Class #40: Recognizing Disease in Nonwestern Societies: Haiti
Prof. Schloss. 12/5/01 Reading: Paul Farmer, Chapter from Infections and Inequality

Farmer is interested in the "collective representation of disease"---which is to say the cultural definition of disease. (What difference does it make to know about how disease is defined? We would have talked about this on Monday but since students were not prepared, we did not do that. This is the kind of issue that is likely to be explored on the final exam.)

Farmer

Farmer is a physician who wanted to know about anthropology
He went to Haiti early in the 1980s when it was thought that AIDS had origins in Haiti
19 1983 when he started his work, AIDS (called sida in Haiti which is the French term---Haitians speak French) was not in the "lexicon (e.g., the language)" of rural culture in Haiti---people had heard of sida, but it was not personally familiar to people.

Events in Haiti

In the early 1980s, tourism was a big industry in Haiti and important because it is a very poor country.
In 1982-83 the tourism industry collapsed because in America AIDS had been linked to Haiti.
The collapse of the industry caused the loss of jobs and business failures.

1984---People had some sources of information about AIDS, but they had distorted images, false ideas about the nature and cause of the disease, and there was a rumor that Americans had brought AIDS to Haiti.
1985---The first "paradigm (or folk theory)" of AIDS appeared---it was thought to be a condition of "bad blood".
"Blood" in Haiti is not what we mean by the term in America.
Bad blood is involved with social relations: people get bad blood because there are bad feelings between people.
1985-86---More structured, modern information about AIDS was sent out by the government and other official authorities, but in the form of songs. So people had some information, but mostly they sang the song for entertainment.

At about that time, General Duvallier's dictatorship (a long-standing, family based dictatorship in the country that was very repressive) began to fail. As this happened, folk stories about AIDS were worked into political stories about political conspiracies and about resistance to the government.

Political change led to public meetings and citizen involvement in politics.
"the muzzle is off" was the saying, which meant that after many years people were free to talk about what they wanted and to receive any news they wanted to seek.
Political news was a matter of concern; people listened to the radio a lot to get the news; in contrast to the insular way that they had lived in the past, people now were more focused on the larger culture, what was going on there, what its ideas were, and how it influenced their local lives.

At this time, according to Farmer's account, one heard spontaneous talk in the village he studied about sida, but it's not very pressing for the people because they have not known anybody who actually had the disease so the talk was on the hypothetical level.
Herbalists in the community who talked about AIDS doubted the "blood paradigm". In their view AIDS was "slippery", which is to say that they did not know how to categorize the kind of disease it represented in terms of their folk ideas about the sources of disease and healing.

Then in 1987, the first person in the village gets AIDS, and this is the case of Manno. Manno himself is primarily worried that he has TB since in the experience of the village this is the really dangerous and socially consequential disease. He does, in fact, have TB but it also turns out that he has AIDS.
As people talked about Manno's illness, people in the community said it's not "normal" TB; this is a way of saying that "someone sent" the TB to Manno. Since Manno is a successful person in the community, it's felt that lots of people are jealous of him and that consequently someone might have wanted to hurt him by sending him a disease. The way the people are talking represents a local idiom for talking about culture.

[Bracketed comment by Schloss]
Many cultures in the world have personalistic idioms for talking about disease. Referring to their way of thinking and talking, Americans would use words like sorcery or witchcraft to describe the way that these people are thinking about how people get diseases. That is, we are used to thinking of other cultures in which people who want to sent bad "magic" contact a witch or sorcerer and have them cast spell. But this is not an accurate way of representing the way these people are actually thinking about how relationships cause disease. In our culture, it's very hard for us not to think in terms of general categories of causation. We have an idea like "virus" which represents a whole category of particular things, and one example of the category causes a particular person's illness. But in our view every case of AIDS is like every other case, at least in terms of its scientific basis and the way we understand how it comes to occur. In a personalistic culture, each relationship is personal, individual, and unique. So there are not general categories. If I dislike you and want to hurt you, it is my special dislike for you that causes bad results for you---that causes your blood to go bad leading to TB or sida. In our culture, we would need to find someone who has access to a general category (magical actions) to do something on our behalf (this is the magician or sorcerer). We do not think that individuals generate their own personal kind of magic (in a way that might compare to creating one's own personal kind of art.) Haitians do think this way, however.

In a traditional culture (that is, one not diluted or interfered with by the influences of modern, industrial society), the personalistic causes of disease would be worked into powerful and regular roles and rituals. The village in Haiti was one where traditional culture had broken down---the people are peasants, which is to say that they are poor workers in a modern society. Nonetheless, when strange or upsetting things happen, they tend to draw upon their traditional understandings to make sense of what is going on. So it is when a new disease like AIDS makes its appearance.]

People in the village thought that the bad thoughts of others caused Manno's disease. Three people in the village in particular are thought to be jealous of him and they are suspects. Manno dies.

A second case then occured, that of Anita, and it is perplexing from the personalistic perspective---from the personalistic understanding of the nature of AIDS that people had developed from Manno's case. She is "innocent", which is to say she's nice, ineffectual and modest. She wouldn't have any enemies. Since they think sida is caused by relationships, they say she cannot have sida. Because of this, her father loses faith in modern medicine as a way of providing her with care and takes her to the herbalist. She sickens and eventually dies and people ultimately are convinced that she has sida.

As politics develop and rumors about bad political possibilities circulate, villagers come to think that their village is, for some reason, a target of attacking ill will. Other villages do not have anyone with the disease. So the only way the people have to explain what is happening (something we would ascribe to the idiosyncratic circumstances of who people in the village came into contact with) is that they have enemies. They decide that Anita got it through her husband---they interpret this as "bad blood"---the first paradigm.

So now they have two theories or paradigms: that it can be sent or that it can be acquired through bad blood (that is, Anita's husband had bad blood and passed it on to her through sex---as they are told AIDS is passed on.)

There is a third case, that of Dieudonne Garcia. He is a poor guy who thinks his sida comes from jealousy. He works with another domestic worker in the city who he thinks is the source, but he is also a poor guy and not the sort of person to inspire jealousy. Where Manno was a big shot, Garcia shows that poor people can get it and send it---not across class lines, suggesting that there is a lack of class solidarity among peasants. The idea with Manno is that since he's a big shot, the hostility was really class hostility.

By 1989, the author Farmer found a stable understanding in the village. In their view, sida is sent. If it is sent, then theories that say sex causes AIDS are irrelevant from the villagers' point of view. Unprotected sex is OK because if it's sent you have to get a healer to reverse the effects of the jealousy or bad feelings that caused your illness.

END OF CASE, BEGIN ANALYSIS

In Haitian culture before AIDS, there was a folk theory that mixed African folk beliefs with Catholicism. One could enlist help from a priest to call forth the dead to afflict another in this tradition. An afflicted person would grow thin and spit blood. That fits the symptoms of TB, so there's overlap. TB could be understood as "simple" or "not simple" (caused by others who will you ill).

AIDS is confusing because it's mixed with this older theory of TB. All things considered, you'd rather have non-simple than simple TB because it can be cured by herbalists.

Let's consider the case of Manno. One important aspect is that the sources of jealousy for him are local---in this framework, one can escape the evil by simply moving away.

The case of Anita is not local. Anita's situation comes from larger causes. A dam had been built flooding the valley of the village. They moved to less productive land on the ridge above. The village could not support itself. Anita's mother died. Anita had to move to the city. In addition, you had the revolution going on and gay Americans moving to Haiti helping to spread the disease. To the villagers, the disease was caused by this dislocation.

Anita knows AIDS was sent to her, and it was---by colonialism and class oppression.