Transcript Document

Why Theory Matters
Three More Social Theories: Social
Suffering, Biopower, and Local
Moral Worlds
A Critical Sociology of Global Health III
Societies of the World 25
Arthur Kleinman
September 10, 2013
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Social Suffering: Definition
1.
2.
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Pain and suffering caused by social forces: Global and local
economics, politics, social institutions, social relationships,
culture, e.g. structural violence.
The interpersonal experience of suffering, experience of
chronic illness.
The contribution that society and its institutions make to the
causality or worsening of social and health problems.
This concept is meant to be omnibus and to mix together
social and health problems of every sort : for example
coordinating social policy with health policy in responding to
the clustering of inner city violence, substance abuse,
depression, suicide.
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Social Suffering: Types
 Structural violence
• “…such suffering is ‘structured’ by historically given (and often
economically driven) processes and forces that conspire – whether
through routine, ritual or as is more commonly the case, the hard
surfaces of life – to constrain agency. For many, including most of my
patients and informants, choices both large and small are limited by
racism, sexism, political violence, and grinding poverty.” (Farmer, 40)
- e.g. Poverty as a major risk factor for infant and maternal mortality and adult
infectious diseases
 Interpersonal experiences
• Illness experience
- e.g. the experience of diabetes, asthma, arthritis, heart disease, etc.
 Suffering caused or intensified by bureaucratic indifference and the
unintended consequences of bureaucratic action
• For example PTSD among Iraq veterans, previously not accepted for
disability claims.
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Suffering and Inequality
 If poverty is the major risk factor for a
number of disorders how can we separate
the issues of inequality and medical care?
 Heath disparities across class, ethnic
groups, gender and age cohort mean that
suffering and inequality is at the heart of
global health policy
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Foucault and Biopower (1)
 “If one can apply the term bio-history to the
pressures through which the movements of life
and the processes of history interfere with one
another, one would have to speak of bio-power to
designate what brought life and its mechanisms
into the realm of explicit calculations and made
knowledge-power an agent of transformation of
human life.” - Foucault (HOS 143)
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Foucault and Biopower (2)
 “Biopower refers to controls over life, denoting
‘what brought life and its mechanisms into the
realm of explicit calculation and made knowledgepower an agent of transformation of human life’” Foucault
• Such transformation are said to occur at two levels: that
of the human body as the object of discipline and
surveillance, and the of the population as the object of
regulation, control and welfare
• Foucault’s example was 18th century France when the
consolidation of the centralized state’s administrative
power worked through counting and controlling the
health and social welfare of populations. .
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Foucault and Biopower (3)
• Biopower is opposed to sovereign power which is
expressed in right to kill, a right of seizure. Foucault
said that history moved from sovereign power to
governmentality (policy based government) and that
biopower was one of the examples of governmentality.
• Biopower seeks to exert a positive influence on life, i.e.
it endeavors to administer, optimize, and multiply it,
subjecting it to precise controls and comprehensive
regulations
- For example measuring the size and distribution of
populations, categorizing populations by gender, age,
occupation, fertility, mortality, etc. are examples of how
biopower works as a political form of control – the census is a
case in point
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Biopower and Global Health (1)
 Anthropometric measurements of the skull and
racial science: the construction of an invidious
evolutionary ladder with Africans at the bottom
and Europeans at the top
• The construction of stereotyped and bureaucratized
divisions between ethnic groups
- Tutsis as a military and royal caste vs. Hutus as peasant
farmers, issued IDs that codified racial differences that later
marked people for genocide and exacerbated ethnic tensions
- British reification, intensification and codification of caste
differences as a form of governance
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Biopower and Global Health (2)
 The development of psychiatry in British
colonial Africa
• Psychiatric hospitals built for colonials and expats
• Racist construction of categories of pathology:
Africans could not have depression
• British psychiatrists used by the colonial
government in the Mau-Mau insurrection for
purposes of political control
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Biopower and Global Health (3)
 Bhopal – A Union Carbide Corporation pesticide factory in
India leaks poison gas in 1984, killing 8,000 and affecting
500,000
• Legal procedure devised to count victims uses inadequate medical
criteria, and ends up excluding many affected
• Historical and geographical notion of the Old City in Bhopal as a
Muslim and low caste area leads to categorizing Bhopal as a
“Muslim problem”
• High caste physicians think of gas survivors as low caste or
Muslim or dirty, and sometimes refuse to touch them during
medical examinations
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Biopower and Global Health (4)
 Chernobyl – 1986 explosion at nuclear plant in
Ukraine
• Aftermath leads to discrepancy between medical
researchers and the disability system
• Medical researchers claim only 2,000 people were
affected, but 1/3 of the Ukrainian population is on
disability as a result
• Adriana Petryna calls this phenomenon “biological
citizenship.” She writes:
- “One can describe biological citizenship as a massive demand
for but selective access to a form of social welfare based on
medical, scientific, and legal criteria that both acknowledge
biological injury and compensate for it.” (Life Exposed p. 6)
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Local Moral Worlds: Kleinman’s
Categories (1)
 Local Moral Worlds:
"Local moral worlds are settings of moral experience which express what
is most at stake for people in their local networks of relationships in
communities. These worlds are no longer limited to the bounded spaces of
traditional ethnography such as the village, work setting, shantytown, or
household – but extend to networks where everyday life is enacted and
transacted, where individuals’ inner subjective experience is in interaction
with the practices and engagements of other people. These could be
transcontinental and trans-national, or professional and business as well as
domestic. Here, lived values of the individual and those of the network
may be in concert or conflict, involving constant contestations and
compromises.”
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Kleinman’s Categories (2)
 Subjectivity: the inner world of the person
 Moral Experience:
• Life is about values. Just being alive, negotiating important
relations with others, doing work that means something to
us, and living in some particular local place indicate that
moral experience is inescapable.
 Ethics:
• Ethics as a professional discourse (A normative language of
elites)
• Ethics in moral life (The translocal aspirations of individuals
to act morally)
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Ethics and Suffering:
Emmanuel Levinas
“the suffering for the useless suffering of the
other, the just suffering in me for the
unjustifiable suffering of the other, opens
suffering to the ethical perspective of the
inter-human”
-- Levinas means that suffering takes its
ethical significance from the response of
others to the person who is suffering
-- Values in global health are usually
unstated and unexamined but are critical.
We believe the ethical demands of suffering
of those in greatest need with least resources
should be prioritized (one example is
Farmer’s “preferential option for the poor”).
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From: Levinas, E. (1998). Useless Suffering. Entre nous: Thinking-of-theOther. New York, Columbia University Press. Page 65.
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social
experience
local cultural
representations
subjectivity
CHANGES IN POLITICAL ECONOMY, POLITICS AND GLOBAL CULTURE
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The remaking of moral life
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Paradox: Caregiving and Global
Health
 Many students and professionals are attracted to global health because
of a passionate interest in caregiving.
 Paradoxically, the quality of caregiving is not a major focus of global
health policy and research, which, to be fair, largely focus on the
question of access.
 But what does it mean for global health that the existential and moral
stimulus for entering the field has become such a small part of what the
concerns of the field are in practice?
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Local Moral Experience
 Why is it important for global health
practitioner-anthropologists to take the local
into account in global health programs and
initiatives?
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Social Theory, Political
Economy, and Global Health
 How does political economy relate to the
social theories we are exploring in this
course?
 What about moral economy and its relation
to social theories and their applications in
global health?
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