BOOK REVIEWS

Half-Lives and Half-Truths, Confronting occurred the world over spreading fallout the Radioactive Legacies of the Cold War. far and wide), and (5) disposal (anthropol- Barbara Rose Johnston, ed. Santa Fe: School ogist Edith Turner, astounded at a very high for Advanced Research Press, 2007. x + cancer rate in Alaska’s Inupiat community 326 pp. in the 1990s, helped illustrate that it was not “lifestyle” but a nearby radioactive dump Brian McKenna site that accounted for the spike). World- University of Michigan-Dearborn wide thyroid cancer, leukemia, birth abnor- malities, and other conditions linked to nu- The world is in a perilous financial melt- clear exposures are far more extensive than down. This book addresses the industry that previously thought. The anxiety of living introduced us to that term. There are 439 next to a radiogenic site is felt by millions. nuclear power facilities on the planet to look Moreover, the majority of the suffering— after. At least two nuclear reactors have more than 70 percent—has occurred in in- already suffered partial or full meltdowns digenous communities, referred to by one (Three Mile Island in 1979 and Chernobyl critic as “national sacrifice zones” (p. 301). in 1986) causing much bodily and psy- Johnston entitles one of her own chapters chological suffering, especially in the now- “more like us than mice” (lower case as radiogenic communities that surround the in original). The phrase is drawn from a plants. The current financial meltdown has transcript from the Atomic Energy Commis- come from the U.S. government’s embrace- sion Advisory Committee on Biology and ment of neoliberalism, a movement that Medicine that referred to indigenous peo- abandoned effective regulatory oversight ples as such. Johnston writes, “This view— over banking, housing, and Wall Street. Has that human groups are more or less evolved, the homeland security state, under neoliber- with primitive ‘natives’ being biologically alism, done any better regulating the most inferior to Western ‘civilized people’—was a lethal industry in the world, nuclear? common and useful notion ...dampen[ing] Not on your life. As Johnston and her any moral qualms about the planned use of 14 anthropology colleagues make abun- the Marshallese population in human radi- dantly clear, it’s not just nuclear melt- ation experiments” (p. 26). down disasters that we should fear but The Marshall Islanders have suffered the cradle-to-grave circuit of nuclear pro- greatly. As we learn in the chapter by Holly duction. This circuit includes: (1) uranium Barker, they live in Micronesia, acquired as mining (Navaho miners have been espe- a trust by the United States as a kind of war cially hard hit with thousands of deaths), booty after the United States defeated the (2) uranium processing (there are 2.35 bil- Japanese in World War II. On the atolls lion tons of radioactive “tailings” remain- of Enewetak and Bikini in the Marshall ing after uranium extraction), (3) weapons Islands the United States detonated 67 ther- development (between 2001 and 2004, tens monuclear weapons from 1946 to 1958. of millions of cubic meters of liquid radioac- It was the equivalent of 1.5 Hiroshima- tive waste were dumped into Russia’s Techa style bombs dropped every single day for River), (4) testing (2,057 nuclear tests have 12 years (p. 214) The 6.3 billion curies

558 Book Reviews 559 of iodine-131 released there is 150 times powerful concluding essay by Laura Nader greater than the estimated 40 million curies and Hugh Gusterson. The book has seven released at Chernobyl. U.S. government re- maps, 16 photographs, and seven tables. searchers evacuated some Marshallese and My favorite figure is on the cover itself: a enrolled them in a secret medical experi- bright yellow and orange rendering of a nu- ment, called Project 4.1, to ascertain the ra- clear explosion replete with seven soldiers diation effects on human beings. Marshall in silhouette. It signals that the book will be Islanders were placed back on the radio- unconventional, and it is. genic islands—with its contaminated food, The decades-old silence within biomedi- soil, and water—to monitor their health cine and anthropology regarding nuclear and calculate radiogenic effects. And they catastrophes is duly noted. When scientists found a very long list of them, from dia- produced data that contradicted the offi- betes, growth impairment, and sterility to cial story they found themselves outcasts, miscarriages, congenital birth defects, and discredited, or unemployed. The message: cancer. The National Cancer Institute pre- there are severe consequences for speaking dicts hundreds of additional cancer cases out. The results are deplorable. As Johnston into the 21st century. The medical and pub- puts it, “control over scientific findings al- lic health infrastructures are overwhelmed. lowed the systematic use of half-truths to Meanwhile, in 2009 the U.S. government pacify public concerns while expanding the contributes just $7 per patient per month in nuclear war machine” (p. 2). In this light the communities most affected by the test- every anthropologist must learn the name ing programs. According to Barker, “There Earle Reynolds, and the chapter by David is no oncologist in the Marshall Islands, no Price is a good place to start. chemotherapy, no cancer registry, and no In 1951, Reynolds, a physical anthropol- nationwide screening program for early de- ogist, moved his family to Hiroshima to tection” (p. 215). work as a biostatistician for the Atomic Johnston and her contributors used Bomb Casualty Commission’s Pediatrics participant-observation, interviews, sur- Department. The more he learned about the veys, literature reviews, government docu- devastation and the physical and psycho- ments, freedom-of-information-act (FOIA) logical horrors endured by the Japanese, the requests—with much governmental mate- more he became convinced that the nuclear rial redacted—and engaged advocacy to as- arms race had to be stopped. He under- certain the hidden history of what Johnston stood that his work was to survey the bod- calls the “first nuclear age.” It is, of neces- ies of Hiroshimans to predict casualties in sity, transdisciplinary work. The chapters a later nuclear war. He quit and became represent critical ethnographic case stud- a world renowned activist. He received let- ies from the United States (secret nuclear ters of support from around the world, even dumping in Alaska, mammoth radiation from Martin Luther King Jr., but his col- releases in Hanford in Washington State, leagues in the American Anthropology As- rebellious Navajo uranium miners in Ari- sociation came to regard him as “a danger- zona and New Mexico, frightened down- ous outsider” (p. 62). wind communities in Nevada, and pseu- Price used FOIA requests to learn to dopublic participation programs in Rocky what extent Reynolds’s actions were moni- Flats Colorado), the South Pacific (e.g., the tored by the state. He was closely watched. toxic Marshall Islands), and two former Moreover, as Price notes, “Reynolds’s Soviet republics (secret nuclear cities in Rus- activist-applied anthropology radically un- sia’s Chelyabinsk, a site whose radiologic hitched mission from employment. His accidents were worse than Chernobyl; and story illustrates how applied research find- Kazakhstan, a region blanketed with radia- ings can bear a weight of uncomfortable tion from 496 Soviet-era nuclear tests). The responsibility—a responsibility that if acted articles are well integrated and build to a upon can lead anthropologists to take duty 560 Medical Anthropology Quarterly bound actions ...[that endanger] their ca- pological action research to help develop reers. That it seems unusual to consider personal injury claims for the Marshallese. the outlaw Reynolds an applied anthropolo- With support from the Public Advocate gist tells us more about the ethical banality for the Nuclear Claims Tribunal and a we encounter in our work in mainstream Marshallese Advisory Committee, they de- applied anthropology than it does about veloped a model to rethink the meaning of Reynolds” (p. 70). land value in accordance with traditional If one wonders why most choose to shun views, where land is not owned but is a social activism and remain silent, a letter means to sustain life. Drawing on Native from a Marshall Islander to one Dr. Conard, American–First Nation–Aboriginal case law a physician, helps provide part of an answer. and related methodologies, they wrote re- ports, organized testimony and worked tire- Your entire career is based on our lessly behind the scenes as advocates. In a illness. We are far more valuable to spectacular April 2007 decision, 16 years you than you are to us. You have since the first claims were filed, the Nuclear never really cared about us as Claims Tribunal awarded the claimants people—only as a group of guinea $1.03 billion, setting enormous precedents pigs for your government’s bomb for years to come. research effort. For me and the And yet, despite this terrific work, people on Rongelap, it is life which Johnston and Barker often seem to be do- matters most. For you it is facts and ing it in the margins. As Laura Nader notes, figures. There is no question about “over the past fifty-plus years, relatively few your technical competence, but we American anthropologists ...have voiced often wonder about your humanity. opposition to this [Marshall Islands] de- [p. 45] struction” (p. 304). Nader critiques the scores of anthropologists who worked in The anthropologists in this book are, the Pacific, like Margaret Mead, but never however, critical rebels like Reynolds rather spoke up about the nuclear testing. More than that letter’s addressee. True to their than just to criticize, the book provides interdisciplinary training and moral con- much insight into why. science, they do not compartmentalize The book has only a few minor weak- knowledge to restricted technical fields. nesses. It would have benefitted from a more Rather, as citizen anthropologists, they ad- intricate theoretical discussion of the culture vocate for the people they study. of neoliberalism. Also, I would have added One of the most significant case studies in an appendix that explained the treadmill of this regard is by Edith Turner who openly nuclear production, in simple form, using reflects on how she transformed from a tra- graphics and pictures, for those readers new ditional academic into what Johnston calls to the subject. And the book would have a “proactive scholar-advisor-advocate who benefitted from a case study on emerging works for and with her host community” nuclear powers like India, or China, which (p. 14). Turner shows that there have been has had more than 40 weapons tests to date. professional advances within anthropology But these gaps pale in relation to the since Reynolds’s era: she can legitimately be- book’s fundamental strength: it serves as a come an open advocate circulating in the means to inform as it models how to do corridors of power in Washington, DC, on engaged medical–environmental anthropol- behalf of her community. ogy. It underscores the importance of study- Again and again the book illustrates this ing up. I have used the book as a template dramatic form of anthropology that directly for student research with good effect, for intervenes into public policy—and often instance in my “Anthropology of Health gets results. For example, in 1999 Johnston and Environment” course. I teach just a few joined Barker to conduct a form of anthro- miles from Monroe’s Fermi plant, site of a Book Reviews 561

“partial fuel melting event” in 1966. News role played by indigenous spiritual heal- of this was kept from the public for seven ers or shurufa suggests the low status of years. My students conducted ethnographic Western medicine in parts of Morocco (in- research into the Monroe area and found deed, some physicians use terminology orig- deep community fear and anxiety over ex- inating from spiritual healers to attract pa- posures. Although official medical and pub- tients). lic health documents reassured them that all Moroccans seem to attribute specific dis- was fine, a good many attributed their can- eases to specific tribes of jinn [demons]. cers and health problems to the Fermi com- Jinn are identified by Maarouf as being of plex and were frustrated that their physi- Muslim, Christian, and Jewish faiths, and cians discounted their concerns. As of this kuffaar [infidels]. They are linked to fire, writing there are plans for building a new heat, and drought (p. 61) as well as ill- reactor at the site, despite increasing com- ness. To heal certain illnesses, jinn must be munity protest. evicted. Functions of the eviction process in- Beyond its use for galvanizing student clude: socialization of the patient, develop- researcher–activists in anthropology, the ing a shared worldview, provision of group book will be helpful in courses on energy support, assisting the patient to master the policy, ethnographic methodology, engi- problem, eviction of the jinn, and member- neering, and science and technology studies. ship in a cult. Not all of these functions have The writing is suitable for both undergrad- to take place for the process to be consid- uate and graduate students. ered successful. What is apparent is that the As a youth in the 1970s, I re- client must admit to some moral lapse in member attending a powerful speech judgment for the jinn to be willing to re- by physician and nuclear activist Dr. lease him or her. The eviction process is Helen Caldicott. I was struck by her sharp very close to that I found among priests and intelligence, passion, and by how well she witches in rural Ghana and the Houngan in integrated health, society, and politics to Haiti. an important medical end. I did not see Jinn eviction is a process that presents an this happening in medical school, so I alibi to explain irrational fears and anxi- turned away from a career as a physi- eties: “The Shurufa are, in this sense, in- cian and chose medical anthropology in- tuitive psychiatrists” (p. 166). Women and stead. Unfortunately, in graduate school, ac- the unschooled seem to be the most frequent tivism was frowned on. I wish I’d had this clients. Maarouf also mentions that there is book then. This book is a blueprint for a a system of charging patients based on their kind of engaged anthropology that matters. ability to pay. It is interesting that a part of the eviction Jinn Eviction as a Discourse of Power: A is done without reciting from the Quran Multidisciplinary Approach to Moroccan but, rather, by beseeching the Saint. This Magical Beliefs and Practices. Mohammad may support the theory that the system of Maarouf. Leiden, the Netherlands: Brill, Sainthood may parallel, rather than be sub- 2007. xiv + 337 pp. servient to, Islam and may explain why small movements seem to spring up around Bill Ward the Muslim world appearing to conflict with University of South Florida the true tenants [tenets] of Islam. Sufism and Sainthood generally have received the sup- The book spends only a small portion of port of the kings of Morocco, perhaps as its focus on actual illness and health, but a way of keeping the more radical move- it does lay a foundation for understanding ments of Islam at bay, because Sufism tends how mental and physical illness fit within to be more of an individual internal system Moroccan traditional culture. The author of beliefs. In fact, the royal family has con- provides the perspective that the important tinuously made efforts to be legitimized by 562 Medical Anthropology Quarterly the Moroccan Islamic Order. To show the above, the book helps answer important nature of this reciprocation, the king and his questions of interest to the Western audi- father have held under house arrests leaders ence who often draw incomplete opinions of the Islamic Jihadist movement tied to the about Islam, a religion typically of peace and Saudi Wahhabis (very conservative ortho- submission. dox Sunnis typically at odds with the Sufi In conclusion, the book is very well done movement predominating in Morocco). and is an important addition to the fields of Maarouf spent considerable time in field- medical anthropology, mental health, and work in communicating directly with the psychiatry. It also adds significantly to our subjects of his book and in translation of re- understanding of Middle Eastern religion, ligious documents. He introduces a number culture, history, and politics. of sociologic and anthropologic models to integrate his fieldwork and historical docu- The Making of Psychotherapists: An ments. He references Souriau’s model of the Anthropological Analysis. James Davies. “founding” legend (Gilgamesh, etc.) and its London: Karnac Books, 2009. vi + 312 pp. components and asks “How well does this fit with the Saint/baraka/afriyt/jinn legend Karen Seeley of Morocco?” He also provides kinship and Columbia University descendent charts and includes maps show- ing the juxtaposition of the various lineages, Although psychoanalysts place a premium their fields, and their zawaayah [religious on developing individuals’ capacities for corner or hangout]. At the end of the book, self-reflection and self-knowledge, when it there are numerous photos of documents comes to examining their own discipline along with translations and photos of the they have failed to cultivate a similar re- settings in which he worked; these enhance flexivity. According to James Davies’s fasci- the book’s message. Because I was familiar nating book, the medicalized mental health with the Arabic terminology but not how it landscape in which English psychoanalytic is in use in Morocco, I found myself flip- institutes currently operate—which favors ping back and force between the writings, cognitive and pharmaceutical treatments— the documents, the charts, and the maps. further discourages analysts from critically They were extremely useful. Readers are en- assessing their institutional systems, theo- couraged to print out a copy of the glossary retical assumptions, and professional prac- and keep it at hand while going through the tices. Indeed, the struggle for survival that book. this landscape fosters has increased the insu- The book is useful reading for those in larity and conformity of a field that already the field of cross-cultural mental health and is distinguished by its rigid adherence to or- psychological rehabilitation. It would not be thodox traditions. useful for someone simply interested in gain- Davies’s provocative study invites readers ing a brief overview of aspects of traditional to do what psychoanalysts long have refused life since it is much too deep for that and to do: to closely examine the workings and is heavy reading. Its strengths are its detail, aims of psychoanalytic training institutions its in-depth understanding of certain aspects or institutes—especially the overriding aim of Moroccan society, and its modeling of a of ensuring their preservation. Treating the process of spiritual healing. institute as a community, he sets out to dis- There are not a lot of weaknesses in the cover its social structure, mythologies, and book. The author has done a good job rituals, and the ways it secures their repro- of making a personal transformation from duction. Because the author is a psychother- what appears to be a rather urban orien- apist as well as an anthropologist, he enjoys tation to the primarily rural view the book dual vantage points and an uncommon de- gives. Further, although not the apparent in- gree of access, letting readers enter a world tention of the author, as addressed briefly that ordinarily is closed to outsiders. Book Reviews 563

Before continuing, it is important to note lished formulas. Moreover, because dissent that this book, set in England, uses the term is pathologized, trainees quickly realize that psychotherapists to refer to those who are it is unsafe to challenge teachings or to pro- trained in models “stemming from Freud’s pose new perspectives. Psychoanalytic insti- original teaching” (p. 18), including the tutes thus systematically inhibit the free ex- classical analytic stance of abstinence and pression and critical thinking that they claim objectivity. This distinguishes them from the to prize. majority of U.S. practitioners. In the United At the same time, as the result of their per- States, English psychotherapists would be sonal analysis, trainees become psychoana- called psychoanalysts. lytic subjects; they come to see themselves The book’s key question is: How do and their minds in psychoanalytic terms. Af- the pedagogical, experiential, and relational ter experiencing an intense course of treat- components of training ensure that the ment, psychoanalytic precepts are no longer next generation of analysts acquires abso- abstractions but are deeply internalized and lute faith in orthodox theories and their embodied. Once trainees embrace them as therapeutic efficacy? The strongest parts of true, they can apply them to others with ab- this book directly address this question. As solute conviction. Davies makes clear, psychoanalytic train- This book’s insights are especially valu- ing is a highly personal endeavor. Candi- able when they are supported by ethno- dates’ subjectivity, sense of self, and emo- graphic evidence. For instance, transcripts tional life are the principal tools of the of clinical supervision enrich the author’s trade. Moreover, to become psychothera- arguments on the reductionism of psy- pists, candidates first must be analyzed— choanalytic etiology. The particular case a process that can take several years. This presented illustrates the ways supervisors kind of requirement is unique to psycho- teach trainees to reshape patient’s stories to analytic training; medical residents do not privilege internal experience and intrapsy- have to undergo heart surgery to become chic fantasy. During this process, they dis- cardiologists. The usual rationale for it is card cultural information that is crucial that trainees must resolve unconscious con- to the patient’s predicament, because it flicts and other personal issues that might has no place in psychoanalytic explanatory undermine their neutrality and objectivity models. as therapists. But the author effectively ar- The book is less convincing when it gues that much more is at stake. Patients, by moves away from ethnography and imposes definition, are troubled and are in need of overly broad categories drawn from other expert help. Even when they are off of the studies to characterize psychoanalytic con- couch and are engaged in the didactic as- cepts and practices. In these cases, it fails pects of their education, trainees can find it to capture what is distinctive about insti- difficult to shake this sense of self-as-patient. tute training. For instance, in discussing the Because the stuff of their private psychic varieties of knowledge that are transmit- life is also the stuff of their professional ted during trainees’ professional formation, training, they often feel vulnerable, exposed, the book informs us that senior psychoan- and judged both as persons and as aspiring alysts rely on “secret knowledge,” which practitioners. they “intentionally conceal” (p. 110) from The imbalances in power that charac- trainees to augment their power. However, terize traditional patient–therapist relation- rather than trying to withhold knowledge, ships form the basis of other dyadic inter- they may be enacting specific norms regard- actions in the institute. Davies claims that ing how and when its transmission should this is a key piece of the institute’s strat- occur. egy for securing trainees’ conformity; the Further, while the book clearly depicts more powerless trainees feel, the more they significant power imbalances between se- seek to prove their worth by accepting estab- nior analysts and trainees, this emphasis 564 Medical Anthropology Quarterly sometimes obscures other facets of their When a Baby Dies of SIDS: The Parents’ interactions. As an example, where prior Grief and Search for Reason. Karen Martin. accounts have discovered parallel interper- Edmonton: Qual Institute Press, 1998, ix + sonal dynamics in institutes and in families, 315 pp. complete with intense attachments, such perspectives are absent here. Lisa M. Mitchell In addition, some of the book’s argu- University of Victoria ments are problematic. In Chapter 6, the book attempts to explain why Freud devel- What is it like to lose a baby to Sudden oped “psycho-centric” theories that locate Infant Death Syndrome or SIDS? This is the sources of mental distress in the indi- the central question asked by sociologist vidual’s psyche, rather than the social en- Karen Martin in her qualitative analysis vironment. The book suggests that Freud of interviews with 21 bereaved Canadian created such theories because he fit comfort- parents. Adopting a grounded-theory ap- ably into his society. However, Freud came proach, Martin draws from the words and of age in Vienna during a period of virulent experiences of these mothers and fathers to anti-Semitism. Key medical texts depicted offer a theoretical model of grief following Jews as malignant and mentally deficient. SIDS and an examination of factors affect- Freud was marked as racially other, to the ing parents’ grieving processes. Her analy- detriment of his career. Consequently, it is sis focuses on how parents experience the critical to ask how Freud’s tenuous posi- loss, differences between mothers and fa- tion in his society, as well as his conflicts thers, the impact of the death and grief on with it, influenced his work on psychoana- marriage, and the factors affecting parental lytic etiology. guilt. The book and her theoretical model Similarly, while the book is critical of psy- are organized along a temporal framework choanalysis for supporting “the conserva- of the SIDS death, beginning with the par- tion rather than the development of psycho- ents’ emotional attachment to their infant, dynamic ideas” (p. 116), it simultaneously discovering the death, being devastated, try- criticizes the field’s fragmentation due to the ing to carrying on as workers, spouses, and emergence of new schools of thought. If, as parents, and, finally, “learning to let go” cogently argued in the book’s final chap- of the grief. On the basis of her findings, ter, psychoanalysis arose in response to so- Martin offers numerous recommendations cial problems created by modernity, then we for health and law enforcement profession- should expect it to evolve as changing social als, as well as discussing the activities of conditions impose new demands on mental SIDS agencies, and she provides a lengthy functioning; we should also expect it to take list of hypotheses to be investigated in fu- varying forms in different communities. In- ture research. deed, this “fragmentation” results from the WhenaBabyDiesofSIDShas much same rejection of conformity and embrace to commend it. Martin suggests that SIDS of innovation that the author appears to deaths are distinctive for several reasons desire. including, for example, the automatic in- Despite these concerns, The Making volvement of law enforcement officials, the of Psychotherapists clearly accomplishes absence of a simple explanation for what what it sets out to do. This thought- causes SIDS, and the fact that it entails the provoking book, which is suitable for teach- sudden death of an otherwise healthy in- ing at both the graduate and undergrad- fant. The book includes many quotes from uate level, should make even the most the interviews with mothers and fathers unreflexive analyst question traditional in- and, as one might expect from a grounded- stitutional practices. If such questioning ul- theory approach, the analysis stays close to timately leads to better patient care, then we their words, phrases, and ideas. Martin does all stand to benefit. not translate parents’ experiences and ideas Book Reviews 565 into abstract or complex theoretical con- ing strategies appear as if they are universal, structs. Although she does situate her find- rather than products of particular histories ings within the sociological and psycholog- and particular ways of ordering society and ical literature on bereavement, her focus is meaning. The inclusion of longer passages clearly on finding order within parents’ sto- or narratives about individuals or couples ries of loss and suffering. even without identifying details would work Many of the quotes are painful to read, to convey a fuller sense of the relationships, and I suspect that bereaved parents will meanings, challenges, and strengths through find much here that resonates with their which the death of a child is experienced and own experiences, ideas, and statements. It interpreted by parents. is evident that Martin has attended care- A further problem is that her analysis of- fully to both commonalities and diversity ten feels as if it is imposing a particularly in the parents’ suffering. Particularly note- neat and tidy order and structure on the tu- worthy is her attention to the gendering of mult and agony of having one’s child die. In parental responses, frustrations, emotions, particular, throughout the analysis Martin and interpretations and to the ways in which makes use of 2×2 matrices, a strategy for spouses interpret each other’s response. In organizing data by investigating the inter- addition, Martin is frank in her estimation action of two factors under investigation in of the strengths and weaknesses of her work terms of four possible outcomes. This ana- and writes openly about losing herself in lytical strategy leads Martin to conclude, for the research and being overwhelmed by the example, that from among the diversity of grief of the parents. This reflexivity provides parental experiences there are four mourn- some insightful material for students and ing strategies, four marital types, four expla- researchers. nations of death, and four choices in dealing Anthropological readers, however, may with challenges to “assumptive worlds.” As find several aspects of Martin’s analysis useful as this sort of analytical technique frustrating. Although there are numerous might be for organizing data, the result feels passages quoted from the interviews, there contrived. is little sense of the men and women as Martin’s writing style and analysis is individuals, living in and creating particu- likely to be accessible to diverse audiences, lar configurations of family, work, income, including students, health care profession- friends, neighbors, personal history, iden- als, and researchers. However, the book tity, and meaning. Bereaved parents appear reads very much like a thesis or dissertation: only as brief interview passages undifferen- statement of problem, review of literature, tiated even by pseudonym and abstracted data chapters, a return to the literature, con- from what are undoubtedly complex, en- clusion and recommendations. The book is, tangled, partial, and contradictory stories in fact, based on research done by Martin of loss, grief, and struggle. Martin explains for her master’s degree; a thorough editing that ethical concerns and a desire to pre- would reduce repetitive phrasing, bring the serve participant anonymity within a rela- literature more fully into conversation with tively small research community motivated her findings, and enhance the narrative flow her to leave out these details, but this has of the text. two problems. First, to a large extent, par- In summary, When a Baby Dies of SIDS ents’ interpretations and actions are decon- offers readers a glimpse into the suffering textualized from the very aspects of their and struggle for meaning of mothers and worlds that inform, sustain, complicate, or fathers in Canada who lose a child to this mitigate their grief and through which they disorder. For medical anthropologists, how- make some or no sense of the death of a ever, the absence of attention to the histori- child. Second, without being grounded in cal, cultural, and social contingency of par- particular social worlds, parental emotions, ents’ experiences and interpretations may grief, attachment to their infant, and cop- raise more questions than it answers. 566 Medical Anthropology Quarterly

Fit to Be Tied: Sterilization and Repro- poor women, immigrants, and women of ductive Rights in America, 1950–1980. color became the target of state-enforced Rebecca M. Kluchin. New Brunswick, NJ: sterilization laws. Future battles over repro- Rutgers University Press, 2009; xi + 269 pp. ductive rights would spring from these di- vergent trajectories. Gina Louise Hunter As the crude biological determinism of Illinois State University eugenics fell from favor in the post-WWII era, neoeugenics emerged in response to Rebecca M. Kluchin examines the legal his- new social anxieties posed by incipient civil tory of sterilization in the United States in rights movement, Mexican immigration, the the second half of the 20th century, doc- expansion of welfare, and women’s roles umenting how the surgery evolved from a outside the home. As Kluchin defines it, tool of eugenics into a popular form of birth neoeugenics is the continuity of ideas, poli- control. Surgical sterilization (via tubal lig- cies, and practices of eugenics reframed for ation and vasectomy) has not received the a new social context. Although never a level of scholarly attention that abortion formal movement, the ideology of neoeu- and the birth control pill have garnered. genics combined racist fears about “wel- However, Fit to be Tied shows that the his- fare queens” and “pregnant pilgrims” with tory of sterilization use and abuse is key concerns about an impending population to understanding the struggle for reproduc- explosion to promote the voluntary steril- tive rights in general in the United States. ization as a solution to these and other so- The book also illustrates dramatically how cial ills. Interestingly, Kluchin demonstrates the reproductive experiences of American how the Association for Voluntary Steril- women have been highly stratified along ization (AVS) in particular was one agency race and class lines. that effectively bridged the transition from Kluchin contrasts the role of sterilization eugenic and neoeugenic moments (as ev- within the formal eugenics movement of the idenced by its membership and politics). early 20th century with the neoeugenic poli- Through its political activities, public cam- cies and practices that followed. Eugenics paigns, and service provision, AVS helped developed as a response to social anxieties to define medical and legal policy regarding in U.S. society wrought by industrialization, sterilization as well as shape public accep- woman suffrage, and the influx of South- tance of sterilization. ern and Eastern European immigrants. The Although eugenic sterilization decreased “science” of eugenics offered a solution to after WWII, the practice of forced steriliza- limiting the supposed hereditary defects of tion continued especially in the South where criminality, illegitimacy, prostitution, and doctors secretly subjected black women to sexual promiscuity. Such social engineering “Mississippi appendectomies.” In addition, appealed to white, middle-class Americans the emergence of federal family planning who feared that immigrants would outbreed policy, increasing legitimacy of voluntary the native born or “pollute” white racial sterilization, and lack of codified informed purity, and that the offspring of “degener- consent practices converged into a new form ate” families would become burdens on the of coercion in which physicians, using their state. Eugenics proponents sought to “bet- own neoeugenic ideas of acceptable moth- ter” U.S. society by encouraging “fit” (i.e., erhood and family size, compelled “unfit” white, middle-class, native-born) women to women to agree to sterilization. Thus, many reproduce, while restricting the reproduc- women signed away their future fertility tion of those deemed “unfit”—poor, mi- without the desire to do it or full knowl- nority, “feebleminded,” and immigrant men edge of the implications of the procedure. and women, and women found guilty of sex- Other women were denied access to steril- ual delinquency. “Fit” women were pressed ization. With the introduction of the contra- to reproduce in service to the nation, while ceptive pill in 1960 and the improvements to Book Reviews 567

IUDs in 1964, women came to expect nearly of reproduction and could be productively 100 percent effective birth control. By the paired with a nuanced ethnographic study 1970s, technological advances in tubal liga- of reproductive decision making. This ac- tion made sterilization more accessible and cessible and highly readable book will work attractive to women. As negative side effects best for students at the intermediate under- of the pill and IUD appeared, women in- graduate level and beyond. creasing turned to sterilization as an alterna- The usefulness of Fit to be Tied in the tive to greater control of their reproductive classroom is hindered by one major fault— careers. Many white, middle-class women, the lack of an explicit definition and dis- however, encountered pronatalist attitudes cussion of reproductive rights. Current con- among physicians and restrictive hospital ceptions of reproductive self-determination policies such as age and parity guidelines (and informed consent) take shape in the for sterilization. Adherents to neoeugenic time period under investigation. Kluchin’s ideologies allied with feminists fighting for discussion and interpretation of court cases greater access to reproductive health care to rest on current notions of reproductive au- remove restrictions on sterilization. tonomy that she never fully explains or ex- Using court cases, news articles, and of- plores. Yet an understanding of the various ficial documents, Kluchin follows both the facets of the concepts of reproductive rights middle-class white women’s fight for greater and politics is necessary to be able to grapple access to reproductive health care and poor with the history that Kluchin tells, and it is and minority women’s struggle to be free especially important given that neoeugenic of coercive sterilization. Her juxtaposition attitudes remain entrenched in U.S. society of fit and unfit women’s legal battles in today. the post-WWII era is perhaps the book’s greatest strength. Her discussion of specific Ethnographies of Prostitution in Contem- court cases is the most engaging aspect of porary China: Gender Relations, HIV/ the book as we see how arguments from AIDS, and Nationalism. Tiantian Zheng. various sides were constructed and delib- New York: Palgrave Macmillian, 2009. x + erations unfolded. Kluchin argues that the 244 pp. legal basis for legitimizing contraceptive sterilization followed precedents set by William Jankowiak abortion cases in which reproductive free- University of Nevada, Las Vegas dom was defined primarily in terms of ac- cess. Although fit women fought for greater Building on her earlier important ethno- access to sterilization, women of color and graphic account, Red Lights: The Lives of other activists sought to put in place mea- Sex Workers in Postsocialist China (Univer- sures to protect women from undue influ- sity of Minneapolis Press, 2009), Tiantian ence of coercive doctors and social workers. Zheng seeks to push her thesis that the Ultimately, competing reproductive politics social transformation of urban China has proved divisive among feminists and within not only enhanced male hostility toward the reproductive rights movement. the central government; it has also fos- Fit to be Tied is a valuable addition to the tered a related anger toward women, es- history of reproductive rights and wrongs in pecially those who work in China’s large- the United States and the history of Amer- scale sex industry. Zheng argues that a new ican women’s struggle to obtain reproduc- form of Chinese masculinity is being con- tive control. It will be of greatest interest structed from the ground up in response to historians of U.S. population policies, re- to requirements to participate in the emer- productive rights, and women. Although fo- gent market economy. This economy re- cused on U.S. legal history, it might be use- wards ambition, roughness, individualism, ful in women’s and gender studies courses conspicuous consumption, rather than re- or anthropology of reproduction courses as straint, understatement, and gentility. These it illustrates so well the stratified treatment new and modified Chinese values have also 568 Medical Anthropology Quarterly given rise to a more pronounced misogyny, This sentiment—let alone this expression— most vividly manifested in the way Chinese is not unique to China. Being a careful males interact with sex workers. scholar, Zheng cites research that reports Zheng discusses how men are ready to similar attitudes among Thai, Kenyan, and foster male bonding or solidarity by verbally Mexican men; I would add that many males abusing prostitutes assigned to flirt with and on U.S. college campuses use this phrase service them. Women for their part seem to too. Zheng insists, however, that the folk put up with these rude and, for some, crim- explanation of “reduced sexual pleasure” is inal acts to keep what is for many a good a secondary or incidental motivation. For income compared to that earned through her, the primary reason for male reluctance alternative nonsex service work (e.g., wait- hasmoretodowithmales’desiretomake ress or department store employee). In fact, a symbolic statement concerning their anger the women are adamant about using their and hostility toward what many view as the youth (18–22 years old) as a means to gain state’s intrusive efforts to regulate personal whatever high income they can obtain and and intensely private conduct. say they will move on later to something In effect, males are tacitly engaged in a else. Zheng does not explore what post- covert effort to undermine state efforts to sex-worker employment might look like. discipline private morality. Oddly, Zheng Rather, she rightfully focuses on the lives notes a Chinese sociological study that of sex workers now and what it can tell us found that 57 percent of men wore a con- about social change across a number of dif- dom if the prostitute was “high class” (i.e., ferent domains in contemporary China. more physically attractive and more edu- Zheng provides a concise, insightful cated) whereas “15 to 20 percent wore one overview of early-20th-century attitudes to- for a [lower-class] streetwalker” (p. 5). Fol- ward and advice regarding the importance lowing Zheng’s logic, men who select a that females reach orgasm (e.g., “go slow high-class prostitute would have less anger to receive her qi or essence,” p. 31) and toward the Chinese state compared to men prevention of pregnancy (e.g., “eat lots of who select the cheaper, albeit less educated live tadpoles,” p. 34). She cites trends in ur- and, no doubt (because of, in part, the stress ban attitudes toward sexuality as revealed in and strain of poverty), less physically attrac- local magazines that comment on the shift tive prostitute. However, it could be argued in China’s sexual morality from puritanical that men prefer educated, better-groomed, to libertarian (but does not say if these are and physically attractive women and are state publications or part of the emergent more than willing to compromise their de- mass of private publications that now litter sire to achieve maximum physical sensation the Chinese landscape). Zheng informs us (i.e., wear a condom) to momentarily pos- that China’s rate of STDs along with AIDS sess the more precious and valued object of is rapidly increasing. It is now estimated in desire. the southern Chinese city of Shenzhen that Zheng is also adamant in her insistence HIV inflection rate is increasing by 25 per- that the primary reason males go to prosti- cent annually (p. 5). Clearly, Chinese society tutes is to make up for earlier years of state is facing a massive health crisis in the com- socialist induced sexual repression. She does ing years. not comment on why men in other Western Given China’s high rate of HIV infection, and non-Western cultures, who never expe- Zheng wants to understand the reasons Chi- rience this repression, visit prostitutes. For nese males are reluctant to use condoms. For her, Chinese men are simply responding via her, Chinese males’ disinterest in condoms personal behavioral acts “against [repres- constitutes a key symbol for understanding sive] socialist moralities” (p. 104). She also wider social issues. Zheng rejects Chinese argues that the primary reason for Chinese males’ assertion that condoms reduce sexual engagement in extramarital affairs is moti- pleasure or, in the words of one male, “feel vated by an “active rebellion against gov- like you are wearing a raincoat” (p. 52). ernment repression” (p. 106). Book Reviews 569

Zheng’s analysis is anchored within a for- biomedical care systems of the Caribbean. malistic political economy framework that It is largely based on data collected from sees males and females as simply engaged in two large-scale field investigations: (1) the competitive, often hostile engagement that Barbados Asthma Genetic Study, conducted is based entirely around the pursuit of per- as part of the multidisciplinary Collabora- sonal interest and gain. Against this view of tive Study on Genetics of Asthma (CSGA) basic “humanness,” the notion of “agency” and jointly carried out in several commu- is periodically invoked to demonstrate that, nities by research teams representing eight no matter how much men and women are U.S. universities; and (2) the Genetics of at odds with one another, on occasion, they Asthma in Latin America Study, a simi- can form common bonds against what they lar project expanded with data from ad- view as the Chinese state’s relentless efforts ditional Caribbean countries. The author to control their private lives. notes that the Barbados portion of the study Tiantian Zheng has that rare ethnogra- has produced “the largest database of asth- phers’ eye for detail and ear for conversa- matics of African descent” (p. 30), and tional nuance that makes her work required “Barbados is among the countries with the reading for anyone interested in contempo- highest levels of asthma in the world, esti- rary Chinese culture of sexuality. Although mated at 18–20 per cent of the population” I disagree with her explanation for many of (p. 9). the behaviors that feature in her analysis, I The author states that Barbados was se- am most taken with the quality of her data. lected as a major research site because It is a difficult undertaking to obtain this it is also considered a center for health level of ethnographic insight, and Zheng’s care, medical education, and pharmaceu- ability to obtain such rich information is tical field investigation in the eastern impressive. Caribbean by both industry and govern- In sum, this book contains wonderful rich ment officials. Nine chapters deal with top- data and bunches of keen insights worthy of ics ranging from theoretical problems with contemplation, reflection, and intellectual the race concept, the genetic basis (“chro- engagement. For those looking for a sup- mosome linkage”) and predisposition to the plementary text, however, I would highly many forms of asthma, pharmaceutical ap- recommend Zhang’s Red Lights: The Lives proaches to asthma management, and lo- of Sex Workers in Postsocialist China.The gistical fieldwork problems encountered in book covers most of the topics explored drawing blood samples, administering ques- in this study but does it in a more nu- tionnaires, and conducting medical exams. ance and balance fashion. Ethnographies The author offers his own recommenda- of Prostitution in Contemporary China is tions regarding the possible redefinition of worth an earnest peek, but I suspect un- the disease and new approaches to its man- dergraduate and graduate students will find agement, based on indigenous concepts of her first study the more rewarding read. causes and meanings in the Caribbean. A number of scattered subtopics are briefly Biomedical Ambiguity: Race, Asthma, and visited along the way: mothers as pri- the Contested Meaning of Genetic Research mary health care providers in traditional in the Caribbean. Ian Whitmarsh. Ithaca, Caribbean societies, variations in Caribbean NY, and London: Cornell University Press, family structure, “biomedical excesses” 2008, viii + 225 pp. (ch. 9) in rapidly changing health care sys- tems, and possible reasons for documented Robert A. Halberstein resistance to the acceptance of modern med- University of Miami ical care. With its narrow focus on a limited Biomedical Ambiguity is a monographic number of topics, the book completely analysis of the epidemiological profile and overlooks several important and relevant 570 Medical Anthropology Quarterly subjects relating to Caribbean health condi- have consolidated all informant and inter- tions and healing systems, for example, the view details in one location in a “Methods” extensive inventory of medicinal plants and section before the findings are discussed. As other natural medicines, the many culture- is, no methods section exists, and we are bound syndromes recorded for the region, left to imagine how the data may have been religious and spiritual healing traditions, procured. and so forth. M. Laguerre’s classic book Despite the above-listed shortcomings, Afro-Caribbean Folk Medicine (1987) and the volume does shed some needed light on thespecialissueofJournal of Caribbean the unusually high prevalence of asthma in Studies (Halberstein 1997) are not cited Barbados and other areas of the Caribbean. in the text or bibliography, nor were im- In provoking questions, it will help clar- portant compendia published by the Pan ify a similar finding in an ongoing epi- American Health Organization (PAHO) in demiological study by the present reviewer Washington, DC, consulted. on the Caribbean American population of In addition, Biomedical Ambiguity is Miami, Florida, and should stimulate fur- completely devoid of tables, charts, graphs, ther research. The book is more suitable for figures, photographs, or other visual aids. research purposes than for use as a class- The data mainly consist of unquantified room text. anecdotal reports and quotes obtained from anonymous sources such as “drug supplier References Cited John,” “Drug Service committee member Janet,” and “a professor at the University Halberstein, Robert, ed. of the West Indies in Barbados” (p. 49). 1997 Health and Disease in the The author also interviewed “one general Caribbean. Special issue, Journal of practitioner who has a private practice in Caribbean Studies 12(1). an eastern rural area,” “a public health offi- Laguerre, M. cial,” “a family doctor,” and “one pharma- 1987 Afro-Caribbean Folk Medicine. S. cist” (p. 105). At the least, the author could Hadley, MA: Bergin and Garvey.