ANTH 2280 Medical Anthropology Final Exam

Week 9: Structural Violence Farmer, Paul (2004) "An Anthropology of Structural Violence" Current Anthropology 45(3): 305-25

Haiti • The woman with the breast cancer is insistent upon telling her story and he, the doctor, must listen. This common among Haitians. • The Haitians nod to her, telling her to continue her story, she gathers strength through their cheering • She was unable to see a specialist in the city, it would cost her 700 dollars. She went from clinic to clinic spending her little money she had • She was taking pills she didn't even know the name of. Folk Model • Dream to stop taking medicine and travel far away to be cured, consulted a voodoo priest who said that each of the lumps had significance. Structural Violence= Violence exerted systematically- that is, indirectly- by everyone who belongs to a certain social order: hence the discomfort these ideas provoke in a moral economy still geared to pinning praise or blame on individual actors. Inform the study of the social machinery of oppression. Agency: The degree to which agency is constrained is correlated inversely with the ability to resist marginalization and other forms of oppression. • An honest account of who wins, who loses, and what weapons are used is an important safeguard against the romantic illusions of those who, like us, are usually shielded from the sharp edges of structural violence • Structural violence is embodied as adverse events (epidemic disease, violations of human rights, and genocide). • Integration of history, political economy, and biology remains lacking in contemporary anthropology or sociology (even though anth integrates biology and social) • Anth of Structural violence needs those listed above plus epidemiology to tally bodies. • Erasure of history and biology in Haiti. Erasing History • Allows for hegemonic accounts of what happened and why, those with agency are allowed to the stories and recreate history. • Can be subtle and incremental, and erasure of links • Forgetting can be natural/biological, too. • Popular media adores the quick fix- a one word explanation. • Long works are needed because the more we know about something, the less easy it is to dismiss any twist of interpretation. Traingle Trade and France • Businessman profited through triangular trade of slaves, sugar, and rum. City of Boudeaux was rebuilt via human flesh. All the "ebony" was going to Haiti (Saint-Domingue). • To have four times as many servants is a marker of prestige and wealth... supreme happiness of a Euro is to be waited on. Modern Haiti: Resocializing History and Biology • Poverty is the biggest concern • Dictatorial governments more concerned with pillaging that protecting rights of workres • Haiti required to pay 150 million francs to govt of Charles X to obtain diplomatic recognition, reparations to the slave owners?? Material consequences.. that are still seen today. The country was debt free, but entangled in a web of impossible financial obligations. • Continued hostility from US and European countries via trade with Haiti... US neglected their independence and blocked them from W Hemisphere Panama Conference. • US has been dominant force in Haitian politics Neoliberal Economics: prevailing constellations about trade and development and government that has been internalized by many in the affluent market societies. Competition-driven ideology replicates inequalities of power. • Historical injsutices have contributed to poverty, underdevelopment, marginalization, social exclusion, econ disparities, instability, etc. • Mircocredit seemingly impossible due to a failing economy • Collapse of public health infrastructure. • US has used influence with lending insts to withhold already approved loans marked for development and improving health to Haiti... an embargo if you will. • More "reparations" in the 19th century... millions as commission fees to IDB to head start programs to improve health. • Structuring and stricturing (constricts agency of victims) Erasing Biology • Everyone interested in structural violence should have a particular interest in these diseases and in the social structures that perpetuate them. • TB: white plague.. rose with industrial revolution • TB in Haiti: disease sent by sorcery, then when treatment came was seen as an airborne disease and stigma soon left. • AIDS: termed a social disease. • Rumors HIV came from Haiti due to voodoo blood rituals and animal sacrifice, tourism collapsed • Aids has more to do with the pursuit of trade and tourism (trading sex with money) than with blood maddened sex maddened negros. • To treat TB: money and political will (but it is lacking). • Distribution of aids: historically given and economically driven.

Week 9: Structural Violence Tuesday, March 13 Lecture- Social Determinants of Health

- Biomedicine is not the only form of treating illness - Distinction between illness and disease - Distinction between rationality and belief - Word belief used to mean something different - Cultural Context in understanding illness - The body is not a bounded, individualist entity - How the body absorbs political, religious, social and influences, among others is equally important to understanding how to provide care. - Think about body self, body social, and body politic - TB/AIDS/Cancer responsibility and blame cast on them by metaphors. Some terms: Disease: "Abnormalities in the structure and function of organs and body systems, as defined by biomedicine" Illness: "The patient's subjective experience of physical or mental states whether based on some underlying disease pathology or not" The Body/Embodiment: Literally incorporate biologically, the social and material world in which we live Impact of social influences on the physical body Way of describing porous, visceral, felt, enlivened bodily experiences, in and with inhabited worlds. Today's Questions What is structural violence? What are its main characteristics? How does Farmer relate the analysis of wider structural issues to the ethnographic study of specific situations and cases? Think about another infectious disease that you are familiar with. What role do you think the various social forces Farmer discusses play in the distribution of the disease? Risk: Individual Behavior and/or Structural Violence? Risk behavior as determined by individuals? Prevention aimed at individual risky behavior Role of politics, economics, history Role of poverty, racism, gender inequality, discrimination Such as efforts to target women in a very sensitive way, but there are problems. STRUCTURAL VIOLENCE: refers to the effects of institutionalized inequalities in wealth and power on those who are underprivileged (for example women, the poor, people of color). We need to look not just at illness and individual risk, but also at its links with the wider contexts of poverty, sexism, racism, and so forth- structural violence- in order to understand the unequal distribution of disease. "An Anthropology of Structural Violence" by Paul Farmer - The ethnographically visible vs. what is obscured - The erasure of history and political economy - Biosocial anthropology Paul Farmer -Places the personal within larger academic argument. -Confronted with women in Haiti and annoyed, Farmer had no time to listen, He brings us to a bigger story of poverty and inequality. Ethnographically visible= wasting bodies at TB and HIV clinics, experiences, narratives, and a crumbling healthcare sector... visible things offer room for rumors...supposedly spread of HIV to U.S. and accusations come with other weird speculations, too. What's ethnographically visible and this focus hides the real history of political, economic forces. Accusations work to distant populations and seem as if it is their fault. Erasure of history and Farmer - Completely wrong/weird to blame Haitians for what is ethnographically visible. - lavishness of french people was made possible by Atlantic Slave trade, "ebony". - Haiti had to pay reparation to France slaveholders for their loss of profits for independence - Haiti had to build a county with reparations, embargo by U.S. and Europe - So how can you build a health structure? - 20 year US occupation of Haiti did not help. - Prioritizing of democratic elections did not influence much aid to Haiti Calls for a biosocial anthropology--> integrating bio and social dimensions of illness

Week 12: Infections and Inequalities: The AIDS Pandemic Farmer, Paul (1999) Infections and Inequalities: The Modern Plagues. Berkeley: University of California Press. (pp. 1-17 and 37-58)

Majority of deaths by infectious disease occur in developing world But also a killer of US poor. Infections and Inequalities • Disease emergence is a socially produced phenomena. • The disparities of risk and outcome are embedded in complex biosocial realities. • Biosocial Analysis= an analysis that draws freely on clinical medicine and on social theory, linking molecular epidemiology to history, ethnography, and political economy. Visual-Field Defects in Anthro and Med • Histories of both disciplines have a lack of attention, to oppression and to the sickness of the poor • Anthropologist and informant are not separate and equal, both are caught up in global web of unequal relations... resulting in a blindness of inequality and structural violence, often the local manifestation of translational forces on part of the Anthros • Ethnographies in which poverty and inequality are reduced to a form of cultural difference • We saw oppression, it looked, well, different, from our comfortable lives in the university, and so we called it "culture". We came, we saw, we misdiagnosed. • To invoke another culture is to locate it in a time and space contamperoanueau with our own, and thus to see it as a part of our world, rather than a mirror or alternative to ourselves, arising from alien origin. • Writings from anthropology on sexual practices and AIDS outcomes focused on exotic reflections of cultural difference (ritual beleifs, etc.) and no relevance to HIV transmission or AIDS outcomes that were linked to systems of oppression, poverty, and inequality. • Result: Victim Blaming Rudolf Virchow: If medicine is to improve the health of the public, must attend at one and the same time to its biologic and to its social underpinnings. It is paradoxic that, at the very moment when the scientific progress of medicine has reached unprecedented heights, our neglect of social roots Virchow so clearly identified cripples our effectiveness. • Physicians need to think hard about poverty and inequality • All of processes leading to sickness, then to diagnosis and treatment are related to a series of social factors. On Claims of Causality • The facts are plain: their health is bad, health costs money and they don't have money. • Poverty and other social inequalities come to alter disease distribution and sickness trajectories through innumerable and complicated mechanisms. • Poverty and racism increase the likelihood of dire outcomes among the sick by restricting access to effective therapy or rendering it less effective if patients are malnourished or addicted. • **Fundamentally social forces and processes come to be embodied as biological events. • Scale of income differences in a society is one of the most powerful determinatnts of health standards in countries. Rethinking "Emerging Infectious Diseases" • Populations long afflicted by the diseases, why are the diseases called new or emerging? Is it because they have come to effect more visible, more "valuable" persons. • Critical epistemiology of emerging infectious diseases is still in the early stages of development. • Malaria, the aspect of disease emergence is obscured by an uncritical use of the term "tropical medicine", which imples a geographic rather than a social topography. • The limitations of these three important ways of viewing the health of populations—the concepts of tropical medicine, health transitions, and national health profiles—demonstrate that models and even assumptions about infectious diseases need to be dynamic, systemic, and critical. • Models with explanatory power must be able to track rapidly changing clinical, even molecular, phenomena and link them to large-scale (often transnational) social forces that shape the contours of disease emergence. Aids • Much of the spread of the HIV in the 1970s and 1980s moved laong international fault lines, tracking along steep gradietns of inequality which are also the paths of labor migration and sexual commerce. • Women and HIV, gender inequality and poverty come to be embodied as risk for infection. Taking a second look at emerging infectious diseases • Modern epidemiology is oriented to quantifying the obbing of corks on the surface waters, while largely disregarding the stronger undercurrents that determine, where, on average, the cluster of corks ends up along the shoreline of risks. • Analysis and context in journalism is a problem too. • Studies that examine the conjoin influence on social inequalities are virtually nonexistent

Week 14: Bioethics and Anthropology Marshall, Patricia A. (1992) "Anthropology and Bioethics" Medical Anthropology Quarterly" 6(1): 49-73.

Abstract: Increased attention to moral phenomenology and a recognition of the importance of social, cultural, and historical determinants that shape moral questioning should facilitate collaborative work between anthros and ethicists. • Limit the application of bioethics to discussions of moral problems associated specifically with Western biomedicine. • Medical eithics has broader applicability because of potential application to moral dimensions of medical practice and systems of healing in alllll cultures. Bioethics in the United States • 1960s moral difficulties of obtaining voluntary informed consent from human subjects of scientific research • 1970s to mid1980s bioethicists became involved in definitions of life, death, and personhood • Since mid 1980s: discussions of cost containment in health care and the allocation of scarce medical resources have gained attention in bioethical discourse • Personhood questions of when life begins or ends continues to be important. • Bioethical discussion embodies an externalized superego in the dynamics of American culture, driven by need for social and personal control over evetns that accentuate individual powerlessness. • Struggle for control over biomedical technology and the complexity of conflicting values in US society...Linares case he pointed gun at staff as he removed his son off ventilator (9 months in coma) • Linares case talked about biotechnology and power to prolong life and values and invidual emotional response on the other. • Normative rules: led to prescriptive behavior—what individuals ought to do or should do • Cartesian Duality: the analytic style of bioethics contributes to a distance of moral discourse from the complicated human settings and interactions within which moral dilemmas are culturally constructed, negotiated, and lived. Winds of Change • Autonomy and individualism in ethical reasoning—where one person's right is often balanced against another's demand- problematic bc it only conerns of white middle and upper class N/A. • Social issues and cultural tradition get pushed aside for self-determination. • Casuistry: a method of analysis whereby each case is explored in detail and then systematically compared to paradigmatic cases. • Virtue Ethics: emphasizes the unique aspects of the patient-physician relationship, focusing on personal qualities that embody a "good physician" such as benevolence, respect, justice, religion, etc. • Ethicisits who embrace the notions of practice, interpretation, and context find themselves within the theoretical realm of Kant's descriptive and empirical anthropology. Anthropology vs. Philosophical norms and values • Anth: not measured ethical proboems against a definitive standard of moral rectitude but has viewed them as culturally constituted and continually evolving. • Definition of medical dilemma and ethical resolution are seen as bound to broad cultural circumstances that influence health and illness behavior. **much in keeping with the new thinking in bioethics. Ethics of Bioethics (PANAMA) • Self interest and social contract view of moral experience of illness leaves little for generosity and community responsibility in matters of health and illness • Coopted: dangerous if biomedical system coops medical ethics because of power of medicine over individual bodies and body politic, which sustains a rhetoric of reedom, autonomy, and sovereignty. • Medical Ethicist is most vulnerable to cooptation in clinical consultations. Intent to inform and improve collaborative experience, negotiated experience so decision is made on mutual understanding - patient and doctor status differentials - ethics consultant is important for when a medical or moral dilemma occurs, a mediator of value and belief constructs or a mediator of the linguistic and psychological nuances necessary in the agreements. Anthropology and Bioethics: A Tentative Relationship • social scientists have not played a significant role in contributing to the evolution of the field. • Why? Deterrants between medical anthropologists and medical ethicists o Cultural Relativism: significant differences between the moral codes of different people. And these have not played in the role of bioethics. o Emphasis on research in non-Western societies: rarely been a focus for anthropologists. o Unique disciplinary training and predominant interests of each group: Ethicists tend to view the individual as the primary unit of analysis, anthropologist employ a broader perspective in which the individual is one element in a larger cultural and historical context. Ethnoethics • Exploration of ethical issues in medical care in non-western societies and describes the field in the following way: - This would include moral norms and issues in healthcare as understood and responsed by members of these societies. Informative in cross cultural variation of issues. - Medical Morality recommendations o Consideration of contact of what is perceived as medical or moral reality o Consideration of the values associated with that reality Truth Telling and Disclosure of Information • Oncologists view frankness and disclosure about cancer as essential in forging partnerships with patients- partnerships that will enable patient to accept greater responsibility in managing their illness. • Beleifs on part of both pateitn and physican about what is appropriate to say regarding diagnosis and prognosis of illness • Belefis about the character and disposition of the patient-practicioner relationship. • Cultural truth telling relate directly to ethical dilemmas and resolution. Knowledge of the cultural conditions and assumptions concering exchange of medical information enhances the process of decision making with regard to therapeutic interventions and diminishes the likelihood ethical dilemmas occur. Informed Consent • The importance of cultural beliefs in understanding ethical dilemmas in the process of obtaining and providing consent for medical treatment. • Moral crises occur in context of disparate value judgements and conflicting assumptions concerning nature of consent and appropriateness of asking permission to treat a medical condition. Death and Dying • How do we know when a person is dead or dying? What social and biomedical processes influence the determination of death? • Need consensus first that individual is dying Critical Care • Parents role is minimal in neonatal intensive care units, not much of a partnership between staff and parents Selection of Organ Transplant Recipients • Cultural assumptions about organ transplantation.

Week 13: Care Garcia, Angela (2010) "Blood Relative" Pastoral Clinic: Addiction and Dispossession Along the Rio Grande. Berkeley: University of California Press. (111-149)

Angela Garcia: The Pastoral Clinic • Story of a mother and daughter in New Mexico's Española Valley. • Co-addicts who shoot heroine together as an affiliation of kin • Circulation of drug is described as maintaining kinship ties. • Unique in the sense that many anthropological studies of heroin addicts describe them as isolated from biological or traditional family ties, a consequence of social and intimate life that frequently accompanies addiction. Local Representational Economy • Male • Stigmatizing labels of female heroin addicts • "Tecato"= junkie- only a masculine form of this word persists. • Language and life of junkie assumes a masculine form (thinness of chest and marks of women who are addicted) Querencia • Show how heroin works through, and provides endurance for, ties of blood and property, of inheritance. "nueva querencia"—shifting meaning of inheritance to heritable experience of addiction • Emotional connectedness to a place or tradition • Transmission of affective traits from one generation to the next. • Passing of property in the name of the father Bernadette • Arrested on drug possession charges and placed on house arrest to await trial • Only legal time away from the house is with her support group or drug counselor and probation officer • Confined to her trailer The Promise • Raided Bernadette's mom's trailer, Bernadette charged mostly because she was high. • Commitment (compromiso) that her and her mother formed a long time ago, to ease each other's pains, to alleviate las malias that are produced by and treated with heroin. IT was because of this commitment that she took responsibility for the drugs. • Weary that her mom was depressed and might suicide so she took responsibility. • Comrpomiso offers an alternative frame for thinking about the relationship between kinship, law, and care. • Complexity of addictive experience, especially as it is shared within families, creates new "Codes of conduct". Forms of inclusion and exclusion Together, Alone • Fear of police, of going to jail, of losing her kids • Bernadette constantly worried about her mother • When asked if she felt betrayed by mother, she responds with she's doing the best she can. • Structural forces keeping them apart: church says to break relations, probation officers restrictions, and tensions surrounding drug bust • Communal land was stolen or sold, with a loss of the land came a steep decline in family fortunes and community well-being. • Family livestock holdings decreased sharply, and state assistance programs that provided food were introduced. • People lived in communiteis within communites that were composed entirely of kin. • Kin-based communities were center of social and economic life and the conduit through which land, language, and tradition were transferred and maintained. Heroine and Bernadette and Eugenia • Used heroine together • The dependencies produced through heroin became a part of the relational mix that is kinship, and the circulation of heroin became the substance through which care was performed and through which affective ties between Eugenia and Bernadette were reaffirmed. But they were reaffirmed at the cost of further fragmentation, and perhaps even further subjections. Women and the Criminal State • Number of incarcerated and criminally supervised women has increased in recent decades, increased at a rate double that of men. • More than ½ incarcerated for "nonviolent drug offenses" • Due to war on drugs, stemming from a view that that sees addiction and lawbreaking as individual pathology and ignores the structural and social casues of addiction and crime. • Feeds into publics fear of crime, fueld by media (CSI and Law and Order) • Drug-addicted female offenders pose little risk to public safety, but only risk to themselves • As long as Bernadette kept writing her back, as long as they both kept their promise- their compromiso- to somehow care for each other.

Week 11: Postcolonial Disorders Lecture Thursday March 29- Trauma

Group exercise on creating a poster based on CACQ of Erica James' "The Political Economy of Trauma in Haiti in the Democratic Era of Insecurity"

Week 10: Violence and Death Tuesday, March 20 Lecture- Death Without Weeping

Farmer link- ethnographically visible, what gets erased? political economic structures and an interplay between micro and macro (violence exerted by structural aspects of inequality) Nancy also with micro and macro with infant deaths in shanty towns, poverty, race economonic imperialism. Uncover local cultural, and intermpersonal baby death under structural conditions. Farmer= more depth/detail of structural macro while Nancy= more depth/detail of micro locality.

Week 12: Infections and Inequalities: The AIDS Pandemic Lecture Tuesday, April 3

Hospitalized with diseases not found in humans, sikin afflictions. More cases of young people dying from these rare cases of diseases. Homosexuality with illness. A "gay" cancer- something happening. GRID- Gay-related Immune Deficiency. - effects of calling it this - as months went on, stragith Haitian and injected heroine users got it. Current epidemic started in 70s then spread to 5 continents. 1968- first confirmed HIV In a context of structural inequalities, where some bodies are at more risk for certain illness than others, how does change happen? "... the disparities of risk and outcome ... are embedded in complex biosocial realities. To understand these realities, nothing less than a biosocial analysis will do-an analysis that draws freely on clinical medicine and on social theory, linking molecular epidemiology to history, ethnography, and political economy. ... The inequalities of outcome I describe are, by and large, biological reflections of social fault lines" (Farmer 1999: 5). 1) What do HIV and AIDS stand for and what is the difference between them? HIV- virus attacks immune system, reduces CD4/T-cells AIDS- Acquired immune deficency syndrome, immuneless state, lower state of CD4 2) How does HIV affect the "helper T cells"? 3) What are "acute" and "latent" HIV? acute- intitial symptoms like flu latent- longer period 4) When does HIV transform into AIDS and what happens once one has AIDS? Social Fault Lines "How did instiutionalized homophobia influence illness risk and premature death in the US HIV/AIDS epidemic? - Homophobia - Political neglect - Threats of quarantine - Bowers V. Hardwick Opening political horizons: ACT UP"AIDS Coalition To Unleash Power Moral shock Change in emotional habitus Expansion of political horizon and political possibilities Direct action aimed at changing legislation, medical research, treatment, and policies

Week 10: Violence and Death Lecture Thursday, March 22 Death Without Weeping II

Nothing important really from what I have already written.

Week 7: Pain Thursday Mar. 1 Lecture

Pain in context of opioid addiction Existential pain is related to larger social, political, and historical significance. There are unethical standards of the pharmaceutical industry sending opioids to West Virginia where they know people are most vulnerable. What role should the government play in stopping this? These people are physically in pain.

Week 14: Bioethics and Anthropology Lecture Tuesday, April 17- Anthropology and Bioethics

Physical/Biological Anthropology Study of the past and present evolution of the human species Especially concerned with understanding the causes of present human diversity Encompasses human paleontology, evolutionary biology, human genetics, comparative anatomy and physiology, primate behavior, human behavioral ecology, and human biology. What makes physical/ biological anthropology unique is that it brings all of these areas to bear on our understanding of the human condition Dr. Josef Mengele "Angel of Death" - made children trust him, etc. - twin studies, experiments - amputations, typhis - sowed two twins together - personally killed 14 twins in two nights. 1948: The Nuremberg Code 1st international code of ethics: voluntary and informed consent a favorable risk/benefit analysis the right to withdraw without penalty Ethical friction at heart of research with human beings Interests of the individual with Interests of society, science, & scientists Advancement of knowledge Quest for medical progress "Advancement of the many" Bioethics: "science of survival ... built on the science of biology and enlarged beyond the traditional boundaries to include the most essential elements of the social sciences, and the humanities, with emphasis on philosophy in the strict sense, meaning 'love of wisdom'" (Van Rensselaer Potter 1971: 1-2, see Marshall 1992: 50) "... bioethics involves the inquiry into moral dilemmas created by theoretical and practical application of technological developments associated with the Western biomedical sciences" 1964: The Declaration of Helsinki Built on Nuremberg Code The interests of the subject should always be given a higher priority than those of society Every subject in clinical research should get the best known treatment Famous examples of ethical misconduct in research with human subjects Willowbrook Hepatitis Studies Jewish Chronic Disease Hospital Studies Milgram Studies of Obedience to Authority San Antonio Contraception Studies Tearoom Trade Study "The Tuskegee Study of Untreated Syphilis the the Negro Male" 1932-1972 1940's: discovery penicillin as cure for syphilis While watching Miss Evers' Boys Examples of ethical misconduct What ethical principles are compromised? No statistical basis that syphilis is a Negro disease, they withheld the name of the disease from study participants by saying they had bad blood and needed treatment (informed consent) also they dont know what they are getting in to. Violated the right to withdraw without penalty, too. The Belmont Report 1) Respect for Persons Treat individuals as autonomous agents Protect persons with diminished authority 2) Beneficence Do unto others as you would have them do unto you 3) Justice Distribute risks and potential benefits of research equally among those who may benefit from the research Bioethics and (medical) anthropology Framing of bioethical problems in terms of particular Western philosophical principles Positivist & prescriptive Move toward bioethics as "interpretive exercise"

Week 11: Postcolonial Disorders James, Erica (2004) "The Political Economy of 'Trauma' in Haiti in the Democratic Era of Insecurity" Culture, Medicine, and Psychiatry 28: 127-149

Question: Where is the line between drawing attention to the suffering of others in order to assist them and appropriating the suffering of others for institutional or personal gain? As much as governmental and nongovernmental humanitarian interventions are motivated by compassion, they are also motivated by concerns for security, global political and economic security, as well as national, and human. Definition of security has expanded, trying to determine the ways in which political, economic, social, or environmental factors impact human security. Goal of Article: Explore the relationship between discourses of security- in West post 9/11- and discourses of trauma or posttraumatic stress disorder (PTSD). There were high levels of fear and nervousness within the Haitain social body because of economic stagnation and ongoing instability following 1991-94 coup years. • Haitian viktim, who was of state sponsored violence • A discussion of the deployment of discourses of security and trauma during this period of research, and the effects on viktim, to show how these discourses can generate new economies based upon commodification of suffering. Trauma in the Post Cold War Era • Postmodern condition marked by disordering, yet productive effects of global capitalism • Identifying threats to the security of the West or to "civilized nations", resulting in form of intervention • The era begun by the end of the Cold War is neo-modern in character and hinges on security at the international, national, community, and individual level. • Since the end of cold war- proto-democracies- nations like Haiti have struggled free from shackles of political conflict and have been targets of intervention (RELATE to PANAMA). o Human development in a manner reminiecent of the missions of colonial expansion (humanitariansm efforts) o Designed to build civil socieites and aspects of human security. o Foucoult's "biopower"= techniques of power present at every level of the social body and utilized by very diverse institutions, operated in the sphere of economic processes, their development, and the forces working to sustain them. o Discourse of trauma permits use of Global biopower revealed through nations making transition toward respect for rule of law, human rights, democracy, capitalism - Via responses to traumatized victims of politically motivated violence • Acts of buereacuratized care can make of suffering and despair something productive o Unintended consequences can engender occult economies of trauma and new forms of victimization and reproduce sociopolitical inequalities at local, national, and international levels of engagement. o Trauma portfolios as victims of violence talk to physicians Discourses of Trauma, Practices of Denial • A denial of experience persisted in that Haitian men and women could not possibly suffer from trauma or traumatic memories in a culture in which political, criminal, and sexual violence are stereotyped as the norm. • US political officers evoked discourses of cultural, moral, emotional, and intellectual relativism that denied the recognition of Haitian psychobiology • Stereotypes of Haitians as supersiticious or sexually liberal. • CDC designated Haitians as vectors of HIV Torture and its Consequences • Violence of the coup years based of files of 2000 viktims • The use of gendered and sexualized forms of torture and terror was intended to destroy the productivity and reproductivity of the individual victim and to rupture the social bonds between the direct target of violence and his or her family community through phycial pain, threats, and coercive acts leaving social death of the victim, the psychosocial effects of torture leave their trace on individual psyche or self over-time, as well as on families and communities of viktim The Traumatic Sequelae of Torture: Social Death and Natal Alienation • Haitian men and women who were victims of violence articulated feelings of humiliation and shame at having been powerless to protect their families, and at having been subjected to abasing forms of torture. • Men= rage and anger over loss of their property, livestock, and public status—essential aspects of the ideals of masculinity. Humanitarian assistance, security, and biopower • In response to criticisms of its practices and the accusation that he United States was not a credible promoter of global human rights, the US government, through USAID, provided humanitarian assistance to viktim from the 1991-1994 period. • Complete medical care to viktim • While also projecting US national security and own image in international community (to make US look accountable). • Funding discontinued after there were no more viktims because it was no longer necessary to maintain US authorit, the existence of viktim was denied once again. • Trauma Brokers: gatekeepers to the humanitarian assistance apparatus who profit from the suffering of others and who supply the demands of consumers of performed suffering in the international humanitarian apparatus. Ongoing Ethical Challenges • Era of Traumatic Citizenship= an era in which individuals and groups seek recognition, agency, political and economic power, and security through attempts to seek justice for past wrongs or experiences of victimization. • (Panama) Form of recognition perpetuate a second-class or undeveloped status for those two are the objects of humanitarian intervention? Does the recognition of trauma in this manner perpetuate forms of bio-power that are rooted in the imperial past. • To examine these activities solely from the present without regard to history would be an error. • Those of us from cultures of relative security must acknowledge that while our intentions may be to "do good," there is always the potential that we who profit from the partial recognition of our subjects' humanity will perpetuate the cycle of global inequality.

Week 10: Violence and Death Scheper-Hughes, Nancy (1992) "Two Feet Under and a Cardboard Coffin: The Social Production of Indifference to Child Death" Death Without Weeping: The Violence of Everyday Life in Brazil. Berkeley: University of California Press. (pp. 268-339)

Questions: 1) Why are Brazilian shantytown mothers so indifferent to their babies deaths? 2) How is this indifference socially produced? 3) To what extent does Scheper-Hughes insistence on the importance of bearing witness contradict or compliment Farmer's emphasis on the importance of attending to structural violence? Underlined sentences Possible blog post= food and water shortages, political and economic turmoil, military coup were reflected in the spidery difficult to read entries of births and deaths. Five hundred babies died in the municipio that year... example of where ethnographically inbisible things intersect with ethnographically visible (deaths of baby and indiffence). Forebodings Page 269: But at what price I wondered, at what physical, pychic, and social cost to Nailza and other women like her and at what risk to their seemingly unbroken succession of "replacement" babies and subsequent angel-children? Core Sentence (270): Rather, what puzzled me was the seeming indifference of Alto women to the deaths of their babies and their willingness to attribute to their new offspinrg an aversion to life that made their deaths seem wholly natural, indeed expected. Core Question (272): What made death so small, of such little consequence on the Alto de Cruzerio? Had the exposure altogether of too much sickness, hunger, and loss turned these women's hearts to stone? Because the indifference appeared in women who were ordinarily vibrant, emotionally charged, and sometimes quite sentimental when it came to remembrances of things and relationships past, it required some explanation. Core Argument (272): In this first of three chapters on child death and mother love, I begin with a discussion of the routinzation of child death in the creation of an average expectable environment of child death, meaning a set of conditions that places the infant at great jeopardy of sickness and death, accompanied by the normalization of this state of affairs in both public and private life. Rephrased as argument: We need to understand maternal indifference to child death in shantytown Brazil in the context of a routinzation of child death in which the conditions that place infants at great jeopardy of sickness and death are normalized both in public and in private. In the ensuing "average expectable environment of child death' it makes sense that the mother love thought to be so universal, is lacking- this routinzation is what constitutes the "social production of indifference." - coming from a society in which babies don't die, or if they die it's a big deal... Page 271: I wept bitter and angry tears all along the way. To my greawt wonder and perplexity, however, the young woman took the news and the bundle from my arms placidly, almost casually and indifferently. Noting my red eyes and tear-stained face, the woman turned to comment to a neighbor woman standing by, "Hein, hein, coitada! Engracada, nao e, Tsk Tsk poor thing, funny isn't she? - her display of grief was amusing. - "Its only a baby" Page 272: In subsequent chapters I move from public to the private realm to explore the conditions that normalize infant deaths within the family and that place all infants at high risk. Social production of Indifference The Discovery of Child Mortality Page 273: Failure to recognize childhood mortality as a significant personal or social problem and to "naturalize" and normalize an infant death rate, that, in various times and places, had reached 40% of all live births. - medical profs and public officals treat infant death as normal and routin - an infant mortality rate was created, suggesting a social awareness of premature deaths and recognition of infant as discrete entity page 274: it is ironic that the discovery of childhood malnutrition (first identified as a pediatric disease in 1933) had to await Western medical doctors encountering these disorders in the topcics and adopting traditional Ghanian term as their clinical diagnostic category. Core Sentence (275): the social invention of child mortality and later, child survival, as important social and medical problems about which something must be done is of fairly recent vintage. Core Argument (276): "I wish to make it clear from the outset that the apparent indifference of Alto women toward the lives and deaths of some of their infants in continuous with, and a pale reflection of, the official beureaucratic indifference of local agents of the church and state to the problem of child mortality in NE Brazil today. The social production of indifference is similar to what Bourdieu meant by meconnaissance, or misrecognition... what cannot be recognized in this instance are the social determinants of the overproduct of Nordestino angel-babies. - child mortality of the rural and urban poor and working classes Child Death in the Northeast: The Colonial Context Page 277: The high infant death rate of the slaves was affected by the economic circumstances of their domestic life and labor... some infants were abandoned as the female worked during the day. Core Sentence: The concern with the slave master's primary means of production promoted some interest in the question of black infant mortality in the colonial period and may have contributed to the negligible differences in the birth-rates and infant death rates of the slave and free populations as recorded for a number of Nordestino plantations and fazendas in Brazil for the late 18th and early 19th centuries. Page 277: the high mortality in the big house was because of the failure of Portuguese colonists to adapt their traditional childrearing practices to a new environment. (practice of swaddling and head bundling that lead to death in hot weather). Child death was not treated as a misfortune in the big house bc plantation women married young and there would always be another newborn to replace a dead sibling. Child Death Today: The Modernization of Child Mortality Conservative economic policies of the military government and the increase in infant mortality in Brazils largest urban centers.. years following coup, military supervised a transfer of the national income from poorest 40 percent to richmest 10 percent.... A decline in standard living was experienced by poor. 1964-1970s.. - wages down infant mortality up Cuba's isolation from Western market forces and from the World Bank's economic development policies for Latin America served it will with respect to insulation from long-term side effects of those policies on the health and well-being of the population. Core Question (279): Insofar as infant and child mortality rates may be taken as a particularly sensitive barometer of how well or how badly a nation... is faring at a given time, what accounts for the persistent and perversely high child mortality in Brazil as a whole and for the Northeast in particular? Core Answer (280): What each of the ecological, population, and demographic transition theory approaches has obscured is the role of pernicious class relations in the social production of child morbidity and mortality." Core Sentence (282): Consequently, one finds in Brazil today two contradictory epidemiological profiles, one for the rich and middle classes and the other for the poor. The Overproduction of Angels: Keeping Track, Losing Count Core sentence (288): The doctor was pulling my leg, of course, but his remarks capture both the social embarrassment and the bureaucratic indifference toward child mortality as a premodern plague in a self-consciously modernizing interior town. Core Sentence (291): When I asked Seu Jao... why the data on baby coffins were not kept separately, he replied: "Because it wouldn't be of interest to anyone.' The deaths of these children, like their brief lives, are invisible and of little or no account. Core sentence (294): The state, then - represented the personages of minor civil servants such as Moacir and Dona Leona- contributes to the routinization and normalization of child death by its implacable opacity, its refusal to comprehend, and its consequent inability to act responsively to the human suffering that presents itself. Bureacurats and civil servants respond to pain and difference with a studied indifference- la belle indifference. Reproductive Histories: Alto Women's Voices Core Question (304): The questions I put to Alto women were not only concerned with patterns of fertility and mortality but also with issues of value, choice, meaning. I wanted to understand and child death meant to Alto women and how they explained and interpreted their lives and actions as women, wives, and mothers. What were the effects of scarcity and deprivation of women's ability to nurture, hold, love, and hope? What kinds of resilience did they have, and how were their survivor values and practices passed on to their children? Mortal Ills, Fated Deaths Core Question (312): I asked a general question: Why do so many babies die on the Alto de Cruzeiro? Core Answer(313): In short, Alto mothers gave highly politicized answers to the question of child mortality in general, ones that stressed the constraints on the ability to care for their offspring. But when these same women were asked to explain why any of their own children died, their answers were more clinical, and the cause of death were seen as more proximate, sometimes as internal to the child" Core Sentence (313): It may be that Alto mothers had to exercise a certain amount of denial because the alternative- the recognition that ones child is slowly starving to death- is too painful or, given the role that mothers sometimes play in reducing food and liquid, too rife with pyscholgoical conflict. Breasts, Bottle, and the Somatization of Scarcity Core Sentence (317): Despite measures such as these, each generation of mothers in the Third World is less likely than the previous one to breast-feed offspring. Core Question (322): Why did the women of the Alto give up their original resistance to powdered milk? How were they turned into avid consumers of a product that they do not need, that they cannot afford to buy, and that contributes to the death of their children? Social Class and Reproduction Core Argument (326): I am suggesting that poverty interacts in many different ways to produce child mortality and to shape reproductive thinking and practice. Core Questions (326-327): But which is cause? Which is effect? Do so many babies die because there are too many of them to begin with, or are there so many babies because so many of them die? Or are they poor because they have many babies? If women Could Choose: Fertility, Mortality, and Ideal Family Size Core Question (330): In short, why do these poor Brazilian women have so many babies? Core Sentence: (331): In other words, the average Alto woman labors through 6 more pregnancies than the average middle-class woman to have 1 child in excess of her more affluent 'sisters'. The women of the Alto, then, are not prodigious reproducers; they must simply work much harder than affluent women to produce a medium-sized family

Week 12: Infections and Inequalities: The AIDS Pandemic Lecture Thursday, April 5- "How to Survive a Plague"

Recap Paul Farmer's emphasis on importance of a biosocial approach Biological and social underpinnings that made HIV especially prevalent among -deadly for -gay men in the U.S. Interest in interplay between the "micro" & "macro"/"bodies" & "larger structures" Question of how change happens in a context of structural inequalities Potential answer: Example of AIDS activism in How To Survive A Plague

Week 11: Postcolonial Disorders Tuesday, March 27 Lecture- "Amuk"

To run amuck- people going insane, going ape shit Postcolonial Disorders is a conceptual area between medical anthropology and pyschology. Malaysia There are some of them [the Javanese] who go out into the streets, and kill as many persons as they meet. These are called Amuco." - The Book of Duarte Barbosa: An Account of the Countries Bordering on the Indian Ocean and Their Inhabitants (1516) To run amock is to get drunk with opium... to sally forth from the house, kill the person or persons supposed to have injured the Amock, and any other person that attempts to impede his passage... indiscriminately killing and maiming villagers and animals in a frenzied attack." - James Cook (1772) What is postcolonialism What are culture bound syndromes? How can we take a postcolonial view of amuk as a culture bound syndrome? Postcolonialism or postcolonial studies is the academic study of the cultural legacy of colonialism and imperialism, focusing on the human consequences of the control and exploitation of colonized people and their lands. - anti-essentialist - knowledge is power - roots in Marxism and postmodernism Colonialism and Anthropology - understood of foreign rule over a distant people, a legal domination of subordinate people and resources for the imperial country. Indonesia and Colonialism Spice trade in Indonesisa established a monopoly and got rich. Dutch tried to bring colony under control Indonesia gained independence, however. Sujarto ousted, first president with a military coup. Colonialism is a fundamentalist social force that has structured modernity Lasting impacts of colonialism worldwide reflected in healthcare worldwide. Under postcolonialism, anthropolgical research has undergone activist type anthropology Culture-bound syndrome= culture specific syndrome, or folk illness, is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture. Amok in Malaysia= dissociative episode characterized by a period of broading followed by an outburst of violent, aggressive or homicidal behavior. when focus on these syndromes, it leaves out structural forces when you focus on individual, pathological aspects too. 1998 Protests in Indonesia Video - Indonesians became fed up with Suharto dictatorship. - economic and political turmoil -Various protests - how the media would use amok to describe groups of political protesters - a year after the use of amok, mass of student protests - suharto finally stepped down - student protesters= anarchists according to the General, normalizing authoritarianism and pathologizes protesters as anarchists. - Media says they were running amok, not different than when general describes protesters----- normalizing and pathologizing Racial inequality as an assumption. Once we try to prove, we can't really. Social Darwinism= influenced Eugenics, where a hierarchy of persons is evident. Strong vs. weak, those are selected for.

Week 13: Care Lecture Tuesday April 10- Care and Addiction

Today's Questions What is care? How does care relate to health? What are the limits of care? 4 phases of care 1.) Caring about: noting existence of need, culturally and individually shaped 2.) Taking care of: taking responsibility for identified need, recognizing own ability to respond to need 3.) Care-giving: direct meeting of needs for care 4.) Care-receiving: recognition that object of care will respond to received care, lets us know caring needs have been met, perceptions of care=giving can be wrong. Johntrell Bowles: Bearing the Struggle- Acknowledging structural violence and ways to truly develop a broken community. Care connotes some type of engagement but if a person is led by interests it can assume a quality or interest. Difference between being interested and caring Care - Implies reaching out to something other than self - Care implicitly suggests that it will lead to some kind of action (taking care of). Definitions of Care: "On the most general level, we suggest that caring be viewed as a species activity that includes everything that we do to maintain, continue, and repair our 'world' so that we can live in it as well as possible. That world includes our bodies, our selves, and our environment, all of which we seek to interweave in a complex, life-sustaining web." care is not restricted to human interactions with others. care is not necessarily dyadic the activity of caring is largely defined culturally, and will vary among different cultures care is both a practice and a disposition We are attuned, relational, open human-beings and respond to things and others (we are influenced by culture). care= engaging with human beings in a way that is not natural/normal. Exstatic care of humans- extending self towards other human beings in contrary to individual bounded idea. - physical presence might be here, but thoughts could be elsewhere - we stretch ourselves out to things we care about. Constant pushing forward, going beyond- is a form of care. Why is drug rehabilitation as a form of care insufficient to heal the broken world people like Bernadette and Eugenia inhabit in New Mexico's Española Valley? (worlds, relationality, ethic of kinship, querencia, dispossession, conpromiso) only accounting for physical not mental, it was engrained in relationships, deeper social, cultural things engrained in their conception of care. Why can we consider the Canadian colonial bureaucratic concern with the biological survival of Inuit individuals to be an indifferent - or even murderous - form of care? (welfare colonialism, biopolitics, bureaucratic care, community, naming practices, intimacy with the dead, cooperation, suicide as non-cooperation) From a state perspective--> not considering the social, cultural, influnences and norms. State of care is statistics- for what, for who?

Week 9: Structural Violence Thursday, March 15 Lecture- Inequality

Today's Questions: How are structural violence and inequality connected? How does social inequality affect the prevalence of diabetes and depression among poor Black South African Women? What examples of illnesses related to inequality can we think of? poo poo train to Alabama - Dispute about where to put NYC poop, no equipped to deal with waste - A landfill in Alabama got contrat to deal with NYC poop - People who live close to landfill... bad - No one wanted poop, so a bunch of strinking trains just on trains. -Why does waste go to Alabama? AL is one of the poorest states. Effects of institiutionalized powers. -A link between inequality and illness, public health outcomes will affect poor people in Alabama. Syndemic of Diabetes and Depression Soweto 1930 in goverment attempt to seperate whites from blacks - largest black city in S. Africa - location of anti-apartheid uprisings. - status of temporary residence Syndemic: a set of linked health problems involving two or more afflictions, interacting synergistically, and contributing to excess burden of disease in a population. Syndemics occur when health-related problems cluster by person, place, or time. For example, the SAVA syndemic is comprised of substance abuse, violence, and AIDS, three conditions that disproportanetly afflict those living in poverty. To prevent a syndemic, one must prevent of control not only each affliction but also the forces that tie those afflictions togethor. Health Transition: "trends of disease patterns in populations" VIDDA means structural violence, immigration, depression, diabiets, and abuse. CACQ method: Core sentence, argument, connection (to first-hand account), and Question (more info, criticism, curiosity) Page 303 Core Sentence: "Indeed, social inequality plays a fundamental role in why and how depression and diabetes cluster among poor populations, although the social problems that contribute to such clustering may differ based on social context. Hookworm epidemic in Alabama: 34 percent tested positive for hookworm 74 percent African-American population 73 percent of population has been exposed to raw sewage Average income 18,046 and 1/3 lives below poverty line 80% of county uncovered by municipal sewerage system. reality: people get jailed for buying a septic tank which cost more than annual income this is the inconvenient truth that there are poor people of color and they don't seem to care.

Week 12: Infections and Inequalities: The AIDS Pandemic Gould, Deborah B. (2009) "A Shifting Emotional Habitus and the Emergence of the Direct-Action AIDS Movement" Moving Politics: Emotion and ACT UP's Fight Against AIDS. Chicago: University of Chicago Press. (121¬-175)

owers V. Hardwick: The Event and Its Aftermath • Supreme court upheld sodomy as illegal after Michael Hardwick and ACLU brought it up. • Decleration of War • Arguing the supreme court had revoked lesbians and gay mens right to privacy and life Bowers V. Hardwick as a "Moral Shock" • Moral Shock= A cognitive=affective state that Jasper defines as occurring "when an unexpected event or piece of information raises such a sense of outrage in a person that she becomes inclined toward political action. • Rulings and government disregard decimated any sense of belonging to dominant society. • Moral shock creates new ways of understanding oneself and the world and the relation between the two, and are both brought to the fore.

Week 13: Care Lecture Thursday, April 12- Care and Colonialism

see above.

Week 11: Postcolonial Disorders Van Loon, F.H.G. (1928) "Protopathic-Instinctive Phenomena in Normal and Pathological Malay Life" British Journal of Psychology 8: 264-276

• A negro has, Australian native, a Chinese, or a Malay has certain well-defined and distinct physical qualities. • Various races, political ones, are racial inherited qualities as constant as their colour or the shape of their skulls... physical ones can not be described only to climate, food, sicknesses and the like factors. • Pychology is a new branch of scicne, has not yet formed many generally accepted theories and gathered relatviley few certain facts... applying hyoptheses to all sorts of practical ends to solve social, economical, sexual and political problems • Environment counts for everything and that very little is genuinely inherited. This why such a view is supported by the argument that is is impossible to produce scientific evidence to the contrary. • Argument: it is often very difficult to demonstrate any psychical difference between individuals of distinct races. • Reason: attention concentrated upon intellectual aptitudes. o Seek our evidence in abnormal behavior o Study the mob and groups whom intellectual control is relatively weak, as primitives and children. o Study psychical abnormalities of forms of insanity special to certain races or special symptoms observed in all kinds of psychoses. Malays • Amuck and Latah as forms of insanity • Amuck= absolutely sudden and unexpected murderous attack of the Malay man, seizing, kills those around him (amuck runner) • Amuck runners were suffering from infectious disease (malaria). • Sudden state of hallunicinatory confusion when instinctively escaping danger (Tiger, enemy) and may kill family while escaping and reacting to danger. • Latah = suddent fright or strong emotion causes a Malay woman to enter into a curious state of hyper-imitativity- she loses all self-control and imitates immediately and most precisely what is done before her or said to her. o Occurs in women who were servants with white masters or those have been in a subordinate position most of their life. (reminds of multinational corporation in Malaysia). o Overwhelming of the whole consciousness by a sudden fright—then the whole behavior to subordinate to the person who made the patient Latah. Europeans and Mass • Seldom runs Amuck and Latah. • But can see related phenomena in civilized peoples and races-not individually, but more especially in the group, crowd, and in mob. o We see crowd reacting in the same way as the Malay running Amuck driven by mad terror, running over anyone, same running amuck driven by instinctive fear. o In terms of mass response, we consider these mass phenomena as a regression, a falling back upon more primitive modes of reacting (INSTINCTIVE element strong, but INTELLECTUAL control or influence is relatively slight). • Civilized man will have other, more useful, intellectual reaction which will go on developing with and by the demands of modern life and strain. But as soon as he loses these higher qualities of intellectual control- in the mob, the mass minded, but the same lower, phenomena among primitive people may still be observed in the individual. • Double life and double personality= "repression under morbid conditions" where early instinctive modes of reaction tend to reappear. Special character of primitivity is the factor which enables these modes of reaction to arise more easily than with other races.

Mendenhall, Emily (2012) "Syndemic Suffering in Soweto: Violence and Inequality at the Nexus of Health Transition in South Africa" Annals of Anthropological Practice 38(2): 300-316

• Focus on structural and interpersonal violence of health transistion in South Africa--- focus on women's narratives of distress and diabteses as well as epidemiology. • Syndemic Theory: demonstrates how violence play a role as a perpetuator of suffering through structural, social, and psychological, and even biological pathways. • Syndemics explaisn how health inequalities came to be, emphasizing how social problems contribute to and exacerbate the clustering of two or more diseases . • Synergistic interaction of social, contextual, and disease-related factors that escalate the burden of suffering and disease on marginalized groups in a way that exceeds impact of single factor. • Role of historical and social contexts in how conditions such as depression and diabetes are distributed epidemiologically and experienced individually. • Most vulnerable spaces associated with noncommunicable diseases are poor urban settings... 14.1% of diabetes prevalence among urban Black women. • Diabetes prevalence much higher among economically diasadvantaged who are also afflicted by diseases of poverty including HIV and depression and poor access to good health care. • 36% people with diabetes in low/middle income countries have occurring depression. • Bidirectional relationship between diabetes and depression. • Social inequality explains why depression and diabetes cluster among poor populations (pooor access to healthy foods, no space to exercise) • Healthy lifestyles, living conditions, and sense of security • Narratives of Mexican immigrant women cannot be dissociated from US-Mexico economic and immigration policies that shape their motivate to migrate or marginilzation through race and class in the city. • Women's stories of extreme physical, sexual, or verbal acts of violence that occurred upon migrating to Chicago where they rarely received treatment for physical or psychological violence..... significant factors for diabetes and depression dyad. • Women reported street violence (74%), interpersonal violence(59%), living with an alcoholic husband (33%), the stress of caring for grandchildren (59%), loss of a family member to AIDS or other sicknesses(56%), financial stress (48%) and diabetes-related stress (30%). Stress and Structural Violence of Soweto • Structural Violence: theoretical orientation and analytic tool to examine how political-economic systems place particular persons or groups in situations of extreme vulnerability that compromise their health. • Structural Violence in S. Africa: historical legacy of apartheid and the hegemonic practices of inequality instituted through education and public policy in postapartheid leadership can be closely linked to unequal distribution of health. Ex: s Africa is one of 12 nations where maternal mortality has actually increased, despite its relative wealth, 17% of HIV global burden, and TB epidemics is bad..... Black population succumbs due to social, economic, and and environmental conditions cultivated by apartheid. Settings: overcrowded squatter settlemetns, migrant labor, and underdeveloped health services • Diabetes: social impact of living a community overburdened by the AIDS virus, and their struggle to manage their chronic illness via purchasing and preparing healthy foods and accessing reliable and affordable diabetes care. • **Virus has lingering effects on family members left behind, including those who suffer from chronic illness... playing a role in depression-diabetes syndemic because many women preference their grandchildren's health and social well-being to their own. • Structural violence of HIV in lives of women living with diabetes is more social than biological. • **Poor access to affordable and healthy foods (food deserts) and healthcare. High calorie, low nutritional diet. Cheap food, filling, majority eaten daily. • Diabetes food insecurity due to apartheids legacy of segregation that shaped the poorly nutritious geographies of food retail. • Meats become staples and markers of status. Food choices are linked with a preferred larger body size juxtaposed with those who are sick with HIV and AIDS. • Women compared and contrasted their knowledge around diabetes with their knowledge of AIDS...reflection of limited extra-insitutional education around diabetes at the community level and decades-long education programs around HIV and AIDS. Interpersonal Violence: Fear and Insecurity in private and public Spehres • Female homicide by males • Abuse reported by 60% of women. • Alcoholic husband • Many women left marriage and due to abuse and infedility • ¾ women experience violence in public to be central of their life (burglary, losing a member to gun violence) • experiences like these affect mental health.

Week 7: Pain Kliff, Sarah. "The Opioid Crisis Changed How Doctors Think about Pain." Vox, June 5, 2017. https://www.vox.com/2017/6/5/15111936/opioid-crisis-pain-west-virginia

• Opoids are everywhere in Williamson, West Virginia because chronic pain is everywhere in Williamson • Population of coal minors with a lot of back pain. • The opoid drugs are being prescribed for real reasons • Pharma sent 780 million opioid pills to WV over six years. Shift in conception of pain in professional medicine •Must cure pain and chronic pain entirely. •Medical guidelines to get pain closest to zero on smiley chart •Opoid pain medications had pushed people to want more and more. •2016 fed govt stops pay out of financial rewards to the hospitals that have biggest reductions in patients pain.... •Rethinking of pain is meant to move professional medicine away from opoiods.. leaving chronic pain patients in a hard situation. •May not be possible to cure every pain •Previous laws had resulted in end of life patients in intense pain and nothing strong enough to relieve suffering. •James Campbell at American Pain Society 1996 annual conference that pain should be a 5th vital sign and should be assessed at the same level as the others. •Beckett, the doctor in the WV town, said that people like to doctor shop. They will go around and try multiple physicians to try and score different types of medication. •AMA voted to denounce the use of pain as a vital sign most recently •Structural: The US government has committed fewer research dollars to pain than to other diseases. Chronic pain to receive 1/6 of what NIH spends on cancer and ¼ what it spends on rare diseases.

Week 13: Care Stevenson, Lisa (2012) "The Psychic Life of Biopolitics: Survival, Cooperation, and Inuit Community" American Ethnologist 39(3): 592-613.

• Welfare colonialism in the Canadian Arctic • Attention to inuit naming practices provides an alternate way of linking death, desire, and community in a postcolonial world. • Bureacrats argue that TB rates, infant mortality rates, and incidence of environmental diseases can be cut by improving housing. o Inuit shacks seen as vectors of disease o Construction of colonial settlements is seen as the only way to reduce disease and provide adequate access to medical care. • "It is more desirable to have a live and slightly disturbed Eskimo than a dead one". • Inuit death is gauged as a symptom of inadequate intervention, inadequate social planning. The state takes responsibility for each death. • Forms of bureaucratic care may also manifest a form of indifference on the part of the state- according to inuit as murderous, even if couched in terms of benevolence and care. • Consider the Inuit practice of naming children after the dead, one that means life is never anonymous and never bare- though perhaps always mournful. Quvianaqtaq's Letter • The decision about how to care for Inuit is not always in the hands of the doctors or nurses who care for them, but are expected to cooperate with these higher regimes of care. • Care and Cooperation still matter in contemporary postcolonial Inuit worlds. • Suicide= everyone feels a need to do something • Article attempts to awaken our sense to the question of when, how, and for whom we care and what it means to require those for whom we care to cooperate in our forms of care. • Questions of colonial desire • Think ethnographic differently- to trace out the ethnographic life of a negation, that which is denied, discouraged, expelled from the mind, forgotten, or lost. Bureacratic Heroes • "welfare colonialism in canada" • Inuit first became visible to southern Canadians through their fascinating and exotic forms of death—starvation, infanticide, and suicide—the postwar period was the moment when Canadian state officirals began to intervene and to sanction that death in an effort to make respectable Canadian citizens out of themselves- and the Inuit. • Unknown tribe now individual names on welfare files • To demonstrate the compassion of the Canadian state for those new names on the welfare files, something had to be done as quickly as possible about the forms and rates of their deaths... emerge as a form of knowledge through "need" for government assistance. • Thinking of the 9,000 Eskimos as a laboratory experiment and to give the imagination full rein on what might be done to improve their culture To Cooperate In Survival • Can build new housing, but how do Inuits use them, no education on that • Although colonial norms were taught, they could never live up to their white counterparts. • Transported by ship to hospitals where no one spoke the indigenous language was bad • Family members would be buried in South without telling indibenous family Biopolitics and Murder • Foucoult: to explain how a state dedicated to promoting life can also destroy it, he points to racism: "a way o fintroudcing a break into the domain of life that is under power's control: the break between what must live and what must die" • Agamben: not racism, biopolitics as ever-present • Bare life= a life that is already exposed to an anonymous death. • Inuit bodies were reinscribed as Canadian to support Canada's international claim to soverieignty over the Arctic • Shift from promoting life to hastening death among Inuit. • How and why the drive to preserve life at the population level may b experienced as a drive to murder • Bare life understdood as a failure of community, failure to recognize other as being embedded in a series of relationships Questions of Cooperation • Pearson's story of returning inuit 12 years later and the family refusing it because the baby was"dead".... Socially dead but not physically. • Disturbing practice of removing inuit from their social networks and calls into question Inuit willingness to cooperate in this mode of survival. • Canadian government issued Inuits with ID numbers on fiber disks to be worn around their necks...erasure of nams A-nonymous Care • Inuit youth suicide • Suicide prevention hotline, discard name • Take intimate affect, care, and apply it indiscriminately and anonymously. • Highlights simultaneous intimacy and distance of a welfare state- a structural distance combined with an intimate affect. Anticiaption of death by tabulating statistical suicide rates does no good for post colonial peoples, especially youth imaginations Ask Inuit to live while also expecting them to die through post colonial policies? Conclusion • Bare life in Agamben's sense exists through a failure of community...when "who" someone is, is ignored. • Bare life might be productively thought of as life that has not been, and is not allowed to be, mourned. • We become part of the human community through being named, through "being called". • Bureacratic modes of proceeding leds to formation of collectivities devoid of biography and devoid of human life in the Arendtian sense... community to call on each other and thus to bring human life into existence. • Life, in Inuit case, is more about bodies linked through the circulation of names.

Week 11: Postcolonial Disorders Good, Byron. J and Mary-Jo DelVecchio-Good () "Amuk in Java: Madness and Violence in Indonesian Politics" A Reader in Medical Anthropology: Theoretical Trajectories, Emergent Realities. Byron J. Good et al, eds. Malden, MA: Wiley-Blackwell. (pp. 473-480)

• Youth as a form of protest and class resistance to Suharto's New Order elections. • Focus on order in the news had a hegemonic element, a quality of naturalizing order, treating nearly all mass political activity as disorder and potentially anarchic. • A man had gone mad and was killed by people in a small village, he had a mental illness, attacking villagers trees and crops • Amok = among culture bound syndromes, which is unique to a particular culture or region of the world. An episode of dissociative violence, a behavorial syndrome of an individual, who suddenly goes berserk, becomes wild and violent, attacking others and threatening to kill them, until he is subdued or killed by those he is threatening, then leaving survivors with amnesia for the events. - Causes: result from infectious disease or opium use, or mental illness • In the news: mass violence indexes lack of social, political, and intellectual development, a sign that the masses are not yet ready for democracy. • Amuk enters into mid 16th century European languages as groups o fexcpetionally courageous men who had taken a vow to sacrifice themselves in battle against an enemy. • 19th Century: Amuk refer to heroic acts of bravery on part of warriors. • Argument: while there were speculation about the causes of amok—whether it reflected Malay or Javanese character, whether it was linked to Islamic fanaticism, constitution weakened by disease or from opium use, or represented culturally distinctive form of suicide--- these ideas were formulated within larger context of discussion s of native violence in response to colonial rule. o Reflected concerns of order and disorder under the colonial regime o Resistance to harsh rule o Amok as an instrument of social protest by individuals against rulers who abused their power... rejection of the physchiatrists' claim that amok was just a local form of insanity, excusing the individual from punishment in contrast to the viscous sentences given out suggest that in the colonial context, some judges saw act of running amok as heinous bc it was a form of violent protest against colonial rule, requiring public displays of punishment. dic