The US cannabis landscape is shifting quickly, and so is the way we talk about the plant and its uses. The push to end its prohibition has entailed a proliferation of stakeholder groups, each with its own labeling preferences. Interviews with Southern Californian parents using marijuana medically for children with intractable epilepsy (pharmaceutically uncontrolled seizures) taught me that what’s in a name matters—a lot. How it matters differs depending on who is talking, and what he or he seeks to accomplish when it comes to this plant and its products.

Cannabis—marijuana—has many medical applications, including for epilepsy. Parent interest in this rose sharply when CNN profiled its success with a child in Denver. However, little scientific research has been done with the plant (its legal classification makes that tricky), so doctors generally will not assist parents proactively in regard to its use. Word of mouth, online resources, and purveyor promises are often all that parents have to go by as they work out dosage and other aspects of their child’s cannabis regimen. My research explores how they manage this, which has implications for our understanding of how regular citizens contribute to biomedicine’s knowledge base and therapeutic tool kit. Findings also may be used to help improve service provision for these vulnerable families.

In pressing their case for access, most parents prefer the plant’s scientific name over lay terms. Cannabis, technically the genus label, sometimes is accompanied by species information too (i.e., Cannabis sativa or Cannabis indica). Many refer just to the key phytochemical CBD (cannabidiol); some talk also of other components of the plant (e.g., CBN, THC, THCA, and various terpenes).

Some parents advocate a whole plant approach, seeking to leverage what experts call the ‘entourage effect,’ in which plant chemicals act synergistically with one another. Such parents generally also prefer local or home grown raw materials and homemade or artisanal products. They tend to call the plant by its popular names (e.g., marijuana, pot). CBD, when referenced, is spoken of as part of a whole.

Yet most parents prefer scientific, medicalized rhetoric even when more generic terms would do. Cannabis, for them, is always capitalized and italicized. CBD and so forth are spoken of as isolates or molecules. In this discourse parents praise the regularity and predictability of big pharma’s highly systematized but reductionist production regimes.

Language is power

Through medicalized speech choices, parents proclaim themselves as knowledgeable insiders who belong in conversation with medical experts. It is the case that their children are often medically unique; parents often do know more about their children’s conditions than their doctors; they certainly know more about pot: they have to. But to get doctors to acknowledge this, parents cannot speak in lay terms. By calling pot Cannabis, using chemical names, and so on, parents assert their right to participate in discussions with authorized experts as more than ‘just’ parents.

They also assert their difference from casual or recreational users by refusing terms (e.g., weed, pot) that others associate with, as one mom put it, Cheech and Chong. Not all parents frowned on recreational use automatically. Some saw the medication–recreation binary as clearly prejudicial. But the primary aim of getting children high was not something with which any parent wished to be associated.

It is no coincidence that parents initially prefer low or no-THC formulations; they also prefer cannabis oils, dropped under the tongue or into a feeding tube, rather than inhalation or having the actual herb in the house. Their children’s medicine looks how medicines are ‘supposed’ to look; and it is treated accordingly.

Of course, recreational users also deploy medical language—at least in states where the only legal way to purchase cannabis is with a doctor’s referral. These are notoriously easy to get and people continue the charade in ‘dispensaries,’ which are used not so much by sick individuals (who favor home delivery) as by a young and healthful crowd that talks about ‘medicating’ rather than ‘partying’ or ‘getting high’ (terms that I am told are used where doing so is legal)..

The recreational market has invented new terms too. For instance, ‘dispensary’ sales clerks are ‘budtenders.’ In so obviously equating pot to alcohol, this term’s use may be read as a raspberry blown to law enforcers; or it may be an optimistic and celebratory disavowal of the need for subterfuge given changes in legalization that appear to be on the horizon. It certainly acknowledges the ludic side of leisure use.

It is not that parents are overly sober: laughter and ironic humor infused many an interview. But having a sick child is no game. Having to call one’s provider a ‘budtender’ is degrading to medical customers who deeply desire authentic, recognized legitimacy—not a nod and a wink. This need is one reason some parents were willing to wait up to one year to be seen by one of the region’s few well-reputed cannabis-approving physicians instead of using a fly-by-night referral mill. The need for real medical advice, and concern about cannabis’s interaction with their children’s other medications, also came into play.

Use of cannabis slang also was seen by some as degrading, implying likewise that one’s turn to the drug or drugs that this plant produces is neither medically indicated nor necessary. Take the term ‘weed,’ which suggests that cannabis should not be considered a legitimate cultivar. Silly strain names such as AC/DC and Sour Tsunami connote a kind of playfulness that may be seen as inappropriate when it comes to serious illness. Some terms even are—or at least were, originally—xenophobic or racist. For instance, the word ‘Marijuana’ was promoted purposefully by US anti-drug interests in the 1930s specifically because it sounded Spanish and thus provoked or leveraged, in some Euro-Americans anyhow, anti-Mexican or Hispanic sentiment. Associations of the older argot with criminality also are rife. Indeed, based mostly on this history, some activists have chastised the media for using lay terms and puns (e.g., “high time”) in cannabis-related headlines and reporting.

Using the language of science instead highlights the legitimate medical potential of the cannabis plant. It helps parents gain credibility with (other) experts by giving a ring of legitimacy to their claims. In the short term this may help speed access to pharmaceutically manufactured cannabis medicines by increasing the publicly perceived legitimacy of this need. As an added plus, pharmaceutical manufacturing processes help in the regulation of dosing and they insure consistency across batches, and purity, reducing the necessity that parents send what they buy out for testing to find out what it really contains. For such reasons, using scientific terms and referencing chemicals makes good sense.

Must we choose?

Yet, history suggests that overly-insistent medicalization will have costs. It may support a transfer of all authority over cannabis to the mainstream healthcare system, disenfranchising parents—whose empiricism and perseverance helped open the healthcare industry’s eyes to the plant’s promise to start. Resulting dependence on corporations and expert systems could foreclose the option of growing and preparing treatments oneself despite the relative ease of doing so. Some parents fear loss of access to the entourage effect because isolated compounds like CBD are being favored over whole-plant products in pharmaceutical processes; price hikes also could occur. For reasons such as these some activists say that at least high CBD strains of cannabis (also known a hemp) and CBD-based medicines, which have no psychoactive component, should be left out of the debate; there is a bill making its way through congress right now (H.R.5226) that would reclassify these as non-drugs, making them as legal to possess or prepare as sauerkraut.

Whether or not that happens, whole-plant language reminds us that cannabis-based drugs come from a flowering herb. It also can help consumers retain some authority over their use of that herb for health and healing. Preserving consumer rights is particularly important in regard to conditions such as intractable epilepsy, which by definition mainstream medicine cannot treat.

This is not to say that medicalized rhetoric is wrong and whole-plant language is right. Rather, we must preserve a context-sensitive combination of ways of talking about pot. In parallel with the entourage effect, each mode of expression, taken together, may well be more effective in fostering human health than a single discourse used in isolation.

Elisa (EJ) Sobo is a professor of anthropology at San Diego State University and President of the Society for Medical Anthropology. She is on the editorial boards of Anthropology & Medicine and Medical Anthropology and she is the Book Reviews Editor for Medical Anthropology Quarterly. Dr. Sobo has written numerous peer-reviewed journal articles as well having authored, co-authored, and co-edited twelve books, the most recent of which are: Dynamics of Human Biocultural Diversity: A Unified Approach (2012), The Cultural Context of Health, Illness, and Medicine (2010), and Culture and Meaning in Health Services Research (2009). Her current research includes not only parent use of Cannabis for children with intractable epilepsy or seizures but also cultural models of child development in Waldorf or Steiner education, and parental thinking on pediatric vaccinations and herd immunity. Interviewers for the Cannabis project include MarkJason Cabudol, Tiyana Dorsey, and Gabriella Kueber.

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We write out of our shared concern over the current Zika virus epidemic in Puerto Rico and the Caribbean in the hopes of making useful interventions. Because of Zika’s adverse effect on fetal development and potential link to Guillain-Barré syndrome, the virus poses serious concerns for public health. The World Health Organization declared a Public Health Emergency in Brazil following the outbreak of microcephaly and Guillain-Barré syndrome cases, strongly suspected to be associated with Zika.

Puerto Rico is already in a state of political-economic emergency, while burdened with a preexisting Chinkungunya epidemic, as well as endemic Dengue virus. All three viruses share the same mosquito vector, Aedes aegypti. In late January 2016 an influenza epidemic was also declared on the island.

Because the main vector is an anthropophilic (domestic) mosquito, well adapted to the human made environment in areas where there are multiple opportunities for water to collect, we find the issue of access to clean water and waste management (especially plastic) to be of great urgency and importance in containing viral spread. We call on the government, as well as agricultural corporations and water-intensive industries in Puerto Rico to share responsibility for the ecologically sustainable restructuring and management of the public water systems, especially in view of the historic drought of 2015 on the island, during which Puerto Ricans suffered unprecedented water shortages for several months.

The potential for negative effects on the population, especially women and fetuses, highlights the urgency of improved access to and funding for public health. Since the virus can be sexually transmitted, reproductive health services offering multiple forms of contraception (i.e., including, but not limited to condoms), prenatal diagnostics, pediatric care, and abortion services are necessary. Despite the Pope Francis’ more liberal views, locally the Catholic Church has condemned the Centers for Disease Control and Prevention (CDC)’s recommendation that people use condoms during sexual intercourse to prevent Zika transmission. This has clear implications for Catholics who may be put at risk of infection by not using proper treatment. Access to and informed use of birth control, as well as reproductive and natal care should be strengthened for Puerto Ricans. People’s right to such access should be supported, and coercive public policy, as well as stigmatizing discourses avoided.

The implications of a Zika epidemic are onerous for public health, considering that Puerto Rico is structurally under-resourced due to the existing cap on congressional spending for health services on the island. This issue has been in the news due to congressional hearings on the fiscal crisis on the island, but no action has been taken to ameliorate the negative consequences of the situation with regards to public health care, which has rightfully been called a humanitarian crisis.

We wish to highlight the absolute necessity of updating the water distribution and treatment system in Puerto Rico, especially under the prospect of the imposition of a control board like the one imposed on Flint, Michigan. In that context, we insist on the protection of the local aquifers and watersheds as central to the control of Zika virus and its epidemiology on the island. We call for a response to Zika in Puerto Rico that accounts for the structural inequalities in health care that exist on the island and moves towards remediating the viral exposure now present.

By the same token, we wish to express concern over the possibility of the presence of high levels of toxic chemicals, including insecticides and experimental agents released by private companies such as Monsanto and Dupont, among others present on the island. We express concern over whatever products are being routinely used in the ecosystem, with which Zika or Aedes aegypti may be interacting and we call for accountability to the residents of Puerto Rico. Further, we call for the full disclosure of any transgenic organisms employed in control efforts.

News reports mention that the CDC is studying the possibility that some Aedes agyptae mosquitos have demonstrated tolerance for insecticides, and we call for public disclosure of any information about the usefulness of various insecticidal agents in use, under consideration for use, or having been shown to effectively prevent mosquito bites, especially for safe use by pregnant women (“Puerto Rico Braces for Wave of Mosquito-Borne Zika Virus,” by Danica Coto, AP). Excessive reliance on spraying insecticides as a mosquito control measure may do more harm than good by encouraging viral resistance.

Furthermore, we as a group of experts on the region call on the US federal government and the CDC to do more than just conduct experiments and issue recommendations with regards to Zika virus in Puerto Rico. The United States has responsibilities to Puerto Rico beyond using the island as a live laboratory. Zika in Puerto Rico is more than just a threat to US public health on the continent. Puerto Rican lives matter. Public health authorities must actively assist the population, and support Zika prevention efforts in Puerto Rico. Immediate actions include: provide and install window screens in homes and businesses, assist in water systems management, and distribute vector surveillance and control strategies (http://www.cdc.gov/chikungunya/resources/vector-control.html). In particular, public health authorities can assist with disposing of any waste that might collect water in order to minimize mosquito populations.

The CDC has a Dengue station headquarters in San Juan, PR and should use that station as a base to conduct Zika prevention and mosquito mitigation campaigns. All prevention and research activities on the island should follow the principles of open access and collaboration appropriate for a public health emergency (see: http://www.sciencemag.org/news/2016/02/plea-open-science-zika and http://www.who.int/bulletin/online_first/zika_open/en/ ). Furthermore, given the strongly suspected association between Zika, microcephaly, and Guillain-Barré syndrome, the CDC should be on high alert for these cases in Puerto Rico and prepared to deal with these diseases as they arise.

Finally, care and support must be provided to pregnant women and their families who have or will experience Zika infection. Puerto Rico birth outcomes have been worsening since the advent of the economic crisis. The infant mortality rate climbed to 9.5 per 1000 live births for 2012 (Departamento de Salud, Informe de Salud en Puerto Rico, 2014). This burden is exacerbated by the large number of health professionals that have recently emigrated from the island (“SOS: Puerto Rico Is Losing Doctors, Leaving Patients Stranded,” by Greg Allen, NPR).

It is imperative that the Medicaid cap be removed for the island and resources mobilized immediately to fight this public health emergency, particularly in terms of prenatal and reproductive health care. Prevention of transmission, expanded medical care, reproductive rights, and long term sustainability of the water infrastructure should be the priorities, beyond the tourist and hotel areas. We call for assistance to local initiatives and support for already existing community structures, and affirm Puerto Rico’s right to defend the health of its population.

Links and Resources:

http://www.ksl.com/index.php?nid=235&sid=38304206&title=puerto-rico-health-officials-declare-flu-epidemic

http://www.npr.org/sections/health-shots/2016/03/12/469974138/sos-puerto-rico-is-losing-doctors-leaving-patients-stranded

http://www.primerahora.com/noticias/puerto-rico/nota/iglesiacatolicacondenaloscondonespeseaamenazadelzika-1135947/

https://www.washingtonpost.com/news/acts-of-faith/wp/2016/02/17/mexico-confirms-zika-virus-cases-in-pregnant-women-as-pope-francis-exits-the-country/

http://www.msn.com/en-us/news/us/puerto-rico-braces-for-wave-of-mosquito-borne-zika-virus/ar-BBq5CPz

https://www.washingtonpost.com/national/health-science/zika-is-expected-to-infect-1-in-5-puerto-ricans-raising-threat-to-rest-of-us/2016/02/29/c1288e30-db62-11e5-891a-4ed04f4213e8_story.html

http://news.yahoo.com/puerto-rico-faces-dry-season-emerges-drought-155634480.html

http://www.cdc.gov/media/releases/2016/a0304-director-puerto-rico.html

http://www.nytimes.com/2016/03/12/business/test-of-zika-fighting-genetically-altered-mosquitoes-gets-tentative-fda-approval.html

http://www.reuters.com/article/us-usa-puertorico-treasury-idUSKCN0SG1TB20151022

http://www.sciencemag.org/news/2016/02/plea-open-science-zika

http://www.who.int/bulletin/online_first/zika_open/en/

http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303114

http://www.cdc.gov/chikungunya/resources/vector-control.html

http://apps.who.int/iris/bitstream/10665/204609/1/zikasitrep_10Mar2016_eng.pdf?ua=1

http://www.metro.pr/noticias/expresiones-de-religioso-ante-el-zika-pueden-interferir-con-la-salud/pGXpbi!7Ml1cHsYHrtUM/

http://www.sciencealert.com/argentinian-report-says-monsanto-linked-pesticide-is-to-blame-for-microcephaly-outbreak-not-zika

Almost five months into the epidemic, on August 8, 2014, the World Health Organization (WHO) declared the Ebola outbreak in West Africa a “public health emergency of international concern.” Military and police responses — both international and national — played a crucial role in responses to the epidemic. A few weeks later, on August 20th, the Liberian military quarantined residents of West Point in the capital city of Monrovia without advance warning, essentially cutting them off from food and supplies and causing thousands of residents to clash with troops and riot police. Images surfaced of troops firing live rounds and tear gas and viciously beating back residents who challenged the lockdown. Military-enforced quarantines around entire districts of Sierra Leone and the shift of power from the ministry of health to the ministry of defense were key features of its Ebola response.

Across the Atlantic, on August 9, 2014, 18-year old unarmed Michael Brown was shot to death by police officer Darren Wilson in Ferguson, Missouri. Peaceful protests and civil disorder ensued in the following weeks, prompting the governor to declare a “state of emergency” and call on local police and the National Guard to control protests and maintain curfews. Greater public attention was placed on the increasing militarization of local police forces as the grand jury, which was convened to hear evidence of the circumstances surrounding the death of Michael Brown, reached a decision not to indict Officer Wilson.

Despite public discourse about the increasing militarization of the police and the political frame of ‘crisis,’ the most notable recent incidents of police brutality in Ferguson, Staten Island, Saratoga Springs, Los Angeles and the subsequent deaths of Black Americans like Tanisha Anderson, Ezell Ford, Eric Garner, Akai Gurley, Aiyanna Jones, Roshad McIntosh, Dante Parker, and Kajieme Powell, are rather ordinary and predictable events in America. These incidents and precious lives lost represent the enduring legacy of American white supremacy and pervasive racism that structures the US criminal justice system and our broader society.

For the region most affected by the West African Ebola outbreak, fragmented and slowly rebuilding health systems, coupled with a delayed response by international agencies have precipitated a serious public health crisis and humanitarian emergency. But, as in the US case, this crisis must also be understood in historical context — and in particular, in relation to empire-building and racial projects. Legacies of the trans-Atlantic slave trade, European (and US) colonialism, post-colonial aid dependency, and civil wars have contributed not only to patterns of the disease’s spread, but also to earlier failures of government and international actors to mount a coordinated response.

This year seemed especially difficult for those of us trying to make sense of these events from afar and for those of us who have deep and intimate connections to these places. During the annual meetings of the American Anthropological Association in early December 2014, therefore, the theme “Producing Anthropology” took on a distinctly activist and political charge. Anthropologists organized protests, drafted resolutions, and put together ‘breaking’ panels to discuss the most pressing issues facing us in the moment: the West African Ebola outbreak; Ferguson and police violence in black communities in the US; divestment from Israel and other progressive social movements with which anthropologists currently align themselves.

There was, however, a stark contrast in the support extended to these issues by the association-at-large, subsections and interest groups, and individual members. And this contrast is at the root of our sense that mainstream anthropology — and its practitioners — reproduces injustices it claims to expose and, at best, the ones it seeks to correct. This contrast is at the root of the discipline’s failure to recognize divisions between minority and non-minority anthropologists as a crisis within its ranks and to misrecognize enduring systemic failures as discrete time-framed crises for the sake of justifying anthropology’s relevance.

Two weeks before the annual meetings, just a couple of miles away, the AAA co-sponsored a two-day emergency meeting at the George Washington University, in which it convened more than 25 social scientists — specialists of the region and/or in infectious diseases — to provide concrete recommendations to aid international responders to the Ebola outbreak in West Africa. While the impact of this intervention remains to be seen, the financial and logistical support from AAA and Wenner-Gren was notable; the executive director presented this meeting as a way for the association to appear “relevant.” Anthropologists were asked to “take critique off the table” as a condition of their participation; for it was to be the primary means by which anthropologists could effectively engage with policymakers and front-line responders.

Whereas initiatives related to Ebola were generously supported (and funded) by our main anthropological institutions, “minority” interest groups like the Association of Black Anthropologists (ABA) were told that they were expected to pursue an agenda on Ferguson, racism, and violence on their own and with little support from executive leadership. The ABA’s statement brilliantly and explicitly calls out this marginalization and what it represents — global and national anti-black racism and anthropology’s complicity with racializing and colonizing projects, including the production of particular black and brown subjects. (AAA president Monica Heller later released a statement on police violence on December 19).

AAA leadership’s disparate focus on these two issues of concern raises questions about where anthropology locates its “objects” of inquiry, its impetus for protest, and its ideological commitments to social justice and critical analysis of power. It had the two of us — medical anthropologists who engage in global health research in the US and West Africa — wondering which black lives matter for the ‘production of anthropology’ and how such deliberations are a function of anthropology’s fraught history with colonial projects; and its alignment with institutions that sometimes indirectly, sometimes quite perniciously, devalue black and brown lives in the discipline and our society at large.

Taken together, the two official responses by executive leadership mirror the two types of misrecognition that facilitate and embolden endemic racism within the discipline. The ordinariness of these events — the possibility that we are not witnessing discrete events but, rather, spectacular instantiations of enduring injustice — forms the basis of two types of misrecognition. One is forced misrecognition, in which anthropologists are asked to put aside their critical faculties to assist in an epidemic crisis, willfully ignoring or tabling questions of health systems, international political economy, and local governance, while also, paradoxically, engaging with them as something anthropologists (alone) know best and can change. The other form of misrecognition is unconscious, ideological: one in which an African crisis is a ‘natural’ node for anthropological intervention and insights, but a North American normal requires no global comment, no provision of financial resources, no gathering of “great minds.” Both kinds of misrecognition are functions of how anthropology positions itself vis-à-vis “the other” but fails to acknowledge and is complicit with anti-black racism in its ranks and in its professional practice.

This time next year, we will again gather at the 2015 AAA annual meeting in Denver, giving and attending talks centered on the theme of “Familiar/Strange.” Perhaps this thematic focus will prompt wholescale reflection, discussion, and plans for action around questions of our collective misrecognition and the racial politics of crises. Meanwhile, global anti-black racism lives on as an ordinary defining fact of life for many of us.

TS: Could you both introduce yourselves, and talk about how you came around to the question of responsibility?

ST: I’d been doing work in the Czech Republic, looking at kids and asthma and comparing what I found there to responses to childhood asthma in New Zealand, and I was quite stunned by the different approaches in these two countries, in terms of their very different ideas about the roles of individuals and the family in trying to cope with a chronic condition. In New Zealand, it’s very much about self-management, while in the Czech Republic it’s focused on medical and other forms of scientific expertise. Obviously I was very much influenced by the work of Nick Rose on “responsibilization” as a way of both understanding mundane, everyday behavior and the larger political forces behind it. But I also started to see that when you begin to unpack the category of ‘care’ – even with respect to a narrowly defined set of care practices, in this case all related to childhood asthma – you can discover a whole range of various modes of responsibility, from responibilization to corporate social responsibility to kinship, and that got me thinking about how we might theoretically come to discuss such competing modes of responsibility in more productive ways.

CT: I came to it looking at a group of New Zealand and British veterans who were involved in nuclear tests in the Pacific, and I anticipated that they would be using the language of rights to talk about their desire to get health care. And in fact, what I found was that it was entirely infused with the language of responsibility and state responsibility and, in contrast, the state trying to ensure that these men took a position of self-responsibility in accounting for their own health, and saying it wasn’t about radiation, it was about their lifestyle habits: diet, smoking etc. So like Susanna, my research had some interesting contrasts between broader social responsibility and individual responsibility, and we started talking about this and saw some interesting parallels. We realized that the concept of “care” has been very carefully unpacked in anthropology but the word “responsibility” hadn’t received the same treatment, and we think it deserves the same kind of interrogation and critique. And as Susanna said, the idea of “responsibilization” is being carefully thought out, but its links to other styles of responsibility less so.

ST: One of the things we talked about in the piece we wrote (Trnka and Trundle 2014) was about how we feel ‘responsibility’ has been colonized by individual responsibilization in political rhetoric. We see it in so many examples around the world, and certainly in New Zealand. For instance, last year, one of my children who was in Intermediate School and was then 13 years old, came home with the news that “responsibility” was the theme for their Social Studies course for an entire school term. But all they talked about during the term was individual responsibility, self-management, and how to improve one-self – they didn’t consider ‘responsibility’ in terms of community responsibility, responsibility to the environment, or their relationships to one another in terms of being collectively responsible as a class, or as young people in New Zealand. Her sense of what they were supposed to learn was the idea that learning to be responsible is all about learning how to be responsible for yourself.

CT: As another example, Susanna, you’ve received flyers in your mailbox that talk about ‘responsible pet ownership.’

ST: Yes, I am now “a responsible dog owner!” In New Zealand, as of two years ago you can be officially registered “responsible dog owner” as opposed to a normal dog owner if you pass a certain course that ensures you know how to take adequate care of your dog. (And as a consequence, your licensing fees are lower). “Responsibility” is thus increasingly permeating into everyday language but primarily – and this is key – through the rhetoric of responsibilization. One of the things that Catherine and I are trying to do is show how unsettling, and dangerous, it is to have “responsibility” become so restricted to such individual-focused forms of “responsibilization.”

TS: Is that what “responsibilization” means? It refers to making individuals responsible for themselves or their own conduct?

CT: It speaks to the language of empowerment very strongly, and autonomy. Whether that’s an individual responsible for her own conduct or whether that’s a parent for a child, a boss for his worker, trying to instill an ethos of self-empowerment.

ST: It’s about self-autonomy and self-reliance.

TS: You referred to Nikolas Rose. His arguments about “responsibilization” have been really important and original and have helped us understand trends in healthcare and politics and so on. So, if you were going to take a snapshot of that idea, that trend, that concept, what does that mean?

ST: I think it refers to divesting or redistributing responsibility from a broader array of sets of obligations and reciprocities to focus it on the individual. So, one of the examples I particularly like, or dislike, was the one in Wellington, where the pedestrian lane has been changed. It’s no longer pedestrian-only, as they now allow buses on it. Of course, when you make a change like that, it takes people a while to adjust because they have a habit of walking across the road without worrying about buses. And so a dozen people, who have been injured or died from walking into the bus lane —

CT: One of those injured was, ironically, the Director of NZ Bus.

ST: So there’s been a public call to respond to this, people demanding not to get rid of the bus lane but something much less costly, namely putting up markers or barriers so people don’t just wander into the bus lane without realizing it. And in response to this the deputy mayor of Wellington said—

CT: He deemphasized the issue of political responsibility, and talked about safety as “a partnership” between “those people who drive on the roads and the pedestrians who cross those roads”, and a Council report on the accidents found that pedestrians were “largely to blame”.

TS: Right, “they need to look after themselves.” I don’t know if I mentioned this, but I have a Google News alert on pedestrian deaths. I’m a big walker, and it’s something I’m obsessed with. Whenever I get a report on a pedestrian death, I put it up on Twitter, “pedestrian killed,” and unfortunately there’s a lot of them. But there’s a new kind of pedestrian activism all over the world. There’s pro-bike activism, but there is also a new focus on pedestrians — or rather, simply people who walk.

ST: We could think about it as another type of responsibility, namely the kind of activism that is demanding that governments and states and local councils take some responsibility for making spaces safe. These are precisely the sorts of tensions and nuances of responsibility that we’re interested in drawing out.

TS: So I think that story’s pretty familiar to a lot of people. When you talk about “competing responsibilities,” what does that capture, or what do you put forward with that idea?

CT: We want to look at the cross-cutting and contrasting types of responsibilities that exist in the different layers of social practice. Some which are very contrasting with some of those dominant neoliberal modes of responsibility, and some are quite aligned and complementary with it. It’s certainly not our idea to take other types of obligations beyond responsibilization, whether they be care or ideas of the social contract, and say that they are the antithesis of or the cure for neo-liberal notions of responsibilities. But we want to show there are a range of ways in which responsibilities get enacted today in a range of contexts, with different moral valences and which enable diverse types of relationships.

ST: I think if you speak with people about responsibility, you won’t get a response that just focuses on responsibilization. Ordinary people have a sense of being enmeshed in all sorts of different kinds of relationships, so that’s what we tried to capture with the idea of competing responsibilities. At times you might be pulled in different directions, at times these different kinds of responsibilities might actually align, but the idea is that there’s a multiplicity of ways you are responsible to yourself, to others, to the environment, to your family, to your community, to your workplace, to the state – as well as a whole myriad of expectations you have that others will act responsibly towards you – that really supersede the way responsibility is being politically redefined.

TS: [Redefined] In neoliberal discourse—

CT: Also we are interested in the ways people respond to the drive for responsibilization, sometimes by purposeful acts of ‘irresponsiblization’ or by demanding others take responsibility. People can have a range of reasons to resist calls to become empowered and personally responsibilized. These types of subjectivities can be a burden in certain contexts. Other times, they can be very enabling. So we are seeking to not just look at different types of responsibilities, but the ways that people respond to calls to be responsible.

TS: I think we talked about this at length earlier — the idea that there is a tension between emergent notions we have about complex systems, and ideas about complexity and enmeshedness, and at the same time, this profound discourse of responsibility, of personal or individual responsibility. Rose talks about that a little bit — where he talks about criminal culpability and notions of genetic determinants of behavior, notions that are orthogonal to the idea of personal responsibility, where one might invoke a phrase like, “maybe I have maladaptive genes”— that kind of thing.

CT: His work sometimes gets simplified down by scholars to say “it’s all about self-responsibility,” but he’s much more nuanced. Genetics implies a whole set of relationships you can’t get away from, and which can become more important, or important in new ways to one’s sense of self and obligations to others. So he does talk about the forms of, for example, pastoral care that develop between genetic counselors and patients, and the way in which family members have to think responsibly for kin, in the present and in an imagined future, and the wide ranging obligations, choices, decisions and demands that come with this. Empowerment is certainly a part of it, he shows, but within more complex contexts of competing responsibilities.

ST: I think what we’re trying to do is to make sure the word “responsibility” stays there and in its broader sense, and so it is important to talk about these other entanglements, dependencies, and obligations as responsibility. And in order to try and encourage people to look at responsibility in all its variations and guises, what we’ve tried to do is suggest two arenas—one is care and the other one is social contracts and ideologies—where a range of different ideas and practices of reciprocity, obligation, and duty get played out.

TS: In that light, then, what is your hope for this conference that you’re organizing in August? August 15?

ST: August 15-17, in Wellington, New Zealand.

TS: What is the conference about? What are you hoping to see there?

ST: We’re trying to “open up” our understandings of responsibility in the 21st century. We hope to do this both in terms of looking ethnographically at the diverse ways that people enact responsibility (or fail to enact it) as well as to then critically look at such responsibility practices in terms of where they fit historically and politically and what they tell us about contemporary social forms.

CT: We’re hoping to get a widely diverse set of case studies: mundane, quotidian forms, corporate and social responsibility, issues of culpability and blame at the national level, philosophical discussions of responsibility. So we’re hoping that in drawing together those diverse ethnographic angles we’ll be able to theoretically and analytically develop and extend this as an anthropological concept.

ST: And show how it’s useful for critical analysis, and why it might be politically important to try and not necessarily reclaim the term ‘responsibility’ but provoke more the debate over its current usage: to create debate around the question “what is responsibility?” so it doesn’t de facto become responsibilization. And I think another key thing about the conference is that we want it to be interdisciplinary so we can bring together a range of the different angles. It won’t be just anthropology, but much broader.

TS: There’s one thing we didn’t discuss yet and that’s the notion of ethnographic responsibility. I’m curious, is that a dimension and a kind of anthropological responsibility that you’d like to examine?

ST: Absolutely. I wrote about this topic in a book with Cris Shore called Up Close and Personal (2013, Berghahn Books) which is about the production of ethnographic knowledge and pulls together a diverse group of anthropologists who to talk about their experiences in the field, in academia more broadly, and in the wider community. One of the things they discuss in relation to anthropological practice is
the responsibilities of the ethnographers to their interlocutors, but also, the responsibilities of our interlocutors back to us? Because at the end of the day we’re all human beings engaged in relationships that are based on forms of reciprocity. Of course you take on a different kind of responsibility if you’re writing about people and publishing what you learn from your interactions with them, but those sort of human interactions supersede the goal of producing some sort of ethnographic work. They are important in their own right, and need to be considered as such. That’s something Catherine and I didn’t explore in our paper — simply because we kind of needed to narrow it a little bit! — but it’s certainly something we would like to see explored in the conference.

CT: We’re not just thinking uncritically about responsibility as an all-liberating concept, because responsibility can get invoked within fieldwork settings in ways that perhaps elide the complexity of what’s going on. I’m thinking about the way the word “engagement” has become one of those tropes that is seen as a social good in fieldwork. Another recent project of mine has been an edited book with Matei Candea, Joanna Cook and Thomas Yarrow in the UK on the idea of detachment (Detachment: essays on the limits of relational thinking, Manchester University Press, forthcoming), which in part seeks to question the often thinly interrogated trope of engagement within anthropology. I think in the same way we need to think hard about what calls for responsibility mean in fieldwork and not necessarily see it as something we simply need more of, but look at all the different shades and consequences of its enactment.
ST: For example, if you look at Annemarie Mol’s work on ‘care’ — that’s very much in line with what we’re trying to do there, to take a concept and inquire about how it’s used ethnographically, but also in terms of critical analysis and in doing so hopefully come up with a sharper conception of what we mean by responsibility, much in the same way that she did for ‘care.’

CT: And in the way she contrasted it with notions of citizenship and notions of choice—we were also trying to compare and contrast with other useful concepts to see how responsibility enables other words.

TS: Why is New Zealand an interesting place to do this work?

CT: Being a small country, in which the competitive market model doesn’t necessarily work well to solve certain social problems, there is a very strong historical legacy of the engaged state. At the same time we led the world in embracing a very strongly neoliberal vision in the 1980s, which really transformed society on many levels. So there is a unique and sometimes tense mixture of responsibilities at play here, between individual empowerment and the social contract. And the other interesting factor in New Zealand is that there is the actively ongoing, contested, and sometimes contentious issue of responsibility between the Māori indigenous population and the Crown, the state. There exists a treaty, the Treaty of Waitangi, a social contract that is unique in many ways internationally in the way in which it allows a political debate about responsibility to occur at the national level based on ethnicity, historical injustice, law and state responsibility. So I think that is also an interesting feature of New Zealand life when talking about responsibility.

TS: And the two keynotes who will be at the conference — Cris Shore is a keynote, and he’s done work on accountability and so on, and obviously Nikolas Rose has worked in this area, so clearly there’s an important conversation occurring between their work.

ST: Through his work on the anthropology of policy and ‘audit culture’, Cris has come at this in quite a different angle, looking at how techniques of modern management and financial accounting are being used as instruments of responsibilisation and to govern people at a distance. They might appear apolitical — ‘it’s just a routine measure of performance’, that kind of thing — yet those sorts of moves toward neo-liberalizing society (which we were discussing above) are being promoted precisely through such different modes of accountability and auditing. Much of his work has sought to understand the various ways in which these policy processes create new categories of persons by operating as technologies of the self that produce responsible – and responsibilized – subjects.

These will be some of the key themes we hope will be picked up in the conference, through a range of perspectives and disciplinary approaches that will, we hope, both build and deviate in interesting ways from the idea presented in the two key notes.

I’ve never met Hewlett, but I know his work. He’s been writing on ebola for over ten years now, since the 2000-2001 outbreak in Uganda, and his book on ebola, Ebola, Culture and Politics; The Anthropology of an Emerging Disease came out in 2007. I’m not a big fan of Cengage’s case studies series, but its hard not to reach for this volume in the fall as classes are approaching and we’re thinking about teaching topical materials. It’s like a unit of an intro course or med anth course waiting to happen.

In fact, as teachable as this work on ebola is, Hewlett’s main work has been on another topic: fatherhood, and specifically the biocultural study of fatherhood in hunter-gatherer societies. Hewlett’s study of Aka pygmys (he doesn’t put that work in scare quotes, so I won’t, although I sure as heck want to). This, the main body of his work, also gets picked up in the press a lot because Aka fathers spend more time raising children then any other group that has been studied to date. They also engage in male breastfeeding (allowing children to sooth themselves by sucking or manipulating a man’s nipples with their mouth) which, of course, is exactly the sort of thing mediocre science journalism loves.

I like Hewlett’s work, and read it when I getting ready to become a father (yes, anthropologists about to become parents read the anthropology of parenting). Hewlett gets featured often in the media because his research topics make for good reading. But its also worth pointing out that Hewlett’s career demonstrates the value of long-term, engaged research with a community. If there were not experts who spend decades studying fatherhood in a place, we wouldn’t have anyone who could switch over to ebola research when that topic suddenly becomes important. The world would be a poorer place without people like Hewlett, who have invested time and energy developing an expertise that pays off in so many ways other than just narrow scholarly expertise in a particular area. Hewlett’s work, like the work of so many other professors, is a demonstration of the kind of academic that the world desperately needs, but which so many countries are increasingly unwilling to pay for.

Last week, the Supreme Court ruled in favor of Hobby Lobby; they are free to deny the insurance coverage of certain contraceptives for their employees. Blogs have written about how this is a loss for women’s rights and a victory for women’s rights, a win for religious freedom and a loss for the religious, a win for corporate personhood, a loss for the LGBTQIA community, and a loss for conservatives. Whichever the case may be, Hobby Lobby is at the very least a win for ethnophysiology.

In 2012, David Green, the founder of Hobby Lobby, wrote a column for USA Today in which he explains his company’s decision to file a lawsuit. He writes,

 A new government health care mandate says that our family business must provide what I believe are abortion-causing drugs as part of our health insurance. Being Christians, we don’t pay for drugs that might cause abortions. Which means that we don’t cover emergency contraception, the morning-after pill or the week-after pill. We believe doing so might end a life after the moment of conception, something that is contrary to our most important beliefs.

The Supreme Court’s opinion (PDF), issued a week ago, bears this out (p. 2):

The owners of the businesses have religious objections to abortion, and according to their religious beliefs the four contraceptive methods at issue are abortifacients. If the owners comply with the [Health and Human Services] mandate, they believe they will be facilitating abortions. . .

If the wording in Alito’s opinion doesn’t distinguish between their religious beliefs and the federal government (i.e. Health and Human Services), a footnote on page nine drives home the point:

The owners of the companies involved in these cases and other who believe life begins at conception regard these four methods [Plan B, ella, Mirena, and ParaGuard] as causing abortions, but federal regulations, which define pregnancy as beginning at implantation, see, e.g. 62 Fed. Reg. 8611 (1997); 45 CFR §46.202(f) (2013), do not so classify them.

Ethnophysiology (or ethno-a&p, as I verbalize it) is the way in which the human body and its functions are understood in a cultural context. Clearly, Christianity’s understanding of reproductive physiology – that life begins at conception, and therefore preventing the implantation of a fertilized egg is tantamount to abortion – is ethnophysiology. Following this, it’s no wonder that so many science bloggers and memes have targeted the Court and Hobby Lobby (Mother Jones, for example) for “disregarding the science.” As Jay Michaelson wrote, responding to the Court’s statement (above) concerning abortifacients, “That should be a statement of fact, not faith.  Either these pills cause abortions, or they don’t. Yet Justice Alito—himself a devout Catholic—says that this fact may be determined based on ‘religious beliefs.’” Dr. Jen Gunter, an OB/GYN, goes one step further, resisting the urge to dismiss the plaintiffs beliefs out-of-hand, as she illustrates that the four contraceptives in question don’t even cause abortions by Christian definitions.

Well, not exactly. Ethnophysiology, like most things culturally constructed, is malleable and often times, you don’t get to decide to what extent. In fact, as many postcolonial STS scholars argue (see Harding 2011), neither the monolithic body of knowledge that we call “science,” nor the process of knowledge production by the same name, are the authority of human knowledge. The reproductive physiology which we refer to as “science” is, itself, an ethnophysiology (and by extension, “facts” are ethnophilosophy). The flaw is in adding the ethno- prefix to something in order to Other it. This isn’t to say that the Court’s ruling is tolerable – women’s health and its direct effects on the nation’s social and economic well-being should trump all – but there are much better arguments to be had. Call David Green, five-ninths of the Supreme Court, and the Christian understanding of human reproduction misogynistic if you want, but to say that they eschew intelligence, logic, and reason because they use the word “abortion” differently is just ethnocentric.

(Bonus Question: Is corporate personhood a form of animism?)

Harding, Sandra G. 2011. The postcolonial science and technology studies reader. Durham: Duke University Press.

Further Reading:

Brewis, Alexandra. 1993. Reproductive ethnophysiology and contraceptive use in a rural Micronesian population. Providence, R.I.: Population Studies and Training Center, Brown University. 

De Bessa, Gina Hunter. 2006. “Ethnophysiology and contraceptive use among low-income women in urban Brazil”. Health Care for Women International. 26 (6): 428-452. 

Rashid, S. 2001. “Indigenous Understanding of the Workings of the Body and Contraceptive Use amongst Rural Women in Bangladesh”. South Asian Anthropologist. 1: 57-70.

Technically, Livingston’s Ph.D. is in history, but worked with Ivan Karp on a Ph.D. on Botswana and it and her previous work demonstrates a keen sense of the importance of culture and history as they affect and are affect power relations. Its this concern with contextualization, particularity, and the relevance of empirical and qualitative work that makes her approach ‘anthropological’, not the fact that she studied in “Exotic Africa”. I’m hesitant to say more about her work because I’m not very familiar with it. But in an age where people believe anthropology must be Quantitative True Science, Livingston’s award helps remind us that interdisciplinary social science is, literally, genius.

In fact, anthropologists regularly figure as MacArthur fellows, and one of the pleasures of writing this blog is making annual announcements that another one of our own has made it big. So congratulations Julie and, if you don’t mind us stealing some of your thunder, congratulations to anthropology as well.

Some interesting paradoxes to contemplate:

• Why are there at least a dozen local brands of sildenafil available from Egyptian pharmacies, and “Viagra sandwiches” or “Viagra soup” is on the menu at almost every restaurant that specializes in seafood, but there is only one brand of emergency contraceptive pill in Egypt, which is sold by an NGO because it’s not considered commercially viable enough for the mainstream pharmaceutical companies to bother with it?

The tap in the bathroom of the apartment where I stay when I’m doing research in Egypt. My roommate and I have often wondered where these came from. Was it a marketing campaign by Pfizer during the era when they weren’t allowed to engage in direct-to-consumer advertising for their product? Or did some sink manufacturer just think it would be cool to put Viagra on the handles?

• A number of studies show that induced abortion (as opposed to “spontaneous abortion” aka miscarriages) is quite common in Egypt; one carefully designed study showed that there are probably as many per capita abortions in Egypt (where abortion is prohibited unless two doctors certify that it’s necessary to protect the health of the mother) as there are abortions in the United States (where it is constitutionally protected but often restricted). Misoprostol, a medication used to treat ulcers, can be used very effectively to induce early abortion, and it’s readily available without prescription from pharmacies in Egypt. Yet preliminary research suggests that its abortifacient properties are virtually unknown to Egyptians. It’s super cheap, and a lot safer than illegal surgical abortions. Women could induce abortions themselves for a few dollars, but instead they risk their future fertility, their health and their lives having unsafe abortions, or they pay huge sums of money to have illegal surgical abortions performed by qualified doctors outside of regular office hours. Why?
  .
• A recent fatwa (a ruling of Islamic jurisprudence) by a leading Egyptian jurist holds that, under certain circumstances, it’s OK for a woman to have surgery to repair her hymen before getting married, to hide the evidence of premarital sex. This fatwa is somewhat controversial, but the person who pronounced the fatwa is no rogue; he’s a highly respected cleric. So if one Islamic authority says it’s OK, why is hymenoplasty not taught in Egyptian medical schools, and why do physicians get nervous or angry when you ask them about it?

I think these are really interesting questions. I’m especially interested in the links between religion and medicine: Like how does the interpretation of a technology by Islamic jurists influence whether something appears on the medical curricula? And when experts in Islamic jurisprudence are asked to provide a ruling on a new technology that they know nothing about, how do they educate themselves about that technology in order to be able to make a ruling about its permissibility in Islam? Who do they go to for answers? Do they go online (like I do)? Do they consult local doctors? International experts?

Beyond the scope of expertise, it’s important to consider what people actually do, sexually and contraceptively, and what extent they are influenced by expert opinion. What about people whose sexual and reproductive lives defy religious codes and cultural norms? What about Christian Egyptians? How do they use these technologies, and do they care about formal religious opinions about these technologies? What about unmarried women who are sexually active? What do they think about expert opinion, how do they navigate fatawa (plural of fatwa) and medical bureaucracies to prevent a pregnancy, or terminate one, or hide evidence that they aren’t virgins when they marry? Things like emergency contraception, medical abortion, and hymenoplasty are technologies that can be used to disguise evidence of non-normative sexuality, and the stakes are particularly high for women, as it is primarily women who bear the consequences of extramarital sex in Egypt – as elsewhere in the world.

But I’m still struggling with the why of this research. Why is this important to study? I was at a dinner party a few months ago with some physicists and I was talking to Professor Ewa Goldys who asked me about my research. Ewa is a big grant-getter in the Physics Department at Macquarie. She listened politely while I talked all about these titillating topics – sex and drugs and abortion and fatwas – and then she said, “But why does this matter? Why is the research important?” I was like, “Because it’s interesting. Duh!”

Unfortunately I have to provide a better answer than “it’s interesting” to get a grant for this research (right now I have a small grant from my university but I’m angling for a big national research grant). So I’ve been thinking about how to frame this as Really Important Research. Maybe someone can help me? Obviously there’s a public health case to be made about women’s health, fertility, and morbidity. And yes, the subject matter is inherently interesting, because it’s fundamentally a story about sex, science, and religion.

But what’s theoretically interesting about this? Yes, religion and medicine mutually influence each other, but that’s hardly a cutting edge insight for medical anthropology. I can say that the project hasn’t been much done before. There’s no work on EC in Egypt, very little written about erectile dysfunction drugs, and not much on hymenoplasty. There have been some fantastic anthropological studies of reproductive health technologies (RHTs) surrounding normative sexualities in Egypt, like Marcia Inhorn’s work on IVF for married couples, but very little work on RHTs that are popularly associated with non-normative sexualities, i.e. for people having extramarital sex. But just saying that “I’m writing about something new” doesn’t get you grant funding.

This is an ongoing project, so any suggestions or criticism are most welcome. You don’t have to know much at all about Islamic jurisprudence or reproductive health medicine to have anything interesting to say about the topic, because the technologies I’m researching are all over the news in the U.S. and elsewhere, and I’m particularly interested in comparative perspectives. Is anyone out there looking at these technologies in other parts of the world?

Next post my Egyptian colleague Dr Hosam Moustafa will join me and we’ll write more about emergency contraception, aka the “morning after pill,” in Egypt. Then we’ll cover erectile dysfunction drugs, medication abortion, and hymen reconstruction surgery. Stay tuned…