Pathologies of Power

California Series in Public Anthropology

Book 4
Univ of California Press
7
Free sample

Pathologies of Power uses harrowing stories of illness, of life—and death—in extreme situations to interrogate our understanding of human rights. Paul Farmer, a physician and anthropologist with twenty years of experience studying diseases in Haiti, Peru, and Russia, argues that promoting the social and economic rights of the world’s poor is the most important human rights struggle of our times. A thoughtful memoir with passionate eyewitness accounts from the prisons of Russia and the beleaguered villages of Haiti and Chiapas, this book links the lived experiences of individual victims to a broader analysis of structural violence. Farmer challenges conventional thinking within human rights circles and exposes the relationships between political and economic injustice, on one hand, and the suffering and illness of the powerless, on the other.

Farmer shows that the same social forces that give rise to epidemic diseases such as HIV and tuberculosis also sculpt risk for human rights violations. He illustrates the ways that racism and gender inequality in the United States are mirrored in pathology, plague, disease and death. Yet this doctor’s autobiography is far from a hopeless inventory of human suffering. Farmer’s disturbing examples are linked to a guarded optimism that new medical and social technologies will develop in tandem with a more informed sense of social justice. Otherwise, he concludes, we will be guilty of managing social inequality rather than addressing structural violence. Farmer’s urgent plea to think about human rights in the context of global public health and to consider critical issues of quality and access for the world’s poor should be of fundamental concern to pathologists, medical students, and humanitarians in a world characterized by the bizarre proximity of surfeit and suffering.
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About the author

Paul Farmer is Professor of Medical Anthropology at Harvard Medical School and Founding Director of Partners In Health. Among his books are Infections and Inequalities: The Modern Plagues (California, 1999), The Uses of Haiti (1994), and AIDS and Accusation: Haiti and the Geography of Blame (California, 1992). Farmer is the winner of a MacArthur Foundation "genius" award and the Margaret Mead Award for his contributions to public anthropology. He recently held the Blaise Pascal International Chair at the College de France. Amartya Sen, whose work challenges conventional market-driven economic paradigms, is the winner of the 1998 Nobel Prize in economics. He teaches at Trinity College, Cambridge University.

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Additional Information

Publisher
Univ of California Press
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Published on
Nov 22, 2004
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Pages
438
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ISBN
9780520931473
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Language
English
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Genres
Medical / General
Medical / Health Care Delivery
Social Science / Anthropology / General
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Content Protection
This content is DRM protected.
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Eligible for Family Library

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Pathologies of Power uses harrowing stories of life—and death—in extreme situations to interrogate our understanding of human rights. Paul Farmer, a physician and anthropologist with twenty years of experience working in Haiti, Peru, and Russia, argues that promoting the social and economic rights of the world’s poor is the most important human rights struggle of our times. With passionate eyewitness accounts from the prisons of Russia and the beleaguered villages of Haiti and Chiapas, this book links the lived experiences of individual victims to a broader analysis of structural violence. Farmer challenges conventional thinking within human rights circles and exposes the relationships between political and economic injustice, on one hand, and the suffering and illness of the powerless, on the other.

Farmer shows that the same social forces that give rise to epidemic diseases such as HIV and tuberculosis also sculpt risk for human rights violations. He illustrates the ways that racism and gender inequality in the United States are embodied as disease and death. Yet this book is far from a hopeless inventory of abuse. Farmer’s disturbing examples are linked to a guarded optimism that new medical and social technologies will develop in tandem with a more informed sense of social justice. Otherwise, he concludes, we will be guilty of managing social inequality rather than addressing structural violence. Farmer’s urgent plea to think about human rights in the context of global public health and to consider critical issues of quality and access for the world’s poor should be of fundamental concern to a world characterized by the bizarre proximity of surfeit and suffering.
Fleeing the murderous Pol Pot regime, Cambodian refugees arrive in America as at once the victims and the heroes of America's misadventures in Southeast Asia; and their encounters with American citizenship are contradictory as well. Service providers, bureaucrats, and employers exhort them to be self-reliant, individualistic, and free, even as the system and the culture constrain them within terms of ethnicity, race, and class. Buddha Is Hiding tells the story of Cambodian Americans experiencing American citizenship from the bottom-up. Based on extensive fieldwork in Oakland and San Francisco, the study puts a human face on how American institutions—of health, welfare, law, police, church, and industry—affect minority citizens as they negotiate American culture and re-interpret the American dream.

In her earlier book, Flexible Citizenship, anthropologist Aihwa Ong wrote of elite Asians shuttling across the Pacific. This parallel study tells the very different story of "the other Asians" whose route takes them from refugee camps to California's inner-city and high-tech enclaves. In Buddha Is Hiding we see these refugees becoming new citizen-subjects through a dual process of being-made and self-making, balancing religious salvation and entrepreneurial values as they endure and undermine, absorb and deflect conflicting lessons about welfare, work, medicine, gender, parenting, and mass culture. Trying to hold on to the values of family and home culture, Cambodian Americans nonetheless often feel that "Buddha is hiding." Tracing the entangled paths of poor and rich Asians in the American nation, Ong raises new questions about the form and meaning of citizenship in an era of globalization.
In this provocative and compelling examination of the deep politics of war, Carolyn Nordstrom takes us from the immediacy of war-zone survival, through the offices of power brokers, to vast extra-legal networks that fuel war and international profiteering. She captures the human face of the front lines, revealing both the visible and the hidden realities of war in the twenty-first century. Shadows of War is grounded in ethnographic research carried out at the epicenters of political violence on several continents. Its pages are populated not only with the perpetrators and victims of war but also with the scoundrels, silent heroes, and average families who live their lives in the midst of explosive violence. War reconfigures our most basic notions of humanity, Nordstrom demonstrates. This book, of crucial importance at the present moment, shows that war is enmeshed in struggles over the very foundations of the sovereign state, the crafting of economic empires both legal and illegal, and innovative searches for peace.

Nordstrom describes the multi-trillion-dollar international financial networks that support warfare. She traces the entangled routes by which illegal drugs, precious gems, weapons, basic food supplies, and pharmaceuticals are moved by an international cast of businesspeople, profiteers, and black-market operators. Shadows of War demonstrates how the experiences of both the architects of war and of ordinary people are deleted from media accounts and replaced with stories about soldiers, weapons, and territory. For the first time, this book retrieves from the shadows the faces of those whose stories seldom reach the light of international recognition.
Americas health care delivery system is in disarray. Politicians on both sides of the aisle believe that they have the answer. But, fixing this problem does not lend itself to a political solution. Ultimately a meaningful solution is one that only physicians can offer. This is as it should be, but it is not happening. This book is my attempt to recast my journey in medicine as one that I believe has isolated the problem and found a solution. It begins with my observations in medical school, my fledgling attempt to be a good doctor, and ultimately my discovery of the problem and its solution. There is no question but we have the most marvelous and sophisticated health care system in the world, but our patient outcomes leave much to be desired when compared with those of other industrialized countries. Our rising health care expenditures, the asymmetry in the delivery of our health care system, and the calcified ideology of both the political right and left are sources of concern. I have attempted to share my insight with our citizenry in hopes that a concerted voice will be forthcoming demanding those changes from the health care industry that it and the government have been unable to accomplish. Without these changes a political solution will win out and mediocrity will replace quality. Time is short. Both political parties are sparring in an effort to imprint their ideology on a roadmap ostensibly designed to fix the problem, but one that does not come close to dealing with the salient issue. The strength inherent in a unified voice of the people will galvanize the industry and my hope is that this book will serve as a stimulus.
Tales about organ transplants appear in mythology and folk stories, and surface in documents from medieval times, but only during the past twenty years has medical knowledge and technology been sufficiently advanced for surgeons to perform thousands of transplants each year. In the majority of cases individuals diagnosed as "brain dead" are the source of the organs without which transplants could not take place. In this compelling and provocative examination, Margaret Lock traces the discourse over the past thirty years that contributed to the locating of a new criterion of death in the brain, and its routinization in clinical practice in North America. She compares this situation with that in Japan where, despite the availability of the necessary technology and expertise, brain death was legally recognized only in 1997, and then under limited and contested circumstances. Twice Dead explores the cultural, historical, political, and clinical reasons for the ready acceptance of the new criterion of death in North America and its rejection, until recently, in Japan, with the result that organ transplantation has been severely restricted in that country. This incisive and timely discussion demonstrates that death is not self-evident, that the space between life and death is historically and culturally constructed, fluid, multiple, and open to dispute.

In addition to an analysis of that professional literature on and popular representations of the subject, Lock draws on extensive interviews conducted over ten years with physicians working in intensive care units, transplant surgeons, organ recipients, donor families, members of the general public in both Japan and North America, and political activists in Japan opposed to the recognition of brain death. By showing that death can never be understood merely as a biological event, and that cultural, medical, legal, and political dimensions are inevitably implicated in the invention of brain death, Twice Dead confronts one of the most troubling questions of our era.
Paul Farmer has battled AIDS in rural Haiti and deadly strains of drug-resistant tuberculosis in the slums of Peru. A physician-anthropologist with more than fifteen years in the field, Farmer writes from the front lines of the war against these modern plagues and shows why, even more than those of history, they target the poor. This "peculiarly modern inequality" that permeates AIDS, TB, malaria, and typhoid in the modern world, and that feeds emerging (or re-emerging) infectious diseases such as Ebola and cholera, is laid bare in Farmer's harrowing memoir rife with stories about diseases and human suffering.

Using field work and new scholarship to challenge the accepted methodologies of epidemiology and international health, Farmer points out that most current explanatory strategies, from "cost-effective treatment" to patient "noncompliance," inevitably lead to blaming the victims. In reality, larger forces, global as well as local, determine why some people are sick and others are shielded from risk. Yet this moving autobiography is far from a hopeless inventory of insoluble problems. Farmer writes of what can be done in the face of seemingly overwhelming odds, by physicians and medical students determined to treat those in need: whether in their home countries or through medical outreach programs like Doctors without Borders. Infections and Inequalities weds meticulous scholarship in medical anthropology with a passion for solutions—remedies for the plagues of the poor and the social illnesses that have sustained them.
“[A] masterpiece . . . an astonishing book that will leave you questioning your own life and political views . . . Kidder opens a window into Farmer’s soul, letting the reader peek in and see what truly makes the good doctor tick.”—Nicholas Thomas, USA Today

In medical school, Paul Farmer found his life’s calling: to cure infectious diseases and to bring the lifesaving tools of modern medicine to those who need them most. Tracy Kidder’s magnificent account shows how one person can make a difference in solving global health problems through a clear-eyed understanding of the interaction of politics, wealth, social systems, and disease. Profound and powerful, Mountains Beyond Mountains takes us from Harvard to Haiti, Peru, Cuba, and Russia as Farmer changes people’s minds through his dedication to the philosophy that “the only real nation is humanity.”

Praise for Mountains Beyond Mountains

“A true-to-life fairy tale, one that inspires you to believe in happy endings . . . Its stark sense of reality comes as much from the grit between the pages as from the pure gold those pages spin.”—Laura Claridge, Boston Sunday Globe

“Stunning . . . Mountains Beyond Mountains will move you, restore your faith in the ability of one person to make a difference in these increasingly maddening, dispiriting times.”—John Wilkens, The San Diego Union-Tribune

“Easily the most fascinating, most entertaining and, yes, most inspiring work of nonfiction I’ve read this year.”—Charles Matthews, San Jose Mercury News

“It’ll fill you equally with wonder and hope.”—Cathy Burke, People

“In this excellent work, Pulitzer Prize-winner Kidder immerses himself in and beautifully explores the rich drama that exists in the life of Dr. Paul Farmer. . . . Throughout, Kidder captures the almost saintly effect Farmer has on those whom he treats.”—Publisher’s Weekly (starred review)

“[A] skilled and graceful exploration of the soul of an astonishing human being.”—Kirkus Reviews (starred review)
Cholera, although it can kill an adult through dehydration in half a day, is easily treated. Yet in 1992-93, some five hundred people died from cholera in the Orinoco Delta of eastern Venezuela. In some communities, a third of the adults died in a single night, as anthropologist Charles Briggs and Clara Mantini-Briggs, a Venezuelan public health physician, reveal in their frontline report. Why, they ask in this moving and thought-provoking account, did so many die near the end of the twentieth century from a bacterial infection associated with the premodern past?

It was evident that the number of deaths resulted not only from inadequacies in medical services but also from the failure of public health officials to inform residents that cholera was likely to arrive. Less evident were the ways that scientists, officials, and politicians connected representations of infectious diseases with images of social inequality. In Venezuela, cholera was racialized as officials used anthropological notions of "culture" in deflecting blame away from their institutions and onto the victims themselves. The disease, the space of the Orinoco Delta, and the "indigenous ethnic group" who suffered cholera all came to seem somehow synonymous.

One of the major threats to people's health worldwide is this deadly cycle of passing the blame. Carefully documenting how stigma, stories, and statistics circulate across borders, this first-rate ethnography demonstrates that the process undermines all the efforts of physicians and public health officials and at the same time contributes catastrophically to epidemics not only of cholera but also of tuberculosis, malaria, AIDS, and other killers. The authors have harnessed their own outrage over what took place during the epidemic and its aftermath in order to make clear the political and human stakes involved in the circulation of narratives, resources, and germs.

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