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Kleinman & Kleinman - 1996 - The Appeal of Experience PDF
Kleinman & Kleinman - 1996 - The Appeal of Experience PDF
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 .
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Arthur
Kleinman
of
ORIENTATION
is one
of the
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
Suffering
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
forced
chronic
famine,
of dozens
migration,
illnesses
on
"infotainment"
mercialized;
and business
ences,
substance
they
the nightly
are taken up
news,
images
into processes
for gaining
market
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
are com
of global marketing
experi
appeal of human
The existential
competition.
to
their potential
mobilize
sentiment
popular
or offer
to witness
and even their capability
action,
now available
of victims
share.
Suffering,
and collective
testimony
are
"though
at a
Chair
Professor
of Medical
Anthropology,
at Harvard
and Professor
of Psychiatry
at Harvard
University.
Associate,
Medical
Anthropology
Program
at
distance,"
the French
it, is routinely
presses
Luc
sociologist
Boltanski
in American
appropriated
ex
tellingly
culture,
popular
the
of
It is important
talizing
timeless
suffering.
or spaceless
munities
inwhich
endowed
of
with
There
and
through
is being
essentializing,
is no single
universal
shape
experience
this cultural
remade,
cultural
represen
out, and
thinned
or sentimen
naturalizing,
to
is no
there
way
suffer;
to suffering.
are
com
There
it is
the utmost
The meanings
and modes
significance.
and
have been shown by historians
of suffering
the experience
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
or
camps
the Cambodian
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
are visible
tive modes
are
and
they
2) Social
taught
interactions
patterns
of how
sometimes
learned,
enter into an illness
not
same
the
as the
illness.5
experience
Collective
expressions.
to undergo
openly,
in at least
two
modes
of expe
collec
Those
and
troubles,
often
indirectly.
(for example,
experience
or
a close
As
these
cancer).
take part,
Both
network
grieving
for a member
with
and
suggest,
relationships
examples
a central part, in the experience
sometimes
collective
of social
aspects
experience?its
terminal
interactions
of suffering.6
mode
and
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,
processes?can
intersubjective
distinctive
cultural meanings
tations,
elaborate
authorized
different
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
that contribute
and political
processes
that have
of
processes
appropriations
suffering,
are experiences
uses
of
what
To
moral
implications.
important
suffering
the cultural
are
put? What
of
the consequences
those
cultural
prac
implications
general
for human
experience,
of suffering
of the cultural
including
appropria
human
experi
ences of suffering?
PROFESSIONAL APPROPRIATIONS
PHOTOJOURNALISM
Image I.
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
that
picture
itwon
described
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.
To
The New
When
the famine
the photograph
that has once
the chaos
civil war
of
first appeared,
again resulted
in the
southern
a story of
it accompanied
from political
violence
and
Sudan.7 The Times3
self
account
fails to adequately
evoke the image's shocking
an
is hardly
than
she
infant; she is naked;
larger
congratulatory
effect. The child
over
in weakness
itwould
incapable,
no family, no one
and sickness,
is
No mother,
she
seem, of moving;
unprotected.
to prevent
is present
her from being attacked
bowed
appears
to starvation
or
the vulture,
by
eaten.
then
and
The
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
chaos of forced uprooting; her family has died; she has been
near
deserted
reader
war
in order
image's
to know more.
success
death
children.
viable
to want
The
great
is this
Why
The
to hold
is that
innocent
on
to more
it causes
victim
the
of civil
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
and
famine
vulture
embodies
but
has been
photograph
in
advertisements
duplicated
The
aid
This
reprinted many
for a number
food
funds to provide
that are raising
agencies
sentiment
instance of the use of moral
is a classic
for social
support
One
cannot
Or,
succumbing
donation.
The photograph
allow
did Carter
calls
for words
the vulture
it in some
sense
to answer
to get
to protect
something
as one aid agency puts it, to prevent
other children
from
a
inhuman
in the same heartlessly
way
by giving
to do
wanting
away.
action.
to refugees.
to mobilize
other
so close without
questions.
How
doing
some
posed?
Inasmuch
as Kevin
Carter
Cultural Appropriations
to take
chose
point
rather
when
she
to save
than
Those
nonrelationship)
his death,
magazine
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
York
Times
suicide
written
as well
spondent,
to Carter's
(or
questions
particular
relationship
to the dying child were only intensified when,
on
a few months
after the Pulitzer
Prize announce
moral
1994,
July 29,
ment, The New
had committed
the child,
on September
12,
Carter's
reported
clarifications
about
followed:9
.. .he wandered
obituary
in which
ends with
cried. He was
depressed
to hug his daughter.10
a section
entitled
"The Horror
of
the Work,"
son "Always
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
his
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
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
vivid memories
starving
police,
of killings
and
or wounded
children,
of killer
executioners_"12
of horror:
and
"I am haunted
and
corpses
anger
of trigger-happy
madmen,
by the
.of
pain..
often
to his
much
Scott Mac
at the execution
reprinted
reports
dilemma:
by newspapers
that Carter was
Time
tioned
right
another
some
vulture
on
of Carter's
the girl."14
It is easy
the
friends
to moralize
scene."
Scott Mac
"wrondered
notes
Leod
aloud why
he had
that
even
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
about
how
Carter's
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
tale of moral
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
Carter's
icon
Kevin
suicide,
of
suffering
Carter
is transformed
of
the photograph
a classic example
the heart of darkness,
emplotted
as
Africa
with
becomes
a subject
in the
the prize-winning
at a distance,
cultural
from
a narrative,
a
of Joseph Conrad's
to
the
site of
story
his
social
story
image,
becomes
a name
is
that
of
depiction
Carter
horror.
photograph
helped
write
he had
infected
by being transformed,
to bear.
But what
Cultural Appropriations
more
than
affected,
by what
the horrors
by the little Sudanese
girl,
experienced
nor
name
a
a
The tension
local moral world?
neither
of
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
who
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
may
professions
help
explain
how
Carter
got
us
into this situation of bringing the global into the local, but they fail
how we will
to explain
get ourselves
complexities
We
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
condition?a
solace.
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
failures
and global
Without
cans
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
must
must
be done
of action
intervention,
aid, even foreign
enous absence,
an erasure of
soon,
an evocation
begins with
local voices
and acts.
of
indig
local worlds.
disasters,
illnesses,
other non-Western
the
of
image
Western
mode:
is alone.
and deaths
in the West.
or, for that matter,
societies,
Yet,
an ideologically
is culturally
in
represented
it becomes
the experience
of a lone individual.20
famine
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
The
next
child
institutions
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,
is deemed
local world
incompetent,
too thoroughgoing
can do good, but
seem
This may
and mobilization
the complexity
seriously
institutions.
local
Moral
to other,
and
unspoken
about
else,
entertainment.
are
Papers
are advanced,
as we
has,
local
also must
involve
witnessing
moral
and political
assumptions.
that
suffering,
especially
suffering
reading
where
of
or worse.
a form of
become
noted,
already
are part of our political
economy.
audience
programs
share, careers
gain
of trauma
Images
sold, television
appropriation
but his victory,
as itwas,
was
substantial
misery
of
the
is that
of
appropriation
of cultural
processes
globalization
across
One message
that comes
distance
Watching
exists some
have
Prize,
dubious
a sensitivity
won
because
of the
human
must
is what
the
through
the Pulitzer
in
misery
be addressed.
the
from a
suffering
we
are
some
society,
from
viewing
inWestern
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"
how
better
different
than
from
a higher
at
colonial
in each
involved
and
the
historical
child
globalization
ened human
Another
view
development?a
are
Both
forms of cultural
carries
commercial,
The point
appropriation
and
the
is that
the
image
and
programs
of
"modernization"
that have
financing),
in sub-Saharan
Africa.21
world's
the postmodern
serious
of
such
images
of
of the vulture
the brutal
including
as the dubious
cultural
entailments,
as well
of colonialism
recent
authorized
in
representation
are deeply
political
cultural
(of markets
problems
effect of
that
of
other.
genealogy
of the more
baggage
nomic
level
exploitation.
the
the moral,
which
society. We
view
that the savage
late nineteenth-century
of our own civiliza
lands justified the valuing
the
in pagan
barbarism
tion
this African
and
and eco
political
forms of suffering
Cultural Appropriations
at a distance
overwhelmed
to see,
and
is that
the viewer.
desensitized
are
Viewers
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
Thus, our
neither understood
of
it has
nor
fixed works
images
with
to produce
of
suffering
and political
empathy,
despair.
iswhen
The appeal of experience
the massive
moral
we
globalization
exhaustion
fatigue,
see on television
of
a wounded
a threatening
accusa
crowd,
protesting
of a murderous
organiza
paramilitary
is when we are shown
that the man
images
surrounded
Haitian,
by
tions that he is a member
tion. The
of
dismay
are
and the crowd
themselves
surrounded
determine
participation
helps
The appeal of experience
and
in Kevin Carter's
photograph,
by photographers,
the direction
the event will
whose
take.22
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
cultural
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
PATHOLOGIZING
When
over
SOCIAL SUFFERING
those whose
to places
another
type
suffering
of refuge and
of
arrogation.24
is appropriated
by the media
submit
safety, they often must
Their
memories
(their
cross
to yet
intimately
10
interior
of violation
images)
trauma
stories
then
These
capital, with
and achieve
are made
become
over
the
into
trauma
the
currency,
stories.
symbolic
resources
for physical
they enter exchanges
the status
of political
those
refugee.
Increasingly,
a
core
to
in
based
real
reduced
events,
stories,
yet
which
complicated
cultural
image
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,
who
specifically
a patient
must
be represented.
Then
a
with
quintessential
a patient,
si?cle disorder
he becomes
fin de
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
is a victim
to one who
sick, who
financial
has
a disease.
to one who
of political
violence
is
of the practical
and
political
the violated
them
transformations,
Because
of such
importance
selves may want,
and even seek out, the re-imaging
as well
tion so that they can obtain
the moral
ill. We
to
the
financial
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
benefits
of
being
need
of their condi
as
what
in what
tient? And
perhaps
and
"paranoia,"
even
is lost and
resistance,
a "failure
to cope"?
There
is an uncomfortable
unnecessary
correlation
and Bosnia
temala, Rwanda,
are reported
in the news. We
and landmines.
off by mortars
terrorizing
into pieces,
details
of
populations,
blown up,
are dramatically
victims?their
trauma
appropriated
and sexual
by the
violence
is replaced
as the
as well
political
by "guilt,"
is an uncanny
and
in Gua
of murder
in which
those deaths
and the way
are shown close-ups
of limbs blown
at
In low intensity warfare
directed
popular
commodified,
codes
through which
physical
sold in the cinema, mar
Cultural Appropriations
keted
tract
other
11
as
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
attention
from
The
aesthetization
at home.
misery
of child sexual abuse
routinized
is another
case
in point.
prepubescent
smile, a tousled
"The
the
Sex Market:
context
of
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,
sought
to represent
the distress,
disable
cost
the
of these conditions.
Therefore,
they
to construct
new metrics
to measure
the suffering
have realized
are unable
These
"morbidity."
the burden
claim, to measure
can enable the just allocation
inmedical
metrics
can
of suffering
of resources
the experts
applied,
in "objective"
terms that
to those most
in need.26
12
One
metric
of
suffering
attention
has
recently
developed
and considerable
gained wide
describes
what
the World
Bank's
result
from
Bank
of DALYs
of the application
illnesses globally.
the World
II
Image
support.27
mean
economists
by the
health
by
It emphasizes
should
suppose,
problems?suicide,
stance
abuse?higher
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
to them.
applied
ask a different
What
question:
and professional
kind
of
appropriation
of cultural
suffering
represen
is this?
Life Years
Adjusted
The World
Disability
by specific
produced
of the disablements
it combines
diseases;
result
that
from
of the premature
deaths
and
impact
at a given
In taking
death
diseases.
age
the expectation
lost is evaluated
by using
the
those
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
is taken
evaluation
differential
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
thereof)
that
of
a given
disadvantage
For
death.
disease
and
of
disability
example,
the female
Source:
Income
the
expert
on
panels
the comparative
represents
Severity
to 1, for
from 0, for perfect
health,
at a severity
of 0.6,
and
rated blindness
lasts.
disability
handicap
a scale
have
system
reproductive
are combined.
In calculating
the
relative
at a severity
of 0.22.
the formula
DALYs,
Losses
takes
from
death
into account
of
those
years),
et al., World
Robert Desjarlais
Countries
(New York: Oxford
and
Mental
University
the years
Health:
Press,
compromised
Problems
1995),
lost
by handicap.
and Priorities
295.
in Low
Table
Region,
1. Distribution
1990
of DALY
13
Cultural Appropriations
Loss by Cause
and Demographic
(percent)
Sub
Saharan
Africa
Population(millions)5,267.0
510.0
Other
Asia &
Islands
China
850.0
Latin
America
& Carib
bean
Former
Socialist
Econo
mies of
Europe
346.0
1,134.0
40.1%
0%
36.0%
74.8%
4.6
6.2
1.3
Middle
Eastern
Crescent
0.2
11.3%
5.9
3.9
45.8%
71.3%
50.3%
48.6%
25.3%
13.0%
42.2%
51.0%
10.7
8.3
10.2
8.6%
10.8
100.0%\
1,362.0
100.0%
293.0
100.0%
100.0%
100.0%
100.0%
100.0%
292.0
201.0
177.0
103.0
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
of
is
as
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
an objective
to develop
indicator may
be important
choice concerning
of scarce resources
allocation
among
and programs.
should
the
(It certainly
support
policies
effort
for rational
different
of
importance
funding
mental
health
programs,
even
though
as it
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
it does
lead
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,
in lay terms.
is expressed
focuses on the individual
sufferer, deny
is a social experience.
This terribly thin represen
of
illness
the index
human
condition
may
It can do
of
experience
suffering.
the apparatus
of cultural representation
which
in time
also
thin out
this by becoming
that creates societal
part
the
of
norms,
in turn shapes the social role and social behavior of the ill,
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
and what
viders.
describe
should
The
American
their problems.
Thereby,
the illness
experience,
for some,
Cultural Appropriations
may
be transformed
from
15
a consequential
moral
experience
is what
Czeslaw
into a
technical
inexpediency.
of experience
transmutation
a refugee
from political
violence,
merely
This
slow
himself
in taken-for-granted
grips with
tion in the popular
culture
that
cultural
infiltrate
Milosz,
to come
to
us
presses
of representa
processes
of
the ordinary
practices
living:
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
Almost
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
and systematically
by those masters
poisoned
also do not know what they are doing?29
DALYs
and
other
economic
indexes
of photography
of health
who
conditions
have
of course. We
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
States, the only authorized
and programs.
These economic
the United
policy
mented
by narratives,
even
to the complex,
sent this other
side,
leaves
out most
construction
measures
need
ethnographies,
and social
contradictory,
the economistic
human
of what
is at stake
histories
side of
measurement
for peoples
of suffering
for
to be comple
that speak
suffering. Ab
of
globally.
suffering
16
ABSENT
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
It
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.
the massive
story was
This
not
reported
in China
starvation
from
though
1959
more
of
policies
the perverse
effect of Mao's
Forward,
on peas
immediate
industrialization
forcing
most
of this, the world's
famine, were
devastating
dream
impossible
ants. Accounts
Leap
of
no
totally
suppressed;
dead were
published.
An
team
stories
or pictures
of
It was
on a detailed
the
starving
or
the
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:
based
survey
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
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,
Wang
Til
die of hunger
in a few days.'"
And
indeed he
did.31
The
Wudian
report
also
County,
includes
a graphic
Shanwang
Brigade:
image
by Li Qin-ming,
from
17
Cultural Appropriations
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
Zhang-yu,
terrible
image:
this
from Guanyu
offered
County,
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
to be at death's door to combat the rumors. He
imprisoned 63 people from the entire country. Thirty-three
seemed
secretly
died in
prison.33
restricted
only.
To
it is to reveal
distribute
state
secrets.
Pre
to have
Party's
the authorities
by
collective
and
suffering,
The
absent
public
silence
is also
image
is perhaps more
images of
delimit
appropriation
by public
the
by denying
forgetting,
a culture
thus creates
a
form
collective
experience
of
terror.
of
of
appropriation;
political
than being overwhelmed
terrifying
Taken
the two modes
of
together
atrocity.
the extremes
in this cultural
process.35
CODA
Our
of appropriations
critique
mean
that no appropriations
of suffering
are valid. To
does
not
that would
be
that do harm
conclude
18
to undermine
be much
would
human
humane
to respond
to human
we
than the problem
any attempt
destructive
more
social
paralyze
action.
suffering
must
We
to
in order
draw
upon
needs
human
identify
It would
misery.
it
have identified;
responses.
to do so,
Yet,
sure
make
images of
and to craft
we
to develop
valid appropriations,
the biases of commercial
emphasis
that
the
must
first
on profit-mak
and the narrow
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
be
to historicize
the
of
issue before
action
are
intended,
and exploited.
up
and health-policy
experts
them and to critique
the
at hand
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
cultural
mechanisms
well
how
taken
current
that
institutional
human
Humanizing
that
have
that work
problems,
professionals,
latent
those
focusing
structures
"experts"
institutional
been
behind
must
authorized
even
the
to respond
to
intentioned
best
be held
effects
responsible
can be controlled.
interventions
to define
are organized
on the interpersonal
and evaluation
planning
context
of action. This
the local, ethnographic
at
is
for participants
with
what
stake
engagement
suffering,
not only
local worlds,
but
those
local
how
means
space
of
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
bringing
into the
participants
of
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 policy.
Those
tools
analytic
19
to
need
ments
that bring
alternative
perspectives
the health
sciences
social
and
sciences,
is to
The
goal
of
purposes
practice.
reconstruct
lems.
Ultimately,
we will
globalization,
commodification
such
uses
pornographic
to violence
relation
that has
attracted
the
of
serious
attention
issue would
first
and narrative
graphic,
to engage
the more
the commercialization
experiences
Regarding
social experience
of how
the object
of degradation.36
in the streets and
scholars.37
ominous
of
and
atrocity
Violence
fundamental
is being transformed
seem
to be to develop
studies
suffering,
and
abuse,
alters
cultural
the
the
question
in untoward
historical,
a more
powerful
that provide
disordered
of
aspects
in the media,
and its
in homes,
is already a subject
from communities
and from
the humanities,
the
on human
prob
of inquiry
and the
have
as
of
from
to bear
through which
the
ways,
ethno
un
the global
connections
between
capitalism
so
and
that
moral
for
experience
subjectivity,
sensibility,
or
becomes
diminishes
different:
example,
something
frighteningly
from
and ac
promiscuous,
gratuitous,
unhinged
responsibility
regime
collective
tion.38 There
plated.
social
is a terrible
The
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
have
been wrong
constraint
limiting
to consider
the moral
change.
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
or
even
to
ought
take
charts
life no
sea on
taking
us.39
ENDNOTES
is drawn
1This essay
from a larger project
to read Arthur
may wish
fering. Readers
concerning
Kleinman
Good
et al.,
Pain
eds.,
the
and
social
experience
Joan Kleinman,
of
suf
"Suffer
as Human
Experience:
Per
Anthropological
Resistance,
China's
following
Cultural
Revolution,"
New
the heterogeneity
of meanings
(Paris:Metailie,
of
and modes
suffering,
1993).
for example,
see,
of the World
John
(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:
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
21
Cultural Appropriations
California Press, 1991); and Elaine Scarry, The Body in Pain (New York: Ox
ford University Press, 1985).
The
Testimonies:
Holocaust
Langer,
Yale University
Press,
1993); Nancy
5Lawrence
Conn.:
Ruins
(New Haven,
Death
Without
of Memory
Sheper-Hughes,
and Kleinman,
its Professional
and
"Suffering
Transformations."
1993, A3.
disorder,
political
show
1991),
Press,
versity
that
crop
in sub-Saharan
famines
failure
Africa
as a result
of
se.
per
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
Time,
Carter,"
12 September
70-73.
1994,
73.
12Ibid.
13Ibid.
14Ibid.
15Forthis view of the "taking" of victimized social subjects by the more powerful
"a privileged
photographer,
observer"?the
of power"
"eyes
idea?see
W.
J. T.
relationship
16On the dilemmas
for cultural
in the Global
tions
Ecumene,"
standing Translation
1993),
See
responsibility.
Ibid.,
421-25.
Discourse
and Anthropological
41-57;
and
representation
"When
Under
(Providence: BERG,
is Everywhere:
Culture
"Media
on
Reflections
because
that philosophical
of decisively
is ultimately disappointing
knowledge
out
sorting
such
"ordinary"
com
human
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
for."
18The analysis
Robert
that
follows
in Arthur
in this
Kleinman
section
on materials,
draws
and Robert
and
contains
several
and
Culture
"Violence,
at the Margin,
in Arthur
of Trauma,"
Kleinman,
8;
Writing
chap.
and Arthur
"Violence
and Demoralization
in the
Kleinman,
Desjarlais
paragraphs,
the Politics
Desjarl?is,
Today
22
and
Robert
"Ni
Desjarlais,
ni
patients
victimes:
Pour
une
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
cultural
of personification
Hebrew Literature
21
See
on
the chapter
of collective
see Alan
representation,
catastrophe
Hurban:
Mintz,
in the Western
tradition
of
to Catastrophe
Response
in
global
change
in Robert
et al., World
Desjarlais
Mental
Fund's
the
health
worked
often
health
of
program
rigorously-applied
in sub-Saharan
of women
and
social
social
and mental
to those
responses
policy
restructuring
volume
also
This
to worsen
either
economic
Africa.
health
The New
"Taking Haiti,"
problems
problems.
York Times
xii.
1988),
section
following
25SeeAllan Young,
on materials
draws
Culture
"Violence,
Desjarlais,
and
The Harmony
in Arthur
the Politics
and
Kleinman
Robert
of Trauma."
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
(Princeton,
Memory
Health:
and
Problems
26ArthurKleinman,
Ware,
Priorities
in Low-Income
and Kleinman,
and
Social
Countries.
in International Health,"
in Chen,
Change.
(New
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,
of Books,
30Central
Committee,
Yang County,
31Ibid.
"The
11 August
State
of Nature:
Notes
from
a Diary,"
New
York
Review
1994, 41.
Chinese
Communist
1961, 188-91.
Party,
Internal
Report,
Annals
for Feng
23
Cultural Appropriations
32Ibid.
33Ibid.
34See James
C.
Scott,
Domination
the Arts
and
of Resistance
State
Under
American
Research
35It is not
the
only
An
Socialism:
in Rubie
Introduction,"
Press,
ed., Memory,
School of
1-20.
1994),
state
totalitarian
Watson,
and Opposition
History
Conn.:
(New Haven,
use
that makes
of
of
the weight
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
that
fact
there were
Western
dozen
several
Times
York
among
ists_"
Westerners
"Western
York
agencies,
7 November
Times,
visitors
in Rwanda,
with
fascination
relief
here?the
The New
tinues:
"A
said:
death
A4.
The
created
Nations
the United
1994,
tour massacre
regularly
in Baghdad.
journalists
and
Times'
sites where
voyeurism
the journal
con
reporter
are
bodies
rotting
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
voyeuristic
ening
be another
may
sensibility
side of
the cultural
process
we
have
identified.
37With
Motives,"
of
fense
still
there
picture,
are
registers
limits
put
by the responses,
in which
campaign
advertising
an oil-soaked
a war
cemetery,
of a Croatian
terms,
to sell clothing.
soldier
uses
to which
in Germany
report on violence
issue of cultural
are used,
even
in a strange paradox
"Benetton
Touches
Nash,
and
atroci
representa
can
images of suffering
to Benetton's
provocative
especially,
with
of bodies
tattooed
pictures
labor in South America,
bird, child
See Nathaniel
"Moral
Harwood,
of
to the commercial
is shown
uniform
Richard
for example,
who
journalists
of the moral
complexity
motivation
the
see,
Post, 21 November
The Washington
the ethical
ties, yet
tion.
38That
to the Carter
relation
"HIV-positive,"
and the bloody
by postmodern
a Raw Nerve,"
18.
of the World,
1914-1991
be