Life in Debt. Clara Han
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and redraw lines of inclusion and exclusion. Attending to the ways in which violence and harm are existentially experienced, however, shifts the anthropological exercise. Rather than focus on representations of the suffering subject to trace a general moral shift, globally speaking, an anthropological writing that acknowledges suffering engages and responds to a specific life and world. This engagement opens thought to the experience of time in relation to violence as well as the concealments and boundaries in everyday life (see Kleinman et al. 1997; Das et al. 2000). For friends, family, and neighbors in La Pincoya, acknowledgment of the effects of present-day economic precariousness falters when an anthropologist holds up a representation of collectivities and intimate relations that existed in the past in order to emphasize what was “lost.” Rather, the past presents in specific ways and moments. These effects, or affects, are refracted through relational modes and their boundaries in the present, and invest relationships with different hopes, desires, and limits.
Through these refractions, I engage moral projects in everyday life, in which care is a problem rather than a given. I take care as being diffuse and not definable in any simple way. Attending to care is similar to attending to violence, in which, as Veena Das remarks, “contests around the question of what can be named as violence are themselves a sign of something important at stake” (Das 2008, 284). To attend to care as a problem in everyday life, rather than a category with defined borders, has implications for my relation to ethnography. Everyday life is a scene to which I am drawn, rather than a set of routines, practices, or interviews that I observe, evaluate, and extrapolate judgments from. It also has implications for how I understand and engage the moral. While there might be a great deal of moralizing in everyday life, the struggles in caring for others and the complex affects that compose a discovery of limits are existentially experienced in ways that implicate the moral fabric of self-making (Kleinman 2006, 2010). Throughout this book, I engage care as a problem within intimate life, which is itself layered with institutions. I consider the moral not in terms of moral judgments but in the very ways in which self is implicated with others.5 This implication is where limits are experienced.
How might such limits appear in ethnographic engagements with poverty and disease? Unsettling any sentimentalized notion of the family and challenging the taken-for-granted affects that “should” manifest among intimate kin, anthropologists have elaborated such limits around the problem of abandonment. For example, Nancy Scheper-Hughes's discussion of child death in a setting of poverty and extremely high infant mortality highlights the complexity and range of what might constitute abandonment. A small error or a moment of inattention can have fatal consequences: “so much greater vigilance is required to keep an infant alive, even the smallest lapse in maternal attention and care can sometimes be fatal” (Scheper-Hughes 1992, 360; see also Das 2010b). But simultaneously, given the pervasiveness of child death and the often overwhelming circumstances of poverty, “a good part of learning how to mother on the Alto includes knowing when to let go of a child who shows he wants to die” (p. 364). In the lives of Alto women and in the face of multiple dangers to life, death is not opposed to life; rather death is a “valid part of existence, so that death, too, must be lived” (p. 364). A play of life and death is at work in the relationship between mother and infant; abandonment here cannot be understood solely as a discrete moment with intentionalities ascribed to it.
Focusing on the shaping of intimate relations by market forces and medical technologies, João Biehl's discussion of abandonment centers on the domestic triaging of the mentally ill and unwanted (Biehl and Eskerod 2005). The normative family is a parapolity—a “state within the state”(p. 185)—engaged in a “making live” and “letting die” of its family members (see Foucault 1978). Those deemed unproductive, economically speaking, are actively ejected from the family and relegated to zones of abandonment—a social and biological death. These works raise a further set of important questions: How is ethnographic method implicated in understandings of accountability, care, and abandonment? How do modalities and temporalities of engagement with ethnographic sites shape descriptions of the dynamics of care? How do anthropologists come to know the shifting lines of the normal and abnormal, and what are limits to an anthropological knowing?
When I first started my research as a graduate student in anthropology and a medical student, I was interested in the high prevalence of depression in Santiago, which had reached 29.5 percent in primary care. According to the World Health Organization, this prevalence of depression was the second highest in the world (WHO 2001). Psychiatrists and public health officials initiated a national depression treatment program for the diagnosis and treatment of low-income women. This program was cast as both part of a national project of moral healing and an intervention for the health of the poor. The project fit key-in-lock within a critical inquiry of the biopolitical state and the medicalization of the family, in which the woman as mother is responsible for the well-being of her children, the future of the population. But situating myself in La Pincoya, I grew uneasy with a project that focused almost exclusively on citizenship and a circumscribed medical intervention. A whole range of relations and circumstances seemed to be eclipsed through a focused critique of the normative family and “the neoliberal state.”
This local density of relations suggested a different reading of Foucault's writings on medicalization, the family, and the biopolitics of the population. In “The Politics of Health in the Eighteenth Century,” Foucault traces how medical politics “has as its first effect the organisation of the family, or rather the family-children complex, as the first and most important instance for the medicalisation of individuals” (Foucault 1980, 174). The “close-knit family cell” (p. 182) is the milieu of the child as future adult and is hooked in a reciprocal relation to public health and the institutionalizing and protection of the doctor-patient relation. For Foucault, this medicalization must be understood through a “history of these materialities,” of institutional rearrangements, medical technologies, urban space, the family cell, and bodies of individuals (p. 182, emphasis mine). I do not take Foucault's point here as an explanation for the daily decision making regarding disease and illness within families today. Rather, he offers a key insight: that I might understand medicine, kinship networks, neighborhood, institutions at the margins of the state, and state violence as a specific history of materialities. That is, medicalization has singular histories. Through interviews and partaking in everyday life, I saw the category of depression dispersed into various bodily aches and pains that women colloquially called depresión a ratos (depression from time to time). Experiences of exile and torture were woven into self-making but also carefully bounded. Life was moving. Another thematic horizon took shape.
Over time, I found myself drawn into a range of relationships, from allowing myself to be claimed as a godmother—and therefore assuming responsibilities to my hijado (godchild) and my comadre, as well as to her intimate kin relations spread over three houses—to being claimed by several intimate friendships that have taken shape over a decade. As I was drawn into these relationships, it became evident to me that my concerns with care were not posed in relation to a fixed ideal of the normative family or its opposite, “nonnormative” kinship relations. Rather, because I became implicated in the lives of others in various ways, I had to engage norms in their lives: to appreciate the work of domestic relations, the stakes in concealing need, the delicate struggles over intimate relationships in which the body was staked, or the small neglects and denials that also made up everyday life.
In his essay “The Normal and the Pathological,” historian and philosopher of science Georges Canguilhem asks us to treat life as “an order of properties,” a precarious organization of forces rather than a system of laws against which the “individual [is] a provisional and regrettable irrationality” (p. 125). From this perspective, “living beings have a normative relation to life” (Marrati and Meyers 2008, ix). That is, they respond to their internal and external conditions. Individuality is not an obstacle to the norm but the very object of the norm itself. Paraphrasing Kurt Goldstein, Canguilhem writes, “A norm…must help us understand concrete individual cases…. An alteration in the symptomatic content does not appear to be disease until the moment when the being's existence, hitherto in equilibrium with its milieu, becomes dangerously troubled” (Canguilhem 2008, 129). Disease is therefore “an aspect of life regulated by norms that are vitally inferior or depreciated” (p. 131). We might extend this