too.  An article synthesizing statements made throughout the conference showcasing women includes: women as long-time champions of the struggle; women as oppressed and therefore needing specific interventions (see the roadmap); and women as gateways to address the needs of “vulnerable families” and others. The Huffington Post’s Global Motherhood blog also echoed these issues.

In line with Kathleen Sebelius’ address to AIDS 2012 noting the gender and HIV/AIDS dimension, the US Health and Human Services announced its release of $68 million for U.S.-based HIV programs focused on linking HIV+ black women to care and treatment (see praise for this in an article by Phil Wilson on for The Body).

5.         Funding Rationalities

How to fund the newly-elaborated multi-pronged strategies dominates the discourse.  The ‘reality’ of the cost of coverage despite global recession is widely noted (AIDS MAP has thorough coverage, including this well-researched piece), as well as discussions about the trade-offs between HIV/AIDS funding versus other global health priorities (see the World Bank sponsored debate and this Bloomberg Businessweek article).

An earlier Broadsheet noted that funding discourse is intensifying a corporate-rationalist logic. Not only must interventions work, but they must work better than others to demonstrate “value for money” and “high impact interventions,” (cited by KFF, 7/19).

In fact, the language of comparative advantage as a targeted approach was used by Global Fund manager Gabriel Jaramillo interviewed from AIDS 2012.  In one passage, he says,

“Once we know where the opportunities are, then we can talk to our partners to see who is going to take care of them. We can also motivate the countries to come to us for specific funds for very specific populations because we know they will be very effective. We will be geared to make that investment because the returns are so huge, and that is what my donors what to hear. They want to know from me that I know where we are putting that money and I understand what kind of impact we are going to get. I am very targeted at what I am doing, and that’s the name of the game now. Money is scarce, donors are more demanding. Rightly so.”

Setting aside the fiction that interventions always follow the plan, two issues to highlight: one is confirmation of the increasingly Fordist, improve-the-production line mentality on display.  The other is the attachment of such logic to donor expectations, defined as promoting confidence that they will have a good ‘return on investment’ for their contributions.  By foregrounding the donor, we might ask questions like: What are the effects of donor expectations on the production of interventions, in imaginary and real terms, for governments, agencies, and people on the ground the world over?  And, to the point of activism being praised and promoted as I described above, how is it figured with/against this notion of donors driving the agenda? Is this Global Fund-speak, or indicative of larger donor-related institutional logics and arrangements?

6. Miscellaneous

How new are the AIDS 2012 messages?  Listening for overlaps took me to the US Global AIDS Coordinator, Eric Goosby’s interview at AIDS 2010. There, he iterates many of the points that were central to this conference: the focus on women and children, and an community and family improvements; ‘country ownership’; and prevention as treatment. What hasn’t lasted? Microbicides, for one –the promise of 2010 does not have a presence at coverage in 2012.

I end with a small but critical observation from the proverbial soap box.  Transcriptions aims to foster cross-disciplinary conversations, pushing all of us forward at the intersections of biomedicine, public health, and the social sciences.  A blog posting like this one reminds us of our challenges. While the writer’s scientific review is well-executed, his offerings on the “non-scientific” side of the Conference undermines the importance of the issues we are confronting. Side-trips to museums and smug remarks about the activists’ volume will not foster our dialogue in productive ways.  We need better ways of taking each other, and these pressing issues, seriously.

 (de)humanitarianism

Paul Farmer has, over the past years, come to represent the beacon of a medical anthropology that blends the medical impulse of the Hippocratic oath with an ethical humanitarianism; Farmer’s key contribution is that being poor – an expression of “structural inequality,” rather than some personal moral failing –  is no reason that one ought not to receive the best possible medical treatment. Arguing that, from the mountains of Haiti to the prisons of Russia, health is a human right, Farmer and his colleagues at Partners in Health (PIH) have become a ubiquitous presence in conversations about global health, international humanitarianism, and the public face of medical anthropology.

However, some medical anthropologists remain concerned that Farmer’s convictions leave much unexamined. Is the PIH strategy really about combating structural inequality, or is it just a wolf in sheep’s clothing, liberal individualist solutions masquerading as redemptive relief?

In a recent blog post, Sam Dubal, a former student of Farmer’s at Harvard Medical School, and now a joint MD/PhD student in medical anthropology at UC-Berkeley, argues poignantly for a renewed attention to the socio-political roots of the poverty that produces poor health. Even as Paul Farmer highlights structural inequalities, Dubal points out, the PIH model treats individual bodies, not systemic problems. In fact, Dubal writes, Farmer and PIH cofounder Dr. Jim Yong Kim urge medical doctors concerned with intervention to forge business partnerships with global players, which may reinforce the same systems of power that inscribed the health disparities in the first place. Citing several medical anthropologists (Fassin 2007; Redfield 2005), Dubal writes:

Of course, there is no such thing as neutrality or impartiality in humanitarianism.  Didier Fassin, a fellow physician-anthropologist and former vice president of Doctors without Borders (MSF), has repeatedly stressed how contemporary humanitarians shift attention from the causes of violence to its consequences in a way that replaces a politics of justice with a politics of compassion – in essence, refuses politics for ethics.  Humanitarians, he argues, operate on an inequality of life and a hierarchy of humanity, aspiring to moral untouchability while avoiding a ‘parrhesia’ – a truth that, once told, can incur a high cost for the teller himself.  For humanitarians, this truth is precisely that humanitarian interventions are always political.  They are guided, as Peter Redfield points out, by a ‘non-ideological ideology’ – that is, an ideology that refuses to recognize itself as such.  When PIH insists that all life, especially the poor’s, is worth saving, it partakes in a negative form of politics that denies the selective reality of its political practices, including questions of sacrifice and triage.  … by accepting funding from Bill Gates, it stands politically together with the notion that a ruthless pursuit of profit can be counteracted by charity.

Dubal’s blog post was circulated via the H-medanthro listerv, as part of an ongoing, dispersed scholarly debate among medical anthropologists about just what the nature of a critique of humanitarianism ought to be. On the other hand, as one contributor pointed out, Farmer and Kim are themselves critical of “the anthropologist who does not act”.

Meanwhile, Kim, who holds an MD and medical anthropology PhD from Harvard, among myriad distinctions, was appointed in March as the new head of the World Bank (WB), following his nomination by President Barack Obama. Some lauded this appointment as a “testament to the power of anthropology to contribute to development and well-being around the world,” highlighting, in particular, the fact that Kim’s background as a public health professional departs sharply from the general trend of past WB leaders with expertise in finance. At the same time, however, Dr. Kim’s appointment reinforced the US monopoly of control of the WB, the Guardian reported. And, other medical anthropologists, critical of the economic platform of the WB, which some argue amounts to neoimperialism, and bearing in mind the ethical questions about humanitarian health interventions that Dubal voiced, perceived Kim’s appointment as merely a minor parallax shift.

Kim himself responded to some of the issues raised with his appointment in a New York Times blog interview. In particular, Kim addressed his own past criticism of the WB’s policies and objectives; he asserted that many policies of the WB have changed, particularly regarding what he calls “pro-poor” policies, or institutional objectives that consider the interests of the very poor.  Kim articulates a vision of a WB that works within the development economics framework, but does so with the local level in mind.

Kim’s path forward is hybridized and optimistic. He situates himself as valuing his anthropological training. Yet, he continues to profess a model of intervention that is positivist, that holds that tested models may be applied again to achieve the same result; and, that subscribes to the logic of economic development as commensurable and even central to the betterment of the lives of the very poor. As Sam Dubal pointed out in an article for a Stanford newsletter, this logic relies on an essentializing logic of both what development is, and who the poor are, imagining either static entities, or entities that move along a singular path of progress.  Or, in Dubal’s words, central “to the relationship between the aid worker and aid recipient today is a mutual fetishization of each other.” Dubal argues that aid intervention, changes both the intervening and the intervened upon in unpredictable ways; and, that the opportunity for mutual transformation goes far beyond health, altering in a profoundly cosmological (as well as political) way, the very consciousness of both aid workers and aid recipients. The same issue of consciousness – especially an ethical consciousness – pertains to altruistic and humanitarian health care initiatives within the United States, as, for instance, medical anthropologist Michele Rivkin-Fish has demonstrated regarding the complex ethical issues that arise when dental students provide care to low income populations (Rivkin-Fish 2011).

On a lighter note, this issue of ongoing mutual transformation (or lack thereof) between aid workers and those targeted by humanitarianism is unpacked, chewed over, and, well, spit back out in the serial blog-novel Disastrous Passions, a tongue-in-cheek bodice-ripper about what really matters to humanitarian workers. Or, for further efforts to consider the “diaspora” culture of expat aid workers, visit Stuff Expat Aid Workers Like, a blog for, by, and about the “SEAWs” highlighting everything from Pinterest boards to self-deprecating memes.

So, the medical anthropology community continues to wrestle with the ethics of intervention, and, indeed of postulating a unified humanity, let alone a universal humanitarian morality. At the same time that some scholars see the world of humanitarianism as effectively feeding a dehumanizing industry, others continue to struggle to render humanitarianism more receptive to the insights of medical anthropology.

changing minds: sexual behavior                            

This May, prominent psychiatrist Dr. Robert Spitzer of Columbia University, announced publicly in a letter to the journal Archives of Sexual Behavior, and in several media outlets, that he now wishes to retract his earlier statements based on the results of a 2003 study, originally published to much controversy in the same journal, to the effect that gay adults who make a concerted effort to reverse their own “sexual orientation” were able to do so through the process of engaging in “conversion therapy” (Spitzer 2003 and 2007). Dr. Spitzer now states that in spite of his initial analysis of the study, he now realizes that it is impossible to verify the factuality of study participants’ responses to the end that they had or had not actually changed their sexual orientation through therapeutic processes. Spitzer came forward to revoke his 2003 statements, because, he said, he feels that it is important that he apologize to those fellow psychiatrists, and to those gay adults, who may have “wasted their time” on conversion therapy, due to his perhaps unfounded interpretation of the research data.

As Slate author William Saletan summed up the revocation,

“Given the fallibility of memory for past events,” Spitzer wrote, “it is impossible to be sure how accurate individuals were in answering questions about how they felt during the year before starting the therapy, which on average was about 12 years before the interview.” The nature of the therapy was never defined, and in half the cases it was administered by a pastoral counselor, support group, Bible study, or other religious practice. As for subjects’ claims that they had stayed gay-free after therapy, Spitzer confessed that he “relied exclusively on self-report” and that this reliance “deserves careful examination in light of the participants’ … high motivation to provide data supporting the value of efforts to change sexual orientation.

Spitzer, in a radio interview (listen here), attributed the fact that he was able to publish such a tenuous study to the fact of his standing in psychiatry, as one of the “architects” of the modern DSM (prior to his interventions in the 1970s and onward, the field of American psychiatry lacked the systematic manner of linking symptoms and diagnosis that the DSM has since provided). A popular audience description of Spitzer’s hand in recrafting the DSM appeared in The New Yorker magazine in 2005, and was discussed in an episode of This American Life in 2002. Notably, Spitzer is widely credited with the removal of homosexuality from the DSM during its initial restructuring (and Sptizer has in the past called for Christian organizations to stop citing his study as evidence that same sex attraction can be changed: watch these video appeals here and here).

Spitzer’s announcement came on the heels of a North Carolina ballot vote, which passed an amendment to the state constitution, limiting “the only legally recognized union” to marriage between one man and one woman, and President Barack Obama’s subsequent announcement that his perspectives on same sex marriage have “evolved” and now supports the legalization of same sex unions as a civil rights issue.

In such a political climate, Spitzer’s public revocation made front page news in the New York Times, and fit neatly into what has become a very heated, partisan debate about the moral nature of same sex partnership, and the bio-social nature of same sex attraction.

The Pan American Health Organization, in partnership with the World Health Organization, issued a statement condemning conversion therapy as medically unfounded and damaging to health, seemingly unrelatedly and only a few days off of Spitzer’s revocation. In an online press release regarding the statement, PAHO/WHO described the move as such:

“Since homosexuality is not a disorder or a disease, it does not require a cure. There is no medical indication for changing sexual orientation,” said PAHO Director Dr. Mirta Roses Periago. Practices known as “reparative therapy” or “conversion therapy” represent “a serious threat to the health and well-being—even the lives—of affected people.”

The PAHO statement notes that there is a professional consensus that homosexuality is a natural variation of human sexuality and cannot be regarded as a pathological condition.

At issue here seems to be the question of whether one particular human difference – same-sex attraction – ought to be considered a biological pathology, or an inoffensive human variation. The issue is complicated by the culturally contingent identity categories that are tied up in perception of same sex attraction. In similar territory, bioethics scholar Alice Dreger has argued that Gender Identity Disorder (GID) should be removed from the DSM for relatedly unnecessary stigmatization, here and here.  Which raises the question, IS biology destiny? Should solutions to problems of identity be biological or cultural? And where therein does a workable balance lie? Can looking to other cultures, with actually existing cultural solutions to what we have defined as biomedical problems help? Paul Vasey, Dreger points out, who researches biological men who live as social women in Samoa, thinks so, arguing that in the case of these Samoans (called fa’afafine), a sociocultural adjustment, rather than a bio-cognitive change in the individual, creates acceptance where Westerners might find medicalized pathology.

All of which is to say, over the course of recent decades, scientists keep changing their minds about same-sex attraction. Medical anthropologists have problematized the DSM, generally, for its failure to capture the cultural and historical contingency of what masquerade as cognitive-biological facts (e.g. Young 1995; Cohen 1995; Valentine 2007). And, we find that a similar critique is relevant to the ongoing changing of minds about whether or not science can change the minds (and bodies, and sex lives) of people who self-identify as having same-sex attraction. Cultural attitudes and norms delimit and shape scientific and medical interpretations.

As Josh Fischman wrote in the Chronicle of Higher Education, Spitzer’s revocation highlights not only the ever-ongoing nature/culture debate, but also the question of what makes good science, and whether a scientist ought to be given the space to be wrong, and, having found himself wrong and said so publicly, to be forgiven. That is, Spitzer’s letter gets to the heart of just what we think it means to “do good science” (in the parlance of the behaviorists and lab researchers). From the perspective of critical medical anthropology and science studies, the question of our cultural presumptions and valuations about “good science” have already been a subject for scrutiny. Science creates a unique climate of being “right,” when each new hypothesis (or in this case, statement) in progression is allowed subsume all previous suspicions, hypotheses or statements (see: Chakrabarty 2000, Latour 1993). In this way, Spitzer’s revocation does more than simply state that as of May 2012 he no longer agrees with his study; instead, it swallows up the nine years between 2003 and 2012, casting his own opinions and the citation of his work during that time into a kind of purgatory. Spitzer changed his mind, and changed, also, all future interpretations of those who accepted his hypothesis about same-sex attraction during that interim.

As Dr. Spitzer now points out, we will never know if the conversion therapy that took place managed to change any minds as, “there was no way to judge the credibility of subject reports of change in sexual orientation” (from his revocation letter). At least, not until another scientist designs a different study model to test this hypothesis.

–

Read the original 2003 journal article and its responses, which has been opened for public viewing for June and July without the usual subscription firewall, here.

NB: Regarding the phrase “a non-ideological ideology,” in the above quotation from Sam Dubal, Peter Redfield (to whom Dubal credited the citation) writes,  ”The phrase he quotes is actually Renée Fox’s.” 

References

(de)humanitarianism

Fassin, Didier. 2007. Humanitarianism as a Politics of Life. Public Culture 19(3):499.

Lakhoff, Andrew. 2010. “Two Regimes of Global Health.” Humanity: An International Journal of Human Rights, Humanitarianism, and Development, 1 (1): 59–79.

Redfield, Peter. 2005. Doctors, Borders, and Life in Crisis. Cultural Anthropology. 20(3):328-361.

Rivkin-Fish, Michele. 2011. “Learning the Moral Economy of Commodified Health Care: ‘Community Education,’ Failed Consumers, and the Shaping of Ethical Clinician-Citizens.” Culture, Medicine and Psychiatry 35 (2) (June 1): 183–208.

changing minds

Chakrabarty, Dipesh. 2000. Provincializing Europe : Postcolonial Thought and Historical Difference. Princeton  NJ: Princeton University Press.

Cohen, Lawrence. 1998. No Aging in India : Alzheimer’s, the Bad Family, and Other Modern Things. Berkeley: University of California Press.

Latour, Bruno. 1993. We Have Never Been Modern. Cambridge  Mass.: Harvard University Press.

Spitzer, Robert. “Spitzer Reassesses His 2003 Study of Reparative Therapy of Homosexuality.” Archives of Sexual Behavior: 1.

Spitzer, Robert L. 2003. “Can Some Gay Men and Lesbians Change Their Sexual Orientation? 200 Participants Reporting a Change from Homosexual to Heterosexual Orientation.” Archives of Sexual Behavior 32 (5) (October 1): 403–417.

Valentine, David. 2007. Imagining transgender : an ethnography of a category. Durham: Duke University Press.

Young, Allan. 1995. The Harmony of Illusions : Inventing Post-traumatic Stress Disorder. Princeton  NJ: Princeton University Press.

On September 12th and 13th, the World Health Organization and World Bank hosted a two-day symposium on the outskirts of DC to discuss the U.S. launch of their new joint World Report on Disability. The two day panel discussion should be posting soon on the University at Buffalo’s Center for International Rehabilitation Research and Information Exchange (CIRRIE) symposium website, so please check the symposium website for the update. I was lucky enough to be able to attend the event and highly recommend reading the report.

The report documents the current state of knowledge concerning the prevalence and condition of persons with disabilities around the world. It also provides details concerning current and potential measures and programs that might help improve disability participation in social, educational and economic spheres. As such, it serves as a guide to the proper implementation of the UN’s Convention on the Rights of Persons with Disabilities.

The report features an in-depth discussion of its new, expanded definition of disability. It explains how the new International Classification of Functioning, Disability and Health (ICF) organizes and defines disability concepts by including both environmental and personal factors as important elements in understanding the barriers that disabled individuals encounter. Click here for more information on ICF application areas in epidemiology, social policy and research. Click here for more information on ICF Application and Training Tools.

As disability scholar, Tom Shakespeare, pointed out, the United States has a tendency to discuss and address disability as a civil rights issue and many of our lobbyist organizations use the disability civil rights legislation as a means to push forward specific improvements and objectives. (For a good introduction to many disability rights issues please see, Charlton’s Nothing About Us Without Us and Shapiro’s No Pity). But global efforts require a more universal perspective and discussions such these are important not only for those interested in multi national disability projects and initiatives but for the U.S. too. As the U.S. population becomes more and more diverse, disability rights lobbyists, special education instructors, and aid organizations will need to understand how disability is constructed and discussed in other cultures. This knowledge has the potential to improve education outcomes for students from diverse ethnic, linguistic and cultural backgrounds in our schools. The need for cultural competency skills in special education was recently discussed in this article in the September Journal for Visual Impairment and Blindness. The U.S. can also improve its own social and economic participation by looking at some of the innovative strategies and programs developed by other countries and cross-country partnerships such as the Finnish funded teacher training program in Ethiopia and the Australian Sports outreach program which seeks to create inclusive sporting and games opportunities (both are discussed at length in the WHO Report).

Panel discussion centered on an in-depth review of the report’s chapters. Tom Shakespeare, sociologist, disability scholar, geneticist and author of Disability Rights and Wrongs, discussed the opening chapter of the report, Understanding Disability. Shakespeare served as an editor and consultant on the project and anyone acquainted with his work is sure to see his mark on the nuanced discussion of the meaning and definition of disability.

The discussion of education focused largely around what barriers exist for disabled students. David Rose of the Center for Applied Technology (CAST) gave an inspiring talk about Universal Design for Learning; those interested in curriculum design and the impediments to achieving inclusive education should consider looking at CAST research, training materials and initiatives.

One of the most interesting discussions concerned the chapter on Work and Employment, including presentations from the Mathematica Policy Research Organization’s Center for Studying Disability Policy. The discussants reviewed labor markets and formal and informal economies but also expanded on issues such as the “benefit trap” encountered in many high-income countries. Two reports go into more detail about the “benefit trap”. The first is from the Organisation for Economic Co-operation and Development, the second is from the International Social Security Association.

Finally, throughout the report and the symposium talks there were comments and concerns regarding the dire need for more quality evidence, both qualitative and quantitative. Particularly in this age of economic crises, when many disability and rehabilitation programs are in danger of being cut, the need for research that can help develop innovative and cost effective projects that are backed up with strong evidence is great.

Elsewhere around the Web for September:

The New York Times’ The Stone features a nice back and forth series between philosophers Alex Rosenberg and Timothy Williamson on the subject of naturalism. Start the discussion with Williamson’s post entitled “What is Naturalism?”, then Rosenberg’s “Why I am a Naturalist” and then Williamson’s rebuttal, “On Ducking Challenges to Naturalism”.

The Atlantic published an article entitled The Triumph of New Age Medicine on the rise of integrative, complementary clinics located within larger academic medical centers such as the Mayo Clinic, Harvard, Yale and Duke.

Both the Washington Post and the Utne Reader explore the rise of alternatives to traditional psychological counseling through philosophical counseling and bibliotherapy.

The New York Times grapples with  the complicated issues concerning allegations of Shaken Baby Syndrome.

The Atlantic also has an amazing review of Shelley Adler’s new book Sleep Paralysis: Night-mares, Nocebos, and the Mind Body Connection. She discusses the phenomenon of Sudden Unexpected Nocturnal Death Syndrome (SUNDS) among young, healthy, male Hmong refugees in the early 1980s and concludes that the deaths occurred as a deadly mix of genetic factors (a rare cardiac arrhythmia found among Southeast Asian populations) and their beliefs in spirits that seek revenge when proper worship and rituals are not observed (something that would have been difficult to continue in their California, Wisconsin and Minnesotan refugee communities).

Three new books from the University of California Press explore the history, meaning and practice of humanitarianism. Didier Fassin’s Humanitarian Reason: A Moral History of the Present explores recent changes in discourse concerning humanitarianism and the moral ambiguity that ensues when humanitarian idealism confronts real political conflict, poverty and war. The second, Miriam Tiktin’s Casualties of Care: Immigration and the Politics of Humanitarianism in France discusses how France’s immigration policies force refugees to create “unusual pathologies” to explain and defend seeking asylum. Omri Alisha’s Moral Ambition: Mobilization and Social Outreach in Evangelical Megachurches examines how faith-based social outreach initiatives allow parishioners to put their faith to practice, and how practitioners often struggle to reconcile their religious and social conservatism with their interests in racial and social justice, compassion and understanding.

The Republic of Therapy: Triage and Sovereignty in West Africa’s Time of AIDS.

By Vinh-Kim Nguyen.

Durham, NC: Duke University Press, 2010.

Pp. 256. ISBN 9780822348740. (Paperback, US $ 22.95)

Reviewed by Betsey Brada (Princeton University)

In The Republic of Therapy, Vinh-Kim Nguyen traces responses to the HIV/AIDS epidemic in Francophone West Africa between 1994, when effective antiretroviral (ARV) treatments emerged, and 2000, a year marked by the 13th International AIDS Conference in Durban, South Africa and by “unprecedented attention to the issue of access to HIV treatments and, increasingly, the state of public health in Africa” (106-7). A physician as well as an anthropologist, Nguyen draws on his experiences working as a community organizer and consultant to international organizations in Francophone West Africa as well as his experiences as a volunteer physician in an ARV clinic in Abidjan, situating these against his medical training and clinical work in Montreal. Moving between the vast metropolis of Abidjan in Côte d’Ivoire and the smaller national capital of Burkina Faso, Ouagadougou, the book focuses on triage, the ways in which both local and international organizations responding to the epidemic “unwittingly sorted those who should live from those who could go without treatment” (6). In West Africa, Nguyen writes, triage “linked procedures for selecting people, the ways in which people seek to transform themselves, practices of ‘telling’ the truth about the self, and the paradoxical affirmation of citizenship” (109), and has “persisted in attempts to design, fund, and implement mass treatment programs in the developing world after 2000” (6). Nguyen’s first objective is to “explore and expose the obscene inequality and insidious logic” that constitutes triage, a logic that “values lives differently” (4). His second objective is to analyze the “forms of politics” to which triage gives rise, that is, a situation in which “the only way to survive is by having a fatal illness” (6). Drawing on Schmitt (2005) and Pandolfi (2000; see 2003), Nguyen argues that, “the informal and formal procedures, protocols, and policies that decide who should live that have played out in the AIDS epidemic in Africa… constitute an exercise of sovereignty” insofar as they constitute the power over life and death (6). Working across multiple scales (from individual confessions to “talking groups” and workshops to international clinical trials and multilateral organizations) Nguyen traces the ways the “technologies” (in Foucault’s sense) that link through and across these scales “constitute a kind of parallel therapeutic state” (186). This is the republic of therapy.

The book is divided into two parts. The first half, chapters 1-4, tracks back and forth between Ouagadougou and Abidjan and provides a close analysis of efforts, both local and international, to constitute and organize communities with HIV. In these chapters, Nguyen argues, we may see the seeds of “the historically unprecedented and massive global intervention into health in the developing world” (8) that has followed. Nguyen gives particular attention to “confessional technologies” (Hunt 1997), the testimonials and practices of disclosure that initially emerged as international organizations sought to give a public “face” to the epidemic, to foster acceptance among those affected by the epidemic in West Africa, and to demonstrate the effectiveness of their own programs. Chapter 1 opens with the story of one community health organization whose young founder assembled “a network of social relations where kinship relations and obligations furnished the idiom through which accountability and hierarchy could be expressed and relationships valued” (17-18). Nguyen contrasts this “moral economy” with the “ideology of patient empowerment” that had emerged in North America in the 1980s in response to perceived government inaction and public apathy (cf. Epstein 1996). Observing that “many Northern AIDS activists were hired to key positions in international organizations, Nguyen argues that the emphasis on and value of public testimonials was “a logical extension of the experience with the epidemic in North America and Europe” (26). As public testimonials of those infected with HIV became “indicators of success of governments’ national AIDS control programs and a key argument in favor of keeping aid money flowing to these programs” (31), this market for stories “disrupted existing moral economies that linked disclosure, trust, and social belonging” (33), leaving those involved in community health unsure how to receive and respond to these public confessions. Chapter 2 focuses on workshops as a primary site where international consultants attempted to foster collective “psychosocial support” for those with HIV, teaching participants to convey “empathy” through “active listening” and “open-ended questions,” using the tools of encounter groups developed after World War II. Drawing from Foucault (1985; 1998), Nguyen argues that confessional technologies “made an inner self available in new ways… as a substrate that must be worked upon” (40). While the techniques Nguyen’s informants and fellow participants learned “made certain assumptions about the relationship between questioner and respondent” (49), the workshops nevertheless provided participants with “powerful tools by which they could transform themselves and others” (40). These newly learned confessional technologies thus had consequences both unintended and unanticipated by those who promoted, planned, and implemented the workshops.

These kinds of self-transformations via confessional technologies, Nguyen argues, emerged within a broader context. In Chapter 3, he presents a “genealogy of technologies of the self and the related forms of social organization” (62) that the book documents, tracing connections “between testimonials, healing, and conversion outside of efforts to organize communities with HIV” (71). The chapter begins with William Wade Harris, an evangelical preacher who traveled across colonial West Africa in the early 20th century. Harris “set the stage for the emergence of anticolonial politics” (54) as Ivoirians, urged to abandon the old in favor of the new, took up the ideas and practices of a plantation economy that eventually gave rise to the first planters’ syndicate. Harris’ movement attuned Ivoirians to the power of “testimonials that bring awareness of gathering individual and social peril, incite hearers to transform themselves, and offer an power promise of redemption” (66). The voluntary associations of the colonial era also “furnished a space parallel to that of religion where new ways of life could be experimented with” (66), and that continued to do so in the postcolonial era as “social laboratories” for practices that “could produce new forms of social relations and even political consciousness” (70). Nguyen notes “the pervasive entanglement of religion and healing” (71), arguing that some church leaders, linking prophecy and self-transformation, “fashioned solidarity out of a highly individuated form of personhood” (74) that also supported members with material resources. These links between confession, self-transformation, and material benefit grew increasingly complex as more people learned they had HIV through recruitment for clinical trials, and some received stipends to speak about their status (76). Competition over resources and acrimony, rather than mutual support, characterized the AIDS organizations formed with the support of the state and Western “technical assistance.” This, Nguyen suggests, could only be the result insofar as the model of “coming out” and “self-help” promulgated by international development agencies relied upon the idea of that people form social relations by revealing “a hidden truth to the self” to one another, and “ignored existing networks of obligation, responsibility, and exchange that both constituted persons and bound them together” (83).

Yet, even as “coming out” placed at risk the truth and solidarity of kinship ties, it began to hold out the promise of benefits in unexpected ways. Chapter 4 examines the emergence of a “therapeutic citizenship” that “emerged in places where other forms of citizenship could not be relied upon to secure life itself” (108). Nguyen begins with the “therapeutic citizenship” of Northern activists whose willingness to take part in clinical trials “grew out of a sense of duty so that others may benefit from treatments eventually found effective” (92). He contrasts this with the therapeutic citizenship that emerged as West Africans, hoping to gain access to medical care and other resources, also sought to take part in HIV-related trials (96). The trials themselves generated a population of newly-diagnosed HIV-positive individuals, many of whom were disqualified from participating and who joined community organizations in hope of gaining support and access to resources. As the head of an organization in Ouagadougou began to receive medicines from concerned European friends, the organization’s “talking group” that seemed to model the ideology of “self-help” and “coming out” began to serve as a venue for the selective distribution of medications to “those who came regularly were more likely to observe the rigorous treatment schedules and those who “contributed” most to the group” (98-99). Thus, a person’s access to ARVs depended on his or her social networks. The connections between confession, self-transformation, and material benefit crystallized as the ability to “tell a good story” became the key to survival (99). Triage parried social relations into biological difference: For those who received treatment, “their ability to harness social resources to leverage access to the drugs translated into healthier bodies, a biological transcription of the discourse of empowerment” (101)—that is, therapeutic citizenship. The logic of triage and its biological consequences could be seen in an attempt make ARVs available to the general public in 1998 through the joint efforts of the Ivoirian Ministry of Health and UNAIDS. A lack of subsidies to cover three medications, repeated stock-outs of drugs, and an emphasis on “getting drugs into bodies” (104-6) meant that many Ivoirians received inadequate treatment, leading them to develop resistance to the medications they did receive.

The second half of the book deals more specifically with the history of Côte d’Ivoire, offering a genealogical account of the forms of politics, sociality, citizenship, and self-fashioning that structured the logic of triage in West Africa in the mid-1990s. Chapter 5 charts the development of a colonial biopolitics through biomedical and administrative technologies that constituted ‘ethnicity’ as an object of governance and spatially organized populations via urban planning policies that “materialized a differential calculus of the value of citizens that erased local notions of kinship” (113). This colonial biopolitics through which the metropole enacted sovereignty “shaped urban life and the forms of tactical citizenship that emerged” (113), laying grounds for the “newer, nongovernmental biopower” (114) that would emerge with the HIV epidemic. Chapter 6 examines how the collapse of the Ivoirian economy and the subsequent erosion of national sovereignty gave rise to “a logic of rationing and competition” (136) and to a form of citizenship “increasingly located… in the realm of self-fashioning” (135). As economic policy in Côte d’Ivoire gave way to the structural adjustment policies of international financial institutions, Ivoirians’ “tactics for disciplining body and mind” in the face of pervasive impoverishment shaped “the cultural logic of self-transformation” (138) that, in turn, shaped the ways Ivoirians took up the confessional technologies explored in the book’s first half. Chapter 7 offers a genealogy of practices of intimate disclosure in the context of the “zero-sum logic of competition” (157) that arose as material scarcity strained social bonds. “Talk about sex,” Nguyen argues,” was linked to economic changes and freighted with anxieties about the new inequalities these introduced” (159). In this context, “sexual and economic desire blended, making the ‘truth’ of sexual identity increasingly difficult to locate” (164). He emphasizes the increasingly political valences such disclosures and their ensuing scandals took on as talk about sexual deviance became a “moral barometer” and “a powerful metaphor for expressing concerns about the republic” (166). Thus, the ground was laid for two contrasting forms of disclosure available as the epidemic and efforts to combat it emerged: “a confessional one that required that attention be directed inward, and one of accusation that focused scrutiny away from the discloser” (173).

While both “therapeutic citizenship” and the concept of “biological citizenship” as developed by Petryna (2002), Rose & Novas (2005) and others denote a form of belonging “mediated by biomedical categories” (108), Nguyen argues they differ in the conditions of their emergence. Biological citizenship depends upon “an understanding of the role of the state and other large, stable institutions as guarantors of health care and social security” (109) insofar as they fulfill biopolitical functions of classifying and managing populations and individuals. Therapeutic citizenship, by contrast, is a “thin citizenship” (109) constituted through reference to a single disease, yet it may stand between life and death when that particular disease “may be the only way to get any of the material security one usually associates with citizenship” (109). Here, Nguyen joins others scholars who have analyzed the ways an HIV diagnosis can sometimes constitute the grounds for claims to political belonging and material security (e.g., Comaroff 2007; Robins 2006; Ticktin 2006), but he shifts the emphasis away from the state, insisting that triage “escaped the control” of the state as Côte d’Ivoire’s national sovereignty receded in the face of economic decline, structural adjustment, and ensuing social and political turbulence. If anything, these political forms unanchored by the state have only grown more pervasive and more robust: The logic of triage and the “therapeutic citizenship” to which it has given rise, Nguyen argues, can be seen in the “bundling” of services (such as food supplements, counseling, microcredit, school fees, etc.) for those with HIV provided by “an ever-more complex assemblage of institutions and management systems” that defy accountability (177). This “government-by-exception” (186; see Nguyen 2009) by foreign NGOs, research institutes, and other organizations on humanitarian grounds echoes the “scramble for Africa” of the late 19th century inasmuch as it has ushered in new categories of belonging, new ways of arbitrating life and death, and new forms of exception and exclusion. Under these conditions, Nguyen grimly suggests, the only exercise of sovereignty left to West Africans, denied even a readily identifiable oppressor, is to refuse to be made to live.

Nguyen’s work is path-breaking on several counts. First, though several anthropologists have touched on the subject (e.g., Booth 2004; Fassin 2007; Kalofanos 2010, to name only a few), The Republic of Therapy is perhaps the first book-length ethnographic and historical monograph that focuses of the emergence of an HIV/AIDS treatment apparatus in Africa. Like Paul Farmer’s milestone ethnographic treatment of the HIV epidemic in Haiti, The Republic of Therapy emphasizes the historical dimensions not only of the epidemic but of the responses to it as “manifestations of the large-scale forces of history and political economy” (Farmer 1992:8). Second, the book contributes substantially to an emerging literature focusing on the kinds of politics, subjectivities, and socialities that HIV treatment programs demand and produce (Biehl 2007; Kalofonos 2010; Frank 2009; Rhine 2009). The book is incredibly timely, given massive expansion of treatment programs over the past decade. (According to the World Health Organization, more than 5 million people in low- and medium-income countries were receiving antiretroviral therapy by the end of 2009.) Indeed, like Charles Piot (2010), Nguyen draws attention to the ways contemporary West African states challenge scholars to account for the new forms of life and death that have arisen in the wake of structural adjustment and the radical transformation of global politics that accompanied the end of the Cold War. Third, The Republic of Therapy complicates divisions between the biomedical and the religious, or between the symbolic and the political-economic that sometimes seems to emerge in the anthropological literature on HIV/AIDS. Nguyen’s focus on how confession and conversion as speech genres move across contexts as diverse as churches, sex scandals, and therapeutic groups, and how the successful performance of these genres can stand between those with HIV and the material substance of “life itself” is refreshing. The book’s focus on the stakes of confession and therapeutic talk complements recent linguistic anthropological literature examining the ways language ideologies structure confessions, their reception, and the subjectivities they both demand and produce (Carr 2006, 2010; Keane 2007).

Nguyen makes several interesting stylistic choices. For example, he leaves the lion’s share of his engagements with the theoretical, anthropological, and historical literature in the endnotes. This may render the book an easier read for those outside anthropology—a commendable goal, and even more so for this book—and Nguyen’s desire to reach a broader audience may also have influenced his decision to place the historical chapters in the book’s second half. This reliance upon endnotes can make the book seem light on citations, an impression belied by the notes themselves and the bibliography. Yet, the book engages less, even in the notes, with the substantial historical and anthropological literature on colonization, conversion, and confession in Africa and the politics to which these have given rise than one might expect. His intellectual debt to Foucault runs deep, and that debt serves his project well, particularly with regard to “confessional technologies,” with the one caveat that things sometimes seem to happen in the passive voice and concrete nodes of power can be difficult to locate. Nguyen’s strengths as an ethnographer are his capacity to move among different organizations and institutions, his sensitivity to the roles he plays in these contexts, and his long-term engagement with local activists and other informants, and he parries these strengths into a nuanced account of the urban politics of triage and HIV in West Africa.

Works Cited

Biehl, J. (2007) Pharmaceuticalization: AIDS Treatment and Global Health Politics. Anthropological Quarterly 80(4):1083-1126.

Booth, K. (2004) Local Women, Global Science: Fighting AIDS in Kenya. Bloomington, IN: Indiana University Press.

Carr, E. S. (2006) “Secrets Keep You Sick”: Metalinguistic Labor in a Drug Treatment Program for Homeless Women. Language in Society 35(5):631-653.

——— (2010) Scripting Addiction: The Politics of Therapeutic Talk and American Sobriety. Princeton, NJ: Princeton University Press.

Comaroff, J. (2007) Beyond Bare Life: AIDS, (Bio)Politics, and the Neoliberal Order. Public Culture 19(1):197-219.

Epstein, S. (1996) Impure Science: AIDS, Activism, and the Politics of Knowledge. Berkeley: University of California Press.

Farmer, P. (1992) AIDS and Accusations: Haiti and the Geography of Blame. Berkeley: University of California Press.

Fassin, D. (2007) When Bodies Remember: Experiences and Politics of AIDS in South Africa. Berkeley: University of California Press.

Foucault, M. (1985) The History of Sexuality, Vol. 2: The Uses of Pleasure, R. Hurley, trans. New York: Pantheon Books.

——— (1998) “Technologies of the Self.” In Technologies of the Self, L. Martin et al., eds., pp. 16-49. Amherst, MA: University of Massachusetts Press.

Frank, E. (2009) The Relation of HIV Testing and Treatment to Identity Formation in Zambia. African Journal of AIDS Research 8(4):515-524.

Hunt, N. R. (1997) Condoms, Confessors, Conferences: Among AIDS Derivatives in Africa. Journal of the International Institute 4(3):15-17.

Kalofanos, I. A. (2010) “All I Eat Is ARVs”: The Paradox of AIDS Treatment Interventions in Central Mozambique. Medical Anthropology Quarterly 24(3):363-380.

Keane, W. (2007) Christian Moderns: Freedom and Fetish in the Mission Encounter. Berkeley: University of California Press.

Nguyen, V-K. (2009) Government-by-Exception: Enrolment and Experimentality in Mass HIV Treatment Programmes in Africa. Social Theory and Health 7:196-217.

Schmitt, C. (2005) Political Theology: Four Chapters on the Concept of Sovereignty, George Schwab, trans. Chicago: University of Chicago Press.

Pandolfi, M. (2000) L’industrie humanitaire: une souveraneté mouvante et supracoloniale. Réflexion sur l’expérience des Balkans. Multitudes 3:97-105.

——— (2003) Contract of Mutual (In)Difference: Governance and the Humanitarian Apparatus in Contemporary Albania and Kosovo. Indiana Journal of Global Legal Studies 10(1):369-381.

Petryna, A. (2002) Life Exposed: Biological Citizens after Chernobyl. Princeton, NJ: Princeton University Press.

Piot, C. (2010) Nostalgia for the Future: West Africa after the Cold War. Chicago: University of Chicago Press.

Rhine, K. (2009) Support Groups, Marriage, and the Management of Ambiguity among HIV-positive Women in Northern Nigeria. Anthropological Quarterly 82(2):369-400.

Robins, S. (2006) From “Rights” to “Ritual”: AIDS Activism in South Africa. American Anthropologist 108(2):312-323.

Rose, N. & C. Novas (2005) “Biological Citizenship.” In A. Ong and S. Collier, eds., Global Assemblages: Technology, Politics, and Ethics as Anthropological Problems, pp. 439-463. Malden, MA: Blackwell Publishing.

Ticktin, M. (2006) Where Ethics and Politics Meet: The Violence of Humanitarianism in France. American Ethnologist 33(1): 33-49.

Humanity is a new periodical published by the University of Pennsylvania Press, which describes itself as an “international journal of human rights, humanitarianism and development.”  These topics have been a central interest for many anthropologists of late and indeed anthropology is well represented among the members of the editorial collective and contributors to the journal’s first issue.  Here’s how the editorial collective begins the statement of purpose for the journal:

“In recent decades, the traditional politics of ideological contest has been displaced by a politics of humanity. In many realms, left and right have given way to life and death. In both domestic and international contexts, the languages of human rights and humanitarianism are often spectacularly marshaled as moral claims to bolster multifarious policies and practices. And development—a central Cold War discourse—has evolved beyond strictly economic or institutional concerns to encompass matters once targeted in human rights activism and has expanded to address the acute humanitarian crises once treated as more episodic and temporary conditions. The goal of Humanity is to provide a single forum for the dispassionate, analytically focused examination of these trends and the political transformations that have reshaped the terms of liberation and idealism as well as the practices of domination and control,” (Editorial Collective, 2010).

All of the articles in the journal’s inaugural issue are available free of charge, although I’m not clear on whether that will continue for subsequent issues.  The journal also has an impressive-looking website, with a blog, which has already featured some interesting pieces, like Andrew Lakoff’s consideration of a recent profile of virus-hunter Nathan Wolfe in The New Yorker.

As you’ll see in the list of article titles and abstracts below, the first issue of Humanity includes an impressive range of scholarship on issues surrounding humanitarianism and human rights.

Table of Contents:

Statement of the Editorial Collective

In recent decades, the traditional politics of ideological contest has been displaced by a politics of humanity.

Lynn Festa, Humanity without Feathers

The title of this essay is not simply an echo of Woody Allen’s neurotic reversal of Emily Dickinson’s ‘‘Hope is the thing with Feathers’’; it alludes, of course, to the venerable enumerative definition, as old as Plato, of man as a ‘‘featherless biped capable of speech and reason.’’

Editorial Collective, Kael Alford, Unembedding War Photography: An Interview with Kael Alford

The Iraq war has certainly blurred the distinction between reporting and waging war, turning information into a strategic weapon. It also triggered the beginning of ‘‘embeddedness’’ as a new military practice of control, ?rst with journalists, but now extended to civilian researchers such as anthropologists. Kael Alford tells us how her ‘‘unembedded’’ project was conceived.

Michel Agier, Humanity as an Identity and Its Political Effects: A Note on Camps and Humanitarian Government

Agier offers an assessment of contemporary humanitarianism and appeals to humanity that juxtaposes a survey of camps with ethnographic reportage. According to Agier, contemporary humanitarianism must be understood as a new and unprecedented form of government that nevertheless leaves room for unsuspected political action.

Andrew Lakoff, Two Regimes of Global Health

The movement for global health is an increasingly prominent rationale for action across a range of organizations, including philanthropic foundations, development agencies, and biomedical research institutes.

Martin Koskenniemi, Human Rights Mainstreaming as a Strategy for Institutional Power

This essay is a comment on the proposal by human rights activists and lawyers, made in various international and domestic contexts, for ‘‘mainstreaming’’ human rights into an aspect of the regular business of (international) governance.

Didier Fassin, Ethics of Survival: A Democratic Approach to the Politics of Life

What is the human? One way to confront this question has been, since antiquity, to distinguish the human from the animal, or rather to ask how humans are not just animals. It is well known that Aristotle’s answer was to affirm that ‘‘man is by nature a political animal’’ and that speech—or language—yields him this exclusive quality by giving him ‘‘a sense of good and evil, of just and unjust.’’

Jan Eckel, Human Rights and Decolonization: New Perspectives and Open Questions

In the global history of human rights in the twentieth century, decolonization is one of the most interesting fields to study. The independence of practically all of Africa’s and Asia’s nations, gained in the almost miraculously short span of the two decades after the Second World War, was one of the most dramatic processes of political emancipation in world history.

Julian Bourg, On Terrorism as Human Sacrifice

In the weeks after the attacks of September 11, 2001, it has become easy to forget, large parts of the world were grappling sympathetically with the victims of the spectacular destruction of the World Trade Center and other devastation of that day. A spontaneous outpouring of compassion and empathy was palpable during those early days, both within the United States and outside its borders. ‘‘We are all Americans,’’ the French and Italian dailies famously declared.

The electronic journal Behemoth which “focuses on the general problem of the fading and/or failing state,” has a new themed issue which focuses on epidemics, more specifically exploring “critical issues arising within the new problem space of emerging infectious diseases,” (Caduff 2010).  As Carlo Caduff argues in his introduction to the volume,

“In the aftermath of the Cold War and its historically distinctive institutions of international order, the specter of emerging diseases has…become a prominent site of thought, action, and passion where crucial meanings of health, safety, and security are articulated and negotiated.  It is perhaps primarily these multiple kinds of ambivalent resonances that make the discourse and ideology of emerging diseases so suggestive and this so powerful and pervasive today,” (Caduff 2010: 4).

The titles and abstracts of this issue’s articles–all of which are open-access–are below:

Carlo Caduff, Editorial

Katherine A. Mason, Becoming Modern after SARS. Battling the H1N1 Pandemic and the Politics of Backwardness in China’s Pearl River Delta

This article traces the early evolution of the H1N1 pandemic as it played out in China’s Pearl River Delta in the spring and summer of 2009, as local public health professionals there tried to contain the virus when their American counterparts did not do so. My informants’ difficulties in escaping their perceived status as a source, rather than a victim, of dangerous viruses; their use of disease control tactics that were portrayed abroad as excessive, unscientific, and unsophisticated; and their fatalism about reforming their local system of governance; all frustrated their ambitions. At the same time, the gulf between their reactions to H1N1 and the reactions across the Pacific suggests the need for a more serious global debate about what local places in all parts of the globe should and should not be prepared to do in the name of pandemic preparedness.

Lyle Fearnley, Epidemic Intelligence. Langmuir and the Birth of Disease Surveillance

In the wake of the SARS and influenza epidemics of the past decade, one public health solution has become a refrain: surveillance systems for detection of disease outbreaks. This paper is an effort to understand how disease surveillance for outbreak detection gained such paramount rationality in contemporary public health. The epidemiologist Alexander Langmuir is well known as the creator of modern disease surveillance. But less well known is how he imagined disease surveillance as one part of what he called “epidemic intelligence.” Langmuir developed the practice of disease surveillance during an unprecedented moment in which the threat of biological warfare brought civil defense experts and epidemiologists together around a common problem. In this paper, I describe how Langmuir navigated this world, experimenting with new techniques and rationales of epidemic control. Ultimately, I argue, Langmuir’s experiments resulted in a set of techniques and infrastructures – a system of epidemic intelligence – that transformed the epidemic as an object of human art.

Theresa MacPhail, A Predictable Unpredictability. The 2009 H1N1 pandemic and the concept of “strategic uncertainty” within global public health

This essay will examine the seemingly new paradigm shift within global public health from the use of a scientific “certainty” to a biological and situational “uncertainty” as one of the foundations of response to infectious disease outbreaks. During the recent 2009 H1N1 influenza outbreak, national and international public health officials often referred directly to the “uncertainty” surrounding both the virus itself and of the course, duration and severity of the pandemic. The vague and flexible concept of “uncertainty” – especially as it was employed by top virologists and epidemiologists in relationship to questions about the predictability of the influenza virus – provided the scientific foundation for much of the rationale behind both national and international health responses to the global pandemic. Public health officials, epidemiologists, and scientists often deployed a type of “strategic uncertainty” as an effective tool for gaining or retaining trust and scientific authority during the H1N1 pandemic.

Johanna T. Crane, Unequal ‘Partners’. AIDS, Academia, and the Rise of Global Health

The last decade has seen the proliferation of “global health” departments, centers, programs, and majors across top research universities in North America and Europe. This trend has been particularly pronounced in the United States, where it is connected to America’s new role as a major sponsor of HIV treatment in Africa. This paper describes the rise of “global health” as a research, funding, and training priority within U.S. academic medicine, and the increasing desirability of “global health partnerships” with institutions in sub-Saharan Africa. Leading spokespersons emphasize that “partnership” with poor nations is central to the mission of global health, an ethic that distinguishes it from older, more paternalistic traditions of international health and tropical medicine. However, at the same time, the field of academic global health depends on steep inequalities for its very existence, as it is the opportunity to work in impoverished, low-tech settings with high disease burdens that draws North American researchers and clinicians to global health programs and ensures their continued funding. This paradox – in which inequality is both a form of suffering to be redressed and a professional, knowledge-generating, opportunity to be exploited – makes the partnerships to which global health aspires particularly challenging.

Zone Books, 2010
408 pp., $36.95 (hardback)

Reviewed by Ross Parsons
(Faculty of Humanities and Social Sciences, Africa University, Zimbabwe)

A recent Zimbabwean joke had it that ‘if the four horsemen of the Apocalypse had not already arrived, then there were some very good imposters about’. It is not a very funny joke unless one is suitably seeped in the mordant despair experienced by those of us struggling on in pursuit of ‘the normal life’ in failing states, ‘low intensity’ civil wars and economic meltdowns. There are others of us facing earthquakes, storms and tsunamis. Social psychology has long recognized the behavior of the ‘bystander’ as being heavily inflected by contradiction and focusing on appeals to others ‘to do something’. Suffering of epic proportions and horrifying details has become a daily diet of shock and sorrow through every imaginable media source and it was Susan Sontag who began to explore for us the consequences of a constant, inescapable ‘regarding of the pain of others’ (2003).

The banal horrors of disasters, natural and man-made, and the scale and intensity of suffering they give rise to have become constantly present to us, while being also curiously peripheral.To risk understatement, these are forms of social suffering that are in urgent need of detailed study. ‘Contemporary States of Emergency: the politics of military and humanitarian interventions’, edited by Didier Fassin and Mariella Pandolfi (2010) is a volume which brings together an extraordinarily broad range of scholars and activists, writing on a very wide range of topics which are framed by Fassin and Pondolfi’s impressive legal survey of the gradual development of ‘the state of emergency’ as an example of Agamben’s (1995) notion of the ‘state of exception’.

“The state of exception thus forms the basis for a government that is at once military and humanitarian, resting on a logic of security and a logic of protection….[and] is inscribed in a temporality of emergency….[it] derives from a desire to intervene, and it increasingly appears that compassion for far-away suffering and its translation into the moral obligation to act has become on of the strongest political emotions in contemporary life” (Fassin and Pandolfi, 2010: 16).

It is worth pointing out that this is the view from above, from the position of interventionist. The perspectives and experiences of those intervened upon are notoriously difficult to capture in academic reflection and the forms of writing they generate. It is thus not too surprising that they are largely absent here. It is also an unjust criticism of the book which, after all, tells us it is concerned with ‘the politics’ of the emergency, and the interventions partially provoked by it. This is a work of reflection on the politics of interventionism as practiced in our world’s power enclaves.

Fassin and Pandolfi begin their survey, substantively, in the reinvigoration of the United Nations and of the contradictions inherent in international law since the appalling destruction of the Second World War and the challenges of the newly postcolonial states. The elephant in the room here (as it is in so many rooms, still) is the Holocaust where humanitarianism and intervention were so conspicuously absent, and suffering so absolute. The formulations that attempt to hold the book together may have been greatly enhanced had they registered the roots of late 20^th century humanitarianism in the utter failures of those unspeakable events. Guilt, as Freud insisted, is the essential human drive in conscious motivation, and military and humanitarian interventions are nothing if not examples of the performance of conscious (and consciously ethical) motivations.

This long shadow aside (if such be possible), this is a book full of remarkable, if uneven, insights. Besides detailed analyses of the political rituals and elaborations surrounding ‘transnational’ interventions, we also have case studies from (amongst others) post-tsunami Indonesia, Uganda, the Balkans and Venezuela. I was especially drawn to Ugo Mattei’s delightfully acerbic recognition of an ‘emergency-based predatory capitalism’. There is impressive frankness here. Language itself is at stake, as perhaps it should be in so strangely new a landscape. I have already mentioned the weighty ironies of phrases such as ‘low intensity civil war’, but there are also ‘compassionate militarization’ and ‘an emancipatory imperium’, to name but a few. Still, the development of relatively stable languages with which to refer to disaster with any recognizable sense of justice having been done is a sufficiently complex task to forgive some clumsy beginnings. Gilles Deleuze (1993) remarked that it was the stutter, the slippage of language, which marked a point when utmost failure and creativity became simultaneously possible.

Without a doubt, the highlight of the book for me was George Marcus’ ‘Experts, reporters, witnesses: the making of anthropologists in states of emergency’ which would make valuable required reading in anthropology departments globally, for large swathes of the globe are now revealed as sites of potential and actual disaster, of social suffering and, in Arendt’s phrase (1963), of ‘the banality of evil’. In Marcus, a reflexive anthropological voice allows us to glimpse part of the contradictions awaiting all witnesses (perhaps all the disaster-struck). Such contradictions might include the emotional freight accompanying the disaster, the problem of who might be addressed by the witness and in which language and the confounding problems inherent in the fact that interdisciplinary engagements (such as that represented by this book) are babels of wildly different methodologies, temporalities and languages.

In ‘The Writing of the Disaster’ (1980), Maurice Blanchot appears to suggest that the disaster is less narratable event (or social configuration) than standing question to philosophy. It becomes increasingly clear though that we need all means possible in a scholarly apprehension of disaster, of ‘contemporary states of emergency’: philosophically sound questions, divergent methodologies, multiple voices. Indeed, stutter and babel. We find some of that here in this compelling volume.

Sources

Agamben, Giorgio. 1995[1998]. Homo Sacer: sovereign power and bare life. Stanford, Stanford University Press.

Arendt, Hannah. 1963. Eichmann in Jerusalem: a report on the banality of evil. London, Penguin Classics.

Blanchot, Maurice. 1980[1986]. The Writing of the Disaster. (trans A Smock). Lincoln, University of Nebraska Press.

Deleuze, Gilles. 1993[1997]. Essays critical and clinical. Minneapolis, University of Minnesota Press.

Sontag, Susan. 2003. Regarding the pain of others. London, Hamish Hamilton.

Columbia University Press, May 2010
160 pages, $15.00 (paperback)

Reviewed by Jennifer Ilo Van Nuil

Tsunamis, hurricanes, volcanoes, pandemics, global warming, and financial crises: lately, catastrophes have become part of a larger conversation about the varied nature of disaster and intervention. Bridging case studies of disasters from around the globe, the contributors to Disaster and the Politics of Intervention speak to the range of events that constitute disaster as well as the breadth of responses these events generate. The book’s essays provide insights into the categorization of immediate and prolonged catastrophic risk and ways in which interventions can be enhanced.

Disaster and the Politics of Intervention includes papers from five authors who each engage with questions regarding the management of risk and the roles and responsibilities of various actors in maintaining collective security. In “Beyond Calculation,” Sheila Jasanoff scrutinizes the concept of “risk” through the development of risk analysis as a disciplinary tool. Using the Asian tsunami and Hurricane Katrina as examples, Jasanoff argues that risk, as a product of imagination, has transformed from a matter of management to a matter of governance. Patrick Roberts, in “Private Choices, Public Harms,” demonstrates the way politics shape preparedness and institutional responses to disaster by highlighting major organizational changes that have occurred within the Federal Emergency Management Agency (FEMA). In “Strange Brew,” P.W. Singer discusses the increased use of privatized military firms (PMFs) in humanitarian endeavors. Singer argues that the identity of humanitarian organizations as neutral entities may be threatened if these organizations hire PMFs to accompany employees in the field. In “Risking Health,” Heinz Klug, focuses on markets and claims to intellectual property of HIV/AIDS medications, making a case for changes to policy that would allow developing countries to have long-term, sustainable access to antiretroviral medications. In the final essay, “Constructing Carbon Markets,” Donald Mackenzie discusses global warming and the development of carbon emission markets as a way to control greenhouse gases. Mackenzie concludes that the only solution to slowing the process of global warming would require collaboration between the international community, individual nations, and the private sector.

Overall, Disaster and the Politics of Intervention is an informative collection that can serve as a resource for scholars studying problems that confront our world today. While individually the case studies in the book are compelling and could potentially offer new ways to conceptualize and manage disaster, the themes that tie the book together seem blurred by the specificity of each scenario. I had hoped to see the development of more intricate theoretical links bridging the essays and the building of a singular framework through which disaster could be discussed. The book raised several important questions about viewing HIV as a disaster in my own work on HIV interventions in Rwanda, but even more so about the response to epidemics––past, present and future. While labeling an event a disaster often mobilizes an immediate response, how long can “urgent” responses be sustained––or asked differently, when do urgency, sentiment, or social concern begin to erode? There are certainly long-term implications––both globally and locally––to labeling HIV as a disaster. Once a single event is “resolved” does that transformation in nomenclature also transform the imperative to act? How will countries maintain the long-term interventions? The momentum of interventions, policies, and programs may decline when the HIV “crisis” is no longer viewed as a “disaster.” If programs are not sustained, will HIV reemerge or become renewed as even greater disasters? The nature of response and the effects on the communities where the response is situated are necessary to consider. The local becomes of the utmost importance. Disaster and the Politics of Intervention opens important conversations precisely because there are very real and very powerful relationships between NGOs, governments, and the private sector, which not only impact the implementation and outcome of interventions, but also are themselves productive of the politics of intervention.