The Appeal of Experience; The Dismay of Images: Cultural Appropriations of Suffering in Our Times Author(s): Arthur Kleinman and

Joan Kleinman Source: Daedalus, Vol. 125, No. 1, Social Suffering (Winter, 1996), pp. 1-23 Published by: The MIT Press on behalf of American Academy of Arts & Sciences Stable URL: http://www.jstor.org/stable/20027351 . Accessed: 30/12/2010 05:33
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Arthur

Kleinman

and Joan Kleinman

The Appeal of Experience; The Dismay of

Images: Cultural Appropriations of

Suffering inOur Times

ORIENTATION

Suffering

existential grounds of human experi a in human ence; it is a defining quality, limiting experience It is also a master conditions.1 subject of our mediatized times. of victims of natural disasters, Images conflict, political forced migration, illnesses famine, of dozens substance

is one

of the

the HIV abuse, pandemic, of kinds, domestic and crime, abuse, are cameras of destitution the deep privations Video everywhere. of pain and misfortune. take us into the intimate details are appropriated to appeal emotionally and Images of suffering to to both audiences and local Indeed, morally populations. global an important As those part of the media. images have become chronic "infotainment" mercialized; and business ences, they on the nightly are taken up news, images into processes of victims are com of global marketing experi appeal of human and collective testimony "though are at a

action, now available

The existential competition. to their potential mobilize sentiment popular or offer to witness and even their capability for gaining market share. Suffering,

Arthur Kleinman isMaude and Lillian Presley man of the Department of Social Medicine, Medical and Professor School; of Anthropology a sinologist, Joan Kleinman, Harvard University. is Research

Chair Professor of Medical Anthropology, at Harvard and Professor of Psychiatry at Harvard University. Medical Anthropology Program at

Associate,

Arthur Kleinman and Joan Kleinman

as the French sociologist Luc Boltanski tellingly ex it, is routinely appropriated in American popular the culture, cultural

distance," presses of

which is a leading edge of global popular culture.2 This globalization

is one of the more signs of troubling suffering era: because of the current transformations troubling and through this cultural thinned is being remade, experience represen out, and

is being used as a commodity, tation of suffering, experience distorted. It is important talizing timeless to avoid There

suffering. or spaceless

essentializing, is no single shape

universal

or sentimen naturalizing, to is no there way suffer; to suffering. are com There

munities
endowed of

inwhich
with

suffering is devalued and others inwhich

it is

the utmost

the experience

The meanings and modes significance. and have been shown by historians of suffering

to be greatly diverse.3 Individuals do not alike anthropologists more what than talk about suffer in the same way, any they live, same or in to Pain at the serious is ways. stake, problems respond even in the same commu is perceived and expressed differently, from the Nazi death Extreme of forms suffering?survival nity.4 catastrophe?are of poverty and experiences "ordinary" as a social can speak of suffering We to this essay: that are relevant 1) ways rience shape individual and perceptions tive modes they 2) Social disease are are visible taught interactions or As a close these and patterns of how sometimes learned, enter into an illness camps or the Cambodian not illness.5 experience Collective expressions. to undergo openly, experience in at least modes two of expe collec Those the same as the

and troubles, often indirectly. (for example, with and terminal

a family dealing with the dementia of amember with Alzheimer's

network grieving for a member cancer). take part, Both suggest, relationships examples a central part, in the experience sometimes collective of social aspects experience?its interactions of suffering.6 mode and

processes?can intersubjective distinctive cultural meanings tations, elaborate authorized different

to be reshaped be shown by the of time and place. Cultural represen and its institutions, community by a moral local differences?in of suffering. modes Yet,

and, of course, subjectivity?as age group, class, ethnicity, gender, as make into local worlds of the well penetration global processes and complex. influence this social partial

Cultural Appropriations
an analysis of to professional important suffering what tions the cultural

of Suffering in Our Times

It is this aspect of suffering that this essay addresses by way of

that contribute and political processes that have of processes appropriations suffering, are experiences uses of what To moral implications. are the consequences of those cultural prac

put? What

tices for understanding and responding to human problems? And

are the more of suffering implications general for human experience, of the cultural including appropria human experi

ences of suffering?
PROFESSIONAL APPROPRIATIONS PHOTOJOURNALISM Image I. OF THE IMAGES OF SUFFERING:

AND PUBLIC HEALTH

Source:

Kevin

Carter,

The New

York

Times,

26 March

1993.

1993

by Sygma.

This photograph won a Pulitzer Prize for The New York Times. In the April 13, 1994 issue of the Times, there was a full-page
advertisement taken out by the Times9 owners in recognition of

Arthur Kleinman and Joan Kleinman

Prizes that picture that year. The Times in the following way: itwon described

the three Pulitzer this award-winning To The New

York Times, for Kevin Carter's of a photograph a vulture perching near little girl in the Sudan who has collapsed from hunger, a picture that became an icon of starvation. the photograph that has once of civil war account over first appeared, again resulted in the southern a story of it accompanied from political violence and Sudan.7 The Times3 self

When the famine the chaos

congratulatory effect. The child appears bowed

fails to adequately evoke the image's shocking an is hardly than she infant; she is naked; larger in weakness itwould incapable, no family, no one by the vulture, The or

and sickness, is No mother, she seem, of moving; unprotected. to prevent is present her from being attacked to starvation and then

succumbing being image sug is led The reader again gests that she has been abandoned. Why? to imagine various in scenarios of suffering: she has been lost the

eaten.

chaos of forced uprooting; her family has died; she has been
deserted viable reader war near children. to want famine and but death The in order for her mother great Why The success is this vulture to hold is that innocent embodies on victim to more the of civil image's to know more. it causes

and unprotected? danger are not in the and real forces of evil the evil, greater dangers are in "natural world"; the those world, including they political or in government in Khartoum. in army uniforms offices nearby a political in the Sudan.8 Famine has become strategy has been photograph in advertisements duplicated The aid reprinted many for a number times, and it has been of nongovernmental to refugees. to mobilize

This

food funds to provide that are raising agencies sentiment instance of the use of moral is a classic for social to do Or, action. One cannot look

support wanting away.

succumbing donation.

to protect something as one aid agency puts it, to prevent other children from a inhuman in the same heartlessly way by giving calls for words to answer other questions. doing How some Carter

at this picture without the child and drive the vulture

The photograph allow did Carter taken? Was

the vulture sense

to get posed?

so close without Inasmuch

thing to protect the child? What

it in some

did he do after the picture was

as Kevin

Cultural Appropriations
chose point rather to take when than moral she the time, minutes is near death, the child,

of Suffering in Our Times

to save

that may have been critical at this to compose an effective picture is he complicit?

Those

nonrelationship) 1994, July 29, ment, The New had committed his death, spondent, magazine written as well

to Carter's (or questions particular relationship to the dying child were only intensified when, on a few months after the Pulitzer Prize announce York suicide ran an for Kevin Carter, who obituary at age thirty-three. That shocking notice of corre Bill the Times9 Keller, by Johannesburg as a longer article by Scott Mac in Time Leod Times 12, reported Carter's clarifications about

on September

how he took the photograph and what

.. .he wandered

followed:9

into the open bush. He heard a soft, high-pitched saw a tiny girl trying to make her way and to the whimpering to a center. As he crouched vulture landed her, feeding photograph in view. Careful not to disturb the bird, he positioned himself for the best possible later say he waited about 20 image. He would the vulture would its It did not, and minutes, wings. hoping spread after he took his photographs, he chased the bird away and watched as the little girl resumed her struggle. Afterwards he sat under a tree, to God lit a cigarette, talked and .He kept saying he wanted afterward... The Times9 his obituary in which ends with cried. He was depressed to hug his daughter.10 entitled "The Horror of

a section

that father, observes Jimmy Carter, Kevin's carried around the horror of the work he did." Keller the burden that it was of this "horror" that may implies to suicide. The article by Scott Mac have driven Carter in Leod a very troubled life, with a messy financial brushes divorce, drug abuse, problems, deep with the police, and was a manic-depressive. We also learn that he had spent much of his career photographing repression political Time shows that Kevin Carter had lived

the Work," son "Always

and violence in South Africa, and that he had been deeply affected
of his best friend and coworker, Ken Oosterbrock, by the shooting for whom, he told friends, he "should taken the bullet."11 have His comes suicide note, besides mentioning these other problems, back to the theme of the burden of horror: and "I am haunted and vivid memories starving police, of killings and or wounded children, executioners_"12 corpses anger of trigger-happy madmen, by the .of pain.. often

of killer

Arthur Kleinman and Joan Kleinman

From Scott Mac to his Leod we also learn that Carter had been present men of right-wing in Bophuthatswana; paramilitary he had missed the master annoyance image snapped reprinted reports dilemma: by newspapers that Carter was

at the execution much

by his colleagues of a white mercenary pleading for his life before

that also was being executed?a picture in Time around the globe. The article aware of the photo journalist's painfully

"I had to think visually," a shoot-out. he said once, describing "I am zooming on a in tight shot of the dead guy and a splash of red. into his khaki uniform in a pool of blood in the sand. The Going a visual here. But dead man's face is slightly grey. You are making inside something is screaming, 'My God.' But it is time to work. Deal with the rest later_"13 Time tioned right another some writer discovered that some ques magazine's journalists Carter's ethics: "The man adjusting his lens to take just the frame of her suffering.. be a predator, just as well .might vulture of Carter's on the scene." Scott Mac Leod notes he had that even friends "wrondered about how aloud why Carter's not helped

success professional was a result of his failure to act humanely. To balance the account, we need to remember that many and photographers journalists some of the more this year covering have been killed violent conflicts the world. around "Hardly career advancement," political Bill Kovach, Curator of Harvard's Nieman cautioned Foundation, to an earlier in response version of this paper. Kevin Carter's career is as much a story of courage as it is a and professionalism failure. Moreover, the photograph he created pro to act. vided political and drove Photo testimony journal people to a global humanitarian contribute effort ists, like Kevin Carter, to prevent is a considerable silence. That contribution. learned about Having an anonymously public part of close experience. on the side of emplotted as Africa becomes with Carter's icon Kevin of suicide, suffering Carter is transformed to the prize-winning at a distance, from story image, becomes a name that is of tale of moral

the girl."14 It is easy

to moralize

the photograph a classic example the heart of darkness, in the cultural

a narrative, a of Joseph Conrad's the site of story his social

depiction Carter horror. helped

a subject

photograph

Cultural Appropriations
write he had who by being transformed, to bear. of

of Suffering in Our Times

more than affected, by what

infected

But what

is given is unrelieved. the story of Carter's of uncertainty Only now, with the the and interfuses. of the repr?senter suicide, suffering represented as as well would Professional interpretations representation popular the two: one a powerless local victim, the other have us separate

the horrors by the little Sudanese girl, experienced nor name a a The tension local moral world? neither

a powerful the account of Carter's Yet, foreign professional.15 a more The of the suicide creates reality. complex disintegration us a vari all. The theories of implicates subject/object dichotomy ety of academic to explain We are professions may help explain how Carter got us

into this situation of bringing the global into the local, but they fail
how we will get ourselves out of the moral complexities

he has intensified for us by projecting the local into the global.16

condition?a solace. failures the unsentimentalized limits of the human left only with silence seemingly without meaning, possibly without And calls for images: the mixture still the world of moral and global commerce

is here to stay.17 immense it is the achievement, photograph's disputing to its moral useful and political There is, assumptions.18 explore Afri for example, the unstated idea that this group of unnamed Without must or Dinka?) cannot their own. They (are they Nuer protect as well as represented, be protected, others. The image of by an the subaltern almost neocolonial of fail up conjures ideology and ure, inadequacy, fatalism, passivity, inevitability.19 Something be done, and itmust setting. The authorization be done of action soon, but from outside the local an for through appeal foreign of indig cans

must

intervention, aid, even foreign enous absence, an erasure of local worlds. The child is alone.

an evocation begins with local voices and acts.

Suffering is presented as if it existed free of local people and

disasters, illnesses, other non-Western image Western mode: The next institutions the of and deaths is not the way that This, of course, are usually or in African dealt with

famine

in the West. or, for that matter, societies, Yet, an ideologically is culturally in represented it becomes the experience of a lone individual.20

is to assume that there are no local step, naturally, or programs. That assumption almost leads invariably to the development or are of regional national im that policies

Arthur Kleinman and Joan Kleinman

on local worlds. or When those localities end up resisting posed not complying to assist with policies and programs that are meant are acts or such then labeled irrational self-destructive. The them, local world is deemed seem This may and mobilization incompetent, too thoroughgoing can do good, but of local or worse. a critique. Clearly, witnessing best when they work they take situations and work through a sensitivity Watching exists some

the complexity seriously institutions. local Moral to other, and where unspoken about has,

reading

also must involve witnessing moral and political assumptions. that suffering, especially suffering have of trauma

else, entertainment. are

as we

Papers are advanced, Prize,

Images sold, television

a form of become noted, already are part of our political economy. audience programs share, careers gain the through the Pulitzer of the the

appropriation but his victory, side of

and prizes are awarded jobs are created, of images of suffering. Kevin Carter won substantial the as itwas, of is what from inWestern was won

because

misery
dubious

(and probable death) of a nameless

appropriation

little girl. That more

in misery be addressed.

human must viewing

of cultural processes globalization across One message that comes distance how is that than for all the havoc this African better

from a suffering we are some society,

status and gain in moral some of our organizations while and politically, gain financially we represent, or appropriate, remain where those whom they are, surrounded vultures. This of suffer moribund, "consumption" by so an era not in is so-called "disordered of very ing capitalism" society. We different barbarism tion which involved and the historical baggage at colonial from a higher the in pagan view that the savage late nineteenth-century of our own civiliza lands justified the valuing level view development?a are Both forms of cultural of commercial, The point cultural recent and and is that the the that authorized in representation are deeply political image of the vulture

exploitation. the the moral, in each child other. carries

genealogy of the more

entailments, as well of colonialism programs of

the brutal including as the dubious cultural "modernization" and that have too often wors

globalization ened human Another nomic

(of markets problems effect of

financing), in sub-Saharan Africa.21

appropriation

of

world's the postmodern serious of such images

and eco political forms of suffering

Cultural Appropriations
at a distance overwhelmed to see, and is that it has

of Suffering in Our Times

the viewer. Viewers

9
are

desensitized

Thus, our neither understood of images of

is too much of atrocities. There by the sheer number to be too much to do anything about. there appears sense can be that complex epoch's dominating problems nor fixed works to produce with moral we the massive fatigue, globalization exhaustion a wounded of

suffering and political empathy, despair. iswhen The appeal of experience

see on television

surrounded Haitian, by tions that he is a member tion. The

of dismay are and the crowd themselves

a threatening accusa crowd, protesting of a murderous organiza paramilitary is when we are shown that the man images surrounded by photographers, the direction the event will whose take.22

participation helps The appeal of experience and in Kevin Carter's photograph,

determine

the dismay of images fuse together in and the story of his suicide. The a is transformation of social life, a politi photograph professional a relevant constructed form that natural rhetoric, cally ironically izes experience. As Michael Shapiro puts it,

.. is the absence of presence, but because the real is .representation never wholly present to us?how it is real for us is always mediated some lose something when through representational practice?we we think of representation as mimetic. What we lose, in general, is insight into the institutions and actions and episodes through which the real has been fashioned, a fashioning that has not been so much
a matter of immediate acts of consciousness by persons in everyday

life as it has been a historically kind of imposition, now developing in institutionalized the kinds of meanings largely prevailing deeply inscribed on things, persons, and structures.23 This of professional and political transformation process to the way we come to appreciate human and problems to prepare policy That appreciation and preparation far responses. too often are part of the problem; become they iatrogenic. is crucial SOCIAL SUFFERING is appropriated by the media submit safety, they often must Their memories (their cross to yet cultural

PATHOLOGIZING When over those whose of

to places another type

suffering of refuge and arrogation.24

intimately

10
interior These

Arthur Kleinman and Joan Kleinman

of violation images) trauma stories then which are made become the over into trauma the stories. symbolic currency,

capital, with and achieve complicated cultural image

resources for physical they enter exchanges the status of political those refugee. Increasingly, a core to in based real reduced events, stories, yet

are used of victimization (a postmodern hallmark), to in rewrite social medical by health experience professionals a terms. The person who torture first becomes victim, undergoes an image of innocence someone who cannot and passivity, repre sent himself, specifically who must a patient be represented. Then a with quintessential he becomes fin de a patient, si?cle disorder

stress disorder).25 to receive even mod (i.e., posttraumatic Indeed, a sequential est public to undergo it may assistance be necessary one from transformation who who suffers political experiences, terror to one who has is a victim sick, who financial a disease. Because to one who of political violence is of the practical and political the violated them transformations, of their condi as the financial what

of such importance selves may want, and even seek out, the re-imaging as well tion so that they can obtain the moral of being ill. We need to

benefits

kind of ask, however, a victim the transformation of cultural of vio process underpins a pathology? to give with What does it mean lence to someone a pa status violence social of those traumatized the by political tient? And in what as the as well political

does the imagery of victimization way an individual alter the experience?collective of pathology as moral as individual?so that its lived meaning and memory, perhaps and "paranoia," There unnecessary is lost and resistance, a "failure to cope"? even is replaced

by "guilt,"

is an uncomfortable correlation

irony here. There between the aesthetics

is an uncanny and in Gua of murder

and Bosnia temala, Rwanda, are reported in the news. We and landmines. off by mortars terrorizing into pieces, details of trauma populations, blown up,

in which those deaths and the way are shown close-ups of limbs blown at In low intensity warfare directed

are dramatically victims?their by the violence

are not just killed; they are hacked people torn apart, burned, and broken. And all the the cultural for us. Thus, capital displayed their their tragedy?is scars, wounds, same are popular commodified, codes through which physical sold in the cinema, mar

appropriated and sexual

Cultural Appropriations
keted tract other The as

of Suffering in Our Times

11

to at and used by tabloids and novelists pornography, forms of trauma readers. from abroad hold an Spectacular as consume our well: interest and deflect significance they from routinized aesthetization at home. misery of child sexual abuse is another case in point.

attention

Appearing in The New York Times of April 9, 1993 was a picture of a child prostitute in the red-light district of old Dhaka, Bangladesh.
a Lolita bare-chested, girl is shown wearing on her arms, ear adult hairstyle, many bangles a and necklace. Behind her thin small, rings, figure looms someone to one hand who be her appears brothel-keeper, grim, mustached, The prepubescent smile, a tousled near his groin. Behind them are the filthy walls of an alley; another or a customer stands off to one side. The accompanying prostitute on the World's Chil Scourge a major this picture newspaper, as child pornography. would The purpose of the picture qualify and the accompanying the degradation of child story is to expose a era in the of AIDS. prostitution, phenomenon greatly increasing story is titled, dren." Outside "The the Sex Market: context of But the picture to intention, not entirely without simultaneously appeals, probably a prurient not enough to It is sensibility. clearly a to child's recreate for the needs the sale; picture body picture of sexual desire. Thus, the media, atmosphere by the success of its it seeks to criticize. gets caught up in the very processes artistry, now turn to explore a different We form of the transformation In recent years, experts of social suffering. in international health and social development, for very appropriate have sought reasons, new ways to develop of configuring the human misery that results from chronic disease and disability. Faced with the problem of cases numbers of of chronic heart increasing illness?diabetes,

cancer, asthma, depression, disease, schizophrenia?as populations to experience live long enough and other diseases degenerative

health conditions of later life, health professionals

rates that mortality and especially ment, have called sought are unable

have realized

to represent the distress, disable cost the of these conditions. Therefore, they to construct new metrics to measure the suffering

from chronic illness, which

"morbidity." the burden claim, to measure can enable the just allocation These

inmedical
metrics can of suffering of resources

and public health argot is

be the experts applied, in "objective" terms that to those most in need.26

12
One has

Arthur Kleinman and Joan Kleinman

metric of suffering attention recently developed and considerable Bank's of DALYs It emphasizes health by the World Bank II Image support.27 mean economists by the

gained wide describes what the World result from of the application illnesses globally. suppose, should

term Disability Adjusted Life Years

(DALYs). Table 1 shows the

to measure the cost of suffering the significant of percentage

loss in DALYs due to mental health problems. This finding, one

would problems?suicide, stance abuse?higher applied to them. the case for giving mental health help make trauma due to violence, mental sub illnesses, so resources can that be greater priority

are In fact, the cost of mental health problems so in the World Bank the that the category discretionary placed by a state is not held is serious for that burden. This responsible in fundamental the that way requires change suffering problem

from mental health problems is prioritized by theWorld Bank. But

here we tation ask a different and professional question: What of kind of cultural appropriation suffering represen is this?

Image II. Disability The World Disability

Adjusted

Life Years

Bank's estimates of lost years of quality life hinges on the concept of Adjusted Life Years (DALYs), which is a measure of the burden
diseases; that result it combines from those of the premature deaths and impact at a given In taking death diseases. age the expectation lost is evaluated by using the

by specific produced of the disablements into

of years of life the number account, at that age to individuals in low mortality countries. Years of life life remaining a year value the life span; thus, most do not have the same value people throughout a year as worth in the eighties is worth. in their twenties three or four times what of This differential evaluation is taken into account in the calculation. To measure the

disability resulting from disease, each surviving year ismodified according to the expected duration and severity of the disability. Duration is simply the years (or
fractions disadvantage For death. disease and of thereof) of that a given the disability on have lasts. handicap panels a scale the comparative represents Severity to 1, for from 0, for perfect health, at a severity of 0.6, and rated blindness at a severity of 0.22. the formula Losses takes from death into account

example, the female

expert

disability the

system reproductive are combined. In calculating value of those and

DALYs,

the age at which

(and relative

the specific disease is acquired, the years of life expectancy

years), the years compromised Problems 1995), by handicap.

lost

Source: Income

et al., World Robert Desjarlais Countries (New York: Oxford

Mental University

Health: Press,

and Priorities 295.

in Low

Cultural Appropriations
Table Region, 1. Distribution 1990 of DALY (percent)

of Suffering in Our Times

Loss by Cause and Demographic

13

Sub Saharan Africa 5,267.0 Population(millions) 510.0 850.0

China 1,134.0 0%

Other Asia & Islands

Latin America & Carib bean

Middle Eastern Crescent

Former Socialist Econo mies of Europe 346.0

40.1%

36.0%

74.8%

6.2

4.6

1.3

0.2

11.3%

13.0%

5.9 45.8%

3.9 71.3% 50.3% 25.3% 48.6% 42.2% 51.0% 8.6%

10.2

8.3

10.7

10.8

100.0%\ 1,362.0

100.0% 293.0

100.0% 292.0

100.0% 201.0

100.0% 177.0

100.0% 103.0

100.0% 144.0

100.0%

100.0%

1.8 286.0

Source: Health

from World Bank, Adapted (New York: Oxford University

World Press,

Development 1993), 27.

Report

1993:

Investing

in

14

Arthur Kleinman and Joan Kleinman

of is as

of suffering was constructed by assigning degrees to years of life and types of disability. The assumption suffering that values will be universal. They will not vary across worlds This metric

as China, different and North India, sub-Saharan Africa, greatly to measures America. also be reducible of economic They will cost. That expert panels a severity of 0.6, while rate blindness with are evaluated at one third female system disorders reproductive is surely a cause for questioning the severity whether bias gender one uneasy with is present, but more it should make the generally means can cost which evaluations of and its be by severity validly across different standardized social classes, societies, age cohorts, and occupational groups. ethnicities, genders, The different importance it does not effort for rational an objective to develop indicator may be important choice concerning of scarce resources allocation among and programs. should the (It certainly support policies of lead funding mental health programs, even though as it

is presently used in theWorld

Bank's World Development

Report

to this conclusion.) to But it is equally important are what the limits and the potential of configur question dangers as an economic social indicator. The and moral ing suffering to fit in this essay cannot issues we have raised be made political to map into this econometric index. Likewise, the index is unable it assumes and gender differences. homo cultural, ethnic, Indeed, to illness experiences, in the evaluation and response which geneity an enormous amount of anthropological, belies and historical, in each of these do clinical of substantial evidence differences are privileged over lay categories, mains.28 Professional categories yet the experience Furthermore, the index human of in lay terms. is expressed focuses on the individual sufferer, deny is a social experience. This terribly thin represen of illness condition may It can do in time also thin out part the of this by becoming that creates societal

ing that suffering tation of a thickly social

experience suffering. the apparatus of cultural representation should

norms,

which
viders.

in turn shapes the social role and social behavior of the ill,
The American

and what

of families and health-care be the practices pro is changing for cultural rhetoric, example, from the language of caring to the language of efficiency and cost; use this rhetoric to to hear patients it is not surprising themselves their problems. Thereby, the illness experience, for some,

describe

Cultural Appropriations
may be transformed technical slow from

of Suffering in Our Times

moral is what presses experience Czeslaw us

15
into a

a consequential

merely This himself

inexpediency. of experience transmutation a refugee from political violence, cultural infiltrate

Milosz, to come to

in taken-for-granted grips with tion in the popular culture that

of representa processes of the ordinary practices

living:
Almost airs nature programs mainly for every day, Public Television animals of the young people. About fish, lizards, coyotes, spiders, and so on. The technical excellence of desert or of alpine meadows, these pro doesn't prevent me from considering the photography grams obscene. Because what they show offends our human, moral understanding?not only offends it, but subverts it, for the thesis of it is is: You see, that's how it isNature; these programs therefore, we a are to of the evolu and we, too, Nature, natural; part belong tionary chain, and we have to accept the world as it is. If I turn off indiffer the television, horrified, disgusted by the images of mutual ent devouring.. I am capable of picturing what .is it because this into translated like when those millions of young children, with impunity since they don't cruelty of Nature? Or, without looks the life of human society? But the minds, are they able to watch this associate the blind anything with are it, realizing they being slowly of photography who

and systematically by those masters poisoned also do not know what they are doing?29 DALYs and other economic indexes

of health

conditions

have

need to formulate health and their appropriate uses, resources. We to priorities for limited social policy with respect of illnesses and their social conse need valid economic indexes can be useful in health-care DALYs reform and public quences. as not become, indexes should economic health Yet, planning. in much in of the recent debate on health-care reform they seemed the United policy mented States, the only authorized and programs. These economic ethnographies, contradictory, the economistic is at stake construction measures and social human need side of of suffering for to be comple that speak suffering. Ab of suffering

of course. We

by narratives, even to the complex, sent this other side, leaves out most

histories

measurement for peoples

of what

globally.

16
ABSENT It

Arthur Kleinman and Joan Kleinman

IMAGES: THE POLITICAL RHETORIC OF OPPRESSION

to balance is necessary the account of the globalization of a commercial and professional with different and images vastly even more cultural process of appropriation: the totali dangerous tarian state's erasure of social experiences of suffering the through of images. Here the possibility of moral suppression appeal through of is it is their absence human and that images misery prevented, is the source of existential dismay. Such to 1961. is the case with This of story was the massive not reported starvation in China from though 1959 more at the time even

than thirty million Chinese died in the aftermath of the ruinous

policies the Great dream impossible ants. Accounts the perverse effect of Mao's Forward, on peas immediate industrialization forcing most of this, the world's famine, were devastating Leap of stories or pictures of the starving or the

no totally suppressed; dead were published. An team It was

internal report on the famine was made for the Central Committee of the Chinese based on a detailed survey

by an investigating Communist Party.

of an extremely poor region of Anwei Province that was particularly affected. The report brutally a statement includes Wei this numbing local peasant Wu-ji, by leader from Anwei: now only in our commune, there were 5,000 people Originally we not remain. When the invaded did lose this 3,200 Japanese we save at least could ourselves This many: year by running away! there's no escape. We die shut up in our own houses. Of my 6 5 are already dead, and I am left to starve, and I'll family members, not be able to stave off death for long.30

Wei Wu-ji
Wang

continued:

that cases of Springs County reported Jia-feng from West were meat discovered. human eating Zhang Sheng-jiu said, "Only an evil man could do such a thing!" Wang Jia-feng said, "In 1960, ten of them died last year. My son there were 20 in our household, told his mother Til die of hunger in a few days.'" And indeed he

did.31 The Wudian report also includes Shanwang a graphic Brigade: image by Li Qin-ming, from

County,

Cultural Appropriations

of Suffering in Our Times

17

to deliver 58,000 In 1959, we were prescheduled jin of grain to the we only turned were hence but harvested, State, jin only 35,000 commune. over 33,000 We really the left for which 2,000 jin jin, eat hemp leaves, anything to eat. The peasants have nothing they can possibly eat. In my last report after Iwrote, "We have nothing to remove my name from the to eat," the Party told me they wanted a Out of Roster. of 280, 170 died. In our family Party population us of five, four of have died leaving only myself. Should I say that I'm not broken hearted?32 Chen this Zhang-yu, terrible image: from Guanyu County, offered the investigators

Last

of cannibalism spring the phenomenon appeared. Since Com could not come up with of rade Chao Wu-chu any good ways out to the order he those who it, put prohibiting secretly imprison seemed to be at death's door to combat the rumors. He imprisoned 63 people from the entire country. Thirty-three secretly died in

prison.33

The official report is thorough and detailed. It is classified neibu,

restricted use only. To distribute it is to reveal state secrets. Pre

sented publicly itwould have been, especially if it had been pub lished in the 1960s, a fundamental critique of the Great Leap, and a moral and political delegitimation of the Chinese Communist
Party's the life of poor peasants. Even improved as is it silence The official dangerous. regard today It prevents another form of appropriation. It public witnessing. an act of political resistance forges a secret history, through keep state rules of things denied.34 The totalitarian ing alive the memory the authorities collective and suffering, The absent public silence by denying forgetting, a culture thus creates is also image is perhaps more a form the of of collective experience of terror. claim to have

by

by public

images of delimit appropriation

atrocity. the extremes

appropriation; political than being overwhelmed terrifying Taken the two modes of together in this cultural process.35

CODA of appropriations critique mean that no appropriations Our of suffering are valid. To that do harm conclude does not be

that would

18

Arthur Kleinman and Joan Kleinman

more paralyze suffering responses. to do so, that any attempt destructive social in order to respond to human we than the problem We must draw human to identify It would misery. it have identified; the images of and to craft must first

to undermine be much would human humane

action.

upon needs

Yet, sure make

to develop valid appropriations, the biases of commercial emphasis

we

of political ing, the partisan agendas ideologies, are technical interests that serve primarily groups professional understood and their influence controlled. The first action, then, is on critical self-reflection the purposes of policies and the effects of We take that to be a core component of programs of programs. a more to in the professions. action is ethics difficult lift Perhaps the veil on the taken-for-granted cultural within which processes no matter and programs, policies and inevitably, usually unintentionally, The idea that the first impulse of social those should cultural current be to historicize of the issue before at hand that mechanisms action how taken well up and health-policy experts them and to critique the are intended, and exploited.

on profit-mak and the narrow

the grain of goes against a is chief of our Nonetheless, practice. implication The starting point of policymakers and program builders analysis. that they can (and often unwillingly needs to be the understanding in the lies latent for harm that potential do) do harm. Because institutional human structures that must effects have been authorized even the problems, that work behind be held to respond to intentioned best to define how means space of

professionals, latent those Humanizing focusing suffering, not only local worlds,

"experts" institutional

responsible can be controlled. interventions

the level at which

are organized

on the interpersonal and evaluation planning context of action. This the local, ethnographic at is for participants with what stake engagement but bringing into the those local of participants

requires in those

(not merely and process assessing developing experts) from the ground Such policy-making up can only suc programs. are more if these local worlds ceed, however, projected effectively on human discourses into national and international problems. national to the globalization the necessary (This may represent complement the it be called should of local images. Perhaps representa global a reformulation tion of local contexts.) To do so requires of the

Cultural Appropriations
indexes and instruments

of Suffering in Our Times

Those analytic tools need

19
to

of policy.

authorize deeper depictions of the local (including how the glo

into the lo markets, displacement, technology?enters those methodologies of policy must the existen engage to reframe tial side of social life. How the language of policies and so are to relate to that large-scale social forces made programs and will local engage biography history require interdisciplinary bal?e.g., cal). And ments social lems. that bring alternative and sciences, is to The goal of purposes practice. Ultimately, globalization, commodification we will such of uses perspectives the health sciences reconstruct from to bear the humanities, the on human prob of inquiry and the ominous of and aspects of the the

the object

have as

to engage the more the commercialization of atrocity Violence

experiences

abuse,

suffering, and

pornographic to violence relation that has scholars.37 of how the first attracted

of degradation.36 in the streets and serious attention the even more

in the media, and its in homes, is already a subject from communities and from cultural in untoward question ways, ethno un

Regarding social experience issue would and narrative

fundamental

is being transformed seem to be to develop studies that provide alters the

graphic, regime collective

historical, a more powerful connections

derstanding of the cultural processes

of disordered

through which

the global

between capitalism so and that moral for experience subjectivity, sensibility, or becomes diminishes different: example, something frighteningly from and ac promiscuous, gratuitous, unhinged responsibility tion.38 There plated. social The is a terrible transformation as shifts experience to be contem legacy here that needs is as much of epochs in about changes in social structures and cultural repre

are the three sites of social transformation indeed, Out of their too transmutes. inseparable. triangulation, subjectivity current The transformation we is no different; see yet perhaps more turn the we hazards of are the historical now that clearly sentations; undertaking. Perhaps existential conditions dangers of civilizational all along we as an ultimate change. have been wrong limiting to consider the moral constraint

At the end of this century it has for the first time become possible to see what a world may be like in which the past, including the past

20

Arthur Kleinman and Joan Kleinman

charts life no sea on taking

in the present, has lost its role, in which the old maps and which guided human beings, singly and collectively, through the longer represent the landscape through which we move, which we sail. Inwhich we do not know where our journey is
us, or even ought to take us.39

ENDNOTES
is drawn 1This essay from a larger project to read Arthur may wish fering. Readers concerning Kleinman the and social experience of suf

Joan Kleinman,

"Suffer

ing and its Professional Transformation," (3) (1991): 275-301; Arthur Kleinman,
DelVecchio Good et al., eds., Pain as Human

Culture, Medicine and Psychiatry 15 inMary-Jo "Pain and Resistance,"

Experience: Anthropological Per

spectives (Berkeley, Calif.: University of California Press, 1991), 169-97; Arthur Kleinman et al, "The Social Course of Epilepsy inChina," Social Science and Medicine 40 (10) (1995): 1319-330; Arthur Kleinman and Joan Kleinman, "How Bodies Remember: Social Memory and Bodily Experience of Criticism,
Resistance, and Delegitimation following China's Cultural Revolution," New

Literary History 25 (1994): 707-23; and Arthur Kleinman, Writing at theMar gin: Discourse Between Anthropology and Medicine (Berkeley, Calif.: Univer sity of California Press, 1995). 2Luc Boltanski, La Souffrance a Distance
3On the heterogeneity of meanings

(Paris: Metailie,
of suffering,

1993).
see, for example, John

and modes

Bowker, Problems of Suffering in Religions

of the World

(Cambridge: Cam

to Suffering," "Moral Orientations Das, Press, 1970); Veena bridge University in L. C. Chen, N. Ware, and A. Kleinman, and Social Change eds., Health (Cam Harvard Arthur The Press, 1994), 139-67; Kleinman, University bridge, Mass.: Illness Narratives: and Human Basic (New York: Experience Suffering, Healing Books, 1988); Arthur Kleinman and Byron Good, eds., Culture and Depression:

Studies in the Anthropology and Cross-Cultural Psychiatry of Affect and Disor der (Berkeley, Calif.: University of California Press, 1985); Paul Farmer, AIDS and Accusation: The Geography of Blame inHaiti (Berkeley, Calif.: University of California Press, 1992); T. N. Madan, "Living and Dying," inT. N. Madan,
ed., Non-renunciation Themes and Interpretations of Hindu Culture (New

Delhi: Oxford University Press, 1987), 118-41; Phillipe Ari?s, The Hour of Our Death, trans. Helen Wever (New York: Knopf, 1981); Piero Camporesi, Bread of Dreams: Food and Fantasy inEarly Modern Europe, trans. David Gentilcore University of Chicago Press, 1989); Carlos Ginzburg, The Cheese (Chicago, 111.: and the Worms: The Cosmos of a Sixteenth-Century Miller, trans. John and Anne Tedeschi (New York: Penguin Books, 1980); IvanMorris, The Nobility of Failure: Tragic Heroes in theHistory of Japan (New York: New American Li brary, 1976); and Ann F. Thurston, Enemies of the People: The Ordeals of the Intellectuals in China's Great Cultural Revolution (New York: Knopf, 1987).
4See DelVecchio Good et al., eds., Pain as Human Experience: Anthropological

Perspectives, David Morris, The Culture of Pain (Berkeley, Calif.: University of

Cultural Appropriations

of Suffering in Our Times

21

California Press, 1991); and Elaine Scarry, The Body in Pain (New York: Ox ford University Press, 1985).
5Lawrence Conn.: The Testimonies: Holocaust Langer, Yale University Press, 1993); Nancy Ruins of Memory Sheper-Hughes, (New Haven, Death Without

Weeping: The Violence of Everyday Life inBrazil (Berkeley, Calif.: University of California Press, 1993); and Pierre Bourdieu, ed., La Misere du Monde (Paris: Editions du Seuil, 1993).
6Kleinman and Kleinman, "Suffering and its Professional Transformations."

7TheNew York Times, 26 March

1991), not show crop that

1993, A3. (New York: Oxford Uni

Africa occur as a result of famines per in sub-Saharan se.

Dreze and Amartya Sen,Hunger and Public Action 8Jean

versity political Press, disorder, failure

9BillKeller, "Kevin Carter, a Pulitzer Winner for Sudan Photo, isDead at 33," The New York Times, 29 July 1994, 138; Scott Mac Leod, "The Life and Death of
Kevin Carter," Time, 12 September 1994, 70-73.

"Time; 12 September 1994, 72.

nIbid., 12Ibid. 13Ibid. 14Ibid. 73.

15Forthis view of the "taking" of victimized social subjects by the more powerful
photographer, "a privileged observer"?the "eyes of power" idea?see W. J. T.

Mitchell, Picture Theory (Chicago, 111.: University of Chicago Press, 1994), 288, 324, 365, 420-21. Mitchell also introduces the fundamental moral issue of the
relationship 16On the dilemmas tions in the Global between representation and responsibility. See Ibid., 421-25. "Media Under on for cultural Ecumene," see Ulf Hannerz, of globalization, analysis in Gisli Palsson, Boundaries: ed., Beyond

standing Translation
1993), 41-57;

and Anthropological
"When

Discourse

(Providence: BERG,
Reflections

and Ulf Hannerz,

Culture

is Everywhere:

a Favorite Concept," Ethnos 58 (1993): 95-111. 17StanleyCavell writes

because it is incapable

that philosophical
of decisively

knowledge
out such

is ultimately disappointing
"ordinary" human com

sorting

plexities. Stanley Cavell, In Quest of the Ordinary (Chicago, 111.: University of Chicago Press, 1988), 88, 147, 149; he goes on to assert, in Stanley Cavell, A Pitch of Philosophy (Cambridge, Mass.: Harvard University Press, 1994), 116,
"the world that for." 18The analysis paragraphs, the Politics Robert that follows in this Kleinman section draws on materials, Desjarl?is, and contains several calls the world, an intuition for words, that words to be is to be answered, experienced, are, Iwill say, world-bound, that this is what words are

and Culture "Violence, at the Margin, in Arthur of Trauma," Kleinman, 8; Writing chap. and Arthur "Violence and Demoralization in the Kleinman, Desjarlais

in Arthur

and Robert

New World Disorder," Anthropology

Today

10 (5) (1994): 9-12; and Arthur

22

Arthur Kleinman and Joan Kleinman

Kleinman and Robert Desjarlais, "Ni patients ni victimes: Pour une

ethnographie de la violence politique," ACTES De La Recherche 104 (1994): 56-63. sociales (ISSN 0355-5322)

en sciences

19Compare the cover picture of The Economist of 23 July 1994, which, in themidst of the Rwandan crisis, is of a frightened Rwandan child. The picture is entitled
"Helpless." 20On the uses of personification representation, of collective see Alan Mintz, catastrophe Hurban: in the Western Response tradition of in

cultural

to Catastrophe

Hebrew Literature
21 See the chapter on

(New York: Columbia University Press, 1984).

social change in Robert Desjarlais et al., World Mental

global

Health: Problems and Priorities in Low-Income Countries (New York: Oxford World Bank and the Interna University Press, 1995), for a discussion of how the
tional Monetary has worsened Fund's the health program rigorously-applied in sub-Saharan of women to worsen policy of economic This Africa. and mental to those restructuring volume also

shows how the end of the Cold War

have changes or to constrain often worked and either social health

and other global, political, and economic

social health problems responses problems.

22SeeAlex Webb and David C. Unger, Magazine, 23 October 1994, 50-53.

"Taking Haiti,"

The New

York Times

23Michael J. Shapiro, The Politics of Representation: Writing Practices in Biogra phy, Photography, and Policy Analysis (Madison, Wis.: University ofWisconsin
Press, 24The 1988), following xii. section "Violence, draws Culture on materials and the Politics in Arthur Kleinman and Robert

Desjarlais,

of Trauma."

25SeeAllan Young,
Memory (Princeton,

The Harmony

of Illusion: An Ethnography

of Traumatic

Princeton and Allan Press, N.J.: University forthcoming); in this issue of of Traumatic and the Origins Memory," Young, "Suffering of people who have experienced Recent of populations Dcedalus. surveys politi 25 and 75 percent that between cal violence report experience posttraumatic on violence et al, World stress disorder. in Desjarlais Mental See the chapter Problems and Priorities in Low-Income Countries.

Health:

26ArthurKleinman,
Ware,

"A Critique of Objectivity

eds., Health and Social

in International Health,"
Change.

in Chen, (New

and Kleinman,

World Bank, World Development Report 27See York: Oxford University Press, 1993).

1993: Investing inHealth

28See, for example, Sheila Rothman, Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness inAmerica (New York: Basic Books, 1994); andMorris, The Culture of Pain.
29Czeslaw Milosz, "The State of Nature: Notes from a Diary," New York Review

of Books,
30Central

11 August

1994, 41.
Communist Party, Internal Report, Annals for Feng

Committee,

Chinese

Yang County,
31Ibid.

1961, 188-91.

Cultural Appropriations
32Ibid. 33Ibid. 34See James sition C. Scott, State Domination An and

of Suffering in Our Times

23

the Arts

of Resistance in Rubie

(New Haven, Watson,

Conn.:

Yale University Press, 1992); and Rubie Watson,

Under Socialism: Introduction," 1-20. that makes

"Memory, History and Oppo

ed., Memory,

History
American 35It is not

and Opposition
Research only the Press, totalitarian

Under State Socialism

1994), state use

(Santa Fe, N.Mex.:

of the weight of

School of
of

silence,

course. In the Gulf War, the US media often disregarded Iraqi casualties on the battlefield, and told the story largely from the American perspective, in spite of
the fact that there were several dozen Western journalists in Baghdad.

36IanPalmer, a British military psychiatrist

York among ists_" tinues: Times to have said: here?the York visitors Times, "A fascination agencies, 7 November Westerners The New "Western relief

in Rwanda,
with death A4. the United

is reported in The New

has created and bodies Times' Nations The voyeurism the journal con reporter are rotting a

regularly

1994, tour massacre

sites where

and still unburied. Visiting diplomats have driven for hours to see bodies washed up in the eddies of the Akagera River on the Tanzanian border." Ibid. This deep
ening voyeuristic sensibility may be another side of the cultural process we have

identified.
37With fense relation of to the Carter picture, of see, for example, Richard Harwood, and "Moral atroci

Motives,"
ties, yet tion. 38That there

The Washington
the ethical still motivation the registers

Post, 21 November
who journalists of the moral complexity

1994, A25, which offers a de

report on violence issue of cultural representa

are

limits

to the commercial

uses

to which

put by the responses, in which campaign advertising an oil-soaked a war cemetery, uniform terms, of a Croatian to sell clothing. soldier

is shown

especially, with of bodies tattooed pictures labor in South America, bird, child are used, Nash,

in Germany

can images of suffering to Benetton's provocative "HIV-positive," and the bloody by postmodern a Raw Nerve,"

be

See Nathaniel

even in a strange paradox "Benetton Touches

The New York Times, 2 February 1995, Dl,

18. of the World, 1914-1991

39Eric Hobsbawm, The Age of Extremes: A History (New York: Pantheon, 1994), 16.