On gratitude, ethnography, & care

Michelle Munyikwa // “Oh, you work with refugees. That’s so wonderful. They must be so grateful!”

For several years, I’ve been working with refugees and asylum seekers as part of my dual training as a physician and anthropologist. While there have been many instructive and interesting moments that have taken place within this work, I’d like to take as a point of departure encounters that have come as a result of discussing this work. Both treating refugees medically and researching their communities seem to elicit a similar conversational response, a mixture of astonishment and adoration that frames refugees in particular as worthy recipients of care. In this blog post, I frame this intimate relationship between the work of care and the work of anthropology in order to offer grounds for some critiques of these impulses.

Anthropological critiques of medicine are rife with concerns about the motivations of doctors, nurses, and humanitarian workers alike. We critique the discursive apparatus that moves others to far-flung places in the search of good, deserving patients in a process of reforming the self. But the oft-mentioned gratitude that arises when I describe my work has me wondering how we may critique these anthropological impulses as well. If anthropology itself is care, then it, too, is subject to the false starts, the broken good intentions, and the self-making practices that traditional caring professions are well-known for.

Refugees, in particular, have long been a site of concern and care. Alongside the humanitarian apparatuses that built to serve them came modes of representation that shaped refugees as a part of global imaginaries. They are represented as faceless masses, sympathetic women and children, suffering victims, threatening terrorists, and economic burdens. Refugees themselves have contested their representation as the grateful recipients of the gift of freedom, uncritical of their new homes. Despite this critical discourse, refugees are still, in my experience, held apart as exceptional (which, in many ways, they are).

Regardless of its source, the twinned reaction to my work as both a doctor-in-training and ethnographer of refugees brings up questions of care and its proper objects. One such question is: what is the relationship between medical anthropology and its sometimes-object, caregiving? Medical anthropology is increasingly framed not only as the study of care, but as care itself; the ethnographer, here, is a kind of caregiver whose mode is witnessing. Certainly, the ethical obligation to witness is not a recent phenomenon within medical anthropology: debates about engaged and critical ethnography have indelibly reshaped the role of the ethnographer. From the handmaidens of war and colonialism, our profession has transformed into one whose duty is to speak truth to power and document in exquisite and careful detail the experiences of those who were suffering at the hands of global power forces beyond their control. A critical role that ethnography plays is to provide testimony to those broader forces which constrain the lives of our interlocutors, to bear witness to their attempts to live, to thrive, to become otherwise. We document practices of care and doing good in all their complexity, for better or worse, as well as participate in these projects ourselves.

Care, Lisa Stevenson writes, can be conceived of “as the way someone comes to matter and the corresponding ethics of attending to the other who matters.” In the practice of anthropology, we can see a practice of the self, she suggests, one in which both ourself and the other are transformed through a relational practice of listening and inscription. Framing anthropological practice this way allows us to add complexity, revealing “both the ambivalence of our desires” and “the messiness of our attempts to care.” What, I wonder, are the implications of this formulation of ethnography as care? What do they tell us about the ethical imperatives of anthropology, or the kind of actors we imagine ourselves to be? And how, too, might we make sense of how to teach this to others, future carers-in-the making, acknowledging both the ambivalence of these desires and the messes they might make?

In particular, gratitude often operates as a social glue of care: it identifies ideal patient and client populations and creates service providers themselves, buoyed as they are by the affective bonds that bring them and their satisfied clients together. I have often thought that gratitude is how we create a sense of the worth of caring labor, from hospital to classroom, clinic to therapist couch, in scenes rife with the alienation of labor under capitalism and its attendant bureaucracies. We long for gratitude because it serves as validation. It anchors us to what matters. Gratitude signifies a job well done in a broader landscape that offers little in the way of encouragement or purpose. Gratitude is the capital we expect in lieu of or in addition to remuneration. Thank you, the patient-client-beneficiary says, tears threatening to appear at the corner of their eye. The grateful patient is, after all, a trope of medical writing, from the medical school admissions essay to the medical humanities poem, a cliche that reflects – and sets – our expectations about what clinical intimacy will entail.

If anthropology is care, then we need a genealogy of compassion, an interrogation of empathy, a set of questions about where the impulses of the good doctor and the good anthropologist coincide. How and when do we care, and what do we expect from the objects of our care? What does ethnographic care afford us, and what happens when communities under study don’t perform the gratitude we so desire from them? What happens when the communities we study are not what we might expect, or have ambivalent responses to our caring representational gazes?

If anthropology, then, is care, then we may consider examining our own practice as we might examine those of other caregiving professions. We may consider the political economic flows that produce investments in particular subjects at particular times. We can consider how media and politics bring some topics to our gaze as more salient and interesting than others. Most interestingly, we can consider the affective attachments to good work that structure what feels good about caring anthropologically, and what’s more, we may consider what we expect from our interlocutors too. If careworkers expect docile, compliant, and active neoliberal subjects who adequately perform gratitude, might that be the case for anthropologists too? Is anthropology still care if communities reject – and resist – our interventions?

Recently, Ramah McKay wrote that “the work of teaching, writing about, and even critiquing global health can be hard to distinguish from the work of constituting it.” I might suggest, in general, that medical anthropology suffers as a whole from this slippage — between critiquing, constructing, doing, and teaching. In a recent conversation with a fellow medical anthropologist, I discussed a problem I’d come across in teaching anthropology courses: at some point, each time, despair washes over the classroom, at which point it becomes increasingly hard to shake. Having usually spent perhaps three or four sessions in the class at this point, the students detect a formula: they will begin the readings optimistic about the intervention, program, or common sense ideas they hold about health, intervention, and care, only to have this excitement dashed by the end of the reading. After weeks of this, they become concerned: is there anything they can do? anything they can say? They become, and with good reason, extremely skeptical and wary of their own impulses, their own desires to care.

For many, anthropology provides a haven in which they can engage in an ethical attention to the other, one wrought with complexities and messy attempts to make things right in the world. In this sense, anthropology is a great way to care, to open the self to others. But as we, too, form ourselves and future generations as anthropologists, we may have to draw our gaze toward our own profession, examining its political-economic foundations, aesthetic and ethical principles, and educational self-making processes much as we might the clinical fields. It might make caring anthropologically more fraught, necessitating further exploration of our complicity in the very systems we so often critique.


Bibliography
 
Nguyen, Mimi Thi. The Gift of Freedom: War, Debt, and Other Refugee Passages. Duke University Press, 2012.
 
 
Stevenson, Lisa. Life beside Itself: Imagining Care in the Canadian Arctic. University of California Press, 2016.
 

Cover Image: Margaret Mead in Bali

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