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Why Theory Matters Three More Social Theories: Social Suffering, Biopower, and Local Moral Worlds A Critical Sociology of Global Health III

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Title: Why Theory Matters Three More Social Theories: Social Suffering, Biopower, and Local Moral Worlds A Critical Sociology of Global Health III


1
Why Theory Matters Three More Social Theories
Social Suffering, Biopower, and Local Moral
WorldsA Critical Sociology of Global Health III
  • Societies of the World 25
  • Arthur Kleinman
  • September 10, 2013

2
Social Suffering Definition
  • 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.

3
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.

4
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

5
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)

6
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
    knowledge-power 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
  • Foucaults example was 18th century France when
    the consolidation of the centralized states
    administrative power worked through counting and
    controlling the health and social welfare of
    populations. .

7
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

8
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

9
Biopower and Global Health (2)
  • The development of psychiatry in British colonial
    Africa
  • Psychiatric hospitals built for colonials and
    ex-pats
  • 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

10
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

11
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)

12
Local Moral Worlds Kleinmans 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.

13
Kleinmans 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)

14
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 Farmers preferential option for
    the poor).

From Levinas, E. (1998). Useless Suffering.
Entre nous Thinking-of-the-Other. New York,
Columbia University Press. Page 65.
15
CHANGES IN POLITICAL ECONOMY, POLITICS AND
GLOBAL CULTURE __________________________________
__________________________________________________
________________ The remaking of moral life
16
(No Transcript)
17
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?

18
Local Moral Experience
  • Why is it important for global health
    practitioner-anthropologists to take the local
    into account in global health programs and
    initiatives?

19
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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