Bringing Medical Anthropology Back into the Fold: An Interview with Daena Funahashi

The February 2016 issue of Cultural Anthropology included the research article “Rule by Good People: Health Governance and the Violence of Moral Authority in Thailand,” by Daena Funahashi, who is an assistant professor in the Department of Anthropology and coordinator of the medical anthropology program at Aarhus University. What follows is a lightly edited transcript of an interview that contributing editor Paul Schissel conducted with Funahashi about institutional biases, research in Southeast Asia, and the interstices of cosmopolitanism, cosmopolitics, philosophy, and (medical) anthropology.

Paul Schissel: Initially, I wanted to draw readers’ attention to an earlier article of yours published in Cultural Anthropology, “Wrapped in Plastic: Transformation and Alienation in the New Finnish Economy,” where you confront the concept of an institutionally determined subject with burnout in neoliberalizing Finland and allow us to reconceptualize institutional power as proceeding by naming new categories in which to corral anxieties and tensions. With your recent research in Thailand, an apparently apolitical scientific imperative from the World Health Organization offers an opportunity for Thai authoritarianism to strengthen its hold. Maybe you could give us a bit of the backstory here: what led you towards institutional designations of health, and what precipitated your move from Finland to Thailand?

Daena Funahashi: Institutionalized health is good to think with. It allows us to examine how the management of life cuts across political, legal, medical, ethical, and social boundaries, while at the same time presenting itself as something independent of all these spheres. Institutions claim to speak in a register of benign care and concern divorced from all other interests, but at the same time this claim often ironically reveals deep-seated interests. This is especially relevant for my more recent work in Thailand, where Thai health experts took over the stage of politics as “good people” who would govern in the name of the public good. In the article you mention and in my book project on burnout in Finland, I take a more nuanced approach to institutional designations of health. There, I break away from the institutional context to argue that while the institutional designation of occupational burnout as an emergent stress disorder shapes the present as at risk for new workplace challenges, this designation does more than give birth to a new institutionalized category of health. Calling attention to occupational burnout as a new hazard and defining those diagnosed with it as outdated individuals who are maladapted to present-day economic imperatives open up larger questions of being.

I was always interested in doing work in Southeast Asia and, in fact, as a graduate student I started off by conducting fieldwork in Cambodia. But through my studies, I noticed how little anthropological work gets done in Nordic countries, especially by nonwhite scholars. Indeed, it was telling that I was always assumed to be working on my own country. Finally, coming down with dengue in Cambodia sealed the deal and I changed my focus to Finland. But during that time, I kept my interest in Cambodia and in neighboring Thailand. When the Finnish EU presidency declared a new initiative on health governance and the World Health Organization (WHO) subsequently held up Thailand’s military junta as an example of this type of health governance, I found that I couldn’t keep away from Southeast Asia any longer and I jumped back to the region.

PS: Perhaps an academic institutional arrangement prone to harboring such spaces of exclusion or bias on the basis of assumed identity (I sense Kafka in the room here) risks sidetracking the overall ethnographic project of writing difference. If anthropologists seeking academic resources, funds, or connections to carry out research must first constantly navigate these unspoken biases, the etic concern of identity politics may be forced into the foreground of our research. It seems more productive to put aside such preoccupations, however, and instead ask more broadly how the relative distances between self and other, or reflexive dynamics in general, operate between our informants.

DAF: This isn’t necessarily limited to institutions. There was nothing within the structure of my department at Cornell that pushed me one way or the other; in fact, my principal advisor was very supportive of my Finnish project and helped me to land funding connected with European studies. But if we take your point more broadly and look at the expectations that many different people within the academic context had—views expressed in conference panels, over drinks, in paper responses, and, of course, sometimes in the classroom or office—that’s where this pressure to study my people stemmed from. What I wanted to emphasize is that we as anthropologists do not occupy a privileged position free from the mirage of identity politics. We play (and are played upon by) them ourselves. What we end up exploring in the field and how we approach it is due to how we ourselves are caught up in the web of meaning that makes us who we are as scholars.

This is something I touch on in “Rule by Good People,” when I question Isabelle Stengers’s promise that keeping ourselves open to worlds in the multiple will allow for radical democracy to come. What is the basis for such a hope? Why should engagement with divergent worlds be necessarily democratic? In other words, might this promise say the most about how Stengers herself envisions the Other?

I argue that this process of thinking with the other in mind, a practice promoted by Stengers, is generative of not only transgressive imaginations that are politically liberating, but also of varied authoritarianisms that enforce orthodoxy. It would be rather too harsh to say that Stengers suffers from a touch of Orientalism, but it is good to think about why this thinking with the Other must necessarily  lead us out of our current crises of Western positivism.

An important attempt to deal with these issues was the anthropological concern with the category of native anthropologist that arose in the late 1980s and 1990s as a part of the reflexive turn. We have, for instance, great works by Kirin Narayan (1993), talking about her experiences being alternately seen as Brahmin, Indian, and American in India, each with its own expectations, or José Limón (1991) talking about the expectations that his interlocutors (people he grew up with) have for him as they see him as native son and as researcher at different moments. Kath Weston (1997) has also situated herself in that tense spot between native and anthropologist. The work of scholars like these was influential in breaking apart the idea that the anthropologist travels far abroad to work with the natives and then returns to the academy.

But in each of these cases, there is a binary; there is the foreign/white/researcher versus the indigenous/nonwhite/research subject. The discourse of native anthropology simply complicates the position of researcher with the indigenous category. However, like most binaries, it falls short of challenging the rules of the game. My initial goal in my Finnish project was to break out of these molds.

In both Finland and in Thailand, I am seen neither as fully anthropologist (real anthropologists, the assumption goes, are white) and certainly not as native. Instead, I am confusing, a problem to be fixed and pinned down. Sometimes I was classed as a student (i.e., a refugee taking advantage of Finland’s educational system), sometimes I was a lesser sort of academic (e.g., once a Thai interlocutor, assuming that I was based at a Japanese institution because of my name, suggested that real academics came from “white money,” meaning American or European institutions), and only very rarely was the latter part of my Asian-American identity acknowledged (“to me,” said one Finnish interlocutor when I explained that I’d lived for most of my life in the United States and United Kingdom, “you are just Asian”). In short, I was coming from outside of the binary and, as such, brought a host of other issues to the fore, issues left largely unexamined by reflexive anthropologists.

As I said, I decided upon Finland as a reaction to those academics and nonacademics who assumed that my fieldwork would be conducted in my own country. Hearing about my Cambodian work, most assumed I was Cambodian. Those who recognized my last name as Japanese saw me as a Japan expert. Sometimes my “Finland” answer would lead to a long pause and then, “. . . Sami [Lapplander]?” But my goal was to provincialize Europe in a sense very different from the way Dipesh Chakrabarty put it. Chakrabarty seeks to tease out the Europe assumed to be universal and therefore hidden within Indian history and philosophy. Here, too, is a binary: history 1 and history 2, a Europe thought to reside out there on the European continent somewhere. So my Finnish project was to go to the periphery of Europe, to a place where a lot of the philosophy, traditions, and infrastructure assumed to be European postdated similar traditions in, say, Japan. My goal was to take this idea of Europe and provincialize it by showing that there are multiple Europes: what Europe means to health experts in Finland (or patients in Finland) is one thing, but what it might mean to Brussels or to the far-right PEGITA party in Germany or to the U.K. Independence Party is another. The West as a monolithic concept is a dead horse that fakes its own death. We must keep hitting it regardless of how often people testify that no, this time it’s dead.

PS: Given your experiences in Cambodia, Finland, and now Thailand, do you see the medical anthropology you are doing as being particularly well-suited to a comparative ethnographic project, or a revival of cross-cultural, ethnographic comparison?

DAF: Really good question! I never saw myself as a comparativist. My focus has not been to compare Thai conceptions of health with Finnish ones. Instead, I’m looking at how specific groups, here health experts, imagine universals. It’s more Kantian than comparative in this way. I am drawing on Kojin Karatani’s analysis of Kant’s idea of the “world-civil-society” here. Pitting Kant against Hegel, who sees this world-civil-society as only emerging through one’s identification with particular national identities, Karatani argues that Kant imagines another possibility for universals to emerge. For Kant, Karatani says, global/universal coming together is realized through individuals who think outside of their national particular communities, those who consider themselves without a homeland. It is not the universal, then, that is the abstracted imagined space, but the national homeland, the supposed dwelling of the individual that is the fantasy. This kind of cosmopolitan thinking, while critiqued by those like Stengers, has increasing relevance in the contemporary moment when global health policies and humanitarian aid attempt to reach out to singular individuals and not to national populations. Slavoj Žižek (2009, 12) supplements Karatani’s analysis when he states “one is truly universal only as radically singular, in the interstices of communal identities.”

Health, and more specifically, health governance is something we ought to examine because in a way, it goes hand in hand with the rise of this kind of singularity/universalism that is spread by international organizations like the WHO. From the idea that we all share a common biology, we have made a leap of faith to say that we can speak for the common good. It is this jump that I find so fascinating.

We are indeed at a growing comparativist moment in anthropology, as new, so-called ontological work would indicate. But this comes with its own dangers and problems: issues that would take us beyond the scope of this interview, I think.

PS: Your work resides in this peculiar, productive (hidden?) space, both as medical anthropology and as ethnography that seeks to rescind the universal applicability of the category of health. From such a position, do you see new avenues of inquiry or applicability for the subdiscipline of medical anthropology?

DAF: I do see increasing opportunities for medical anthropologists to enter into collaborative projects with those in the positivistic sciences (e.g. epidemiology and biology). I think this comes from the global health movement and the push for health as a common global goal. But in many of these cases (and based on my experience), medical anthropologists are still given the task as cultural translators. Our expertise, according to many, lies in our capacity to translate public health campaigns in ways most effective to the local community. Such an assumption misconstrues the anthropological project. Still, I believe these increasingly common invitations to engage with scientists and to think with them are the very opportunities we have been waiting for, so long as they are true collaborations.

The explicit way in which health experts have entered the realm of politics, albeit through the apolitical register of public/global health, makes looking at science and its practitioners all the more interesting. That is, the medical anthropological project encompasses much more than how specific illness, suffering, or healing unfolds in different parts of the world. Instead, it could offer a look at how scientists authorize themselves as holders of a specific type of knowledge. That they demand translation (of the other) while posturing that no trans-fer of information in the reverse need take place requires an imagination of science as the origin of truth. But authorizing themselves as holders of truth requires a look at how some and not all are granted such status. As I show in “Rule by Good People,” where one’s power is derived from military force, it is much harder to legitimize. One just is an authority or one isn’t.

So, to cut this long-winded answer to a close, I think a new horizon has dawned on medical anthropology. It is one that reawakens ties with Continental philosophy and with classic anthropological examinations. It is in a way a re-embrace of the medical back into the classic anthropological fold.

PS: What are your plans or projects, at the moment?

DAF: This summer, I have a research grant to conduct additional fieldwork on the intersections between politics and health in Bangkok, as a part of my second book project. But for now, I am finishing my first book, Happy Workers: Burnout and The New Economy in Finland. Happy Workers is an ethnographic look at the emergence of occupational burnout as an issue of concern for popular media and health experts in Finland, and at how burnout gained social relevance as a hazard of the new economy, the result of maladaptiveness to new challenges. I want to challenge these understandings. Instead, I see how burnout, placed within epochal brackets (e.g., the “new economy”), marks the present as a particular time and place, revealing certain things and obfuscating others. So rather than just focusing on how stress disorders like occupational burnout gain popular and institutional recognition at specific moments in time, I want to push further and argue that emergent forms of distress open a window into the enigma of why we sacrifice ourselves at all. Shifts in work ethics and communal obligations reveal just how alienated we are from the very causes for which we risk our well-being, for we do not author them ourselves and yet they take hold of us in uncanny ways.

PS: Do you have any concerns about returning to work in Thailand, with the junta installed at present?

DAF: The current junta has targeted a broad array of academics and activists, ranging from self-proclaimed royalists, public intellectuals, and of course student pro-democracy advocates. What’s more frightening are extrajudicial actions, or invitations, by military forces to regime critics. This is indeed a cause for concern, but one can’t let concerns like this rule over ethnographic work. I feel as though I present the pro-junta position fairly in my work, and indeed some of the issues I bring up—a discomfort with the knowledge that their position claims to be stemming from absolute truth while being totally reliant upon force, the anti-democratic nature of health governance, and so on—would, in fact, likely be acknowledged by supporters of the junta. Of course, at the end of the day, I am obviously not in support of their regime, and so whether fair or not, they will see my stance as being antagonistic. Yet as I do not have to reside in that country (and do not have family there), I feel that I should be more vocal about these issues.

Most of my concerns are for my Thai colleagues, for those whose families get nighttime visits or calls from soldiers or who are invited for weeklong attitude adjustment sessions in the military barracks. So, do I have concerns? Yes, but not really in my ability to do my work.

What the junta has done, however, is to destabilize some of the alliances I map out in “Rule By Good People.” The alliance between health experts, NGOs, the Democrat party, and the military can no longer be taken for granted after a series of high-profile splits. The long, slow tide seems to be turning against the military, but without a clear image of what’s to emerge afterwards.

PS: How, if at all, has your early training in philosophy enhanced or challenged your encounters with the discourses on Dharma or Buddhist-nationalist politics that you describe?

DAF: Getting into anthropology from a background in philosophy, especially the Continental kind, has helped me to better appreciate the limits of anthropology. My students often talk about “using” and “applying” theory as if the ethnographic is devoid of the theoretical. Their (mis)conceptions, however, point to a gulf that is growing between anthropology and disciplines like philosophy and literary criticism with which we were once allied, as we develop new bedfellows (e.g., in the sciences) in their stead. They also point to anthropology’s reliance on philosophical thinking developed outside of the discipline as part of our bricolage; remember that we weren’t always readers of theory, but that often we made our own contributions (e.g. Levi-Strauss; Geertz)!

To me, this problem of “using” theory aside, this limit of anthropology is also its very strength. We are fundamentally open, and always on the edge as we search for the words and the ideas that might help us to attain some form of understanding. Our lack of text or of an original father figure (for they are multiple) ensures that we do not fall into orthodoxy or dogma. We do not keep reading Descartes over and over; we have a burst of interest in Agamben, for instance, that subsides with the rise of Deleuze, and so on. We keep searching and we keep moving. In contrast to philosophy, this is what I find animating our field.

PS: Perhaps the limit of anthropology can take us back to the conclusion of “Rule by Good People,” which you referenced earlier. Could you say more about your engagement with Isabelle Stengers? You take pains to highlight the limitations of a cosmopolitical framework, in which absolute desire for difference is as likely to be a vehicle for authoritarianism as it is for emancipatory life. But, from this position, what resources do we have and how do we attend to difference, to the horrors or wonders of life?

DAF: I think you touch on something very important, but difficult here. It’s difficult because, despite my reservations about Stengers’s cosmopolitics, I agree with her that we should hold back from forging a plan on how to attend to these horrors and wonders. As Stengers puts it, there can be no “and so . . .”   The minute we believe we can say “and so . . .” would be the point at which we cease to act in the presence of others. It would mean that we have access to some transcendental truth, a universal good. It would be the point at which we start speaking in the register of orthodoxy and dogma—things anthropology sets itself against. This goes back to my earlier point about anthropology as a dynamic interface that is open to ideas and developments about, for instance, subjectivity, being, and language, outside of it. This openness and constant positioning of the discipline on the threshold of itself is the magic of anthropology.

I gain inspiration, too, from Stengers’s Goddess, who answers not what ought to be done, but rather transforms each protagonist’s relations with his or her own knowledge, hopes, fears and memories in ways that will allow each, in his or her own way, to develop a method to attend to unfolding realities. This Goddess offers no guidance. She is indifferent to how we fare in the face of the world and, against this indifference, we are forced to own up to our hopes and fears as our own hopes and our own fears. This is, in the end, all that we can say we own and are responsible for. It is an ethics that does not hold us accountable for all, but for our own actions.

PS: What do you miss from Thailand?

DAF: I’m heading back next month, so I won’t have long to miss it. Right now, though, I’d have to say grilled fish, stuffed with lemongrass and coated with salt, served with a lime-garlic-chili–fish sauce dip at a roadside restaurant, with good conversation and semi-frozen Leo beer.

References

Karatani, Kojin. 2003. Transcritique: On Kant and Marx. Translated by Sabu Kohso. Cambridge, Mass.: MIT Press.

Límon, José. 1991. “Representation, Ethnicity, and the Precursory Ethnography: Notes of a Native Anthropologist.” In Recapturing Anthropology: Working in the Present, edited by Richard G. Fox, 115–35. Santa Fe, N.M.: School of American Research.

Narayan, Kirin. 1993. “How Native Is a ‘Native’ Anthropologist?American Anthropologist 95, no. 3: 671–86.

Stengers, Isabelle. 2005. “The Cosmopolitical Proposal.” In Making Things Public: Atmospheres of Democracy, edited by Bruno Latour and Peter Weibel, 994–1003. Cambridge, Mass.: MIT Press.

Weston, Kath. 1997. “The Virtual Anthropologist.” In Anthropological Locations: Boundaries and Grounds of a “Field” Science, edited by Akhil Gupta and James Ferguson, 163–84. Berkeley: University of California Press.

Žižek, Slavoj. 2006. The Parallax View. Cambridge, Mass.: MIT Press.