Thursday, April 28, 2011

Book Review: 1984 by George Orwell

I decided some time ago that I wanted to review this book on my blog, simply because it is such an iconic portrayal of the political and economic issues that dominate the contemporary world. In some ways, this work is incredibly prescient. To be sure, it is probably one of the most frequently quoted works of literature of the twentieth century.  At the same time, this novel embodies some fundamental misunderstandings and creates a number of false oppositions which I believe deserve some discussion, as they have attained the status of taken-for-granted dogma.  In particular, Orwell ascribes some characteristics to totalitarian/socialist states which, rather than being the end point of some slippery slope away from capitalism/democracy, are actually endemic to capitalism/democracy.

Disclaimer: it has been a while since I read the book, and it is fairly long, so this is not a comprehensive evaluation of the work, by any means!

Let me start by acknowledging the strong points of 1984. There are two areas, in particular, where I believe Orwell hit the nail on the head. Most significantly, his concept of a "permanent war" was incredibly predictive of the rise of the military-industrial complex and the use of military interventions and military spending as a means to increase demand and facilitate economic growth. According to Orwell, large-scale production for the arms industry allows those in power to keep the working class busy, without having to create demand for what is produced (i.e.  allowing the workers to buy more and raise their standard of living) since all that is produced is eventually destroyed. The working class becomes more productive but still makes do with the bare necessities. Ernest Mandel, in Late Capitalism, made a similar argument regarding the role of the permanent arms economy that has developed following WW2.  Mandel, however, sees the rationale less in any direct concern for the conditions of the working class (lower wages/standard of living is only advantageous in so far as it raises profits margins for the capitalists), but rather in capitalists' need to find another outlet for investment if they are to maintain profitability.   Remember the general principle that continued investment in a profitable enterprise decreases its profitability.  The advantage of the new investment in the armament industry is that it creates demand by forcing the working class to finance it through tax dollars. Thus, even in this case, Orwell overlooked the way in which the "permanent war" derived from the inherent principles of capitalism itself.

A second strength of 1984 is the way in which it demonstrates the power of language, and in particular, the relationship between thought and language. This is a topic that has been endlessly pondered and debated among linguists, anthropologists, linguistic anthropologists, philosophers, and literary critics. Although there are widely diverging opinions on this subject, most would agree that language is neither neutral nor natural. It is not natural because it is an arbitrary social convention: for example, the word "tree" could just as easily mean "rock" if we decided it was so.  There is nothing about the sound "tree" that is inherently connected to the physical object to which it refers.  Language is not neutral because the words one chooses always convey a point of view.  The existence of words themselves entail a specific way of categorizing the world which is never the only means of doing so.  How one categorizes the world (the language one uses) will, then, affect how one views and interpret the world.

 Orwell is absolutely correct that relationships of power involve strategic use of language to influence consciousness and generate consent.  Yet, Orwell also misses the mark here.  First, even while he acknowledges the political use of language, he still seems to uphold a naturalist perspective of language, in which there are "correct" and "distorted" uses of words.  For example, Orwell assumes that the word "peace" has one "correct" referent in the real world, regardless of social usage (he doesn't seem to countenance the idea that meanings are arbitrary and can shift and change).  If conventional use of the word "peace," however, changes or broadens to include circumstances that previously would not be accorded such a label, it is not the original concept itself that is disturbed, but merely the word, the symbol.  The real question is, if a concept has no word to refer to it (through shifts in language use) does that concept suddenly cease to exist, and can it never be brought back into existence?

Because he does not allow for the fluidity of meaning, Orwell's view on the politics of language amounts to something like absolute control:  the powers that be essentially brainwash people by forcing them to adopt new forms of language use.  In reality, however, meaning can never be controlled and manipulated that effectively; one cannot prevent the multiple interpretations, misunderstandings, and resignifications that make resistance a perennial counterpart to power.  Most problematically, Orwell seems to think that the "manipulations" of language he describes are a problem endemic only to totalitarian states.  Yet, one need only look at the United States to find examples of Orwellian abbreviations (CENCOM, USSTRATCOM, etc.) as well as the application of words to circumstances that contradict their own meaning (the "free market").

This last point is illustrative of two major weaknesses of Orwell's work. First, the book is premised on certain fundamental oppositions between socialism and capitalism, democracy and totalitarianism, which I have already argued are false distinctions (follow the links to see those discussions).  It is clear that many of the trends Orwell describes are already present in the capitalist, democratic world, and it is much more due to the inherent nature of these systems themselves, than in any movement toward anything else.

Second, Orwell's fallacious construction of the relationship between language and power is symptomatic of his more general mischaracterization of the nature of power, the state, and government (once again, follow links to view my previous discussions of these issues). Orwell presumes that power is centralized in a single person (Big Brother) or group of people (the Party), and in a single institution (the state). This contradicts the principle that power is without a unified center or source, and is most certainly NOT monopolized by the state. Just look at the criticism leveled at Facebook and Apple for their invasions of privacy!  If anything, a non-unified group of corporations has become our "Big Brother."  More radically, using these technologies we have all become each other's "Big Brother."

To this end, Orwell also misunderstands the way in which power works. He views power primarily in terms of direct, coercive and restrictive force, while overlooking the more subtle, consent-based and productive strategies that can achieve more spectacular results. Power relationships have extended their reach not primarily through the use of police, surveillance, imprisonment, and torture. To the contrary, power relationships have extended themselves inward, penetrating consciousness in a manner that allows the subject to act freely.  Strategies of power encourage behaviors, and they do so without force.  (Following from my last series of posts, consider how images and discourses about "health" promote consumption of diet products, gym memberships, and pharmaceuticals, just as they more generally shape personal eating habits and behaviors.)  Recall my argument that the difference between dictatorship and democracy is the extent to which democracies are able to use wealth and other resources to build phsyical and ideological infrastructure to reduce reliance on coercive mechanisms of control.  Coersion is less effective, and if this were the sole base of power, as in the world of 1984, there would most surely be an uprising.  (Just witness events in MENA right now.)

However, Orwell justifies the scenario by portraying the workers as too uneducated and ignorant to recognize their own interests and challenge the system.  This is a third weakness in his work. Orwell severely underestimates the capabilities and consciousness of the working class, even when denied an education and saturated with propaganda.  One need only look at historical and anthropological evidence to see that this hypothetical scenario has no empirical justification.  Nationalism and propaganda do work, but only to a certain extent.  At some point, when conditions become harsh enough, a breaking point will be reached.

Orwell's neglect of the most common mechanisms of power also prevents him from foreseeing the type of imperialism that eventually emerged in the post-WW2 era.   It is not, as in the past, an imperialism based primarily on military violence and direct force, though this is the nature of Orwell's "permanent war."  In contrast, imperialism today is more often a matter of manipulating social and economic polices via transnational lending organizations, multinational coporations, and foreign development aid programs.  The generation of consent through the spread of neoliberal ideology, and the creation of a guise of "humanitarian" motives, have become extremely effective ways of maintaining control without violence or coersion (although the latter do still have their place, and may also appear under the guise of "humanitarian" motives!).

Thus, the most harmful aspect of 1984 is the way in which it encourages us to look for power in places where it does not reside ("Big Brother," particular forms of government) and to ignore all the relationships of power in which we ARE enmeshed, in increasingly subtle ways.

Tuesday, April 26, 2011

Alan Greenspan Admits Marxist Principle

A week ago on Sunday (yes, I know, I've gotten behind!) I was watching Meet the Press, and I saw the following interesting interchange between the host, David Gregory, and Alan Greenspan:

MR. GREGORY:  Back now with our roundtable.  Alan Greenspan, I want to talk economy writ large.  And a couple pieces of data here, from the interview with Secretary Geithner, he says, referring to private economists, he thinks that unemployment could get to 8 percent or below by the end of 2012.  And this is interesting, too.  Persistently high unemployment but look at the performance of the stock market while President Obama's been president.  Up in 2009 from 7949 to over 12,000.  We've got, as you always say on this program, that's real money, that's real wealth, and yet we have persistently high unemployment.  What, what is your view?  What is this outlook you're seeing?
DR. GREENSPAN:  Well, first of all, the major reason why the stock market, in fact, asset values in general, came off those extraordinary lows in early 2009 is that productivity improved very dramatically in the business sector.  That meant that profits and cash flows would be engendered in a very substantial amount, which pushed asset prices up to an extent that, coupled with the increased contributions, 401(k)s added a trillion dollars to the actual net worth of the individual households who hold them.  And they are very big spenders, and that has been a very important factor in keeping the economy going up.
MR. GREGORY:  But you're saying companies doing more with less.  The question is when do they start spending and creating jobs?
DR. GREENSPAN:  Well, the problem, basically, is that there was a contradiction in those who say that you want one and not the other. Increasing productivity, by definition, means that you are producing more goods with fewer employers.
MR. GREGORY:  Mm-hmm.
DR. GREENSPAN:  Now, what--employees.  What is happening now is we're now beginning to see that productivity growth flatten out, and that's where all those jobs are coming from very recently.

(Accessed from; emphasis mine)

What is Greenspan saying here? In effect, he is acknowledging the fact that there is a CONTRADICTION (a favorite Marxist term) between the personal goals of individual capitalists - increased productivity - and the goals of the general population (in this case, increasing employment).  Of course, what Greenspan does not pick up on is the fact that increasing productivity does NOT, in the long run, increase profitability.  In fact, it decreases the rate of profit, as human labor is the source of surplus value, and thus increasing productivity (utilizing less human labor) decreases the rate at which surplus value can be accumulated.  Furthermore, as our current economic recession is a result of a global crisis of overproduction, increasing productivity most certainly is NOT the solution!  In this case, then, it is not a matter of wanting to have our cake and eat it too, as Greenspan suggests.  Rather, the increased productivity merely represents the determination of corporate billionaires to milk the last bit of juice from the system before it collapses.  It is self-serving and not in any way helpful for the economy as a whole.

Thursday, April 21, 2011

Health Myth 8: Without Death and Disease, The World Would be a Better Place

People would not believe so strongly in our capability to conquer death, disease, and suffering, if this were not perceived to be a worthy goal. In a simplistic, black-and-white way, disease and suffering have become our enemies, the "bad guys." Who would disagree that if it were possible to eliminate them, we should?

This is probably more of a philosophical issue than anything else and certainly not one that has been overlooked by millions of others! It all boils down to whether or not certain forms of suffering might serve a useful purpose, or whether a life free of pain would be worth living. However, I don't think this blog is a useful place to try to answer those questions. I am more interested in the assumptions that underlie our answers to these questions.

I am not trying to argue that all medical advances are bad, or that no one should try to cure illnesses. What I am questioning here is the ultimately purpose for which we do this, the framework for understanding health that this entails, and the potential consequences of our endeavours.

What I find problematic is this: the assumption that there is one physical ideal, that any deviation from this ideal is problematic, that health should be viewed in moralistic terms, and that any inability to bring deviations under control (so that everyone can approximate the one ideal) should be viewed as a human failure, and not simply a necessary part of human existence that we should learn to accept in some way. Accepting the bodies that we have may, in part, mean accepting the occasional aches and pains, accepting weaknesses, and accepting our appearance. If we can't be content with what we have before trying to "improve" things, then we will never be happy.

I would also argue that our inability to be content with what we have, our constant desire for something more and better, is a product of capitalism and the processes by which capitalist interests attempt to increase demand by increasing want. Likewise for our unceasing faith in the ideology of progress and the benefits of science and technology, which serves to naturalize and legitimate the capitalist world order as the apex of cultural evolution.

Wednesday, April 20, 2011

Health Myth 7: We Can Conquer Disease and Death

We spend a lot of time and money trying cure diseases. Owing to the ideology of progress, we have faith in the near inevitability that any given disease will eventually be cured, if only we devote enough research to it. Those who envision a future in which all diseases have been cured (most eradicated), allowing us to live long lives before dying peacefully of old age, are generally not considered pie-in-the-sky idealists.

Clearly our belief in progress necessitates a certain view of health as "conquest" (just as political and economic progress entailed colonial conquest). Progress involves the subordination of all things to human (generally means certain humans) control. But can death and disease ever be entirely within our control?

First, consider: everyone dies. Some people have noted that as the death rate from one disease goes down, the rates of others, by necessity go up. Is this really an accomplishment? Curing and preventing diseases never lowers the rate of death!

You may argue, "Yes, but by combating [another militaristic metaphor!] disease, even if those potentially affected die anyway, at least we have eliminated the suffering caused by that illness." True. But remember, old age comes with its own forms of suffering: mental deterioration, physical weakness and pains, accidents resulting from impaired abilities, etc. Eliminating a disease does not by any necessity reduce suffering in the long run. It might. But it might not.

"Maybe we could control that too. With medical advances, we could eventually prevent the mental and physical deteriorations of old age!" However, by believing that we can eventually control everything, we are once again relying upon the model of simple, linear causality, that is ultimately inadequate to account for a complex system like the human body. The environment is constantly changing in ways that we cannot predict (by virtue of the fact that it, too, is a complex system), and therefore the body will always be responding to these changes in unforeseen ways. The growth of antibiotic resistant bacteria is only one of many ways in which our world continues to transform itself.

To eliminate death and disease, we would have to be able to bring every single aspect of our living environment under our control. Unfortunately, the properties of complex systems and chaos make this goal completely unattainable.

Tuesday, April 19, 2011

Myth 6: It is Normal to be Healthy

Although it is obvious that everyone gets sick at some point, we tend to treat illness as if it were some form of a "deviation" from a normal state. Likewise with disorders, syndromes, etc. It is as if there were one particular way the body is "supposed" to function, if not affected by assaults from without or perversions within.

But the body is a complex system. It is the very nature of a complex system to embody multiple physical configurations and to respond in highly unpredictable ways to changing conditions - to itself be constantly undergoing processes of change. Thus, thunderstorms, though possibly unpleasant or even dangerous, are requisite aspects of weather systems, following directly from their internal logics, as much as nice, sunny days. The same with illness and disease.

Furthermore, what it is to be "healthy" is itself a socially determined matter. No one is exactly the same; no body functions identically to any other. We are all unique and have our individual quirks, strong points, and weaknesses. So what, exactly, is the boundary between "healthy" and not "healthy"? If I have allergies, am I still healthy? My muscles are a little less flexible than the average person, and my ankle joints are tight... does THAT make me unhealthy? Is a person with lactose intolerance (coincidentally, a much more prevalent "condition" than lactose tolerance) still healthy? What about a hemophiliac? The lines we draw are arbirtary. But they do have meaning.

I mentioned in Myth 5 that the religious aspect of the "invasion" approach to disease has only partially been shed from contemporary thought. Although modern medicine is an ostensibly "secular" enterprise, the moralization of illness and disease still persists (and, in fact, is vital to the narrative of progress). It takes the form of a pervasive yet tacit assumption that health status is a measure a person's moral worth. Disease is often associated with unhygenic, "primitive," or deviant behavior. It also tends to become associated with particular groups of people (AIDS was a "gay disease" before it became a "black disease"; hepatitis is a druggie disease; syphillis is a pervert disease; TB is an immigrant disease; etc. etc.). Our notions of "health" and "disease" are a significant means by which we imbue human bodies with social meaning.

In the era of capitalism, we may do this to create social divisions among the human population to enact a division of labor; to construct a visual map of scientific/capitalist progress using human bodies (a task which requires contemporary representatives of our "primitive," diseased past); to evaluate and manipulate personal choices; and, of course, to sustain a consumerist attitude toward physical well-being, wherein if one just "tries hard enough" by investing wisely in food, in doctors, in pharmaceuticals, etc. then one can attain "health."

Sunday, April 17, 2011

Myth 5: It's All About Genes and Germs

Or: Understanding a medical condition involves locating a gene or isolating a foreign agent.

The fundamental premise of this myth is that the human body is characterized by simple, linear cause-and-effect relationships. Granted, some leeway may be given for multiple causes and "complicating facors," but these are mere qualifications of the basic linear model which is employed.

Example 1: Genes. Medical researchers have become obsessed with finding the gene or set of genes responsible for everything from autism to homosexuality to political preference.

However, any responsible researcher will also admit that the relationships between genes, "internal" bodily processes, and "external" environment are not clearly understood. Furthermore, as discussed in Myth #4, many of these conditions may not be of a homogenous or easily definable nature (i.e. they are not "things" that can take part in a linear causal chain), and some (such as sexuality and political preference) are social constructions. This is akin to looking for the gene that causes one to speak French rather than English! True, genetic correlations are often found. But correlations are pretty easy to construct, and they do not by any necessity have any real significance.

Example 2: Germs. "Sickness" is most often conceived in terms of infections and germs. We take all sorts of measures to avoid "catching" other people's germs, which some people carry to the point of clinically-defined neurosis. We also view germs within a military framework - invasions and attacks - and seek all-out assaults on the perpetrators of illness via copious use of pharmaceuticals.

The whole idea that ill-health is caused by the intrusion of foreign agents derives from a Medieval religious perspective in which physical malady was conceived as a moral condition caused by the invasion of the body by tiny demons. This idea has persisted and, stripped (partially) of its religious component, frames our current understanding of illness. In fact, medical researchers throughout history have often ASSUMED the presence of foreign agents with absolutely no proof of their existence, and worked laboriously to find material evidence to back up what they already believed to be true.

There are several shortcomings of the "invasion" perspective. First, the body does not have a clear "inside" and "outside." In fact, the skin is the largest organ of the human body. Second, there is not always a clear distinction between what is part of the body and what is "foreign." Parasitic relationships are extremely common, and the human body also makes use of this arrangement. Bacteria, in fact, perform many vital functions in the human body. If you have ever taken an antibiotic that has killed too many of your intestinal bacteria and experienced the uncomfortable results, then you might not think of them as intruders! Third, most disease-causing agents are already present in the body under normal circumstances.

Some in the medical field have sought alternatives to the "invasion" metaphor. Ludwik Fleck suggested that the human body might more effectively be likened to a garden, in which the key to health involves a particular balance among its various components. Certain stressors or events may upset the balance from time to time. Since there is no distinct barrier between the "outside" and "inside," altered balances in the overall environment (for example, the people who surround you) may ripple and affect you as well. This is still a notion of contagion, to be sure, but a more holistic one, which does not rely as heavily on a linear causal chain, and views the body together with its environment as a unified, complex system.

Saturday, April 16, 2011

Myth #4: Diseases are Discrete Entities

Modern medical practice is essentially built upon the idea that deviance comes in discrete packages ("disease," "infection," "disorder," "syndrome," etc.). This leaves the following tasks for medical researchers and health practitioners:

1. Refine the definition of the deviance-entity; draw sharper boundaries.
2. Improve the process by which it can be recognized according to its symptoms.
3. Identify the cause(s).
4. Discover potential treatments.

If a patience presents a heretofore unencountered set of symptoms, medical professionals immediately attempt to determine "what" this person "has," and isolate the essence of this newly discovered entity.

This regimen has produced two major tendencies:
1. The proliferation of diseases and disorders. As new realities are encountered, new entities are devised to account for them. Additionally, new diseases mean new research programs, new grants, more journal articles, more conferences, different ways to market treatments: in effect, more ways to circulate capital and sustain the work of those in R&D fields.

2. Growing prevalance of certain diseases. In part, this occurs when new experiences are not separated into new disease categories, forcing already existing ones to expand. And in part, this results from the pathologizing of characteristics that were previously viewed in a different light. Once again, from an economic standpoint, escalating rates of disease mean expanded investment in research and increased markets for treatments.

This is not to say, of course, that capital investments are the only (or even most important) driving force behind these tendencies, or that the medical establishment does not accept these premises concerning the nature of disease with all intellectual sincerity.

However, this does highlight the way in which our propensity to view health in terms of discrete, material entities is shaped by a capitalist organization of social institutions (including those related to medical research and public health), in which capital investments are discretely categorized and allocated according to quantifiable outcomes; goals and results are measured in terms of material inputs; and individual human bodies serve as the primary site of intervention (as opposed to integrated social processes).

This all occurs in the face of one undeniable fact: it is really hard to define diseases in such a way that they may be sustained as discrete entities. In actuality, we don't discover diseases; they are not just sitting there, waiting for us to learn of their existence. We create diseases, disorders, syndromes, etc. Faced with a complex and variable reality, we impose categories upon our experience in order to simplify and more easily understand it. Oftentimes definitions of diseases are based more upon history and accident than on any coherent set of principles. Furthermore, a single disease may present such widely varying symptoms that any two people may experience it in entirely different ways, and the causes may be multiple or unknown. (Autism is a great example.) Why, then, should it be considered a single "thing"? Still, we proceed as though the categories that we have created have an essence and an existence all of their own, and our task is to simply discover what that essence is.

There are significant social and political implications as to what behaviors and conditions become pathologized (or de-pathologized, in the case of the removal of "homosexuality" as a psychiatric disorder). What we see as a "problem" is deeply socially embedded. It should also be noted that the creation of "problems" is, in itself, a strategy that is employed by dominant forces to mobilize social and political resources, as well as capital flows, in the service their own agenda. Not that every new disease is a conscious and strategic creation of a conspiring economic elite, but one should be aware of the way in which this generalized (and non-uniformally applied) strategy can be employed in the domain of health.

Thursday, April 14, 2011

Myth #3: Causes of Ill Health are Physical and Personal

By now I have just about hammered home the point that, as a general principle, the health profession looks for causes that are physical and tied to the individual. This approach has led so many in the field to focus on diet (fat, cholesterol, salt; now carbs, transfats, etc.), personal habits (how much do you exercise, how long do you sleep, how much do you smoke, how many sexual partners do you have...), family medical history (in so far as "the family" represents a personal gene pool), exposure to disease causing agents, and the like.

On the contrary, emotional, social, political, and economic causes of disease are given secondary consideration, if any at all.

I remember reading Malcom Gladwell's book Outlier, which begins with the story of an American immigrant community who presented phenomenally low levels of heart disease. Gladwell recounts the investigative process undertaken by medical rsearchers to determine the cause of this felicitous situation, including all the many dead-ends and their ultimate conclusions. I found the discussion fascinating and began describing the scenario to my mother. Immediately, she began throwing out possible explanations, in pretty much the same order as the medical investigators considered them. "It must have been their mediterranean diet" (no, they had switched to a high-fat, high-carb diet). "They must have walked frequently and performed a lot of physical labor" (not a chance). etc. etc. What never occurred to my mother, and in fact, what only occurred to the researchers after they had pretty much exhausted all other possibilities was this: the community had very tight social bonds and spent a lot of quality time together, they regularly participated in religious activities, and they exhibited a general sense of emotional well-being. Is it possible that happiness, strong social relationships, and spirituality may promote health more than diet and exercise?

In Myth #2 I discussed the role played by inflammation in such conditions as high blood pressure and heart disease. This raises the possibility that stress is more of a "root cause" of these maladies than diet, exercise, and other personal habits. It would follow that the promotion of personal, social, and spiritual well-being may be a more effective way to nurture one's physical health than avoiding salt or constantly striving to lose 10 pounds. However, interventions aimed at the individual are easier to implement and control, and are infinitely more profitable.

Another example. It is often suggested that people with less money are more likely to be fat because healthier foods are more expensive. If you have a limited budget and work two jobs, then McDonald's is going to seem like a much more attractive option. This is a great argument for those who prefer to view health in terms of personal responsibility. It is the choices poor people are making (even if their options are limited) that cause them to be fat.

Yet, it is also true that living below the poverty line is significantly more stressful than living above it, and in the case of classic urban poverty, it generally entails fractured familial relationships and impoverished communal bonds. Could the political economic processes that create conditions of poverty be responsible for obesity among the poor? Is it more than simply a matter of the food they buy?

Similarly, a lot of noise is made about how African Amercians are "naturally" predisposed to high blood pressure, heart disease, diabetes, etc. This "medical fact" is convenient in two ways: not only does it locate the cause of these diseases in personal defects, it also sustains ideas about racial difference! How nice. Once again, we must consider: 1. African Americans are more likely to be poor (go back to above paragraph) 2. African Americans have to deal with racism, which is another significant stressor. Some medical researchers, in fact, have argued that the African American "predisposition" to high blood pressure is really caused by racism.

In the above cases, emotional status, social relationships, and political economic conditions are intertwined. It should also be underscored that in some instances political economic circumstances may play an even more direct role in health. Another book provides an example.

In Stories in the Time of Cholera, Charles and Clara Briggs recount their experiences with an epidemic of cholera that swept through a portion of Venezuela, and analyze the way in which this epidemic was represented by the media and government officials as eminating from a coastal indigenous population, as a result of their "primitive" behaviors. Yet, the Briggs' describe how cholera is a distinctly modern phenomenon, in fact, nurtured by particular forms of political oppression, marginalization, and economic alienation that have been instrumental to processes of state-making and market formation during the capitalist era.

Taking the same stance, physician-anthropologist Paul Farmer argues in Pathologies of Power that disease has distinct social, political, and economic causes which are very often ignored.  In order to legitimate the current world system, these factors must be ignored, because they represent a challenge to the status quo.  On the other hand, focusing on individual habits (particularly those labed "premodern" and "primitive") in the promotion of health is an important means of constructing the narrative of Progress that makes the desirability of the current state of affairs seem unquestionable.

Wednesday, April 13, 2011

Health Myth #2: Correlation Equals Causation

Even though the axiom "correlation does not equal causation" is frequently parroted within the sciences, it is much easier to say a principle than it is to actually integrate it into one's structures of thought. Case in point, a lot of scientific thought is premised on the contrary notion that correlation equals causation. And nowhere is this more apparent than in the field of medicine.

Let's start with examples from Myth #1. The fields of medicine and public health are very concerned with how much people weigh, going so far as to decry an "obesity epidemic." What, exactly, is the problem with being fat? We are told that "excess" fat is associated with heart disease, high blood pressure, diabetes, and just about every other threatening condition you can think of. In a slippery way, "associated with" becomes "caused by," in that weight loss is recommended to prevent all of the latter conditions; but losing weight can only prevent these conditions if it is a cause.

Doctors are hard-pressed to address the inquiries of more critical patients who ask, "If the purpose of losing weight is to prevent high blood pressure and I have very low blood pressure, why are you telling me to lose a few pounds? If I eat right and exercise daily, should that not be enough?"

At the same time, other health professionals have noted that fat storage appears to be an inflammatory response that is co-present with other such effects of inflammation. According to this view, it is very probable that the association between obesity and things like heart disease and high blood pressure is due to another underlying cause. Furthermore, when it comes to inflammation, the probable causes start to become more nebulous, being attributable to things such as "stress." (But I will save this discussion for Myth #3.)

As with fat storage, the same goes for cholesterol. Both fat and cholesterol are vital substances that perform necessary bodily functions. However, in each case a correlation has been discovered between high amounts of these substances and undesirable health conditions, and in each case this correlation has been construed as causation. Now, both fat and cholesterol are often seen as "unhealthy." Yet, just as high fat storage may be viewed as an inflammatory response to some other (internal or external) condition, it has also been noted that the ill effects of certain forms of cholesterol only occur in the presence of.... you guessed it, inflammatory responses in the cardiovascular system that only implicate cholesterol in a tangential way.

These same cardiovascular inflammatory conditions may also have an indirect, non-causual relationship with salt (just like cholesterol). Although people now tend to view salt as "bad" and avoid it like the plague, the only direct effect of salt is that it increases water retention (which, in itself, is a neutral effect, and can, under certain circumstances be beneficial). However, in the presense of unfavorable conditions created by inflammation, the increased fluid volume can coincidentally contribute to high blood pressure.  Hence, decreasing salt intake does nothing to address the inflammatory causes of high blood pressure.

Of course, it is possible that "inflammation" may eventually replace "bad diet" in the simple causal chain employed by public health professionals (a move which would by no means lend to a more complex, holistic understanding of health); but, for this to happen, the idea of "inflammation" must be condensed into a simple, material entity that can be integrated into and reconstitute the web of market relations and commodity chains that comprise the practice of public health.

Tuesday, April 12, 2011

Health Myth #1: You Are What You Eat

This particular myth is emblematic of the captialist-driven desire to find simple causes for complex conditions.

The human body is constantly converting one type of substance into another, and the foods that you eat by no means escape this process.

Yet, for a long time it was a medical truism that excess fat on the body was caused by a diet with a high composition of fat. If you have too much fat inside of you, you must have put that fat there, directly, via fat consumption. Nevermind that carbohydrates can easily be converted into fat...

A more reasonable, and thus still widely accepted, logic is premised on a simple calculus of "calories in, calories out." Thus, you gain weight when you eat more calories than you burn, and lose weight when you eat less. Anyone who has had some fluctuation in their weight, diet, and exercise regimen can tell you that, unfortunately, it does not work like that. It is a lot easier to put weight on than it is to get it off, and these changes never follow the expectations derived from calorie counting. This suggests the ability of the body to actively respond to changing conditions and adapt its internal processes to conserve energy reserves.

Another still widespread example of "you are what you eat" logic is the recommendation that high cholesterol be treated by reducing cholesterol in the diet. However, a vast majority of cholesterol is produced by the body itself, and will thus remain unaffected by diet.

What this simple logic ultimately amounts to is an attempt to attribute undesirable conditions to "bad" inputs - and, thus, personal responsibility. Let us not forget, as well, that with food as the fulcrum of many public health endeavors, it is possible for regulatory organizations to use this concern as leverage to subsidize and promote particular agricultural industries. For example, the low-fat craze and the food pyramid built thereupon were a major boon for corn, soy, and grain industries, which have been heavily subsidized both in the U.S. and abroad. This demonstrates, once again, the way in which the trope of personal responsibility and governmental power work in tandem.

Monday, April 11, 2011

Capitalism and Health

I decided that I wanted to devote a number of posts to the subject of health.  The way we view and act upon the human body is a concern of central political, economic, and social importance, as well as instrumental to the way in which we perceive ourselves as individuals.  To start, I will provide an overview of the capitalist approach to health that has become so pervasive and naturalized.

This approach entails the following assumptions:

1. It is the "normal" state of affairs to be "healthy." Thus, ill health and other physical maladies are a form of deviance.

2. Deviance comes in discrete packages: "disease," "infection," "syndrome," and "disability" are the most common. Each form of deviance, in turn, has a discrete and identifiable cause. Some causes represent inherent abnormality (genetic defects); some represent outside threats (bateria, viruses, fungi) which can be managed and prevented; and some derive from behavior. Furthermore, to the extent to which susceptibility to "outside threats" is determined by "inherent abnormality" and behavioral causes, its role is more that of a secondary cause.

3. Health is managed at the level of the individual, in terms of individual defects and behaviors. In this way, each individual often becomes directly culpible for his or her own health, and public health strategies focus on "education" and the management of behavior (encourage kids to exercise, regulate salt content, tax cigarettes, etc.). An ideology of "personal responsibility" and the employment of governmental power relations (two non-contradictory components of capitalism: both seeking to effect change at the level of the individual) are the name of the game.

4. Understanding of causation is extremely linear and material. A one-to-one correspondance is often sought between illness and personal hygiene, eating habits, level of physical activity, and engagement in "risky" (i.e. non-socially sanctioned) behaviors.

5. With discrete, material causes of health-related deviance, the restoration of "normality" may be pursued by equally discrete, material means: thus, the domain of health care is easily penetrated and transformed by capitalism and its tendency toward commodification of every possible aspect of life.

The following are some examples of the "simple math" that has characterized our approach to health:

-People with heart disease are often fat. Therefore, being fat must cause heart disease. Furthermore, you must be fat because you eat fat. Consequently, a low-fat diet will prevent heart disease. Oh, how convenient, now we have created a market for I Can't Believe It's Not Butter!

-If you have chest congestion and fatigue, you probably have a respiratory infection. Infections are caused by outside agents. Outside agents must be killed by antibiotics (because the human body is not designed to deal with bacteria and viruses on its own). Oh, how nice for the pharmaceutical companies, people are willing to pay lots of money for drugs! (Oh, too bad for the poor people who actually need them but can't afford them...)

-Syphillis is a sexually-transmitted infection. Since syphillis is a "deviant" condition, it must result from deviant sexual behavior. Therefore, only people who deserve to get syphillis get syphillis. Hey, why not use poor black people with syphillis for the unnecessary medical research that supports our gainful employment? If we treated them, we would only be shielding them from the consequences of their actions anyway.

-Everyone's body is, ideally, exactly the same. If someone's body deviates from this ideal, it must be their fault. They should live in constant guilt and shame. They also should spend an inordinate amount of time, energy and money trying to become closer to the ideal. Since practically nobody is "normal," what a large market that creates for diet products, exercise equipment, fancy scales, and magazines with helpful tips on how to "get the abs of your dreams" (or, just for Schadenfreude, investigations into which celebrities have gained 2 pounds)!

Friday, April 8, 2011

Understanding Western Intervention In Libya

I would actually like to address the MENA unrest once more before moving on (a series on health is to follow!).  I just read a blurb by one of my favorite neo-Marxist theorists, Immanuel Walllerstein, which seeks to make some sense out of the U.S./NATO decision to intervene in the Libyan conflict.  His premise:  that it was more a matter of subduing the Arab resistance movement and maintaining the geopolitical structure of the region than about humanitarian aid or oil.  Read "The Great Libyan Distraction."

Wednesday, April 6, 2011

Book Review: The Revolution Will Not Be Funded

The Revolution Will Not Be Funded: Beyond the Non-profit Industrial Complex is a must-read! In sum, it outlines the way in which progressive social justice movements have become organized along capitalist lines in such a way that their projects serve to uphold the status quo rather than foment real social change. It is a great example of the way in which non-profits compose a part of the physical infrastructure that enables the illusion of "democracy."

The essays in this volume detail the relationship between non-profit organizations and their sources of funding, including the U.S. government and foundations. The latter are examined in critical detail and exposed as a sort of tax shelter, in which large corporations and wealthy individuals can store their income without paying taxes, and only need to pay out a small fraction each year on actual projects. The vast majority of foundations' wealth is unspent and untaxed. Furthermore, with the leverage over the work of non-profits that the grant process affords to these foundations, they have been able to redirect and dilute movements for radical social change.

While the book reveals the extent of capitalists' abilities to manage and control society for their own benefit, penetrating even forces of resistance, many of the essays also provide guidance and positive solutions to circumvent the non-profit-industrial complex. At times, the essays may also seem slightly repetative and redundant, yet it is overall a very worthwhile read!

Tuesday, April 5, 2011

Dictatorship and the USSR

Before leaving the topic of dictatorship, I want to address one more issue that has nothing to do with the MENA protests. For, it is often claimed that the events following the Russian Revolution of 1917 demonstrate a truth about human nature that implies the necessary failure of any attempts to create an egalitarian society.

The argument goes something like this: It is human nature for people to try to gain power and take advantage of others. Therefore, attempts at creating an egalitarian society will necessarily end with power being concentrated into the hands of a few people. It should come as no surprise that the Russian Revolution resulted in a repressive dictatorship. (In fact, I am basically outlining the entire premise of Animal Farm, as I remember it.)

But it is always a mistake to haphazardly attribute to "human nature" (a muddled concept anyway) circumstances that have emerged out of specific historical processes and material conditions.

From an anthropological standpoint, the above argument is unfounded. In fact, there is a much better explanation for why the Russian Revolution produced a dictatorship.

At the time of the Revolution:
-Most of the country suffered from poverty and famine
-Infrastructure had been ravaged by World War 1
-Adequate ideological infrastructure had not been developed to integrate the very diverse regions of the Empire and to legitimate the rule of the Tsar.

Thus, amid conditions of poverty and an infrastructural void, the state had to rely on repression and violence to consolidate its rule, just as it does in other countries facing the same internal conditions.

When the conditions that have produced dictatorships all over the world, time and again, were present in Revolutionary Russia, then one must assume that it was these conditions that predisposed the USSR to dictatorship.

So, neither did the U.S. possess an economic organization that was diametrically opposed to the USSR, nor did it possess such a political organization. The difference between the U.S. and the USSR was always a difference in wealth and not in ideology.

Monday, April 4, 2011

MENA Dictatorships and Colonialism

The recent history of the MENA (Middle East/North Africa) region has been characterized by three successive waves of colonization. First, by the Ottoman Empire, until the Arabs were "liberated" by the British and French. This inaugurated a period of British and French colonization, until the Arabs were "liberated" by the United States. The United States then took up the torch of colonization (under its fancy new guise: neocolonialism). It should also be mentioned that Israeli imperialism has been pereceived as an extension of European imperialism; and the USSR also made some in-roads before its collapse.

Two means of resisting imperialism have been salient in the capitalist era. Nationalism is an assertment of the right to self-determination and a challenge to the racist assumptions (re: the superiority of European culture) that undergird the colonial enterprise. Socialism is a reaction to globalization and capitalist exploitation. These movements have often been employed in concert with each other in liberation struggles all over the world.

In the MENA region, Islamic fundamentalism represents a third mode of colonial resistance. It is many ways a type of nationalism, as it an assertment of the superiority of traditional Islamic values over Western, secular culture. This is most definitely a challenge to institutionalized racism, particularly the scholarly enterprise of "Orientalism," which has portrayed Arabs and those of the Islamic faith as cuturally backward and prone to irrationality and liscentiousness.

Various combinations of Arab nationalism, socialism, and Islamic fundamentalism have been employed in resistance struggles in the MENA region. Arab nationalism and Islamic fundamentalism have also been actively cultivated by, first, the British/French and then the U.S. to fuel resistance movements against OTHER colonial powers (the Ottoman Empire in the first case; the USSR in the second).

At other times, the British and French created and encouraged religious sectarian rilvaries in order to effect divisions among the population and consolidate their own rule. Furthermore, the British, French, and U.S. have all had an interest in undermining socialist movements, overthrowing democratically elected governments (for example, in Iraq and Iran), and supporting (sometimes installing) dictators with whom they could "do business." In this way, these colonial powers have actively nourished instability, authoritarianism, and infrastructural weakness to maintain neo-colonial control over the region.

And for what ulimate purpose? The necessities of capitalism.

The MENA protestors are just as concerned about employment, wages, and social services as they are civil and political rights. In part (notwithstanding concerns about political repression and abuse), they believe that democracy is a means to effecting better socio-economic conditions. Yet, it is poverty that creates the conditions for dictatorship, and not vice versa.

Attempts at social and economic reform that would mitigate poverty and create more egalitarian conditions are routinely squelched by the U.S. and other capitalist powers. For it is in their interest to keep markets "open to foreign investment" (read: open to exploitation by multinational corporations).

In short, inequality and widespread poverty exist in MENA because it is a necessity for capitalist profitability. U.S. and European foreign policy in the region has revolved around creating and sustaining these conditions.

If the Arabs wish for a better life, it is capitalism and colonialism that they must continue to fight against. Not just the individual dictators.

Saturday, April 2, 2011

The MENA Protests

In my last post I asserted that the difference between dictatorships and democracies is a difference in degree and not in kind. State repression and violence are tied to overall conditions of poverty and lack of infrastructure.

What does this mean for MENA? Will these revolts truly end in a flowering of democracy in the Middle East?

Probably not. The root of the problem in that region is not dictatorship, per se. It is a history of colonialism and continued capitalist exploitation that has resulted in the destitution of a vast majority of the population. (Subject of part 3.)

The problem, as I see it, is that the revolts are not being directed at the real locus of oppression: capitalist imperialism. I am truly excited by the energy and commitment to change that is rippling across the region. Revolution is truly needed at this point. However, I just hope that energy can be harnassed and transformed into a global struggle to demolish the pillars of capitalist, neocolonial domination.

If the revolts remain relatively localized struggles to replace heads of state and other government officials, I fear that nothing will change in the end.