Who is crazy? Who is normal? Describing somebody as “not normal” has serious implications for this person, can destroy her life. From an anthropological perspective, there is nothing called normal. What we have are endless ways to lead a more or less meaningful life. Principally, everybody is as crazy as everybody else. The distinction in normal or crazy is artifical – it has to do with culture, history and politics, and is therefore an interesting object of study.
In this book he explores the roots of mental illness stigma around the world – and reveals how our prejudices and notions of mental illnesses and ‘normality’ reek of cultural biases that stop many from seeking help.
According to a very interesting review by Claudia Wallis in Spectrum News, Grinker shares Sigmund Freud’s wish that mental illnesses would be viewed “like the common cold, something everyone gets from time to time,” and that people “might eventually feel no shame in seeking psychological care for their problems.”
So why do people in the so-called West, and increasingly everywhere else as well view mental illnesses differently? And where does the stigma come from?
Grinker traces the stigma back to industrial revolution and capitalism in in late 17th-century Europe, Claudia Wallis writes:
With industrialization, people with intellectual disabilities, schizophrenia and other serious brain conditions were moved out of their homes and into asylums, along with criminals, debtors and addicts — basically anyone viewed as incapable of being a productive and self-sufficient worker.
Once institutionalized, people were sorted by their caretakers into categories: “idiotic” and “insane,” “probably curable” and “probably incurable,” and eventually more specific, medicalized terms. The words “normal” and “abnormal” were borrowed from mathematics and statistical averages.
As new categories of sickness and perceived deviance were added — mania, melancholia, dementia, masturbation (an actual diagnosis!) — the number of people consigned to asylums exploded in England and the United States. “Experts were at a loss to explain the apparent epidemic created by illnesses they themselves had invented and were now counting,” Grinker wryly observes.
When capitalism took hold, we started to value individual autonomy and productivity for everybody. Before that, we didn’t hold a person responsible for all of their differences and all of their successes and failures
In the U.S., the hero is the individual. People with disabilities aren’t necessarily always able to be independent. By the very nature of capitalism, the person who depends on others, who lives with others, or who isn’t an efficient worker is considered to be a failure.
As a contrast he provides an example from rural Namibia:
A man I’ll call Tamzo, who lives in rural Namibia, has what we would call schizophrenia. He walks 20 kilometers to the village once a month to get antipsychotic medicine. The Western doctor there writes down his diagnosis as schizophrenia.
But at home he is thought to be the victim of a curse that somebody placed on their village that settled randomly on Tamzo. In his family and his village, as long as he is not hearing voices, he’s not considered at all to be sick. Whereas in the clinic, it’s “once labeled, always labeled.”
The anthropologist does not deny the existence of mental illnessess, Virginia Hughes writes in her review in the New York Times. But for the past few centuries, Western doctors have been fixated on distinguishing normal from abnormal. And those bright demarcations have made it easier to stigmatize people.
Grinker does not believe that a focus on the precise genes and biological mechanisms behind brain conditions such as autism and schizophrenia will reduce stigma. Neuroscientists hoped this would make mental illness more equivalent to for example heart disease:
Grinker disagrees. He notes that in some parts of the world a genetic basis becomes even more stigmatizing, as it casts doubt on bloodlines. And he believes that mental illness can never be entirely reduced to biology. As with hypertension, osteoporosis, hypercholesterolemia, obesity and many other conditions, the line between healthy and not healthy is constructed, or, as he puts it, “drawn more by culture than by nature.”
Reading about his book, I remember a useful concept that the Norwegian researcher Ivar Morken introduced – in Norwegian he called it “normalitetssentrisme” – in English it might be normalcentrism. He thinks it would be fruitful to talk about nornalcentrism in a similar way as we talk about ethnocentrism.
Mental illness and normalcentrism has been topic before, therefore:
Who is crazy? Who is normal? Describing somebody as "not normal" has serious implications for this person, can destroy her life. From an anthropological perspective, there is nothing called normal. What we have are endless ways to lead a more…
Do you wear a mask when you meet your friends? Do you?
Recently I often had to think of an observation of a Twitter user in Germany: She or he realised that people do wear masks in public transport or in supermarkets but showed careless behaviour when they are with people they know: They rarely wear a mask when they are with friends or with colleagues at work.
Today I’ve stumbled upon anthropological research that conforms this observation: In her short article Staying safe in the time of coronavirus: pay attention to ‘the guy you know’ medical anthropologist Lisa J. Hardy writes about her ongoing research on how people in the US experience living during a global pandemic. She and her team bserved the same tendency: People feel safe with people they know, but are scared of people they define as “others”, although people know that “viruses do not travel along lines of familiarity”. Our behaviour is far from logical:
What we are seeing in our data from this project has a twist on the idea of “other.” People are telling themselves stories about the safety of people they know. This means that many people report that they’re doing everything possible to stay safe and, in the next breath, tell us about a party they attended for the holidays with friends and family. “It’s OK,” they say, “we knew everyone there.”
The danger, we tend to think, always comes from “the others”.
Some interviewees in the Southwest told us that they avoid shopping where Indigenous people go because of high rates of Covid-19 on reservations, indicating the kind of racism and avoidance that often comes with contagious disease.
These “sometimes illogical conclusions about other people” are ” not unexpected”, she writes:
Throughout history there have been examples of epidemics and blame. Someone else is often considered to be the vector of disease.
In her article she also links to a paper she published in the journal Medical Anthropology last September called Connection, Contagion, and COVID-19 where she in the abstract stresses the importance of social science research when dealing with Covid-19:
In the United States people understand the global pandemic not as biology, but as the manifestation of political affiliation, difference, connection, and disconnection. COVID-19 is, according to public perception, dangerous because it maliciously mutates to attack. It is “a guy we don’t know.” Relationships between the mysteriousness of the virus and heightened visibility of longstanding inequality in the United States form new contexts for existing social tensions. (…)
Here I draw on analysis of 50 semi-structured interviews we conducted from March to August of 2020 demonstrating how understandings of the biology of a virus are woven into perceptions of politics, inequality, and the fractures of a divided nation. To understand social and political responses to the global pandemic it is essential that we continue to investigate xenophobia, inequality, and racism alongside the biological impact of SARS-CoV-2.
She also has a nice website with many articles, including creative writing, check www.ljhardy.com
Spring 2011 I attended seminar “Engaging medicine” at the University of Oslo in honor of one of the most prominent medical anthropologists in Norway – Benedicte Ingstad. One of the speakers was Nancy Scheper-Hughes with a paper “Medical Migrations – From Pilgrimage and Medical Tourism to Transplant Trafficking».
Since I got engaged in medical and critical anthropology, Scheper-Hughes has been to me a constant source of inspiration and provocation. As an anthropologist who supports and has been doing public and applied anthropology she co-founded Organs Watch, a medical human rights project focusing on organ trafficking. In more than ten years she has been working on the global organ trade. Following the illegal flow of kidneys, she has mapped the tragic network of rich buyers and poor sellers all over the world.
I always wondered how her adventure with kidneys started. She answers:
– It was a very different kind of a project and it was not one that I ever could have imagined spending so much time on.
– I wrote an article that emerged from chapter 6 of my book “Death without weeping” where I write about bodies in dangers, the dead body and favela residents’ fears and their feelings of ontological security or insecurity of the body. And I was studying the emergence of local death squads that were operating after the end of the military period, taking the place of the militarized state. I found that there was real medical mistreatment of poor bodies in clinics, in forensic institutes, and in the graveyard. And above all of this was hovering a terror that people had that their bodies would be used for organs. So I wrote some articles trying to explain why people thought they would be subject to kidnapping for the purpose of organ theft.
– At the time I still thought that this was mainly an urban legend. But then underneath the legend were these real experiences that poor people encountered in forensic medical institutes or police morgues where the unidentified, unclaimed body was, in fact, state property, and (to be crude) chopped up and harvested. So the people were right in fearing that their bodies were not safe.
[teaserbreak]
– Then I was invited to the Rockefeller Institute’s Bellagio Conference Center in 1996 for a high powered international meeting with transplant surgeons from several countries, North and South, East and West. And my job was, I think, to reinforce the confidence of these transplant surgeons that there was really no need to worry about theft of organs, that it was an urban legend but this is why people believe it. And because I was the only anthropologist and the meetings were long, I took walks with several of the surgeons from Russia, USA, Israel, Taiwan and elsewhere. And each one told me stories that led me to realize that the traffic in organs was real. Then, in 1997 on a trip to Israel I heard about the transplant and organ brokers.
– So bit by bit I began to realize that this was serious business. By the end of this Bellagio meeting, I was nominated to do some ethnographic work on that subject. In fact it was simply to discover and to document: what in world is going on?
Since the Bellagio meeting, Scheper-Hughes has traveled all over the globe and followed the organ transplant community:
– In the early days when I thought: “Oh God, this traffic is really damaging people, both the buyers and the sellers, I need to stop this”, I would go to the International Transplant meeting, then I would go to the American transplant meeting, to the Canadian, Polish, Brazilian. But then I said: “No, I can’t spend the rest of my life going to the transplant meetings”.
– But each place I traveled as an anthropologist I would learn very different notions of the body, organs, what is acceptable and what is ethical. I was surprised to learn that in France there is very little living kidney donations; it is just not done. And I am talking about within loving families and altruistically. “No”, I was told, “That’s barbaric, why would we ask healthy people to sacrifice a body part to someone else when we should be getting from the dead?” And also, some transplant coordinators in some countries say that dealing with deceased donation is also very difficult. “It’s too hard because you have to deal with people in grief and mourning, it’s undignified to be asking them over the dead body. It’s easier to ask living people”.
– But then you go to countries where living donation is common and people will say: “You know, it’s good for the solidarity of the country for people to do this”. So you really see these alternative ethics that work. So some of these travels were really important.
Working on the organ trade she became interested in understanding commodification process and the reification of parts and body parts. These interests resulted in “Commodifying Bodies” co-edited with Loïc Wacquant. She also developed interest in the body itself, the meaning of scars and the differential experiences of selling a kidney.
She gives an interesting example:
– In the Philippines the scars of the surgical removal of a kidney means you are person of honor. It means: “I have taken care of my family”. As opposed to Moldavians who are ashamed of being caught up in the transplant trade and they say they had an accident when I looked at their scars. Or in Brazil where the kidney sellers who were recruited to South Africa to provide kidneys to wealthy transplant tourists, they are called the mutilated ones because the beautiful body is so important to Brazilians. Men and women love their bodies. It’s interesting how they defend themselves in neoliberal, but it really is pre-neoliberal notion of “it’s my body”. It’s almost an anarchy of the body, of the self.
When I asked if I understood correctly that she doesn’t see all the organ sellers as victims she said she had two answers:
– Yes, the kidney sellers were exploited. Pure and simple. They were deceived. They were considered objects. Sometimes they have personal relationships with the brokers. So in that sense, yes, they were victims.
– But is there still agency? Yes, of a limited sort. I usually rephrase Marx: people make history but they don’t make it just as they please. Or under conditions of their making. Well, people here are making choices but not just as they please.
– The kidney sellers in Manila want to sell an eye, a whole eye ball. They want to sell a testicle. They want to sell any organ of which they have two. Why? Because if it’s a job, if they are commercial workers, a kidney is a one off deal. It is not reproducible. The only other option for a kidney seller who is still in debt is to allow their teenage children to sell, or their wives to sell, and by recruiting within their family, they can get a little bonus of about $50.00 for handing them over to the organs brokers. Not very pretty. Structural violence gets reproduced within the household.
– But the Brazilian kidney sellers don’t want publicly to be called victims. Brazil has a pretty good organized system for the capture of organs, but the bureaucracy is corrupted in different parts of the country and the waiting lists there were a mess.
– And this was leading to what I would call patron-client kidney donations. They are people who are life long retainers, household servants, nannies and cane cutters with their bosses asking them to provide kidneys. What kind of choice is that? But it fits very well into a very classic patron-client relation. And the people would say that they gave their consent: “Oh, willingly”. Or: “Of course I would give to this household I’ve been serving”. Because their livelihood, their very survival depends on their bosses. So they must do it. It doesn’t even make any sense to think that you wouldn’t do it.
– So choice is there, but if choice were the only thing that mattered the answer is very simple – that everybody sells. But choices are not the only thing that matters because the choices are over determined, part of the logic of a bad faith economy, as Pierre Bourdieu would put it.
Scheper-Hughes is critical towards the jargon used by transplant community and terms like “organ scarcity”, which contributes to the development of the moral obligation to be a donor. She responses with term “artificial scarcities”, which expresses the socially and politically created phenomenon.
This term arises strong reactions. She is also criticized by many of the potential kidney buyers who accuse her of «producing extraordinary suffering in the world» as she is against the black markets. In a response to one of the many letters she receives she wrote a brochure on what you should think about before you buy or sell a kidney. She explains:
– It’s not a cogito ergo sum, I think therefore I am, but “embodied, therefore I am”. So the first principal is that you have a right to your body. You are existentially thrown into the world with your body. Sometimes they are imperfect. Sometimes they are disabled bodies. But they are your bodies. And they are your treasure, your legacy. You do have a right to donate. But you don’t have an obligation to donate. No one has a right to demand it of you. Because that demand is a kind of invisible sacrifice that’s being asked. And it puts the asker, the demander into a moral and ethical gray zone. You know, making demands of another in the desire for self-survival.
– If you have absolutely made up your mind that you must have, as one of the potential buyers calls it, “a fresh native kidney” from someone, and you say that you don’t want to ask a relative and it’s better to pay somebody who is doing it for a living, I will make one adjustment to that. I’m not against money. We live in a world where markets mean a lot of different things to different people, I mean desires and friendship and sociability, as in many parts in the Middle East. And of course markets can be a good thing.
– So, why can’t we maybe bargain over a kidney? Well, I have argued that the kidney is not a redundant organ, that there is no such thing as a ‘spare’ kidney. You pay a big price in bartering over the value of your ‘spare part’. So I would ask the buyers that if they feel it is what you must do, then pay a relative, pay a dear friend. Because you’ll make then sure you will look after them. Pay your wife. Put a nephew through college who has no way of going to college.
– Is there any objection to that? Families are doing it all the time in different ways, circulating money through wedding obligations, making loans. And being indebted to someone is not necessarily servitude. There were times and places where gifts and debts were the same. And so, a gift is a kind of debt after all. That’s what Marcel Mauss is all about. So why not kidney debts within families?
– But just be sure you are not asking a sacrifice. People are not angels. They are not sprits, they have a body and its organs are limited. They have a right to those organs. But if they are in a relationship with kinship and affection and love, don’t just take it. Give something back that really matters to you and that obligates you to further gifting and responsibility for each other’s welfare and wellbeing. Don’t pay a stranger to whom you owe nothing but a one off payment.
– So I think these are anthropological questions. They have to do with kinship, with nature of gifting, the nature of debt and body debts.
The engaged anthropologist has been addressing the uncomfortable truth about the organ trafficking to transplant surgeons, politicians, the House of Lords etc. What was the major challenge with addressing her work to these groups? What were the reactions? Do they want to hear all that? Do they get angry?
– Well, it’s changed. Sure they get angry. Often, in the early days, I was in the international transplant meeting and transplant coordinator got up and called me a kidney terrorist because I was preventing kidneys from being moved around.
– I used to say to some transplant people, if you are satisfied living in a world where the third world have to pay a body tax to help the rich and you are satisfied with that, then I have nothing else to say to you. If that worries you a little bit than I think we can sit down and have a conversation.
– But of course there is resistance. Since the Istanbul Summit in 2008 there are now a key core of transplant doctors who really are rephrasing everything that I’ve been saying over the years. So I feel like a good part of my job is over. I mean, I don’t think that any profession can totally police itself without some outsider perspectives. I think that transplant profession needs help from social scientists who are critical thinkers and independent of medicine. It is not a job for bioethicists because they often share a worldview with the surgeons. They are not critical or independent enough. But basically I feel that more or less political job is done.
2010 - Body and State - Buying and Selling the Body, Pt 1 | The New School
Video: Nancy Scheper-Hughes at the Body and State conference, Buying and Selling the Body
Scheper-Hughes is done with research on organ trade now and she is making plans for new projects:
– Well, I have a lot of unfinished work. I would probably go back to South Africa. I have a series of essays about the transition from Apartheid to the new South Africa that is historical now because I was first there in 1993–1994, but I was working in one newly formed shantytown. And I visited there several times since and I have witnessed many changes there. So I would probably go back. And I have also a draft, a manuscript, which may end up being a series of essays. But that will be my next project.
– And then I’m still always working in the Pernambuco town I call Bom Jesus da Mata. I have been asked to bring my book “Death without weeping” up to date because the situation has changed so completely there. The death of infants is not happening anymore, because of the demographic transition that all of Brazil has experienced in the past two decades. So I want to put it in a more historical perspective. But also to maybe write a book on the death squad that has terrorized the town. On this particular squad and how it came to take over the entire government of the municipio. Not just of a favela. But in an area that includes rural hamlets of 50.000 people, not gigantic but a substantially sized town.
– The judiciary, courts, the town counselors and the prefeito – everybody was in the hands of and employed by the death squad. How did it happen? In a town which was fairly distinguished as a sugar plantation town, which also had some shoe factories, that had an educated class, they were educated outside the place, that had also a radical class of organic intellectuals, had a lot of resistance, had very strong liberation theology movement – how was it possible? And that’s the question I’ve been asking and still don’t have the answer. They don’t have the answer.
– So I want to return. I think in terms of understanding violence that is beyond the everyday violence – how vigilantes can come to become the governing force? It’s seems to me a large enough question.
The complexity of this crisis came to light during a recent study tour to Tucson, Arizona, in which Rachel Stonecipher took part.
Dehydration and heat-related illness claim hundreds of lives annually, and many of these deaths go unrecorded. No uniform system exists to count or repatriate remains. “We can only imagine the impact of these missed opportunities for identification on family members searching for their loved ones”, Stonecipher and Willen write.
For migrants who do reach their destination but face subsequent arrest, “interception” itself can involve serious health risks:
What happens to migrants after they are arrested and detained often remains shrouded from both the public eye and, to a great extent, the eyes of the human rights community. This is a particularly grave concern when arrested individuals already are sick or injured. (…) One especially serious concern involves the deportation of injured individuals who have not yet been medically stabilized. (…)
Detainees are also at risk of abuse – physical and mental – at the hands of police and Border Patrol officers. Despite official denials, No More Deaths, the Border Action Network, and other NGOs have collected and responded to numerous reports of abuse.
Through water stations, humanitarian aid camps, and desert patrols, a handful of NGOs provide assistance to migrants in need. But this cross-border health crisis is “far too vast for activists to address alone”, the anthropologists note:
Both human rights principles and contemporary realities demand that we hold countries with porous borders – including but not only the U.S. – accountable. Not only must such countries recognize migration as an enduring global phenomenon with complex causes and share accountability for both lives and deaths, but they must also engage in transnational public health efforts to develop the kind of multi-layered interventions needed to protect human life in border regions. (…)
Like the humanitarian organizations that work along the border, we all must insist on an expansive understanding of “public health” that recognizes people in transit as members of a common moral community: as people who are connected to us, and whose lives matter. Whether or not we understand or agree with the choice to migrate, activists along the U.S.-Mexico border remind us that border crossers are human beings who – like all other members of our moral community – are deserving of health-related attention, investment, and care.
A multi-dimensional public health crisis is unfolding on the U.S.-Mexico border that few seem ready to acknowledge, anthropologists Rachel Stonecipher & Sarah Willen write on the Access Denied blog.
The complexity of this crisis came to light during a recent study…
Russia has one of the fastest-growing rates of HIV infection in the world, and the Church remains its only resource for fighting these diseases.
Antropologi.info contributor Aleksandra Bartoszko reviews Jarret Zigon’s recent book „HIV Is God’s Blessing”. Zigon takes the reader into a Church-run treatment center near St. Petersburg that employs both priests and psychologists to work with the HIV-infected drug users.
—-
Review: HIV Is God’s Blessing. Rehabilitating Morality in Neoliberal Russia by Jarret Zigon, University of California Press, Berkley, 2011
When I read it, I was slightly surprised. I asked myself if we read the same book and why have I focused on totally different points while thinking of Zigon’s work.
I believe that one of the reasons for the huge discrepancy between what the two of us have learned from reading is our fields of research and interests we had in this book. As I am not too familiar with anthropology of morality and ethics, and many theoretical discussions in the book were pretty new to me, I must admit that this book did not invite me to further exploration of the subject. The book was difficult to read, a little bit chaotic and badly edited.
What Is this Book About?
Jarrett Zigon’s book „HIV Is God’s Blessing”, according to the publisher:
„examines the role of today’s Russian Orthodox Church in the treatment of HIV/AIDS. Russia has one of the fastest-growing rates of HIV infection in the world – 80 percent from intravenous drug use and the Church remains its only resource for fighting these diseases. Jarrett Zigon takes the reader into a Church-run treatment center where, along with self-transformational and religious approaches, he explores broader anthropological questions of morality, ethics, what constitutes a “normal” life, and who defines it as such. Zigon argues that this rare Russian partnership between sacred and political power carries unintended consequences: even as the Church condemns the influence of globalization as the root of the problem it seeks to combat, its programs are cultivating citizen-subjects ready for self-governance and responsibility, and better attuned to a world the Church ultimately opposes.”
As an ethnographic case Zigon takes a rehabilitation centre near St. Petersburg called The Mill, which is a cooperation between secular NGOs and Russian Orthodox Church, employing thus both priests and psychologists to work with the HIV-infected drug users. Zigon follows his informants both in the rehabilitation centre as well as the recruitment process in the city, and he is attending events arranged by the NGOs and Church outside the Mill.
Writing and the Art of Repetition
How the book is written and its style is usually mentioned at the end of every review. Unfortunately, when it comes to this book, the writing style was so disturbing that it influenced my overall reception of the book. I like some of the stylistic choices, like the description of the road leading to the rehabilitation centre, which I read as a metaphor for the social position of the centre and the life history of the rehabilitants (p. 33).
But unfortunately the book suffers from a very poor editorial work. There are a lot of redundancies, repetitions and the language itself creates at times confusion. It is hard to read this book. The excessive repetitiveness is most disturbing. Usually, there is nothing wrong with repeating, especially for learning purposes, but in this case this is just too heavy and achieving, in my opinion, a ludicrous dimension.
[teaserbreak]
Not to be ungrounded, I am giving an example. These sentences appeared at 3 pages:
„To live sanely in the world, then, is to a large degree to live what Russians call a normal life. But to live normal life, or a sane life, is not to live a life determined by any one discursive and authoritative structure (…) To be normal is not to adhere to one specific way of living – or one specific disciplinary and discursive tradition – but to live within an acceptable range of what counts as normal. (…) In other words, the social world is a range of possibilities, and to live it sanely is to have the sensibility for negotiating these possibilities. (…) That is, as persons work on themselves to fit themselves within the range of what counts as normal, this range is itself altered. (…) There is no one normal life. Just as in statistical analysis normal indicates a distribution, so too a normal life can be conceived of as a distribution of possibilities. (…) That is to say, responsibilized freedom as a „formula of rule“ is that which allows persons to negotiate the range of possible discursive traditions, and thus the range of possible ways of living normally in a social world“ (pp. 226-229)
Methodology and Analysis
Like most of the contemporary anthropological monographies, the book unfortunately does not offer any extensive presentation of method used during the fieldwork. The author is also sparse in presenting reflections regarding access to field, communication with informants and methodological challenges at all. We are presented with some reflections regarding the author’s presence during the activities in the centre. These are of great value.
The author presents also a good deal of quotes, so there is more «talking» from the fieldwork, than «doing», and thus description of how the rehabilitants actually are «working on themselves» (p. 196) is pretty thin. This might be a reason for the ethic/emic problem in the book.
Zigon’s normative explanations and conclusions are bothering. At times I even think that he puts words in mouths of his informants. He writes extensively on what the Church means, thinks and wants to do, but when the author does not present any sources, documents, and provides only a small number of references, it is difficult to know where the information, and thus data and conclusions, come from. This lack of methodological transparency worries me. I would also like to know how the informants themselves perceive the «Soviet times» which Zigon refers to, and what kind of change they experienced. It is often unclear where Zigon’s knowledge of the “Soviet Man” and Soviet society is taken from except from a rather uncritical use of Oleg Kharkhordin’s book „The Collective and the individual in Russia”. In this way I experienced Zigon’s text as slightly stereotypic.
I also did not like the way Zigon makes generalizations which anthropologists should try to avoid. We often read «Russian mean…» (p. 13) and we read of “American drug program” or “American context” (p. 193). We all know there are different groups of Russians, different ways of seeing the world, life and morality. We also know that there are thousands of rehabilitation programs in USA, so in my opinion speaking about American rehabilitation is not a fruitful way of comparison. Lack of nuances is also disturbing in presentation of the rehabilitation program at the Mill. I would like to know more about the relation of the rehabilitation program and the Church itself.
Rehabilitation and Normality
The book still has something to offer, although I needed to work really hard to dig up the essence of some of the most important ideas of the book. And still, I am not sure if I was able to grasp it. One of the biggest contributions which I see in this book is the processual approach to rehabilitation. Zigon writes:
”That the rehabilitation process is not simply about overcoming addiction. If this were the case, nearly all rehabilitation programs would be considered failures, since studies show that up to 60 percent of clients treated for alcohol or other drug dependence begin to actively use again within a year. There must be something more to this process” (p.3)
I believe that his understanding of rehabilitation as a process is a very important point which should be taken up not only by anthropologists and social scientists, but also by health personnel working on both physical and mental rehabilitation. The book contributes to the rehabilitation study indeed. And the approach can (and should) be applied also to the strictly (if existent) physical rehabilitation. The book adds also some interesting perspectives to normality discussion, which appears mostly in disability studies and medical anthropology. Zigon presents some interesting and new examples on the notion of normality and sane life.
Responsibility
Zigon devotes a significant part of his book to the idea of responsibility, and the changes surrounding the concept and experience of responsibility in the light of neoliberal discourses. This is an interesting idea and I was looking forward to reading Zigon’s exploration of this subject.
Nevertheless, the author’s reflections lack consequence. To me it was difficult to grasp what kind of changes in the ideas of and perception of responsibility actually had happened. As he included historical perspective and presents extensively the Soviet Man (also, a little bit unclear on what basis but Kharkhordin’s book), he also presents the “responsibilized Soviet person” (p. 103). At the same time he writes that responsibility is a neoliberal feature (intro, p. 104, 105). The difference between the „responsibilized subjects” of neoliberalism and during the Soviet period stays still unclear to me.
Neoliberalism(s)
Interested in studies of post-socialism and political changes in Eastern Europe, I was looking forward to reading this book and hoped for an intricate text on changes in neoliberal Russia in relation to church, HIV-patients, drug abusers and healing process at all. Unfortunately, the author seems to stay in rather unfruitful and uncreative thinking box: yet another text which is based on the distinction neoliberalism vs. … Yes, exactly versus what?
The author set up neoliberalism against the Russian Orthodox Church values or Soviet values (when it suits better, is my impression), but the values that he seems to define by himself. His starting point is his own opinions and taken-for-granted, almost populist visions on what neoliberalism is about. Therefore I was extremely happy to read finally (p. 181):
„Many of the values, reasonings, and practices may be quite similar across many global assemblages, but the kinds of persons and the processes by which they come to embody them locally may be quite different. For this reason it may be more appropriate to speak of neoliberalisms”.
To me, this point is the most important part of the book. And probably most innovative and brave. Anthropologists tend to work on the discourses of neoliberalism as if they forgot about the locally based communities and the different ways of dealing with the global economy, neoliberal politics and so on. I was therefore delighted to read that Zigon made this kind of reflection and pointed to the nuances in speaking of neoliberalism and neoliberal life and person. Therefore it was also a huge disappointment that on the pages following this important reflection he seems to be back to the stereotypical thinking of neoliberalism as a phenomena or term that stands for itself.
Both before this reflection appears in the book and after, Zigon seems to use the notion of neoliberalism still as a statical, encompassing and all-covering term. And he consequently uses this term in a non-dynamic and generalizing way.
His generalizations are also confusing regarding his own ideas and understanding of neoliberalism by the informants. When he quotes one of Caroline Humphrey’s informants, he concludes for example: ”Zhenia’s comments are not meant to be critical of the dominant discourse and way of life of neoberalism” (p. 151). It is difficult to not know what he means here by life of neoliberalism. And what most important, what Zhenia means by life of neoliberalism? This kind of confronting individuals with the often abstract to them discourses is difficult enterprise, and I am not sure that Zigon has managed to do it.
Punishment from God and Illness Explanatory Models
Regarding HIV/AIDS patients and understanding of the disease and illness experience, Zigon offers an interesting insight into the perception of both the drug abusers and the employees at the rehabilitation centre. As the title of the book suggests, the readers will be given an understanding of perspective that connects getting sick and believing in God. The dominating perspective amongst his informants working for the rehabilitation centre and who shared the view of the Church was that getting sick was ”punishment from God for the immoral acts that led to infection” (p. 58).
To readers who are familiar with different explanatory models regarding illness and disease, and especially models which include religion, this statement is not new, and I would like to hear more analysis around this statement than what the author offers. Unfortunately, Zigon does not challenge his informants to give other explanations. It is hard for me to believe that the informants’ own reflection on their life, life of the rehabilitants and disease was limited to the moral dimension, mostly circulating around the notion of punishment. Zigon was obviously in search of the moral dimension and thus he found morality discourse everywhere.
It would be also interesting to read more about how the rehabilitants themselves understand their disease and to what degree they share the Church view on sin. This subject is undercommunicated, in my opinion. I supposed that anthropologists interested in illness experience, would also find it interesting to read more explicitly how rehabilitating morality influences this experience. Of course, this was not main focus of Zigon’s book. Nevertheless, his ethnography and some of the theoretical discussions on rehabilitation and morality invites to see these in the broader context of illness experience as presented in medical anthropology.
Missing Theoretical Discussion
Zigon devotes also a significant space on the secular vs. sacred distinction. It is thus surprising that there is no theorizing on the subjects to be found in the book. Zigon presents his conclusion that it is not easy to separate these two and tell what kind of social action or phenomena are secular or sacred, but without any following (or preceding) discussion on the subject.
Even if not explicitly written, this book is about social change. While Zigon writes about the Soviet society, he mentions phenomena that according to him are „typical” to change from socialist to post-socialist society. And in this respect, he follows the tendencies amongst scholars of „post-socialism” who often forget that a lot of phenomena that happens, let’s say in Eastern Europe, are typical to every society in change, not only the post-socialist ones. In order to keep the comparative perspective that used to be so fundamental in anthropology, anthropologists of post-socialism need to include in their research more reflections which do not limit their research and theoretical work to post-socialist societies or Eastern Europe.
In this respect, I also felt like the discussion on continuity vs. discontinuity is completely omitted in the book. It is methodologically challenging to determine whether social phenomena are inherited from an old order or whether they are an expression of a new situation, and anthropologists should show caution so as not to find the “socialist legacy” where it does not exist. And I agree with Nancy Ries who suggests to look at the cultural systems as “’web of significance’ that is constantly woven and rewoven, continually integrating all sorts of historical changes and innovations” (Ries 1997: 22). Still, Zigon work is in a way reducing the complexity of the social process to the model continuity vs. discontinuity without mentioning the problems appearing around this way of thinking of social change.
Works cited:
Ries, N. (1997). Russian Talk. Culture and Conversation During Perestroika. London: Cornell University Press.
