Works Reviewed
Joao Biehl, 2004. Life of the mind: The interface of psychopharmaceuticals, domestic economies, and social abandonment. American Ethnologist 31.4: 475-96
Peter Redfield, 2005. Doctors, Borders, and Life in Crisis. Cultural Anthropology 20.3: 328-61.
C. Jason Throop, 2008. On the Problem of Empathy: The Case of Yap, Federated States of Micronesia. Ethos 36.4: 402-26.
“For millennia, man remained what he was for Aristotle: a living animal with the additional capacity for a political existence; modern man is an animal whose politics places his existence as a living being in question.”
—Michel Foucault (1978)
This essay presents a critical review of socio-political formations of morality and an ethics of empathy—what might be understood as an empathic anthropology—as discussed in three ethnographic accounts, two of which explicitly address questions of bio-power, humanitarianism, and care (Biehl, “Life of the Mind” and Redfield, “Doctors, Borders, and Life in Crisis”), the other which focuses more on questions of empathy and social articulations and mediations of “shared feeling” and connections to a common or at least communally intelligible sense of self (Throop, “On the Problem of Empathy”). The main common thread that links these accounts is the matter of human value and worth as an ethical subject, how morality and empathy are socially felt and figured, and how ethics is reinforced or reified according to socio-political exigencies and economic imperatives.
Bio-power, Bare Life, and Networks of Care and Exclusion
Medicine can be economically defined as the application of science to the treatment of disease. Illness whether physical, psychological, neurological, whether somatic or social in origin, develops and manifests itself within structured networks of human-environmental interactions. To study any illness is to take account of its ecology. The study of illness necessitates a dynamic and ecological approach. Epidemiology is as much a matter for sociological and ethnographic analysis as it is for any other paradigm, particularly where human subjects—psychological, social, and moral personalities—are concerned. This is the perspective adopted by Joao Biehl in his (2004) account of the infirmary at Vita and specifically in the case of Catarina. Biehl’s ethnography can be understood as “thick description” in many senses of the term. It is in any case a detailed and sensitive work of sociological analysis. It is neither economical nor to the purpose of this essay to examine Biehl’s account in comprehensive detail. What is the primary point of concern here is the extent to which Biehl’s use of the concepts bio-power, bare life, morality and ethics, empathy and care cast light on the larger anthropological question of subjectivity and the social morality of the self at the intersection of the empathic “other.”
Biehl’s account places high premium on the embedded nature of subjectivity and the structured networks of power that mediate social experience and political placement and definition of medical patients in treatment scenarios. Such “treatment” as he observes in places like Vita, however, leaves much to be desired. His stated interest in this study is “in the place of psychopharmaceuticals in local ecologies of care and in the ways they affect changes in human values and subjectivity” (476).
Psychopharmaceuticals present for Biehl many problems, not the least of which being that their deployment leads all too often to negligence, mismanagement and malpractice. Because Catarina’s condition for so long goes unrecognized and improperly diagnosed—and therefore all but entirely untreated, and indeed if anything exacerbated—Biehl sees her outcome (“destiny” is the word he most often employs in this connection) as not only a medical failure but a “social death.” Catarina suffers abandonment in the worst way a human can—abandonment by her family, by her community, by the medical doctors and establishment such as it was, and ultimately by the entire political economy and society that fails to provide the infrastructure and appropriate channels for the proper diagnosis of illness and the administration of care.
Administration, in Biehl’s account, is figured as a term of opprobrium. The reduction of medical service to yet another crisis management scenario—a perpetual “triage” situation that can itself be factored as the manifestation of a social apparatus reduced to “bare life”—is in Biehl’s assessment yet another case of a neoliberalist reduction of human needs to impersonal and depersonalized “containments” at the basest clinical level. Pharmaceuticals, even the wrong pharmaceuticals, are applied and patients are pushed off to families or otherwise medically untrained and ill-equipped to provide the necessary care.
Places like Vita are in Biehl’s account themselves symptomatic of larger social, economic, and moral degradation. People like Catarina are rendered “ex-human” and treated accordingly by a system that has itself been stripped of its humanity and value for the dignity and care of the human person. The problem, in short, is social and systemic. Biehl writes:
Seen in this light, Vita is a social symptom, not a solution. It is an outcome of recent political and economic readjustments that have driven large segments of the population further into poverty and despair. This harshness is amplified by a malfunctioning universal health care system—a supposed democratic gain of the late 1980s—and complicated by new pharmaceutical possibilities. … The destinies of the useless, so to speak, are determined by a whole new array of networks, and as formal institutions either vanish or become nonfunctional and as government becomes increasingly remote from the citizenry, the household is further politicized. (Biehl 2004:484)
The household, one might add, is further rendered socially dysfunctional, as the case of Catarina makes clear.
Biehl expands on the point of personal devaluation and social abandonment in such a neoliberal economy:
That so many are regarded as socially and morally superfluous testifies to the further dissolution of the country’s moral fabric. The Brazilian middle class, for instance, has historically acted as a buffer between the elite and the most vulnerable, as both guardian of morality and advocate of progressive politics. In the wake of the country’s democratization and fast-paced neoliberalization, however, this vein of moral sensitivity and political responsibility has been largely replaced by sheer contempt, sociophobia, or sporadic acts of charity like the ones that sustain Vita. (484)
Thus, in the final analysis, the problem of Vita is the problem of a disintegrated society, a society in which the very concept of the social has been rendered meaningless outside of a narrowly circumscribed sphere of those considered to be worthy members of social life. The “human” is here valued to the extent that one can be factored and figured to be an economically productive member and not pose too much of an inconvenience to others as a result of illness or disability, whether that problem arises for genetic reasons or just a matter of bad environment situated within an even larger structural network of broken life and diseased relationships. The problem of Vita, as in the case of Catarina is a problem of abandonment at every level of social and economic life. Abandonment is at once seen to be symptom and cause of the larger and more pervasive disease of social dissolution in the wake of an increasingly fractured world.
The question of “care” in this configuration is a matter for morality, which is in Biehl’s account a matter for little optimism or hope at any level. Catarina’s condition is the condition of a “humankind” that is little in the way of “human” and even less in the way of “kind.” Biehl’s diagnosis is not encouraging. At least he sheds some light on the systematic scale and magnitude of the problem. This one can only conclude is better, perhaps, than nothing. Bio-power and bare life are in Biehl’s account simply the way the world…at least the way of the world in the place called Vita.
Bare Life and Crisis Management
In the case of Doctors without Borders, humanitarian action and care become figured as the application of the techniques of crisis management in matters of medical urgency. The politics and practice of Doctors without Borders (DWB) speak to a genuine human concern but without the commitment of long-term (medical or political) investment beyond addressing the basic, “bare life” concerns of the crisis situation. In Redfield’s account (2005), humanitarianism is treated not as an “absolute value” but is instead understood as “an array of particular embodied, situated practices emanating from the humanitarian desire to alleviate the suffering of others” (330).
DWB for Redfield can be understood as morally invested in the health and human dignity of the peoples served through their intervention, but ultimately uncommitted or not adequately committed to an amelioration of the large scale humanitarian needs, which amounts for Redfield in many ways to a maintenance of a perpetual state of crisis and crisis intervention. Redfield praises their humanitarian work but criticizes DWB for what he regards as a politics and philosophy of short-term interventionist solutions and a lack of an “overriding conceptual strategy of development or a political ideal” (338). To put it another way, DWB is too limited to efforts to address “bare life” and human concerns at the level of “zoology” (Agamben’s zoe over bios). The model of the “camp” illustrates this problem in Redfield’s account:
The camp arranges itself around an effective rationale of immediate concerns localized within biological necessity. There are bodies to cleanse, to shelter and protect from hunger and disease. There are children to weigh, inoculate, and categorize by the circumference of their upper arms. … Life itself is exposed beneath the language of rights invoked to defend it and the protest against conditions that produced the camp in the first place. In this setting, human zoology exceeds biography: those whose dignity and citizenship is most in question find their crucial measurements taken in calories rather than in their ability to voice individual opinions or perform acts of civic virtue. The species body, individually varied but fundamentally interchangeable, grows visible and becomes the focus of attention. (Redfield 2005:342)
Redfield further comments on an “ethic of refusal” on the part of DWB: refusal, that is, to commit to long-term political investment in the application of medical and humanitarian care. DWB “operates as a technical agency, alongside other NGOs, to administer a substitute for medical government amid what it identifies as a political failure.” “Yet,” Redfield continues, “this action rests squarely on a central, categorical paradox: the more successful MSF [DWB] is at protecting existence in the name of a politics of rights and dignity, the more this temporary response threatens to become the norm.” DWB, that is, “remains attached to the language of urgency” and it is this attachment to the language of urgency that, in Redfield’s view, prevents its organization from more serious and long-term political investments. The language of urgency establishes a particular ethos of care and treatment: “An established oppositional ethos takes shape within a definitional claim to humanitarian ethics. Therefore, in the face of continuing disaster, MSF responds with a defense of life that both recognizes and refuses politics” (Redfield 2005:343). All this is another way of saying, as Redfield claims on the following page, that DWB advances a “minimalist biopolitics” (344).
DWB, in Redfield’s critique, despite its best efforts and intentions, maintains and operates within a business of bare life management. Thus, Redfield concludes, “the problem before us is not crisis per se but the very codification of crisis into a state, a condition of action, and the subsequent limiting of emergency to within these borders” (347).
Empathic Acts and Moral Performance
Throop’s (2008) analysis of the cultural and phenomenological mediations and conditions for the emergence of “empathetic acts” and what he describes as “empathetic attunements” bears much relevance on the foregoing and is especially applicable to the larger question of the ways in which ethical subjects become constituted cross-culturally.
It is a recognized truth in the science of ethics (morality) and philosophical anthropology that a precondition for ethical treatment is recognition of the other a priori as a valuable moral agent. Such recognition is rooted in a common humanity and a sense of the value of the life of another. Ethics is rendered impossible without the recognition of the value of the other. Throop makes this point in his article in various ways.
Ethical recognition among the Yap of Micronesia arises from a bodily engagement with the world, cultural and otherwise, and a cultivated empathic awareness (the “empathetic attunement”) as a result of “ongoing acts” of one’s “embodied stream of awareness” (Throop 2008:404). This emergence of empathetic awareness and attunement not only brings into being a recognition of ethical value but provides and enforces the conditions for any practice of care within the society. To recognize the other as an ethical subject who is worthy of moral treatment not only implies but in a very real sense necessitates care as a matter of course. The very notion of “care” is inconceivable outside of an awareness of the other as an ethical being and moral subject—in other words, as a human equal at least in the sense of equal potential for the development of health in all senses.
To see another as ethically important is to see that other as valuable and entitled to good treatment as one would expect in a social order of shared values and responsibility. One is responsible for another because one is a moral agent and recognizes the other as a moral agent. This is at the most basic and vital level the theoretical beginnings for any engaged sociality, which is a precondition for care of any kind.
Throop’s account of empathetic awareness and practices among the Yap brings to the fore the recognition that empathy does not emerge necessarily and in all situations with equal force or assurance. Empathy, Throop explains, “is configured culturally” and it arises and is affirmed under particular conditions (406). The contingent and configurational nature of empathy is an important anthropological reality and is central to any serious understanding of ethics and particularly as ethics informs conditions for care.
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