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Pathologies of Power: Health, Human Rights, and the New War on the Poor

PAUL FARMER
WITH A FOREWORD BY AMARTYA SEN
Copyright Date: 2003
Edition: 1
Pages: 438
https://www.jstor.org/stable/10.1525/j.ctt1pnznf
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  • Book Info
    Pathologies of Power
    Book Description:

    Pathologies of Poweruses harrowing stories of life-and death-in extreme situations to interrogate our understanding of human rights. Paul Farmer, a physician and anthropologist with twenty years of experience working in Haiti, Peru, and Russia, argues that promoting the social and economic rights of the world's poor is the most important human rights struggle of our times. With passionate eyewitness accounts from the prisons of Russia and the beleaguered villages of Haiti and Chiapas, this book links the lived experiences of individual victims to a broader analysis of structural violence. Farmer challenges conventional thinking within human rights circles and exposes the relationships between political and economic injustice, on one hand, and the suffering and illness of the powerless, on the other. Farmer shows that the same social forces that give rise to epidemic diseases such as HIV and tuberculosis also sculpt risk for human rights violations. He illustrates the ways that racism and gender inequality in the United States are embodied as disease and death. Yet this book is far from a hopeless inventory of abuse. Farmer's disturbing examples are linked to a guarded optimism that new medical and social technologies will develop in tandem with a more informed sense of social justice. Otherwise, he concludes, we will be guilty of managing social inequality rather than addressing structural violence. Farmer's urgent plea to think about human rights in the context of global public health and to consider critical issues of quality and access for the world's poor should be of fundamental concern to a world characterized by the bizarre proximity of surfeit and suffering.

    eISBN: 978-0-520-93147-3
    Subjects: Anthropology

Table of Contents

  1. Front Matter
    (pp. i-viii)
  2. Table of Contents
    (pp. ix-x)
  3. FOREWORD
    (pp. xi-xviii)
    AMARTYA SEN

    “Every man who lives is born to die,” wrote John Dryden, some three hundred years ago. That recognition is tragic enough, but the reality is sadder still. We try to pack in a few worthwhile things between birth and death, and quite often succeed. It is, however, hard to achieve anything significant if, as in sub-Saharan Africa, the median age at death is less than five years.¹ That, I should explain, was the number in Africa in the early 1990s,beforethe AIDS epidemic hit hard, making the chances worse and worse. It is difficult to get reliable statistics, but...

  4. ACKNOWLEDGMENTS
    (pp. xix-xxiv)
  5. INTRODUCTION
    (pp. 1-22)

    In the summer of 1999, in the company of friends and co-workers, I crossed the border between Mexico and Guatemala. The frontier was heavily militarized on the Mexican side. We were searched there, as we had been searched elsewhere in Chiapas: with up to seventy thousand troops stationed in the region, the Mexican government can readily do a good deal of rummaging.¹

    We walked across the frontier uneventfully and there, close to the appointed hour, met our friend. Call her Julia. A broad smile broke over her face, a beautiful and reflective one; long black hair fell over her back,...

  6. PART I. BEARING WITNESS
    • [PART I. Introduction]
      (pp. 23-28)

      YOU DON’T HAVE TO BE a doctor to know that the degree of injury, of suffering, is unrelated to the volume of complaint. I have seen the sullen, quiet faces in waiting rooms in Peru, say, or in prison sickbays in Russia. I have seen these faces in the emergency rooms of the United States. I have seen the impassive faces of the silent women trudging across the public spaces of the towns of Chiapas. But their silence is of course imposed from above. Perhaps if Greene’s Dr. Plarr had been an even better listener, he might have heard the...

    • CHAPTER 1 ON SUFFERING AND STRUCTURAL VIOLENCE SOCIAL AND ECONOMIC RIGHTS IN THE GLOBAL ERA
      (pp. 29-50)

      Everyone knows that suffering, violence, and misery exist. How to define them? Given that each person’s pain has for him or her a degree of reality that the pain of others can surely never approach, is widespread agreement on the subject possible? And yet people do agree, as often as not, on what constitutes extreme suffering: premature and painful illnesses, say, as well as torture and rape. More insidious assaults on dignity, such as institutionalized racism and gender inequality, are also acknowledged by most to cause great and unjust injury.

      So suffering is a fact. Now a number of corollary...

    • CHAPTER 2 PESTILENCE AND RESTRAINT GUANTÁNAMO, AIDS, AND THE LOGIC OF QUARANTINE
      (pp. 51-90)

      Haiti, it is well known, is a country long wracked by political turmoil. But the coup d’état of September 1991 was unique in many respects. Most significantly, it represented the overthrow of Haiti’s first democratically elected president, Jean-Bertrand Aristide, whose popular support was so strong that he had won 67 percent of the vote while running against almost a dozen candidates. By any criteria, Aristide was more popular in his country than any other sitting president in the hemisphere. Thus when he was overthrown, a great deal of military force was required to silence Haitians’ angry opposition to the coup....

    • CHAPTER 3 LESSONS FROM CHIAPAS
      (pp. 91-114)

      On January 1, 1994, the world’s attention was drawn to the Mexican state of Chiapas. Before dawn, masked rebels took over the administrative offices in San Cristóbal de las Casas, a small city nestled in the high limestone mesas of southern Mexico. The city takes its name from the famous “Protector of the Indians,” Fray Bartolomé de Las Casas, who condemned the Spanish colonists for their brutal treatment of the native population. Las Casas accompanied Columbus on his third voyage to the New World, not as a priest but as an aspiring colonist. His experience on the island of Hispaniola,...

    • CHAPTER 4 A PLAGUE ON ALL OUR HOUSES? RESURGENT TUBERCULOSIS INSIDE RUSSIA’S PRISONS
      (pp. 115-134)

      Sergei was tall and thin, with black horn-rim glasses that gave him more the look of an owlish accountant than a felon. His fellow prisoners and their guards were silent as he told me his story. The only other sound aside from his soft voice was that of coughing: like him, all the other young convicts who crowded the cell were sick with pulmonary tuberculosis. At times, Sergei seemed bored with the tale; at times, intimidated by the hush. He punctuated his sentences with a rattling cough of his own, raising, as an afterthought, a long pale hand to his...

  7. PART II. ONE PHYSICIAN’S PERSPECTIVE ON HUMAN RIGHTS
    • [PART II. Introduction]
      (pp. 135-138)

      A FRIEND OF MINE, an anthropologist, suggested that I explain why I felt this book was divided into two parts. The first half ofPathologies of Poweris called “Bearing Witness” because it relies on eyewitness accounts and on my own interviews (whether as physician or anthropologist). The second half of the book consists of a series of essays about the analytic perspective that informs my critique of human rights as conventionally defined. “Analytic perspective” may be too grand a term, and by qualifying it as “one physician’s perspective on human rights” I mean to be humble in two ways....

    • CHAPTER 5 HEALTH, HEALING, AND SOCIAL JUSTICE INSIGHTS FROM LIBERATION THEOLOGY
      (pp. 139-159)

      For decades now, proponents of liberation theology have argued that people of faith must make a “preferential option for the poor.” As discussed by Brazil’s Leonardo Boff, a leading contributor to the movement, “the Church’s option is a preferential optionfor the poor, against their poverty.” The poor, Boff adds, “are those who suffer injustice. Their poverty is produced by mechanisms of impoverishment and exploitation. Their poverty is therefore an evil and an injustice.”¹ To those concerned with health, a preferential option for the poor offers both a challenge and an insight. It challenges doctors and other health providers to...

    • CHAPTER 6 LISTENING FOR PROPHETIC VOICES A CRITIQUE OF MARKET-BASED MEDICINE
      (pp. 160-178)

      The Old Testament prophets cannot have had a very easy time of it, and not because their primary work was as clairvoyants or seers. Prophetic voices were more often raised in protest against the social conditions endured by widows, orphans, and the poor majority. These voices were raised in opposition to structural violence—the poverty and inequality that meant opulent excess for a few and misery for most. Many prophets were regarded by their literate contemporaries as certifiably mad; few were heeded.

      In some ways, the prophets failed, for the inequities they deplored still endure. A growing and globalizing market...

    • CHAPTER 7 CRUEL AND UNUSUAL DRUG-RESISTANT TUBERCULOSIS AS PUNISHMENT
      (pp. 179-195)

      It’s easy to find, in the long and grim history of punishment, inventive ways of making prisoners suffer. The crudest of these are usually known as penal torture, a practice roundly condemned by all governments—and practiced, still, by many. This chapter does not focus on whether the term “torture” aptly describes capital punishment, hard labor, flogging, or isolation, although I’m fairly certain that we can and must make finegrained distinctions when we can. Nor does it address, as Chapter 4 does, the experience of tuberculosis within prisons. Rather, this chapter discussestuberculosis as punishment.

      Tuberculosis has a long history...

    • CHAPTER 8 NEW MALAISE MEDICAL ETHICS AND SOCIAL RIGHTS IN THE GLOBAL ERA
      (pp. 196-212)

      On March 30, 2000, while working in rural Haiti, I received an e-mail from a medical student. The subject line flashed by as the files reached me through the wonder of satellite technology. “More Tuskegee,” it read.¹

      The Tuskegee Syphilis Study was conducted in Alabama by the U.S. Public Health Service from 1932 to 1972. The researchers recorded the natural history of syphilis in an attempt to learn more about the disease by following six hundred men, of whom about four hundred had syphilis, throughout their lifetimes. All were African American, many were sharecroppers, and most lived in poverty. Despite...

    • CHAPTER 9 RETHINKING HEALTH AND HUMAN RIGHTS TIME FOR A PARADIGM SHIFT
      (pp. 213-246)

      Medicine and its allied health sciences have for too long been only peripherally involved in work on human rights. Fifty years ago, the door to greater involvement was opened by Article 25 of the Universal Declaration of Human Rights, which underlined social and economic rights: “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his...

  8. AFTERWORD
    (pp. 247-256)

    Today’s date—March 8, 2000—still seems futuristic. This in spite of the fact that I’m writing between Moscow and Port-au-Prince. A long flight, and so plenty of time, if not elbow room, for reading the complimentary newspapers offered all passengers. Whether the dailies are from London or New York or Paris, they share an editorial tone; the giant full-page advertisements, many of them in color, are now overtly similar from capital to capital. And although I cannot read the Russian papers, I was able to read the billboards en route to Sheremetyevo airport. They too are adorned by familiar...

  9. NOTES
    (pp. 257-332)
  10. BIBLIOGRAPHY
    (pp. 333-378)
  11. CREDITS
    (pp. 379-382)
  12. INDEX
    (pp. 383-402)