We needed to find a new plumber. I called around. The first business that seemed willing to clean our boiler and replace a problematic hose spigot had availability soon. Before settling on a date, I remembered to ask the woman answering the company’s phone–let’s call her, Mary–a non-plumbing question: Will the plumber who comes into our house to work on the boiler for a few hours be fully vaccinated?
That inquiry took us to a place I hadn’t prepared to enter while finding the right vocabulary to explain our garden issue. Indeed, Mary’s unwelcome answer brought us into one of those difficult conversations we all dread these days. Here’s my best memory of how it unfolded:
Mary: I can’t guarantee that the plumber would be fully vaccinated.
Me: Are SOME of your company’s plumbers fully vaccinated?
Mary: We don’t require our staff to be vaccinated. The owner can’t force them. We’re not legally allowed to do that.
Me: Absolutely. But, the owner doesn’t have to keep paying people’s salaries if they won’t get vaccinated. That’s not forcing, that’s just his legal right to hire whoever he wants to hire. He’s got that freedom.
Mary: He won’t require it.
Me: But, are ANY of the plumbers who work for you vaccinated?
Me: Hmm. In that case, I’ll probably wait to use your services until after the pandemic is over.
I sensed that Mary was struggling to refrain from going into a political tirade about how Democrats and scientists were lying to Americans, and the vaccine would make people magnetic or sterile or digitally trackable or . . .
A normal person would have ended the conversation there. But I’m not a normal person. Suddenly, this conversation offered new possibilities for engaging with someone outside my usual social circle. The anthropologist in me was activated. I forged on.
Me: My husband and I are both vaccinated, but this aggressive Delta variant is now causing some mild, breakthrough cases that people might pass on without knowing. Since we have young grandchildren who can’t yet get the vaccine, and we’ll soon see them, we’re being extra-cautious.
Now the citizen in me was activated. Reckless, I plunged ahead.
Me: Meanwhile, since only the unvaccinated are dying from Covid now, you might want to recommend that your plumbers get vaccinated–not only to protect themselves, but also your customers.
Mary: We won’t do that.
Re-enter the anthropologist.
Me: Ah. [Pause.] Out of curiosity, I’m wondering why you don’t urge them to get the vaccine.
Mary: All our plumbers are very healthy and have great immune systems. They won’t get sick.
Me: Oh, that’s wonderful that they’re so healthy. [Pause.] Still, I keep seeing videos of people in the hospital with Covid, on ventilators, who said exactly that. This Delta variant seems to be extra-contagious and is getting so many people sick who had strong immune systems. The vaccine is a great way to protect your plumbers.
Mary: My husband and I don’t believe in the vaccine. We’re not vaccinated, and we don’t want our employees to get the vaccine, either.
Me: Really? Why’s that?
Mary: [Hangs up.]
So much for my long-honed interviewing skills. I’d have to grade myself an “F.”
But I’m never one to take failure lightly. The anthropologist in me wanted to call back and see if I could gently persuade Mary to explain her opposition to a vaccine that has so much overwhelming scientific evidence supporting its efficacy. Exactly what unfounded fears had grabbed Mary’s imagination? Who, or what, was her source of information? Why did she trust that source?
Still, the plumbing issues beckoned. Rather than re-engaging with Mary–trying to conduct instant phone ethnography that was, undoubtedly, doomed–I sighed and returned to an inventory of plumbers recommended on a neighborhood list-serv.
Phone call #2 produced an outcome at once similar, and worlds apart.
The woman answering the phone of the second business I rung up–let’s call her, Carol–offered a complicated reply that invited a conversation. Here’s what I remember of the non-plumbing portion of our exchange.
Me: Will the plumber who comes into our house to work for a few hours be fully vaccinated?
Carol: Probably, yes.
Me: Ah, that’s great. My husband and I are, too. But since we have young grandchildren who can’t be vaccinated yet, we’re being extra-cautious. Are all your plumbers fully vaccinated, then?
Carol: All but one. But, I can make sure that the one who isn’t vaccinated isn’t the one who comes to work in your house.
Me: Thank you, I appreciate that. [Pause.] Out of curiosity, is your boss encouraging that plumber to get the vaccine, to protect himself and your customers?
Carol: Actually, he’s already gotten the first shot. He just hasn’t gotten the second one yet.
Me: Oh, great.
Carol: Yeah, our boss is very big on the vaccine. He’s encouraged everyone in the company to get it. I’m the only one who hasn’t!
Me: Oh. [Pause.] Well, since you won’t be coming to work in my house, that’s not a problem for me. [Pause.] But, would you mind me asking why you haven’t gotten it, if your boss is encouraging you?
Carol: I’ve heard there are a lot of bad sideeffects. Did you have any bad side effects after your shots?
Me: Well, after my second shot, I was tired for a few hours, and the spot on my arm where I got the shot hurt a lot for about a day. But, really, it was no big deal. I’d much rather have a sore arm than die from Covid!
Carol: Oh! [Giggles, pauses a few seconds.] But,I have underlying conditions, and that’s what makes me very nervous about the vaccine.
Me: Ah, I can see that would make you nervous. Have you discussed your situation with your doctor?
Carol: No, I haven’t. I’m just reading stuff on social media.
Me: Maybe your doctor might have more information about whether your condition would make you a good candidate for the vaccine — whether it would be safe for you.
Carol: I guess so. But, I had [pauses] cancer some years ago, and I wouldn’t want the vaccine to bring that back. That was a nightmare. The treatment was so awful. And, the vaccine’s so new, no one knows what it will do, years later.
Me: I hear you. My husband was actually in treatment for cancer the past year, and his oncologist urged him to get the shot as soon as possible. He got it very early. I was online every day for a few hours, starting in January, looking for an appointment for him.
Carol: Wow, really?
Me: Yes. My husband got the first shot as soon as he could. Even though he’s now completely recovered from his cancer, now that booster shots are available, he’s going to get that third shot as soon as he’s eligible. His doctor thinks that’s a good idea.
Me: Yes, there’s a list of underlying medical conditions that make you more vulnerable to catching Covid, and suffering more, if you do. Cancer is one of them. Diabetes and asthma and obesity are some others. That’s why people with those underlying conditions were being urged to get the vaccine early on, before other people.
Carol: Hmm. You sound very knowledgeable. [Pauses.] Maybe I should consider it.
Me: Just this morning, my husband was almost in tears when he read a profile of an ER doctor in Los Angeles who is so, so frustrated with her Covid patients. None of them was vaccinated, and now, many of them are dying. As a doctor, she wants to do everything she can to help people survive, and she can’t believe that people are refusing to get vaccinated, since the vaccine pretty much guarantees that, even if you come down with Covid, it’ll probably be mild, and you won’t end up in the hospital and won’t die from it. Just about everyone in the hospital with Covid now is unvaccinated.
Carol: Where did your husband read that story?
Me: I think he said it was in the Los Angeles Times. If you like, I can ask him and maybe send you the link.
Carol: Oh, yes, please, I’d like to read that.
Me: Sure, I’ll send that to you as soon as I can.
We scheduled our plumbing appointment and Carol dictated her e-mail address so I could send her that newspaper article link. A few minutes after ending the conversation, Carol called back to double-check our street address. But first, she said, “I haven’t gotten that link yet. Are you still going to send it?”
I reassured her I would, then told her some updated statistics about Covid’s ravages that I’d read in the past few minutes. Carol eagerly resumed our conversation.
Carol: You sound so knowledgeable. I’ve enjoyed talking with you.
Me: Thank you. Same here!I do spend a lot of time every day reading updates, since the pandemic has taken such a toll.
Carol: I think I need to stop looking at social media and stop listening to people telling me not to get the vaccine.
Me: I know there’s a lot of claims out there about how the vaccine is unproven or dangerous. But, there’s definitely a lot of scientific evidence now that shows that the vaccine is super-safe and super-effective to keep you from dying from Covid. So far, something like 200 million Americans have gotten the vaccine, and no one has died from it. But we’ve had over 600,000 deaths from Covid.
Carol: Wow, really? [Pauses.] I think I’ll get it soon.
Me: That sounds like a good decision for you.
Carol: Yeah, I’m sure I’ll get it, now.
On the surface, the two women I spoke with share a lot of demographic characteristics. They’re both white. They both sounded within about 10-15 years of each other (I’d say, in their 40s to 50s). They’re both part of the working class. From a variety of speech styles and other markers, I’d guess they both stopped their formal education after high school. They’re both native English speakers. They’re both American. And they’ve both resisted getting the vaccine to protect themselves, their families, and their communities against Covid-19.
But, that’s where the similarities end. Together, Mary and Carol occupy two distinct points on the non-vaccinated spectrum in the U.S.
To put the contrast at its starkest . . .
Mary opposes the vaccine for political reasons; Carol opposes it for personal reasons.
Mary is angry about the vaccine; Carol is afraid of it.
Mary is sure in her decision; Carol is uncertain about hers.
Mary refuses to listen to counter-evidence that would challenge her decision; Carol is willing, even eager to listen to counter-evidence that might impel her to rethink her decision.
What does this tale of two women tell us about the people who have yet to get a free vaccine in the U.S. against COVID-19, despite incredible effectiveness and widespread availability? True, they’re only a sample of two. I can hardly claim that’s a scientifically representative group. But between them, these two women cover a lot of fascinating territory that I think is important, and instructive.
I draw some admittedly big lessons from my conversations with those two plumbing company receptionists. At the ethnographic level:
The “vaccine-hesitant” are not a single, homogeneous block. They include a variety of people who have arrived at their caution–or refusal–from a variety of subject positions.
If Mary and Carol offer strikingly different reasons for rejecting the Covid vaccine, they still do not represent the full range of reasons. Notably . . .
Some undocumented immigrants remain nervous about deportation, in case they have to show an ID at a vaccine clinic (as with some in the Cape Verdean community I research in Rhode Island);
Some blue-collar laborers work such long hours that they don’t find time or energy to go get a shot (as with the Stanley Steemer employee who came to clean our carpet earlier this spring, pre-Delta);
Some young people find it impossible to imagine that they could die (who among us hasn’t been there?);
Some “gig economy” workers live so precariously, from paycheck to paycheck, that they can’t risk missing a single unpaid day or two of work (why can’t the federal government address this with direct compensation?);
Some people of color retain such deep distrustof a medical system steeped in racism that they see no reason to let down their guard now (happily, physicians and nurses of color are starting to effectively address these concerns).
At the pragmatic (or, should I write, methodological?) level: Because “vaccine hesitancy” has many, diverse foundations, addressing it requires a multi-pronged approach.
“Meeting people where they are” has recently become a catch phrase among some in the medical community. That pithy motto is really just a simple way of signaling that what’s needed is an army of anthropologists. Who better to plumb people’s hidden, implicit values?
If the Biden administration were on the ball, they’d be recruiting anthropologists left and right for their medical team.
At the truly big-picture level: Education matters. Without research skills training us to evaluate the clearly false from the potentially true from the absolutely true, we are at the mercy of anything passing for “fact” that crosses our screen. Whatever the grade level, whatever the class subject, whatever the instructor’s expertise, every teacher’s first task should be to teach basic skills to evaluate evidence. The story of Mary and Carol makes it clear: our lives depend on those skills.
Meanwhile, here’s a rash prediction. This Monday, the F.D.A. is said to announce full authorization of the Pfizer vaccine. For some of the under-informed and mis-led Carols of the world ruled by a troubling combination of fear, misinformation, and eagerness for reliable advice founded in facts that regularly evade them, that authorization should provide some assurance that may motivate them to roll up their sleeves for their first shot. In short, I anticipate an enormous wave of new vaccine doses in the coming week or two, as several dams of hesitation break.
And, a wish. Maybe, just maybe, as the Marys of the world watch more people they know and even love die needlessly of Covid, at least a few of them may find some face-saving cover in the F.D.A. move and finally decide to go for a shot. After all, joining the pro-life camp of the vaccinated will confer the ultimate freedom.
Recently, I checked in with Dr. Bjørn Westgard, to see how he was doing.
Back in the ‘90s, Bjørn was enrolled in a wildly demanding, combined M.D./Ph.D. program at the University of Illinois, where I had the pleasure of serving as his academic advisor. After completing his medical school coursework, Bjørn conducted doctoral research in cultural anthropology in a small town in northern Senegal, studying the complexities of intersecting local and global medical systems as they sometimes complemented one another and sometimes competed. He intentionally combined “bottom-up” and “top-down” perspectives, interviewing everyone from village-based farmers and healers to biomedically trained nurses and doctors. (From that research, Bjorn is fluent in French and Wolof, the most widely spoken language in Senegal; he also speaks Serer and Mandinka, two linguistically unrelated languages spoken in the region of his research.)
When it came time to choosing a medical specialty in which to pursue his residency, Bjørn surprised me: he decided against his early interest in pediatrics or family medicine and opted instead for emergency medicine.
Initially, I was disappointed: I thought that working in ER rooms would waste Bjørn’s formidable scholarly skills. How could he get to know transient patients and put his extensive training in biomedical cultural sensitivity to work? Of course, Bjørn had already thought through that concern. “There are more return patients than you’d think,” he explained. Bjørn understood what few others in the U.S. yet knew: that many, many uninsured Americans used emergency rooms for routine medical services. That included the poor and the undocumented—for all of whom, Bjørn (with his ample wading into the deep waters of culturally sensitive issues) would have special insights.
Bjørn had an additional reason for selecting emergency medicine that made equally compelling sense. “There’s so much wrong with the American medical system, and a lot of it is encapsulated in ERs,” I remember him explaining. “As an anthropologist, I can start addressing the systemic problems if I have a position working in the belly of the beast.” At the time, no one was talking about this problem in such clear ways–at least, not in public conversations about healthcare policy. I remember being instantly both impressed and persuaded: Bjørn was making the right decision.
Besides, if I thought about everyone I had ever known, Bjørn would have been my first pick for an ER doctor. He has the sort of calm temperament and clear, logical mind that would make him the obvious choice for captaining any sinking ship.
Fast-forward fifteen years, and Bjørn now finds himself working as Research Director and Senior Staff Physician at Regions Hospital, aLevel 1 Trauma Center in Minneapolis thatsees over 90,000 Emergency Center visits every year. A Fellow of the American College of Emergency Physicians, Bjørn holds secondary medical appointments in emergency departments of four other hospitals in Minnesota and Wisconsin.
Clearly, Bjørn has harnessed the wisdom he gained from studying pluralistic health practices in a small town in Senegal to the technical skills he gained in studying medicine. With his incredible combination of scientific and humanistic talents, I was unsurprised to learn that Bjørn is now leading a medical team that is fashioning policy responses to COVID-19 for the state of Minneapolis.
On his home page, Bjørn describes his approach to medicine this way:
My teaching and research have focused on Emergency Department use for preventable conditions among priority populations, “food deserts” and diet-related Emergency Department visits, longitudinal changes in Emergency Department use among the homeless, supportive housing, and reducing health disparities in emergency care.
Who could be more qualified than an ER physician-anthropologist such as Bjørn Westgard to understand the COVID-19 crisis in both scientific and human terms?
(You can read a brief bio of Bjørn Westgardhere and his LinkedIn pagehere.)
Recently I had a conversation with Dr. Bjorn Westgard about this long COVID-19 moment—about what he has learned, and what he can teach the rest of us.
BW = Bjorn Westgard
AG = Alma Gottlieb
AG: An ER doctor in New York, Dr. Cameron Kyle-Sidell, recently claimed that ER doctors around the world may have drastically misjudged the nature of the COVID-19 beast when it enters the lungs, and may have unintentionally harmed patients by keeping them attached to respirators administering too much pressure on fragile lungs. His claims are quite striking and disturbing! If this ER doctor is right, it’s tragic to think of what damage might have already been done by mis-calibrating those respirators. What do you think of his claims, medically? And, why do you suppose he posted this video on YouTube for general consumption?
BW: This has gotten a lot of play. Unfortunately, his understanding of high-altitude pulmonary edema is a little off, and no one has put anything together about his critique that is systematic or peer-reviewed. However, multiple physicians from China, Italy, and New York in particular (on some emergency medicine podcasts and the like) have raised the possibility that treating COVID using ventilator parameters for ARDS [acute respiratory distress syndrome] may be incorrect, at least initially.
The ventilator management of these patients doesn’t sound incompatible with early ARDS, but it is still very controversial. I just got into a heated argument with an intensivist earlier today for even bringing up the above. There is fear among all sorts of health professionals right now, especially among those who tend to “know what they know” with the most certainty. So the idea of managing critical pathophysiology that might be different from what is expected–requiring a veritable,Kuhnian paradigm shift–can be very anxiety- and anger-provoking.
To add further fuel to that fire, there has also been discussion of a possible hemoglobin issue (oxygen carrier in the blood), but there has been nothing other than a pre-press 3D computer modeling paper out of China in the rapid-fire literature to support that idea. However, a group from NYU did use machine learning to predict severe disease, with results that could support the idea of ahemoglobinopathy. I even have colleagues in my other Board specialty, hyperbaric medicine, who are working on a trial to use hyperbaric oxygen to get around the possible hemoglobin issue. I think there’s probably more to the receptor for COVID, which is present in all of the body’s vasculature, which could potentially trigger inflammation and coagulation that way, and that inflammation and small clots, which we’re finding everywhere in coronavirus patients, could be causing diffuse injury.
It’s fascinating to watch the accretions of science and knowledge in the age of the Internet and social media. Already, cranks are hawking conspiracy theories and supplements in response to the “censored” knowledge above.
As an emergency physician and an anthropologist, I’m a bricoleur of the contingent and the emergent, by trade. I’ll consider new ideas if they make pathophysiologic sense, and I have no doubt that someone will examine these ideas further and more systematically, so I’ll keep watching for more evidence. For now, I’ll care for the patient in front of me and adjust their vent settings as needed.
AG: That sounds like a good strategy both for an ethnographer and a doctor. But then, I always thought that all doctors ought to have training in anthropology.
BW: I hope I didn’t give you the impression in my last email that I was resistant to the ideas presented, just that I’m looking for more information, whether from personal, clinical experience or other data. I’m just not generally inclined to change my clinical practice in response to social media. I’m in the middle of our Thursday morning residency conference right now, and we’re discussing initial and ICU ventilator settings, given developing information, and it’s fascinating to hear an intensivist colleague suggest that “we’re all in the same boat here, the attendings [fully credentialed, attending physicians], the fellows, the residents, and the med student . . . we’re all learning together as we go.”
AG: Speaking of combining social and technical approaches, we’ve been reading about efforts to systematically calculate social contacts for COVID-19 patients, to help track the socio-geographic spread of the disease. What do you think of those?
BW: Very cool. I’m trying to get our state to do something similar using an app I’ve worked with a team to develop. I’m arguing with our Department of Health, who have difficulty appreciating how technology might help. But they’re also feeling less pressure to consider novel options, since our state is doing relatively well.
AG: Here’s something else I thought you might have a lot to say about . . . the whole “herd immunity” question strikes me as so interesting for anthropologists. I’ve been reading a lot about this recently. This piece in the Boston Globe really caught my attention.
First, there are the epidemiological questions. How accurate is the concept of “herd immunity” to begin with? As a doctor and scientist, I assume you’ll have much to say about that.
Second, there are the sociological implications. How can your perspective as an anthropologist speak to the epidemiological factors? If the US (and/or other nations) adopts a “herd immunity” approach at some point (before a vaccine is widely available), what sorts of people will be allowed—or even encouraged–to be exposed to the virus? What sorts of people should be allowed, or even encouraged, to be exposed to the virus? Are those two groups of people the same? Or, will socioeconomic disparities intervene, and might large numbers of the wrong people (the most vulnerable) end up being exposed to the virus? I’m thinking about this because, over the past two weeks, many mainstream journalists in the U.S. have begun noting racial disparities in COVID-19 mortality. Of course, that’s no surprise to anthropologists (and some other social scientists), though it seems to be surprising plenty of politicians. Thinking about these social factors, are there new risks to perpetuating racial disparities with a “herd immunity” strategy?
Third, there are the symbolic/conceptual/philosophical implications. As a scholar steeped in sensitivity to discursive implications, what are the ramifications of using a metaphor of (non-human) animal behavior for human behavior, in evoking “herd” immunity?
The maddening “organism at the edge of life” (as virologist E. P. Rybicki describes viruses) that is far too dangerous to appear this beautiful
BW: I haven’t had time until after my shift this evening to get to your questions, but I like them. It prompts me to reflect and consider with a wider lens.
I’m not an expert in infectious disease or epidemiology, but my understanding is that “herd immunity” is primarily a statistically useful concept that expresses the aggregate balance between immune systems and infectious vectors such that there’s enough immunity to prevent ongoing transmission. But when you get into the immune system, things become very complex very quickly. Talking about vaccines and immune medications (like those being discussed as treatments forcytokine storm, for example), the questions pertain not just to the dose of a drug in the volume of an aqueous human, but also to what the most productive triggers are for the bodily machinery churning out the immunity widgets of antibodies. The questions become: What is needed to trigger the production of immunity? How effective is the immunity that is produced? Does it wane, and if so, when?
And all that is without discussing the social patterns of intermixing that we all experience, and which have become the main means by which we are currently intervening upon the spread of this pandemic. I think that’s where the concept of “herd” becomes interesting. Anthropologists and many others are comfortable with the idea of the population as a biopolitical concept generated by a certain kind of governmentality. But how do we, the multitude, deploy that in an effective, self-governing manner?
It seems to me that the concept of the “herd” could allow us to conceive of our collective biology, our animality, in a way that is positive and potentially collectively empowering, rather than biostatistically disempowering. That said, it seems clear that a “herd immunity” strategy that treats the lot of us like chattel (the flip side of the “herd”), positing that we should all “put on our big boy and big girls pants” and accept that a lot of people must die, will undoubtedly do more harm. We’re seeing this in those areas of the country where few or late actions have been taken to mitigate the spread of coronavirus.
It’s my hope that we’ll use available information from around the world to develop better methods that capitalize upon our current collective engagement. It seems like “flatten the curve” has brought the collective back to the biostatistical. Hopefully, well-thought-out approaches to “reopening” and easing social/policy measures could do the same. But the evidence for these measures is thin, and we are all learning about one of my favorite areas or research, complex population models of disease. This is another area where science is being built daily, as the pandemic provides some of the first empirical test cases for these tools.
But it is disheartening that in areas both with and without aggressive measures, we see the impact of racial and socioeconomic disparities. Those disparities are at play in health inequities and inequitable care in the best of times. Now, resources are strained, so it would be almost unthinkable that those factors would not be significantly at play in the pandemic. In areas with less, or late, social and political measures to isolate people, the historic clustering of populations through systemic segregation, with associated increases in population density and decreases in access to resources, lead tosyndemic conditions. In areas with more social and political measures to isolate people, many who work low-end jobs become unemployed, with all the accompanying fears and hardships, while those who keep their low-end jobs–clerks, janitors, service workers, etc.–are left out in public in positions that put them in contact with large numbers of potentially infectious people. So, between the two groups, disparities in rates of infection and adverse outcomes should come as no surprise.
I’ll get back to you with more, as this is the next bit of thinking required. In Minneapolis, the group I’ve assembled between HealthPartners and the University of Minnesota are going to consider how to model this process to provide guidance for the long term of the pandemic.
AG: Yes, racial disparities are emerging with disturbing alacrity and intensity in the US. But, as you say, that’s hardly a surprise, for all the reasons concerning systematic, structural disempowerment that have characterized US society since Europeans set foot on these shores. Those sorts of disparities have begun to be part of a growing national conversation since the Civil Rights movement of the ’60s, and they took on new force more recently with the Black Lives Matter movement. One of the components of the current horrible moment that I’m actually finding most heartening is the extent to which social conditions ARE finding their way to being front and center of many conversations. It strikes me that this moment of national (and global) crisis offers America new opportunities to expand that conversation and really take its lessons seriously in a new way for the first time in US history. And, medical researchers and doctors will be at the forefront of that conversation. Someone like you, with your dual training, is especially well positioned to think systematically about just how to operationalize those lessons in ways that work with public health protocols. That’s why I’m excited about our continuing conversation!
BW: I think it’s very clear that this virus is hitting communities in both indiscriminate ways (with some reportedly healthy individuals going on ventilators or even ECMO life-support machines) and in VERY discriminating ways, hitting poorer communities and those of color. What I haven’t heard exactly is any discussion about ways to focus resources on those communities that are hardest hit, which is disappointing but not unexpected, given the current national leadership.
I actually think race and structural inequalities and violence have very much come to the fore within medical practice. It’s just that our sphere of influence is limited. For example, in Minnesota, our healthcare system has an Equitable Care Committee that has done a lot of great work, although it has vacillated between focusing on equitable care and health equity, depending upon what we think we can actually achieve. Residents and med students, particularly the med students, are very aware of disempowerment, and it’s one of the things I teach about when I’m on shift [teaching residents]. In fact, next week, I’ll be drawing directly from anthropology in giving a talk as part of a panel at our Society for Academic Emergency Medicine national meetings (now online!) about teaching residents to be “structurally competent”—meaning, thinking about larger, structural issues that shape the experiences they see in particular patients.
What’s most difficult is to figure out how to get beyond the clinical domain and affect pathologies upstream, closer to their source. It helps one understand why Paul Farmer long ago advocated for large-scale wealth transfers between north and south, and why we need to do the same in the U.S. That’s actually some of what was achieved by the Affordable Care Act but then was largely undone or undercut by recent tax cuts for the wealthy. So it’s good that these issues are front and center, but I think they could be even more so. And it’s good that we’re thinking communally, as I said before, but the idea that we might differentially focus collective resources upon communities that are hardest hit seems to meet resistance with predictable frequency.
AG: In Rhode Island, where I now live, there’s actually a vigorous initiative (Beat COVID-19) with just that emphasis. Beyond the capital, the two cities hardest hit in Rhode Island are Central Falls and Pawtucket, both of which have large, immigrant communities of color (mostly from Latin America and Cape Verde). The current rate of infection in both those cities currently surpassess that of New York City. Nationally, these two small cities are invisible in news reports, but locally, a multidisciplinary coalition has formed that is forging creative approaches to reach these communities. The coalition includes a normally unlikely set of folks, including a local doctor, representatives from the state’s Department of Health and the two cities’ police departments, marketing specialists, local community organizers and advocates, translators, and even yours truly, as an academic critic. I’ve been heartened to see a far more open-minded approach to reaching these communities than I would have imagined. For example, since many residents of these neighborhoods feel more comfortable speaking either Spanish, Portuguese, or Care Verdean Kriolu, a new COVID-19 hotline in these three languages now welcomes callers, and there are now public service announcements in those three languages that are being promoted online in all sorts of social media spaces where people from these communities are likely to read them. I’m so impressed by what I’m seeing that I’m starting to consider this local initiative a model for communities elsewhere.
Once COVID-19 starts hitting the white heartland–as now seems inevitable–because of resistance both by Republican governors and local residents to maintain social isolation procedures, and insistence to “re-open” the economy prematurely and indiscriminately–it will be interesting to see how those communities respond to the crisis suddenly invading their families. As a physician, I imagine you must feel quite frustrated by those conditions.
BW: Just look at the largely white nationalist forces that have hijacked what began as small-business protests about state efforts to enact social-distancing policies, in an effort to minimize the impact of the COVID surge.
Those folks are having trouble getting on board with just the baseline collective actions needed for public health. Currently, so many folks in the rural parts of the country see this crisis as an urban thing. But if we look back at the influenza pandemic of (supposedly) 1918-19–which actually lasted three years (my grandfather nearly died of it in 1921)–the initial wave hit densely populated areas, but the next waves were largely rural. And today, if you look at rural areas, they’re as disproportionately disadvantaged as are many of the low-income, urban communities from which we’ve divested as a society. In fact, rural America overall is actually less insured, has less access to services, and is more dependent upon government transfers of resources than is most of urban America. So, I’d really like us to be able to see both of those kinds of communities with one gaze.
AG: That makes a lot of sense both politically and intellectually. It will be interesting to see if white conservatives come around to that position, once they are affected.
Since you’re enjoying thinking about epistemological issues raised by COVID, I wonder what you might think of an e-mail I recently received.
A prominent medical school has decided to confer MD degrees a little early, for med students who had completed all their training and were scheduled to receive their degrees within a few months. (The e-mail subject line read: “Emergency Powers Exercised: Approved Early Degree Conferral of 4th Year Medical School Students.”)
That will allow these brand-new medical residents to start practicing in COVID-19 hotspots and help alleviate the hospital crisis in those areas. Seems like a great idea–this is a good time to challenge bureaucracy, right?
But I also saw an online petition on a related question that made me more nervous–to grant “registered nurse” (RN) licenses to “licensed practical nurses” (LPNs), who have quite a bit less training than registered nurses do. That struck me as way riskier. But perhaps I’m being too conservative. Maybe LPNs are actually being asked to do the work of RNs in this crisis, and so they should be credentialed and salaried accordingly. What do you think?
BW: I definitely agree with deploying fourth-year medical students early. It strikes me as a safe move at this time in their training.
However, in areas that are not already seeing surge conditions, I think the country would be best served by deploying medical students to docase-contact tracing.
And I agree with you that granting RN licenses to LPNs is riskier. Credentials are indicators of different kinds of training, and their significance should be maintained, though that’s the professional in me coming out and maintaining boundaries.
As with many things at the moment, one could simply and temporarily alter practice parameters for surge or crisis standards of care.
AG: I recently read another, especially thoughtful piece in the New York Times, about when to “re-open America”—with the intentionally provocative title, “Restarting America Means People Will Die. So When Do We Do It?” A staff writer for The New York Times Magazine moderated a panel discussion with five people with varying backgrounds (a minister, an economist, a global health specialist, a civil rights specialist, and a bioethicist). They raised sociological issues related to those raised in the Boston Globe piece about “herd immunity”–but from broader perspectives, and more critically, I think. Lots of food for anthropological thought here. As a physician-anthropologist, you can, I imagine, bring special perspectives to this emerging national conversation about how we think about risk in “re-opening society.”
BW: There definitely needs to be attention to those who are at higher risk for contracting and dying from COVID-19, and to those communities whose residents don’t have a choice about going back to work. It’s really a matter of whether people are forced to be at risk, or are allowed to be agents of their own risk and that of their loved ones. Are we going to make re-opening businesses opt-in?
Unfortunately, the baseline state of affairs in America is far from a level playing field. Some people will, essentially, be forced to work so that states don’t have to pay them unemployment benefits, and small business owners will be forced to run risk so they can qualify to get loans and other state-funded stimulus funds. Yet, somehow, there’s no national conversation questioning whether oil, airlines, and other large industries should be bailed out.
I think we could consider restarting by focusing on the social and the scientific. I think most of us would be doing better with all of this isolation, quarantine, and lockdown if we had a few more people to connect to. If you look at places that are opening up, or even how we started this all, we could start clustering in smaller groups, 10 people or fewer. Just folks who you would know were sick. And we could get the kids back together. Given the low likelihood of adverse effects in children, the fact that they have been much less symptomatic, but that they are also very good at transmitting disease to each other (just ask any parent of a daycare child), getting them back together would get us started with herd immunity. Bioethicist and oncologist, Zeke (Ezekiel) Emanuel was one of the first to say that we should probably get summer camps up and running. To me, that makes sense. But, again, it’d have to be opt-in, both for those who run the place and those who go to camp.
AG: Scholars and doctors aren’t the only ones talking about how to protect ourselves from this virus. I just discovered a pretty awesome rap video about COVID-19 from Y’en a Marre, a group from Senegal (here). Any thoughts?
BW: Y’en a Marre are a great group. They were instrumental inmobilizing the youth vote to get Wade out of power in Senegal, so I feel like they’re always “au service du peuple et de la nation” [in the service of the people and the nation]. It’s so interesting how hip-hop and other forms of art in a smaller country, fending for its own identity and economy with a smaller media space due to the constraints of language, can be called on–if not officially (like this probably was), then culturally–to serve the body of the nation. In this new video of theirs, I love how they’re all doing scientific activities–looking at charts, microscopes, and blood specimens–instead of just striking stereotypical poses in hazmat suits. It’s a solid video. I can’t imagine many hip-hip artists in the States pulling something similar off with the same tone–in Minnesota, maybeAtmosphere, but not many others in the national mediasphere.
AG: You mentioned that you’ve just co-authored a short piece about COVID-19 that you’ve submitted to a medical journal. Can you talk a bit about the orientation of that article? Were you able to insert an anthropological perspective into an article for a medical journal?
BW: In Minnesota, we’ve just had a huge decline in visits to the emergency department and to the hospital for just about everything. Most of the news outlets have covered it, but no one has published any numbers or more detailed reports of what’s not coming in. I’m fine with a slowish day in the ER, but across the country, particularly in those places not seeing the surge, the changes in patient volume have had devastating effects on clinics, hospitals, and health systems that have to operate at near full capacity and with razor thin margins in normal times just to stay afloat. So, at the same time as we have surge, we’re also seeing mass furloughing and pay cuts for nurses, doctors, and even (gasp) administrators.
So we just pulled the numbers for before and after our great Governor Walz’s announcement of a statewide “peacetime emergency,” comparing volumes and visits to a year ago, and we found a 70% drop off in strokes, and a 50% drop off in heart attacks, but also declines in really painful things like kidney stones, too. And, who’s not coming in? Well, it’s the elderly, children, and those who have insurance through Medicare. Much of this drop is likely prudence on the part of high-risk individuals, but we know there’s also some desire to not burden the health systems with non-COVID related care, as well as some fear of actually contracting coronavirus in healthcare settings.
Similar trends have been seen in China, Taiwan, South Korea, and Europe, as well as in chronic care. In Minnesota, the HealthPartners Institute has a chronic care surveillance group, and they saw visits drop off by 90% in three days after the statewide announcement.
We’re interested in doing follow-up studies, monitoring for the effects of delayed or deferred care, both acute and chronic, and seeing who comes back first, and with what.
AG: That sounds like an important set of considerations I haven’t yet seen anyone talking about in the press. Everyone is so focused on the now of the emergency, and how to extricate ourselves from it, that few I’ve seen are allowing themselves the luxury of imagining ancillary questions such as those you’ve just raised. Again, I imagine your training in anthropology makes it easier for you to keep your eyes focused not only on the big picture, but on seemingly unrelated factors that, in the end, turn out to be deeply related. That’s what we do in anthropology, right?
Well, let’s end on a positive and practical note. Last week, the team you’re leading produced a new app, “SafeDistance,” to provide up-to-date information about COVID-19 incidence in micro-neighborhoods.
Online, the website for the new app describes it this way:
SafeDistance is a free, non-profit app and website that crowdsources symptom data to help detect, predict, and prevent the spread of COVID-19, while assuring your privacy.
· Personalized, social distancing recommendations
· Neighborhood-level COVID-19 risk map
· Privacy assured – no account required, you remain anonymous
Can you talk about what sorts of social knowledge about Minnesotans factored into how you designed the app for ordinary people?
BW: The basics are maintaining privacy while collecting data of actionable utility. So we’re focusing on anonymity–both to allay privacy concerns, and also to make it an easy tool to begin using. Instead of identifying individuals, we’re mapping and doing analytics by neighborhood. This approach allows both individual users, and anyone else who is interested in the data from a more sociogeographic perspective, to have some granularity to what they’re seeing.
If you look at most of the data that’s out there, even the Johns Hopkins and Unacast or SafeGraph data, it’s mostly out there in county form, which is fine if you’re interested in the temperature of the pandemic locally, but it doesn’t tell you the weather and how much caution you should be exercising. Right now, that’s not a huge deal, because we’re all being very cautious with our efforts to self-isolate, mask and the like. But as we open up, and we find that our prior efforts burn out and COVID-19 flares up in different spots, we’ll probably have to dial up and dial down and differentiate our self-protective and collective efforts to deal with the virus. As I said, the “1918” influenza pandemic actually lasted until 1921, so it’s like [epidemiologist] Mike Osterholm has said, we need tools to figure out how we’re going to live WITH this virus, since it’s unlikely that we’ll just out and out defeat it–at least, until an effective vaccine is available globally.
AG: You initially launched the app in and for Minnesota, but it’s now available for anyone across the U.S. via auser-friendly website. Do you imagine it could have equal relevance anywhere in the country?
BW: If all the app does is give users good information and maps that convey the details of the pandemic in their neck of the woods, I’ll be satisfied.
But the detailed neighborhood maps that will be produced in the app from new user data will soon be available nationwide. If the data that are generated can be combined with other datasets to get us to a geospatial SEIR model that would allow us to predict more accurately when and where future outbreaks might occur, that would be a real contribution to fighting this pandemic–as well as to science more generally.
Well, it’ll likely only be the former, but hope springs eternal.
N.B. Another version of this post appears on the website of the anthropology journal, Public Anthropologist. You can find it here.
UPDATE, June 19, 2020: Bjorn has just published a co-authored article analyzing changes in the numbers and kinds of patients arriving at ERs in one large, public Minneapolis hospital. You can request a copy here: https://www.researchgate.net/publication/342111120_An_analysis_of_changes_in_emergency_department_visits_after_a_state_declaration_during_the_time_of_COVID-19
Cultural anthropologist, Robbie Davis-Floyd, is a leading anthropologist in the fields of childbirth, midwifery, and obstetrics.
A Senior Research Fellow in the Department of Anthropology at the University of Texas-Austin, she has studied childbirth practices firsthand in the U.S., Mexico, and elsewhere, and has promoted the work and legitimacy of midwives around the world.
Robbie Davis-Floyd (back row, right) honored by the North American Registry of Midwives (NARM) for helping create a nationally recognized certification process for professional midwives in the U.S., Mexico, and Canada
She has also lectured as a featured, keynote speaker at over 1,000 universities and health practitioners’ conferences in the US and internationally, always taking the opportunity to learn more about the maternity care systems of the countries she has visited.
Robbie Davis-Floyd speaking at the 2014 Symposium of the California Endowment
Considering the cumulative impact of her energetic and creative efforts on many fronts to promote healthy childbirth without unnecessary, high-tech interventions, it is probably no exaggeration to say that Robbie Davis-Floyd has long served as the “public face of anthropology” to the international childbirth movement. Her work has been instrumental in bringing anthropological insights into the global childbirth arena and in effecting humanistic changes in childbirth practices in many countries. Indeed, given the impact of her work, she is considered a “living legend” among birth activists both within and beyond anthropology.
Despite the enormous impact of her research, writing, and speaking on childbirth practices in the U.S. and elsewhere, birth is by no means the only topic that Davis-Floyd has studied. She’s recently given birth to a delightfully readable, new book, The Power of Ritual, co-authored with neuroanthropologist, Charles Laughlin.
Cultural anthropologist, Claire Farrer, has called the new volume “an exquisite and informative book,” writing:
I wish that this book had been available during my long teaching career–I would have used it in all my relevant courses!
Beyond professors and students, because of its breezy writing style, combined with its captivating examples from common experiences in Westerners’ lives, the book will surely appeal to many “ordinary” readers. Birth educator, Debra Pascali-Bonaro, has written:
Before I read The Power of Ritual, I thought I knew what ritual was, yet now I know that it is so much more–it can be everything from a simple conversation-opener to a powerful healing process, from an individual’s daily habits to full-scale ceremony. I have learned much from this book that I can apply to my own life to enable me to more consciously perform my daily, family, and professional rituals.
Robbie and I recently chatted about the book online. You can read our conversation below.
Meanwhile, you can learn more about Robbie Davis-Floyd’s work on her website here, including her C.V. You can also find a view of Davis-Floyd’s many published books here, and downloadable PDFs of most of her dozens of published journal articles and book chapters here.
RDF: Robbie Davis-Floyd
AG: Alma Gottlieb
AG: You’re well known for helping develop and promote the anthropologies of childbirth, midwifery, obstetrics, and reproduction. Your fans may be surprised at the focus of this book on ritual. Yet, your first book (developing from your dissertation), Birth as an American Rite of Passage, used ritual as an analytic frame.
In that sense, would you say that The Power of Ritual reprises the conversation about ritual that you began nearly 30 years ago? Or, takes it in new directions? Or both?
Put differently (and more broadly), why would an anthropologist of childbirth write a book about ritual?
RDF: I’ve come full circle, as I did not start out as a birth anthropologist! My original graduate training was in both Folklore and Anthropology, and my interest in ritual was sparked by one of my Folklore professors, Roger Abrahams, whose writings on ritual I found enticing.
I did my Master’s thesis on the folklore of a Texas madam, Edna Milton, who for many years ran the notorious Chicken Ranch in La Grange, Texas—featured, after its closing, in the movie, The Best Little Whorehouse in Texas. The article I wrote about how Edna’s masterful use of jokes and other forms of language manipulation kept her in total control of the Chicken Ranch, its customers, and its employees was published in the Journal of American Folkore and was widely used for teaching for many years, as it clearly shows how jokes and folktales can be used for manipulation, plus it is hysterically funny!
In the middle of my PhD studies, I took some time off to spend a year traveling around Mexico and learning Spanish. I returned to Mexico often and worked with two shamans—Don Lucio, a traditional shaman and “weather-worker” (trabajador del tiempo) from a small village in central Mexico, and Edgardo Vasquez Gomez, a wealthy businessman living in Cuernavaca who had traveled the country in his younger years studying sorcery (brujeria), magic, and traditional healing, and later combined that with the teachings and philosophy of the Russian philosopher, G. I Gurdjieff. Both had large followings, and both could actually manipulate energy and perform what I experienced as magic. If you combined them into one person, you would get someone very like Carlos Castaneda’s Don Juan.
I know that Castaneda’s work has been discredited, but the two shamans I worked with were real—as were the effects of the (very different types of) rituals they performed. We used to joke that Edgardo was Don Juan. In my doctoral program, I later wrote several long papers on myth, ritual, and shamanism in Mexico and expected to do my dissertation research with those two. (That was before computers, and those papers, sadly, were lost in a house fire.)
But then I had a baby, got “bitten by the birth bug,” and decided, instead, to research women’s childbirth narratives, as I was still in folklore mode. Yet the more women I interviewed, the more one question grabbed me:
Given the highly individual nature of each woman’s birth experience for that woman, why is birth treated in such a standardized way in American hospitals?
I began to research the scientific literature on birth. I soon realized that the vast majority of “standard obstetric procedures” did nothing to make birth safer. Instead, they made it more predictable and controllable—while unnecessarily harming women and babies in the process.
Davis-Floyd has chronicled how fetal heart rate monitors keep women attached to a bed and claim attention on a machine’s readouts, rather than on a laboring woman’s subjective experience
At first, I was confused. Like most people, I had assumed that obstetrics was based on science. When I realized it wasn’t, I had to ask the most basic anthropological question: Why? Why would doctors do things to women that didn’t make birth safer? The explanation hit me like a bombshell.
’”Standard obstetric procedures” do not come from the logic of science but, rather, from the logic of ritual. Like most rituals, they reflect the core values of their culture—in this case, the culture of technocratic societies.
They are designed, as so many rituals are, to try to control the uncontrollable forces of nature, to keep fear at bay–in this case, fear of both death and lawsuits. So, I switched from simply analyzing women’s birth narratives to a focus on analyzing obstetric procedures as rituals.
To fully explore this notion, I needed to understand ritual more, and its primary characteristic– the use of powerful symbols to convey meaning. I took a summer seminar at the University of Virginia with Christopher Crocker on what was then called “symbolic anthropology” (now “interpretive anthropology”). I also taught myself medical anthropology, which I had never formally studied. But I had to become an expert in it, as pregnancy and childbirth had long ago become defined as medical events.
After reading almost everything that Victor Turner, Clifford Geertz, Arnold van Gennep, and many others had written about ritual, I saw that birth, which used to be a physical and social rite of passage replete with social rituals, had become a completely medicalized rite of passage. The rituals that characterize birth everywhere had become medical rituals, officially disguised as “standard procedures.”
Dissatisfied with the many definitions of ritual I read, I created my own:
a ritual is a patterned, repetitive, symbolic (and often transformative) enactment of a cultural (or individual) belief or value.
a technocracy is a hierarchical, bureaucratic, capitalist, and (still) patriarchal society organized around the supervaluation [a word I coined] of the progressive development of high technologies and the global flow of information via those technologies.
I generated a list of what we might perceive as characteristics of rituals: symbolism, rhythmic repetition, order, formality, framing, performance, acting, stylization, staging, and often, intensification toward a climax. In my dissertation (which became my first book, Birth as an American Rite of Passage), in a chapter called “Birth Messages,” I dissected each standard obstetric procedure—its official rationale, the scientific evidence against it, women’s highly varied responses to it—and explained how it acted as a ritual by enacting, displaying, and transmitting specific core technocratic values and beliefs to women, their partners, and their practitioners.
In Birth as an American Rite of Passage, Davis-Floyd analyzes the wheelchair as a powerful symbolic statement conveying the clear message that the woman in labor is “disabled”
At first, some ritual scholars like Ron Grimes argued that I was metaphorizing obstetric procedures as rituals, but that they were not really rituals—they were like rituals—because most scholars saw ritual as religion-based. But since the publication of my book in 1992, and its second edition in 2003, my analysis of hospital birthing practices as rituals has held, and its framework for understanding the characteristics of “secular ritual“ (using childbirth as an example) has been widely used.
AG: What a fascinating intellectual history! So, for this book on ritual, how did you decide to collaborate with a co-author who specializes in neurological approaches to human experience?
RDF: From analyzing birth narratives, I saw that women’s perceptions of themselves and their ability to give birth were profoundly affected by technological hospital rituals (such as IVs, electronic fetal monitoring, Pitocin induction or augmentation, episiotomies, immediate cord clamping, etc.). So I knew there was a missing piece in my growing understanding of ritual. It seemed clear that ritual can affect the human brain–but how?
Davis-Floyd’s research has helped document the much higher likelihood of a C-section once a woman’s labor is “induced,” or accelerated, with Pitocin
I searched the literature but found no answers until, one day, while browsing the book stalls at the annual American Anthropological Association conference, I saw a book way at the back of the Oxford exhibit booth. That particular book was literally glowing at me—in much the same way that I could often see the reins of energy that Edgardo held in his hands glowing during group meetings. I pulled the book out, and my life changed! It was called The Spectrum of Ritual, and it gave me the answers I was looking for. Here, finally, was the missing piece—the neurophysiology of ritual, the explanations for how ritual works on the brain and, thus, where it gets its power over us humans—starting with its multiple roles among animals.
A few years later, I met one of its authors, Charles Laughlin, at a conference. We both had read everything the other had written, so our meeting was intense and our ensuing friendship equally so. We eventually decided to co-author a book on The Power of Ritual–because I wanted to expand my study of ritual into other arenas besides birth, while Charlie wanted to put his highly esoteric work on ritual (characterized by what he termed ”neurognosis”) in more straightforward language, so he could make it accessible to people with IQs lower than 180. I kept telling him, “Just dumb it down and tell stories”!
AG: Did you run up against differences in approach?
RDF: Not really. Charlie accepted my definition of ritual as the one we would use. We also used most of my list of the characteristics of ritual. At some point, though, we realized that some factors on my original list, such as the fact that rituals generally work to preserve the status quo yet, paradoxically, can also be used to generate rapid social or religious change, were actually effects of ritual, not characteristics.
In this book, I finally was able to write about my long-ago work with the two Mexican shamans. Unfortunately, it was all from memory, since, as I previously mentioned, the graduate school papers I had written about those experiences had all burned up in a house fire.
AG: This book begins with a theoretical discussion of how to define and analyze ritual, but it ends with a surprisingly down-to-earth section offering models for how contemporary readers might create their own rituals for important moments in their lives, whether for menarche, meditation, lucid dreaming, prayer, birth (as Melissa Cheyney has shown, homebirthers in particular create lots of rituals for honoring, de-medicalizing, and helping them through the labor process–see her article, “Reinscribing the Birthing Body: Homebirth as Ritual Performance”), death, or other significant events or experiences.
When we think about “engaged anthropology,” we usually have more economic or political transformations in mind. Would you consider the “how-to” section of the book another variety of “engaged anthropology”?
RDF: Yes! And also of “applied anthropology.” Anthropological understandings gained from studying people and their lifeworlds should be expressed in ways that enable people to apply them to their own lives and use them for their own purposes. We need to come down out of our ivory towers and make our work relevant and useful in immediate ways. That is why Charlie and I put so many personal examples of ritual into our book—to engage readers with those experiences and help them directly apply them, should they wish to do so.
AG: So, what’s next?
RDF: Our refinement of both of our life’s works in this book is now feeding back into the third edition of Birth as an American Rite of Passage, which I am working on now, and which will be a complete revision and update (this time with a co-author, the amazing Missy Cheyney). Another full circle!
But I‘ve never confined myself completely to birth and related subjects. In addition to ritual and symbol, I’ve also intensively studied cults (as described in The Power of Ritual), medical doctors who became holistic healers (as described in From Doctor to Healer: The Transformative Journey), futures planning via global scenarios, and aerospace engineers. But those are stories for another time. That’s one of the great values of anthropology. Once you have the tools, you can study any phenomenon that captures your interest!
AG: Any other future projects in the works?
RDF: Betty-Anne Daviss and I are in the process of finishing Childbirth Models on the Human Rights Frontier: Speaking Truth to Power—a sort of follow-up to our book, Birth Models That Work(2009), which has been called “seminal” (though we would have preferred “ovarial”) because it was the first book to describe truly functional birth practice models that are woman-centered and evidence-based—as opposed to the dysfunctional, non-evidence-based maternity care models that predominate almost everywhere.
This new follow-up volume describes models that are way more “out on the edge”—in high-poverty, disaster, and war zones, for example. It also discusses birth models that are more iconoclastic, while addressing professional bullying and competition among doctors, and the de-skilling of obstetricians in techniques for vaginal breech birth.
Our next project will be an edited volume called The Global Witch Hunt: The Ongoing Persecution of Woman-Centered Birth Practitioners. Its purpose is to call attention to the often-intense persecution of some of the most skilled midwives and obstetricians in the world, who will often go out on a limb to honor the wishes for a normal birth of women considered high-risk, by attending them at home or in hospital, but then get punished for putting the woman, not the protocols, first. The “witch-hunted” practitioners will tell their own stories in each chapter, while we co-editors (Betty Anne-Daviss, Hermine Hayes Klein, and myself) will contextualize those stories in the Introduction and Conclusion.
In another vein, for years I have been writing short stories, which I hope to publish some day in a book called Robbie’s Reader: Vignettes of My Magical Life—for my life has indeed felt magical, primarily because my anthropological research and international talks have taken me all over the world, filled my life with adventure, and given me great stories to tell!
Brown recluse spiders normally live in South America and a few southern and midwestern states of the U.S. They’re also loners and rarely approach humans. Yet, somehow, one managed to find its way to Manhattan, and to me.
Rational choice theory is alive and well, even in those who challenge it
When in NYC, if I worry at all about the risks to life and limb, I probably focus (unconsciously) on getting hit by a speeding taxi, or crushed by a collapsing construction site, or shot in a terrorist attack. What I have most certainly neglected to worry about is getting bit by a subtropical spider far from its home territory. In this, my calculations must implicitly revolve around a rational choice model of risk/benefit assessment.
But, really, I should have known better. Back in 1975, my graduate fellowship had me assisting in (and once lecturing to) a course that highlighted Mary Douglas’ theory of risk–a far different perspective that emphasizes individual perception shaped by complex social and cultural factors well beyond “simple” (especially economic) costs and benefits. Mark Twain’s insight is an earlier (and pithier) way of saying: statistical odds, at best, provide likelihood rather than certainty.
, to be honest, there aren’t enough hours in the day to worry about every catastrophe that could conceivably befall us. So, we pick and choose our worries based on statistical odds that turn out not to be all that rational.
Globalization works for creatures beyond humans, too.
After surviving a herniated disc/back surgery, 15 months of intestinal parasites, and two unmedicated childbirths (my choice) a couple of decades ago, my pain threshold apparently remains pretty high. Okay, the partly-necrotic tissue now disfiguring a big chunk of my leg might have reminded me of a Green Day song about taking Novacaine. Still, wincing from the throbbing wound on my leg, I’ve managed to keep up with e-mail and other work tasks while popping only a few ibuprofens.
Despite the above-mentioned point: Our life plans are frailer than we may hope.
Scheduled errands, meetings, outings, and dinners with friends are all on hold. My doctor predicts that my bite may take anywhere from a few days to a few weeks to heal. The Internet warns me it could even be a few months. That’s a lot of iCal events to tentatively reschedule.
I now know what bit me while living in a small village in Ivory Coast.
Back in 1980, a mysterious wound showed up on my ankle that worsened alarmingly, nearly causing gangrene. The local Senegalese doctor prescribed nine antibiotic treatments a day (3 shots + 6 pills) . . . and declared me lucky to avoid amputation of my foot.
In Parallel Worlds, Philip Graham and I wrote that my wound’s origins stumped the doctor, although he thought it might be an allergic reaction to an insect bite. But the symptoms resembled those of my current spider bite so closely that I am now certain it must have been a spider, not an insect, that assaulted me. Perhaps it was a kind of violin spider–the Loxosceles lacroixi, which lives in Ivory Coast and belongs to the same Loxosceles family as my more recent nemesis, the brown recluse. Of the violin spider, one website notes: “Their venom destroys tissue, causing a specific kind of skin necrosis known asloxoscelism in 66% of cases. The danger of secondary infection is high if left untreated.” Yep.
Snakes loom larger in the popular imagination than do spiders.
That could be a sign that Americans (including medical researchers) are more nervous about snake bites than spider bites. Or it could be, as my scientifically minded nephew opines, that it’s because spiders are smaller than snakes, so it’s harder to catch them . . . and harder to catch enough of them to extract sufficient venom to produce antivenin. Plus, their name–recluses.
I am now officially nervous around spiders.
In any case, arachnophobia is a thing (not just a horror movie), and it’s definitely gendered. Until now, I’ve never had much patience for girls who screamed at the sight of a (harmless) spider. Hmm–is it too late for a feminist to enthusiastically embrace demeaning gender stereotypes?
Speaking of gender . . . turns out my poison was probably deposited by a devoted spider mom looking out for her kids’ interests.
That’s what Nobel Prize-winning chemist, Kary Mullis, wrote in his 1998 memoir, Dancing Naked in the Mind Field: “It’s a mother spider that first gets you and she wants a hole in you that oozes and expands and doesn’t ever heal. The females have the most powerful venom . . . . She wants that hole because her babies need a place to feed. They can dip their ugly little heads into the pool of nutrients that you are exuding and suck your vital fluids through their sucking tubes, and they can live. . . After making the hole, she moves away and lays her eggs. It’s elegant biotechnology from the point of view of the spider.”
I find this alarming. As a devoted mother of two, myself, I should sympathize with any mom’s efforts to nourish her children and give them the best foundation she can for their health and well-being. I have certainly tried to do that for my kids. Somehow, though, there’s a cross-species sympathy chasm I’m simply unable to traverse. I guess that’s a second blow to my identity as a feminist.
Brown recluse spiderling on an egg sac (photo by Sturgis McKeever)
Conclusion: Maybe it’s time for a new approach to studying pain.
Pain is a biological fact; it’s also culturally constructed.
When you live with long-term, disabling pain from childhood, how does that shape your brain, your temperament, your world view? Your sense of self, and your sense of being subject to, and capable of overcoming, hardships? By contrast, when pain invades your life only rarely, and briefly, what sort of identity forms surrounding notions of (in)vulnerability?
Anthropologists: We have explored how plenty of other somatic experiences are influenced by factors beyond biology. Pregnancy and childbirth, menstruation, diseases from cancer to mental illness, and sports from walking to basketball have all claimed our attention. Yet, we live in a world of many people who experience pain routinely or even chronically. And when we’re not actively suffering from pain, we may spend much time thinking back on past episodes with amazement that we survived . . . or anticipating future episodes with dread. Puzzlingly, few anthropologists have put that fundamental human experience front and center. True, some scholars discuss pain in investigating particular topics such as childbirth, endometriosis and acupuncture. But to date, the 48 sections and interest groups contained within the American Anthropological Association–which focus on topics ranging from visual anthropology, music, and museums to agriculture, corporations, and tourism–do not include a group dedicated to exploring the world of pain.
In a rundown of selected global perspectives on pain, anthropologist Mary Free has crafted a superb opening for a new subdiscipline. The brown recluse spider that deposited its poison in my leg this past weekend has suggested to me: it may be time for a systematic and dedicated anthropology of pain.
Postscript (Oct. 5, 2017): I’ve now been in touch with two entomologists who specialize in spiders, one of whom is a leading expert on brown recluse spiders. Both are quite skeptical that a brown recluse could have found its way to a park bench in Manhattan. My doctor and I are revisiting the diagnosis. Stay posted.
Donald Trump has revived old stereotypes in claiming that Fox News commentator/Republican debate moderator Megyn Kelly was ruled by her hormones (“bleeding from her wherever”) when she critiqued his multiple sexist statements and stances. Explaining away women’s anger by reference to the menstrual cycle is an old habit of those who wish to exclude women from decision-making positions. Let’s see if I become a new target of Donald Trump after being quoted in this NPR blog post by Susan Brink . . .