In Life Beside Itself, Lisa Stevenson takes us on a haunting ethnographic journey through two historical moments when life for the Canadian Inuit has hung in the balance: the tuberculosis epidemic (1940s to the early 1960s) and the subsequent suicide epidemic (1980s to the present). Along the way, Stevenson troubles our commonsense understanding of what life is and what it means to care for the life of another. Through close attention to the images in which we think and dream and through which we understand the world, Stevenson describes a world in which life is beside itself: the name-soul of a teenager who dies in a crash lives again in his friend’s newborn baby, a young girl shares a last smoke with a dead friend in a dream, and the possessed hands of a clock spin uncontrollably over its face. In these contexts, humanitarian policies make little sense because they attempt to save lives by merely keeping a body alive. For the Inuit, and perhaps for all of us, life is “somewhere else,” and the task is to articulate forms of care for others that are adequate to that truth.
Format: Book
Casualties of Care
This book explores the unintended consequences of compassion in the world of immigration politics. Miriam Ticktin focuses on France and its humanitarian immigration practices to argue that a politics based on care and protection can lead the state to view issues of immigration and asylum through a medical lens. Examining two “regimes of care”—humanitarianism and the movement to stop violence against women—Ticktin asks what it means to permit the sick and sexually violated to cross borders while the impoverished cannot? She demonstrates how in an inhospitable immigration climate, unusual pathologies can become the means to residency papers, making conditions like HIV, cancer, and select experiences of sexual violence into distinct advantages for would-be migrants. Ticktin’s analysis also indicts the inequalities forged by global capitalism that drive people to migrate, and the state practices that criminalize the majority of undocumented migrants at the expense of care for the exceptional few.
The Antibiotic Era
In The Antibiotic Era, physician-historian Scott H. Podolsky narrates the far-reaching history of antibiotics, focusing particularly on reform efforts that attempted to fundamentally change how antibiotics are developed and prescribed. This sweeping chronicle reveals the struggles faced by crusading reformers from the 1940s onward as they advocated for a rational therapeutics at the crowded intersection of bugs and drugs, patients and doctors, industry and medical academia, and government and the media.
During the post–World War II “wonder drug” revolution, antibiotics were viewed as a panacea for mastering infectious disease. But from the beginning, critics raised concerns about irrational usage and overprescription. The first generation of antibiotic reformers focused on regulating the drug industry. The reforms they set in motion included the adoption of controlled clinical trials as the ultimate arbiters of therapeutic efficacy, the passage of the Kefauver-Harris amendments mandating proof of drug efficacy via well-controlled studies, and the empowering of the Food and Drug Administration to remove inefficacious drugs from the market. Despite such victories, no entity was empowered to rein in physicians who inappropriately prescribed, or overly prescribed, approved drugs.
Now, in an era of emerging bugs and receding drugs, discussions of antibiotic resistance focus on the need to develop novel antibiotics and the need for more appropriate prescription practices in the face of pharmaceutical marketing, pressure from patients, and the structural constraints that impede rational delivery of antibiotics worldwide. Concerns about the enduring utility of antibiotics—indeed, about a post-antibiotic era—are widespread, as evidenced by reports from the Centers for Disease Control and Prevention, academia, and popular media alike. Only by understanding the historical forces that have shaped our current situation, Podolsky argues, can we properly understand and frame our choices moving forward.
The Life of Cheese
Cheese is alive, and alive with meaning. Heather Paxson’s beautifully written anthropological study of American artisanal cheesemaking tells the story of how craftwork has become a new source of cultural and economic value for producers as well as consumers. Dairy farmers and artisans inhabit a world in which their colleagues and collaborators are a wild cast of characters, including plants, animals, microorganisms, family members, employees, and customers. As “unfinished” commodities, living products whose qualities are not fully settled, handmade cheeses embody a mix of new and old ideas about taste and value. By exploring the life of cheese, Paxson helps rethink the politics of food, land, and labor today.
Republic of Therapy
The Republic of Therapy tells the story of the global response to the HIV epidemic from the perspective of community organizers, activists, and people living with HIV in West Africa. Drawing on his experiences as a physician and anthropologist in Burkina Faso and Côte d’Ivoire, Vinh-Kim Nguyen focuses on the period between 1994, when effective antiretroviral treatments for HIV were discovered, and 2000, when the global health community acknowledged a right to treatment, making the drugs more available. During the intervening years, when antiretrovirals were scarce in Africa, triage decisions were made determining who would receive lifesaving treatment. Nguyen explains how those decisions altered social relations in West Africa. In 1994, anxious to “break the silence” and “put a face to the epidemic,” international agencies unwittingly created a market in which stories about being HIV positive could be bartered for access to limited medical resources. Being able to talk about oneself became a matter of life or death. Tracing the cultural and political logic of triage back to colonial classification systems, Nguyen shows how it persists in contemporary attempts to design, fund, and implement mass treatment programs in the developing world. He argues that as an enactment of decisions about who may live, triage constitutes a partial, mobile form of sovereignty: what might be called therapeutic sovereignty.
Mosquito Trails
Dengue fever is the world’s most prevalent mosquito-borne illness, but Alex Nading argues that people in dengue-endemic communities do not always view humans and mosquitoes as mortal enemies. Drawing on two years of ethnographic research in urban Nicaragua and challenging current global health approaches to animal-borne illness, Mosquito Trails tells the story of a group of community health workers who struggle to come to terms with dengue epidemics amid poverty, political change, and economic upheaval. Blending theory from medical anthropology, political ecology, and science and technology studies, Nading develops the concept of “the politics of entanglement” to describe how Nicaraguans strive to remain alive to the world around them despite global health strategies that seek to insulate them from their environments. This innovative ethnography illustrates the continued significance of local environmental histories, politics, and household dynamics to the making and unmaking of a global pandemic.
Adventures in Aidland
Anthropological interest in new subjects of research and contemporary knowledge practices has turned ethnographic attention to a wide ranging variety of professional fields. Among these the encounter with international development has perhaps been longer and more intimate than any of the others. Anthropologists have drawn critical attention to the interfaces and social effects of development’s discursive regimes but, oddly enough, have paid scant attention to knowledge producers themselves, despite anthropologists being among them. This is the focus of this volume. It concerns the construction and transmission of knowledge about global poverty and its reduction but is equally interested in the social life of development professionals, in the capacity of ideas to mediate relationships, in networks of experts and communities of aid workers, and in the dilemmas of maintaining professional identities. Going well beyond obsolete debates about ‘pure’ and ‘applied’ anthropology, the book examines the transformations that occur as social scientific concepts and practices cross and re-cross the boundary between anthropological and policy making knowledge.
Care in Practice
In what way is care a matter of tinkering? Rather than presenting care as a (preferably “warm”) relation between human beings, the various contributions to the volume give the material world (usually cast as “cold”) a prominent place in their analysis. Thus, this book does not continue to oppose care and technology, but contributes to rethinking both in such a way that they can be analysed together. Technology is not cast as a functional tool, easy to control – it is shifting, changing, surprising and adaptable. In care practices all things are (and have to be) tinkered with persistently. Knowledge is fluid, too. Rather than a set of general rules, the knowledges (in the plural) relevant to care practices are as adaptable and in need of adaptation as the technologies, the bodies, the people, and the daily lives involved.
The Body Multiple
The Body Multiple is an extraordinary ethnography of an ordinary disease. Drawing on fieldwork in a Dutch university hospital, Annemarie Mol looks at the day-to-day diagnosis and treatment of atherosclerosis. A patient information leaflet might describe atherosclerosis as the gradual obstruction of the arteries, but in hospital practice this one medical condition appears to be many other things. From one moment, place, apparatus, specialty, or treatment, to the next, a slightly different “atherosclerosis” is being discussed, measured, observed, or stripped away. This multiplicity does not imply fragmentation; instead, the disease is made to cohere through a range of tactics including transporting forms and files, making images, holding case conferences, and conducting doctor-patient conversations.The Body Multiple juxtaposes two distinct texts. Alongside Mol’s analysis of her ethnographic material—interviews with doctors and patients and observations of medical examinations, consultations, and operations—runs a parallel text in which she reflects on the relevant literature. Mol draws on medical anthropology, sociology, feminist theory, philosophy, and science and technology studies to reframe such issues as the disease-illness distinction, subject-object relations, boundaries, difference, situatedness, and ontology. In dialogue with one another, Mol’s two texts meditate on the multiplicity of reality-in-practice.
Presenting philosophical reflections on the body and medical practice through vivid storytelling, The Body Multiple will be important to those in medical anthropology, philosophy, and the social study of science, technology, and medicine.
The Logic of Care
Mol, in the early pages of this book, recounts a panel discussion she is invited to chair on patient choice and autonomy. The discussants – ethicists and psychiatrists – are presented with the case of a patient on a psychiatric ward who does not want to get out of bed. The panellists are asked, “are you going to allow him to stay in bed or not?” Different panellists give different answers, reflecting on whether a choice might harm, whether a patient is ‘capable’ of making their own choices, and whether individual choice might hinder the value of communal living in psychiatric care. One doctor, however, gives an altogether different answer, pointing away from questions of autonomy and choice, and instead towards the need for patient care, saying:
“On a ward with enough staff, I’d send a nurse to sit next to the patient’s bed and ask him why he does not want to get up. Maybe his wife is not coming for a visit that afternoon. Maybe he feels awful and fears he will never be released from hospital. Take time for him, let him talk. Someone who does not want to get up…needs care”
Mol argues that the dominant logic currently surrounding disease and patient treatment is that of a ‘Logic of Choice’, and that this undermines what she terms a ‘Logic of Care’. For Mol, worrying solely about ‘patient choice’ is often a form of neglect. A fascination with ‘choice’ often occurs at the expense of care. ‘Individual choice’ is an idealized part of Western medical systems, but what does an attention to ‘choice’ obstruct? For Mol, ‘patient choice’ is often at odds with ‘good care’.
The idea of championing ‘patient choice’ in modern health care services is meant to disrupt top-down approaches to health care that tend to silence patients and make them subservient and passive recipients. What Mol demonstrates is that ‘choice’ has not corrected this hierarchal relationship, but has instead complicated health care systems ability to work alongside patients to manage the complexities and intricacies of their disease. Based on long-term ethnographic research with people suffering from diabetes, and fused with real clinical examples, Mol carefully details the ways that a logic of choice has upended health systems, while arguing for a relational logic of care that is oriented to the everyday lives of those living with disease.
