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.

Encounters with Aging

Margaret Lock explicitly compares Japanese and North American medical and political accounts of female middle age to challenge Western assumptions about menopause. She uses ethnography, interviews, statistics, historical and popular culture materials, and medical publications to produce a richly detailed account of Japanese women’s lives. The result offers irrefutable evidence that the experience and meanings—even the endocrinological changes—associated with female midlife are far from universal. Rather, Lock argues, they are the product of an ongoing dialectic between culture and local biologies.Japanese focus on middle-aged women as family members, and particularly as caretakers of elderly relatives. They attach relatively little importance to the end of menstruation, seeing it as a natural part of the aging process and not a diseaselike state heralding physical decline and emotional instability. Even the symptoms of midlife are different: Japanese women report few hot flashes, for example, but complain frequently of stiff shoulders.

Articulate, passionate, and carefully documented, Lock’s study systematically undoes the many preconceptions about aging women in two distinct cultural settings. Because it is rooted in the everyday lives of Japanese women, it also provides an excellent entree to Japanese society as a whole.

Aging and menopause are subjects that have been closeted behind our myths, fears, and misconceptions. Margaret Lock’s cross-cultural perspective gives us a critical new lens through which to examine our assumptions.

Laboratory Life

This highly original work presents laboratory science in a deliberately skeptical way: as an anthropological approach to the culture of the scientist. Drawing on recent work in literary criticism, the authors study how the social world of the laboratory produces papers and other “texts,”‘ and how the scientific vision of reality becomes that set of statements considered, for the time being, too expensive to change. The book is based on field work done by Bruno Latour in Roger Guillemin’s laboratory at the Salk Institute and provides an important link between the sociology of modern sciences and laboratory studies in the history of science.

The Pasteurization of France

What can one man accomplish, even a great man and brilliant scientist? Although every town in France has a street named for Louis Pasteur, was he alone able to stop people from spitting, persuade them to dig drains, influence them to undergo vaccination? Pasteur’s success depended upon a whole network of forces, including the public hygiene movement, the medical profession (both military physicians and private practitioners), and colonial interests. It is the operation of these forces, in combination with the talent of Pasteur, that Bruno Latour sets before us as a prime example of science in action.

Latour argues that the triumph of the biologist and his methodology must be understood within the particular historical convergence of competing social forces and conflicting interests. Yet Pasteur was not the only scientist working on the relationships of microbes and disease. How was he able to galvanize the other forces to support his own research? Latour shows Pasteur’s efforts to win over the French public—the farmers, industrialists, politicians, and much of the scientific establishment.

Instead of reducing science to a given social environment, Latour tries to show the simultaneous building of a society and its scientific facts. The first section of the book, which retells the story of Pasteur, is a vivid description of an approach to science whose theoretical implications go far beyond a particular case study. In the second part of the book, “Irreductions,” Latour sets out his notion of the dynamics of conflict and interaction, of the “relation of forces.” Latour’s method of analysis cuts across and through the boundaries of the established disciplines of sociology, history, and the philosophy of science, to reveal how it is possible not to make the distinction between reason and force. Instead of leading to sociological reductionism, this method leads to an unexpected irreductionism.

Reassembling the Social

Reassembling the Social is a fundamental challenge from one of the world’s leading social theorists to how we understand society and the ‘social’.

Bruno Latour’s contention is that the word ‘social’, as used by Social Scientists, has become laden with assumptions to the point where it has become misnomer. When the adjective is applied to a phenomenon, it is used to indicate a stablilized state of affairs, a bundle of ties that in due course may be used to account for another phenomenon. But Latour also finds the word used as if it described a type of material, in a comparable way to an adjective such as ‘wooden’ or ‘steely’. Rather than simply indicating what is already assembled together, it is now used in a way that makes assumptions about the nature of what is assembled. It has become a word that designates two distinct things: a process of assembling; and a type of material, distinct from others.

Latour shows why ‘the social’ cannot be thought of as a kind of material or domain, and disputes attempts to provide a ‘social explanations’ of other states of affairs. While these attempts have been productive (and probably necessary) in the past, the very success of the social sciences mean that they are largely no longer so. At the present stage it is no longer possible to inspect the precise constituents entering the social domain.

Latour returns to the original meaning of ‘the social’ to redefine the notion, and allow it to trace connections again. It will then be possible to resume the traditional goal of the social sciences, but using more refined tools. Drawing on his extensive work examining the ‘assemblages’ of nature, Latour finds it necessary to scrutinize thoroughly the exact content of what is assembled under the umbrella of Society.

This approach, a ‘sociology of associations’, has become known as Actor-Network-Theory, and this book is an essential introduction both for those seeking to understand Actor-Network Theory, or the ideas of one of its most influential proponents.