Book Review: Violence & Subjectivity, edited by Veena Das, Arthur ...

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Style file version June 4th, 2002

C 2002) Journal of Medical Humanities, Vol. 23, Nos. 3/4, Winter 2002 (°

Book Reviews Violence & Subjectivity, edited by Veena Das, Arthur Kleinman, Mamphela Ramphele, and Pamela Reynolds. Berkeley, CA: University of California Press, 2000. 379 pp. As I was working through my copy of this volume one afternoon, I took a brief break for some lunch and turned on CNN only to find yet another scene of school devastation and violence. It was Santana High School near San Diego and the scenes were all too familiar: children running for cover, parents nervously waiting, police doing their best to maintain control, and emergency services personnel tending to the wounded. Watching these events unfold forced me to take this volume very seriously, and to consider the root question of what academic scholarship can and should offer society to help make sense of violence. Perhaps these standards are too stringent to place on a single volume, but they are difficult to avoid given the moral and political dimensions of violence in modern society. Violence & Subjectivity is the second in a series offered by members of the Committee on Culture, Health & Human Development of the Social Science Research Council. The first volume was titled Social Suffering and has been previously reviewed in this journal (Karnik, 1999). The editors for the present volume, Veena Das, Arthur Kleinman, Mamphela Ramphele, and Pamela Reynolds, have collected leading ethnographers who “provide graphic accounts of the manner in which everyday life is transformed in the engagement with violence” (p. 2). Throughout this volume no clear definition of violence emerges, which is one of the problems of theorizing violence. It is a term that is inexorably intertwined with the definitions of trauma, suffering and pain, and yet stands apart from these experiences. In some sense we know violence when we see it, feel it, listen to it or otherwise experience it. Several themes emerge in this volume on the connections between violence and other social phenomena. Deepak Mehta, Jonathan Spencer, Mamphela Ramphele, and Pamela Reynolds all address the centrality of masculinity to violence and its connections to senses of community, nation and family. Mehta in his essay on “Circumcision, Body, Masculinity: The Ritual Wound and Collective 267 C 2002 Human Sciences Press, Inc. 1041-3545/02/1200-0267/0 °

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Violence” begins with the terms of violence that Hindus and Muslims use against one another in India. He then traces the origins of these terms into the inner sanctum of the sacred lives of people, and the ways that masculinity is inscribed on the body in both physical and linguistic senses through the ritual of circumcision. This action forms one axis along which people come to see themselves as different from other groups. The notions of gender and sexuality, and their linkages to violent actions, underscore the centrality of the body in Hindu-Muslim violence. Mehta, who teaches in Department of Sociology at the University of Delhi, is building creatively on the work of Elaine Scarry (1985). His work also has important connections to scholarship on the anthropology of the body by Nancy Scheper-Hughes and Margaret Lock (1987) who divided the study of the body into three parts: the individual body, the social body and the body politic. Mehta’s study shows the ways the terms we use and the understandings we have transform between these bodies in rapid ways; at one moment the young boy whose circumcision he witnesses is a young child in pain, the next the boy is moved from the feminine world of his mother to the masculinity of his father, the next he is a full male of the community. All of these moments highlight the ways that such traumatic events and socially defining moments go deep to our sense of self and community. Several essays in the volume engage the significance of the body that Mehta addresses. Both Emma Tarlo and Margaret Lock explore the body as a site of violence. Lock’s contribution, “The Quest for Human Organs and the Violence of Zeal,” sees the donor-recipient relationship in organ transplantation as rooted in the violence of medical experiment and therapy. While this clearly does not come to mind as the first or perhaps most pressing aspect of violence in modern society, her paper traces the important ways that violence comes to be routinized in medical practice, the ways that institutions adapt to try to cope to with the need for organs, and how society has failed to answer basic questions regarding what qualifies as death for the donor and to what extents we are willing to go to preserve the life of recipient. Arthur Kleinman, Veena Das, Kay Warren, E. Valentine Daniel, Jonathan Spencer and Murray Last struggle with conceptions of memory and remembering. Memory, as these essays demonstrate, is simultaneously a repository for our understandings of violence, a point from which future violence is launched, and a place where healing and recovery can take place. This may ultimately be the place where we need to focus our energies if we are to stem the cycles that violence seems to perpetuate. The damages that violence produces, we learn, are not isolated to the present or the individual. Instead they extend into the future through families, communities and even nations through tales of violence passed on from generation to generation. We do not want to be beholden to our histories, nor do we want to erase the past and in the process lose a portion of ourselves. Kleinman continues to try to construct a theory of social suffering and violence in his contribution “The Violences of Everyday Life: The Multiple Forms and

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Dynamics of Social Violence.” In this paper, Kleinman draws the experiences of a survivor of domestic violence, hemophiliacs with AIDS, political repression in China and the violence of images to demonstrate “the violence of everyday life as multiple, as normative (and normal), as the outcome of the interaction of changing cultural representations, social experience, and individual subjectivity” (p. 238). While I am sympathetic to Kleinman’s pursuit, I am wary of the outcome. There is inherent in his theory a comparative notion of violence, because in bringing these disparate instances together and trying to build a social theory, he posits them against one another. The inevitable question that arises is whether the domestically abused wife is on the same stratum of violence as the suffering of hemophiliac with AIDS. In many respects these events are not comparable; they are unique and singular, and resist the generalizing process of social theory. In an ideal world, violence would be given the same degree of concern, response and attention regardless of its magnitude or scope. But this is not that world. We live in a world where terrible violence may be routine for some and singular for others. Perhaps we should resist attempts to theorize violence in comparative frames and instead move to understand these instances in their nuances and particularities. In this way we may move the focus from the acts of violence to those who suffer and those who perpetrate violence. Here we may find clues to who is more likely to commit violence and why. And, more importantly, we may find how people cope with violence and come to heal. The students who witnessed and were victims of the tragedy at Santana High School have a difficult task ahead. They will need to grow beyond their fears and understandable wish for retribution to go on with their lives. Once touched by violence, their world will likely never be the same. We can only hope that they will learn that ultimately violence harms not only the victims but also the perpetrator, and therein is the hope of an end to violence.

REFERENCES Karnik, N. S. (1999). [Review of the book Writing at the margin: Discourse between anthropology and medicine]. Journal of Medical Humanities, 20(3), 223–226. Scarry, E. (1985). The body in pain: The making and unmaking of the world. New York: Oxford University Press. Scheper-Hughes, N., & Lock, M. (1987). The mindful body: A prolegomenon to future work in medical anthropology. Medical Anthropology Quarterly, 1(1).

Niranjan Karnik Department of Sociology and Medical Scholars Program University of Illinois at Urbana-Champaign *****

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Frontiers of Medicine in the Anglo-Egyptian Sudan, 1899–1940, by Heather Bell. Oxford: Clarendon Press, 1999. 261 pp. Cloth. Race, Science, and Medicine, 1700–1960, edited by Waltraud Ernst and Bernard Harris. London: Routledge, 1999. 300 pp. Cloth. In the 1920s, British scientist John Lancelot Todd declared that the “future of imperialism lay with the microscope.”1 These two texts map the cultures of imperialism and the histories of scientific development that led Todd to this claim. Heather Bell’s study of the colonial medical apparatus in the Anglo-Egyptian Sudan reveals complex relations among military, medical, and colonial power structures; uncovers intricate relations between colonial authorities and native populations; and argues for the impossibilities of separating social policy, imperial ambitions, and medical practice in a colonial context. Ernst and Harris gather a collection of compelling articles that argue for the interconnections of economics and global politics in the social construction of race and the participation of subjugated as well as dominant populations in those constructions. Together, these two texts not only bring important case studies to light, but through sophisticated readings of scientific and political documents, they show us the cultural stakes of discourses on medicine and race. Frontiers of Medicine is organized thematically. Bell first examines colonial medical policy and practitioners and the center of colonial medical research in Sudan, the Wellcome Tropical Research Laboratories in Khartoum. These first three chapters set up Bell’s argument that “colonial medicine was centrally concerned with boundaries and frontiers of all kinds, physical and psychological, natural and imposed, real and imagined” (p. 3). The remaining chapters address the racial categorization produced through the Gezira Irrigation Scheme, economically-driven campaigns to encourage native migration to facilitate labor supplies, and decisions to limit such migration in order to contain sleeping sickness and yellow fever. The text concludes with an excellent chapter on the training of Sudanese midwives by British women reformer/explorers which provides a much needed historical context to current debates in feminist studies on female genital surgeries and the roles of European women in imperialism. As a whole the monograph presents a compelling case study of the colonial project; individually each chapter conveys the tensions of medical research, economic pressures and the violence of colonization. Bell is keyed to the complexities of colonial medical constructions of race and she uses her sources, “unpublished sources from an explicitly political archive, namely the medical files if the Sudan government’s civil secretariat,” (p. 7) artfully 1 Quoted

in MacLeod and Milton Lewis (p. 7). (1988). Disease, Medicine, and Empire. London: Routledge.

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to refute positivist claims of apolitical medical development. The archival information that Bell uncovers reveals the tangle of colonial administration, medical advances, and inter- and intra-administrative bickering that produced twentieth century models for disease control, tropical medicine, and the regulation of colonized people in the name of public health. Readings of letters and diaries highlight the administrative, scientific, and political duties of medical officers and their often heartfelt beliefs that medical quarantines and social controls would in fact benefit the Sudanese, the colonial administration, and medical research simultaneously. Bell tells her stories well, weaving clear and often compelling narratives of “extreme exertions of state power and the extreme tenuousness of state control that simultaneously characterized the colonial situation” (p. 129). Ernst and Harris’s collection similarly maps relations of power among subjects of medical and state control. And like Bell, Ernst and Harris’s contributors are interested in the products of scientific racism, imperial legacies, medical institutions, and scientific inquiry. As Ernst argues in her introductory chapter, “‘Scientific racism’ presents itself in cultural as well as biological guise” (p. 16). This argument for the cultural as well as biological “guise” of scientific racism has broad implications for work on race in the medical humanities, in science studies, and in the philosophy of science. Ernst and Harris’s anthology produces a unified argument for the imbrication of cultural factors with the development of science in the production of scientific racism. As contributor H. F. Augstein argues, “[w]hile deploring scientific racialism, we must also shun histories that oversimplify the career of racial theory” (p. 74). Arranged chronologically, the essays also build on one another thematically and as a whole the collection embraces of the complexity of social formations and rarely produces easy answers or overly tidy narratives. This collection intervenes into critical race studies and the history of medicine by expanding scholarship of the impact of race on a wide range of medical fields. Moving beyond studies of the racialization of Darwinian evolution, eugenics, physiology, and sexology, essays in this anthology carefully read the impact of racial discourse on emergent fields such as bacteriology, immunology, psychiatry, and epidemiology. For example, in one of the few essays to look outside England and its colonies, Paul Weindling examines early-twentieth-century German regulations of migrants from Eastern Europe and the impact of bacteriology on discourses of race and disease. He argues that while “the history of bacteriology has been traditionally conceived of in value-neutral terms” (p. 218), early bacteriologists in fact “pressed for an ambitious social programme of sanitary improvements and preventative measures” (p. 219) imbued with political and racist agendas. Whereas early in the anthology Augstein cautions against an overreading of racism into the history of scientific development, Weindling emphasizes the “historical contingencies in German society, [especially around the first World War that] elicited a virulent strain of bacteriological racism” (p. 231). Thus the history of the development of bacteriology is exposed as intertwined with the xenophobic culture that produced it. Similarly, Mark Jackson looks beyond the superficial racism of

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the designation “mongolism” to analyze the changing medical classifications and representations of Down’s Syndrome. Not only were debates over environment, ethnicity, and heredity informed by scientific racism, but the persistence of the term “mongolism” in discussions of chromosomal variations indicates to Jackson that “the racial assumptions inherent in [John Langson Down’s] work persisted” (p. 182). This persistence “highlights clear continuities in depicting disease in the face of decisive transformations in scientific understandings” (p. 182) of Down’s Syndrome. Scientific racism, then, becomes a problem not only in the eighteenth and nineteenth century origins of modern medical research and practices, but remains embedded in the language and practice of disease, diagnosis, and research. Race, Science, and Medicine works extremely well as a collection. The editors skillfully selected a group of essays that treat a broad range of subjects. Each essay contributes to an overarching argument for the imbrication of racist ideologies in the development and practice of many medical fields previously underrepresented in studies of race and medicine. Yet this contribution to the field can only be fully realized by reading the collection as a whole, almost as a monograph. In contrast, Heather Bell’s monograph can be easily excerpted without diffusing her argument’s power (this is useful particularly for the university classroom). Frontiers of Medicine’s thematic organization, careful readings, and brisk style capture in each chapter the violence of colonization and the permeability of the medical and cultural boundaries it worked so hard to police. Though the format and styles of these two works vary, together they utilize cultural critique, postcolonial theory, and historical research to move studies of race and medicine beyond readings of the racism of medical research or practice to a deeper understanding of the material consequences of colonization, medical discourse, and classifications both on medicine itself and on the bodies it studies. Deborah Cohler University of California at Berkeley **** Life, Death and Love in the Hum of Medical Technology: The Resurrection Machine, by Steve Gehrke. Kansas City, MO: University of Missouri-Kansas City Bookmark Press, 2000. Selected for the 1999 John Ciardi Prize for Poetry, Steve Gehrke’s poetry book, The Resurrection Machine, poignantly discusses issues such as disease, degeneration, death, love, transplantation, and loss. Beginning with poems such as “Chronic Fatigue Syndrome,” where Gehrke portrays the visceral picture of a woman with the disease, (“her weather-less body holds onto its skin, to its bones,/those instruments of sadness,/locked into their cases”), Gehrke moves to

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more controversial themes like transplantation surgery and contemplates the line between “artificial” and “natural” healing (p. 12). Perhaps because of his own life experiences (Gehrke’s received a transplanted kidney donated by his sister at the age of 13), transplantation is a recurrent theme in the book. Gehrke explores transplantation surgery and the risks and benefits of exploring this unknown territory of human/machine living. In one particularly powerful piece written about his own transplant, Gehrke makes the thoughtful metaphoric linkage of “his grandmother’s false teeth” and his new “kidney.” As he remembers watching his grandmother pull her teeth from her mouth, always waiting for her to “unscrew a finger, an eye to pirouette from its socket,” he shifts suddenly to his own surgery where his sister has given up her kidney, “when it has been cut from her body and laced into mine,” he thinks of the “empty dish” of his grandmother’s mouth to comfort himself (p. 30). Gehrke’s approach to the subject of transplantation and other current medical conditions is creative and unabashedly frank. His book offers an original and complicated perspective of what it actually feels like to be a transplant receiver or giver. In another poem, “News Item: Man Receives First Hand Transplant,” Gehrke describes what it is like today, in an age of technological invasion of human bodies. He says: “There are thousands of us who own/fractions of the dead: kidneys,/livers, hearts, corneas, lungs, and one/new hand, waving away paradise./We are not superhuman/but not less than human. Not dead, but not not-dead./We are imaginary as fractions,/the simple arithmetic of us divided by them” (p. 32). Gehrke doesn’t attempt to sugarcoat the transplantation procedure or brush away its ethical complexity; he also doesn’t try to deny the way love and feelings transcend the boundaries of flesh. He retells a recent newspaper story about a man who doesn’t know how he will feel about his wife once he gets a new heart. He writes: “the man still loves his wife/though he takes down/all the mirrors in the house./The Jew still fears Allah./Some nights, he dreams Muslims hold his old heart hostage,/and force it to convert” (p. 34). Doctors, too, are explored through Gehrke’s poems. In “Three Doctors,” a gathering of physicians comes each morning to check on their narrator/patient, “cataloguing medication in pencil/while they murmur to each other, not intending/for me to hear their confusion.” One time, however, the three have some disagreement, and “their throats rattle, lips draining their faces of color,/voices shred into breathy fragments” (p. 27). This work carries a message of caution to doctors who forget that patients do, indeed, read the body language of their caretakers. Gehrke’s poems cover a range of other subjects such as the failure of the body, sketches of day-to-day life experiences and personages of famous and notso-well known people. In a poem entitled “Dialysis,” Gehrke writes from first-hand experience about his “drive to the clinic,” and the nurses “feed(ing him) ice chips” (p. 28). In “Rocky, he writes about thinking some mornings about how our “bodies abandon us” as “the referee waves his hand once over our head and we disappear” (p. 29). Gehrke doesn’t limit his tone to serious reflections about life. He also writes humorous, straightforward and biting poems with no covering up of human

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fallibility and egocentrism. Gehrke strikes at the hypocrisy of the appearance versus the reality of 21st-century living in “The Block Party at the End of the World,” when he talks about our need to catastrophize human foibles. Focusing on the possible demise of his own love relationship, Gehrke writes, “Sometimes the apocalypse doesn’t/come. And if all the lawn chairs collapse/in the shade, if the cold chicken with coleslaw’s/gone, to be close to each other, bravely sentimental/in our good-byes, the sky peeled back/like tinfoil from a pan.” At the end of the poem Gehrke says that even he can see the paperboy weaving his bike trail, delivering the clear devastating news—“Anonymous Source Claims: We Are All Still Here” (p. 67). In another poem entitled, “For the Good Counsel Nun Who Left Her Brain to Science,” Gehrke describes the cold anatomizing of the doctor who slices “the frontal lobe, thin as wafers from a loaf of bread” (p. 64). A personal favorite is his poem, “Anna Anderson,” a bio-poem about the experience of a schizophrenic known in the 19th century as ‘Princess.’ He begins with the phrase, “Schizophrenic moon,/half-lit and fat with gravity,/wakes up the Princess in Me./I have the ghost of a girl/locked in side. I raise her in my mind,/ the royal orphanage. “He ends more tragically and factually, capturing what it must feel like to feel ‘possessed’ by another. He writes, “I have no fools, no wizards/to quiet her. I do/what I can do-to shut her up,/I dance around the room” (p. 58). Any reader who has felt powerless in the hum of 21st century technology and its inability to process feeling and emotion will find Gehrke’s poems thoughtful and delving without being overly sentimental or simplistic. Gehrke’s subtle use of words captures the raw emotion of human beings who wrestle with sickness, aging, illness, and death. Because the poems in this book are short, well written and loaded with entangled ethical dilemmas about the inevitable future of transplantation, genetic altering, and cloning, they can be used in a diverse number of ways in medical humanities teaching situations. It is refreshing to read a poet who unusually captures the essence of current medical ethics without polarizing the moral dilemmas of modern medicine. Kathleen Welch, Ph.D. University of Missouri-Kansas City School of Medicine