Tuesday, 1 December 2015

Fielnotes and Thoughts Series: Ben Belek

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We are delighted to welcome Ben Belek with his sharp new blog for our series 'Fieldnotes and Thoughts'.
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What’s the use?

by Ben Belek
Cambridge University


Ben Belek has recently submitted his doctoral thesis to the Division of Social Anthropology at the University of Cambridge. His research deals with questions concerning emotions, subjectivity and community among autistic adults in the UK. He’s also author and editor of the blog The Autism Anthropologist.

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“A doctor and three medical anthropologists – Hans Baer, Michael Taussig, and Arthur Kleinman – are standing by a river. Suddenly they hear the final cries of a drowning man. The doctor jumps into the river and, after battling against the swift current, hauls in and tries to resuscitate the dead man. After a short while another body floats by and the same attempt is made to save it. Another and another comes down stream. Finally it occurs to Hans Baer to head upstream in order to investigate the contradictions in the capitalist mode of production that are responsible for the mass fatalities. Meanwhile Taussig goes off, very much on his own, bushwalking in search of the cryptic message in the bottle that at least one dying man or woman would have had the foresight to send out. Dr Kleinman, however, stays behind at the river bank in order to help facilitate the doctor-patient relationship.” (Scheper-Hughes 1990:189)

How is medical anthropology useful exactly? That’s the question I’ve been asking myself repeatedly during the past couple of months. Incidentally, two months is more or less the time that had passed since I submitted my PhD. So the process seemed to have been this: sign up for a long, difficult and demanding project; work your ass off to complete it, at the expense of mental well-being, the intactness of family life, and (quite likely) future financial stability; and then once it’s over, try and figure out what the hell it was all for.


A logical progression of events, no doubt.

But I don’t mean to sound too cynical or morose. The truth is I never seriously doubted that anthropology can be useful. Scratch that - that anthropology is useful. What recently changed is that I now feel the need to find a way to articulate its usefulness. To put it into words, to invoke relevant examples, or to try and predict possible anthropological solutions to current, real-world problems. To prove, to myself, if not to others, that anthropology does, in fact, have a purpose.
Of course, this emerging necessity has everything to do with my new hard-earned status, upon completion of my doctorate, as an unemployed, utterly unproductive member of society. No longer a “postgraduate student”; merely another jobless soul. If this less-than-desirable status is ever to change, I’m beginning to realise, I need to be able to demonstrate the potential productivity of my curiously compiled skill-set. I need to figure out a way to make medical anthropology – or at least, my own version of it – work. I need to do that so that I can work.
Yes of course there’s academia, where the need to demonstrate the actual practical utility of one’s skills and knowledge decreases to a bare minimum. Thank God for that. But I don’t know how I feel about this prospect. ‘Creating knowledge’ (otherwise construed as building intellectual sand castles) is great and all – truly is – but I am nevertheless hoping to combine academia with some actual-world employment. To build some slightly more durable castles, possibly even from plasticine or clay (not stone though, because let’s face it: I’m not going become an engineer or architect all of a sudden).

On a slightly more serious note, the truth is I do feel it’s important to offer something to society beyond abstract musings – appealing as those may well be. To contribute something of practical importance. And also, you know, to accumulate some useful real-world experience in preparation for the day when the social sciences eventually do fall under the rubble of neoliberalism, as it seemed to have done in Japan, for example. And besides – even academia itself is apparently showing increasing concern for the applicability of one’s research, if the REF system in the UK is any indication.

So let’s go back to the question presented in the beginning of this post – how might medical anthropology be useful? Nancy Scheper-Hughes published an interesting article on this very question back in 1990 (this is the same article from which I grabbed the curious moral tale I started with). In this article, Scheper-Hughes characterises medical anthropology as having two potential benefits, each lacking in some essential way. You have the type of individualised meaning-centred studies which focus on micro-dynamics, such as, say, patient-doctor encounters. And you have those studies which take a broad, depersonalised, macro perspectives on the social, cultural, political and economical circumstances under which the world of medicine ­– and consequently, discourses and understandings of health and illness – function.

Scheper-Hughes makes the point that the former sort reveals only part truths about humans, while the latter sort reveals only part truths about things and systems. And so none are as effective or useful as one would have liked.
Like all generalisations, this one is also, well, somewhat generalising. I definitely remember reading broad, macro-perspective studies which still took into their consideration the subjective experiences of the people involved, and I definitely remember reading analyses of micro-dynamics which did not fail to note the wider institutional and structural processes within which the events described took place.
But I can still relate to the point Scheper-Hughes is making, as the focal point of most literature in medical anthropology is generally of a specific scale; relaying a perspective that could indeed be said to be either that of the eagle or that of the anteater. Either very wide or very narrow. Either too general or overly specific. And yes, there might be a problem there. Because while the very general argument could be said to lack in its applicability, the specific argument could be said to lack in its generalisability. So if we accept this premise, what middle ground could there be?

Scheper-Hughes goes on to offer three potential designs to what she refers to as a critically applied medical anthropology. I won’t go into them at length though, because honestly, I personally didn’t see much appeal in any of them. A first option is to work towards narrowing the jurisdiction of the biomedical establishment, rejecting its attempts to tackle ailments that are not strictly physical, and illegitimising its effort to cure suffering whose origin is social, psychological or spiritual.
The second option is to embrace the possible efficacy of alternative, heterodox forms of treatment, and become – this is already my own interpretation of her suggestion – champions of that vast world of ideas and techniques, theories and practices that is non-allopathic medicine. Thus supporting a viable alternative to what she perceives as the prevailing shortcoming and injustices of biomedicine.
The third option is to work towards revolutionising biomedicine itself, introducing our discipline’s own understandings and traditions into medical school curriculums, hospital wards and science journals, in an uncompromising and unapologetic fashion.

But the truth is, I don’t feel particularly driven to pursue any of these goals, though I can certainly see the merit in each and I could support others’ endeavours to pursue them if they so wish. But of course, I’m not quite the revolutionary Scheper-Hughes is, and though I’m often accused of being far too critical towards biomedical establishments, their practices and epistemologies, I’m probably not quite as critical as she is. A space exists for me, I feel, for us, to work alongside medical doctors and hospital administrators, pharmaceutical companies and public health officials; to promote our own ideas without conceiving of our work as an ongoing battle over turf and hegemony between two competing armies (or, for a more accurate military metaphor, a battle between a superpower and a dispersed militia).
With the exception of – quite a few, I admit – instances where our different notions of right and wrong, desirable and objectionable, effective and damaging stand in direct competition, I’m quite happy to do my job, and let others do theirs. The merit of one’s work depends on a great many factors, and there’s clearly a lot of disadvantages and falsities in biomedical research and practice. But positivism is not evil; neither is, necessarily, power and riches. Let them be successful positivists. Our critiques shouldn’t mean tearing down their castle. Nor do they have to mean digging up materials to build our own. And they don’t have to mean trying to take their castle to ourselves.

In the last bit of her article, taking a slightly more amused tone, Scheper-Hughes proposes that applied medical anthropologists take the role of the jester:

Rather, let us play the court jester, that small, sometimes mocking, sometimes ironic, but always mischievous voice from the sidelines (‘but I say the king does appear a bit underdressed today’!). To the young, up-and-coming medical anthropologist I would say: “Take off that white jacket, immediately! Hang it up, and put on the white face of the harlequin. Don’t be seduced; be the seducer! Don’t be subverted; be the subverter!” Laughter, as they say is the best medicine, laughter and Rabelaisian love of the absurd, the grotesque, and for the tumbling of received wisdoms, and of privileged epistemologies! There’s our role-afflicting the comfortable, living anthropology as the ‘difficult science’. In so doing we are exercising to the core what our discipline has always been about, its insistent challenge to commonsense, taken for granted assumptions about the meanings of this diverse and troubled world in which we live.(Scheper-Hughes 1990:195)

Yes. I doubt this really answers the question posed in the beginning of my post, but it does hopefully leave us with a somewhat inspired and optimistic air. I suppose I’ll have to continue thinking in the abstract, at least until a more concrete dilemma presents itself and I’ll be forced to envision actual solutions to actual real-world problems. Until then, while I remain locked in the intangible, I’m happy to take on Scheper-Hughes’s advice and play the role of the jester – in one way or another. Realities won’t necessarily change, but some minds might – provided my performance of the harlequin is persuasive enough.

References
Scheper-Hughes, Nancy. "Three propositions for a critically applied medical anthropology." Social Science & Medicine 30.2 (1990): 189-197.