Reflections on the Nancy Scheper-Hughes vs. Roy d'Andrade debate

Nancy Scheper-Hughes in action (Photo: Viviane Moos)

by Gideon Lasco, MD, MSc

One can feel the disgust of Roy d’Andrade in his denunciation of the seepage of a “moral model” in anthropology, especially in the wake of Scheper-Hughes’s Conrad-ian battlecry. It it as if he were a churchgoer made to be feel guilty of not making a donation - or a pedestrian made to feel bad at not giving alms to the homeless when all the others are giving five-dollar bills. “I’m still a good person!” he protests.

In this short response, I will focus my critique on d’Andrade’s usage of “morality”, his simplistic view of what critical anthropologists have been doing all along, and his failure to offer an alternative.

The world is a moral terrain and navigating it doesn’t necessarily make you a “moralist”. d’Andrade’s critique of “oppression-as-badness” conflates “moralizing” with simply seeing things as they are. Oppression is “bad”, but its badness can be incidental to its existence. “Since when is evil exempt from human reality?” as Scheper-Hughes counters.

Moreover, as ethnographers have demonstrated time and again, writing about “oppression” or “suffering” do not generate a “negative view” of the world that d’Andrade fears, but actually, a more textured view of power: there is resistance, contestation, struggle, and unexpected trajectories. Here, d’Andrade forgets that the very strength of anthropology is its microscopic view, its power to animate the ‘field’ but showing its complexity.

More glaring is his carte blanche denunciation of these “moral models” without providing any kind of viable alternative. His piece would have been more powerful had he followed a “show, not tell” approach, that is, by using ethnography to argue for his points, and in doing so, provide a model for the “value free”, “objective” anthropology that he has nostalgia for (here, Scheper-Hughes scores more points). Neither does he reflect on how we can arrive at “empirically demonstrable truths.” Then as now, a thoughtful consideration of what “interpretation” means in anthropology would have been most welcome. But in failing to offer a credible alternative, he himself is guilty of his critique of having  a “model [that] is almost entirely negative in character.”

In fairness to d’Andrade, I think he is warranted in his concern in an "unreflexive assumption that one is a member of an elect that by natural grace knows what is right, and this elect consists of those who hold the current moral model.” A priori assumptions based on clear agendas can definitely diminish the power of anthropology, not just methodologically but in the way people will receive our work. Which is why, in short, neither can I subscribe to Scheper-Hughes view at the opposite pole of this debate.

My stand is to see ethnography not just only a methodology, but also an episteme of my morality/politics as an anthropologist. By simply discovering and then illuminating “what is at stake” for our informants (Kleinman, 1997), I believe that we can preserve our “moral authority” (d’Andrade) but at the same time fulfill our “ethical obligation” (Scheper-Hughes). Let me end, however, with the caveat that given the immanence of politics in the production of knowledge (i.e. in selecting topics for research), this is easier said than done.

St. Louis, Missouri
April 2015

Brief comment: Nancy Scheper-Hughes and the "socially unborn"

By Gideon Lasco, MD, MSc

“In the absence of a firm expectation that a child will survive, mother love as we conceptualize it (whether in popular terms or in the psychobiological notion of maternal bonding) is attenuated and delayed with consequences for infant survival. In an environment already precarious to young life, the emotional detachment of mothers towards their babies contributes even further to the spiral of high mortality-high fertility in a kind of macabre dance of death.” - Death Without Weeping by Nancy Scheper-Hughes (pp. 325-326)

A classic example of a critical-interpretive approach in anthropology, Death Without Weeping illuminates the seemingly-contradictory notions of motherhood and 'passive infanticide' by contextualizing women's lives in a shantytown in Brazil. First describing how this 'lifeboat morality' is experienced by mothers through vignettes and her own reflections in decades, she takes us from the personal to the institutional, revealing at the end of the paper how the state and the church are complicit – or at least, apathetic, to what is going on. Filled with pathos for the babies, Scheper Hughes offers an indictment not of the mothers themselves but of the society that allows such "violence" to take place.

Scheper-Hughes’ work is associated with works on social suffering, “the "collective and individual human suffering associated with life conditions shaped by powerful social forces" (Kleinman) – a theme she pursued in latter works (Scheper-Hughes, 1998). In the latter  This reminds me of the position of Kleinman and Kleinman (1991) that “a central orienting question in ethnography should be to interpret what is at stake for particular participants in particular situations.” In the case of Scheper-Hughes, she privileges the death of infants – the ‘death without weeping’ as the thing at stake in this particular specific situation.

The title, 'Death without weeping', provokes us based on the underlying assumption that all of us expect death to be worth weeping over, and conversely, human life is important. But we know that this is not the case. Life and death, far from distinct categories, are bridged by states of liminality, which has necessitated the creation of terms like 'social death' (Sweeting and Gilhooly, 1997), and in the case, what we construe as the 'socially unborn'. How can anthropology help us reflect - philosophically, critically - on the differential values of human lives?

Brief comment: Words and numbers in public health nutrition

By Gideon Lasco, MD, MSc

"In the field of global public health where well being is dominated by the numerical alchemy of measurement, the work of describing that which eludes measurement remains a challenge for anthropology." Complex carbohydrates - on the relevance of ethnography in nutrition education by Emily Yates-Doerr

In her short article about transporting a gift from Guatemala to New York, and reflecting on the significance of that gift - which happened to be some loaves of bread - Emily Yates-Doerr speaks in two levels, both of which are conveyed by the quote I chose.

The first is a call for ethnography in nutrition. People don't really think in terms of proteins, fats, and carbohydrates. There is more to food than what it is made of physically. Eating can mean remembering - as in the article, feeling happy, and many more emotions. Significantly, even the implementors of nutrition initiatives concede that the programs don't work. The limited resources make it difficult to. Though  Yates-Doerr doesn't offer anything concrete in terms of what might actually work (which would have been nice, but I also understand the limited goals of such a short article) - she hints at the right way to find out.

Secondly, she reflects on the relevance of ethnography itself, in general terms, and what it can contribute to fields such as global public health, development. What follows my chosen quote elaborates on this: "the challenge of representing aspects of life that will never be fixed is not small, but the value of complexity makes a case not only for the importance of ethnographic knowledge but also for its importance well beyond the field of anthropology."

This role of ethnography in describing complexity also surfaces in Robert Pool's work; in his case the complexity is that of sensation, what is felt, what is experienced. Annemarie Mol's more theoretical peregrination on the subject of taste - incidentally a fine example of an attempt to capture and convey complexity - has an epistemic concern that echo Doerr's anxiety over measurements: "in the act of testing, knowing and intervening intertwine." Finally, as I embark on my own research about height I am sensitized to the importance of meaning over measurements; and how certain physical measures may be magnified in its social construction. The small differences in height among humans, for instance, create difference, which are reproduced in various forms. Measurements are meaningful in ways beyond their power to indicate certain things,  and even when they are seen as such, they are still limited in their ability to express complexity.  Anthropology addresses these by foregrounding words over numbers, a "thick description" of what Malinowski calls the "imponderabilia" of life over a mathematical formula.

Looking at the quote again, I would like to refine its last sentence. It is not only a challenge for anthropology, it is the challenge for anthropology. But how can we anthropologists assert our voices in a world where numbers are more important than words?

Amsterdam
December 2013

Brief comment: "Being in the ward" - Patients' perspectives on hospitalization

by Gideon Lasco, MD, MSc

“To be on this ward means I have to be ready to agree, always pretending I know nothing and that my body does not react to medications in ways that the doctor will interpret as my hidden resistance. Therefore, I may not even ask to change the medicines that are hurting me. (Mr Ndege, 54, multiple myeloma) in "Patients’ perspectives on hospitalisation: Experiences from a cancer ward in Kenya" by D. Mulemi

This quotation - actually from one of the cancer patients interviewed - captures what the author wishes to convey, which is the deprivation of agency and a passive role in the healing process that lead to disillusionment and despair. By demonstrating that the health care providers’ version of care actually leads to a form of hidden suffering that coexists with the suffering brought about by illness, Mulemi makes the point that dissonant expectations between doctors and patients can lead to poor outcomes, construed broadly to include decreased quality of life. Moreover, his insight that "patients’ acquiescence might not be consistent with the medical perspective of compliance” has implications for clinical practice, problematizing notions of compliance and consent even when on the surface it is “voluntary and informed”. 

In reading the text, I am somewhat reminded of Foucault’s The Birth of the Clinic in which the hospital was seen a site where medicine and disease blurs in the process of making each other visible. What Foucault lacks in his master narrative, however, is how such transformations of the clinic (and thus of ‘care’) is experienced by patients, and hospital anthropology affords us this view.

The context here is important: the hospital is for poor, charity patients who do not have financial leverage and healthcare choices are very limited. These structural constraints, as alluded to in the paper, can be explored further. Following Geest and Finkler’s contention that “the hospital is not an island but an important part of the mainland” (2004:1998), what social realities does the hospital in this particular setting reproduce? Or is there a relation of power between doctor and patient that is produced independently of their cultural and socio-economic divide -  a uniqueness of place that suspends social relations to some extent, as Taussig (1980) might suggest? I think these questions can be answered by further characterizing the patients in this study, not simply as “poor” but looking into their different backgrounds, as poverty is not a fixed category, but a spectrum of categories. Or perhaps studying other socio-economic classes in the same area. Have poor people, amidst the commonness of their predicament, become a “marginalized majority” (de Certeau, 1984)?

Amsterdam
December 2013