A Will to Engage – A short Review of “Will to Live – AIDS Therapies and the Politics of Survival” by João Biehl

(One of my Assignments at the YIF of my favourite course till date – ‘Anthropology Today’ by Prof. Mekhala Krishnamurthy)

At the very outset, I must confess that it was difficult for me to ‘zero in’ on one of the works to review for the purpose of an ‘assignment.’ It proved necessary for me to sit through every class and get a perspective on each of them, even though I could not read each text thoroughly. So I used this exercise to determine my own engagement, as I explored this all –encompassing and diverse discipline. I then discovered that Biehl’s work[1] was which engaged me on several levels. It is with clarity of thought, having ‘clinically dissected’ the text and then re-examined it with my own motivations as an aspiring anthropologist that I pen my thoughts here.

On our very first class we were introduced to the quote by João Biehl.[2] A part of which literally ‘spoke’ to me was “…the anthropological venture has the potential of art: to invoke neglected human potentials and to expand the limits of understanding and imagination – a people yet to come…”[3] With my background in Law, an often-realised disgruntlement was of how the law today seems distant and disconnected to the humane.[4] Policy frameworks are motivated by ‘teleos’ and a utilitarian or cost-benefit analysis, with each legal expert, bureaucrat  and political leader asking the same question – will this socio-welfare measure be economically feasible for the State?[5] On one hand there is the ‘tortoise’ of antiquated judicial and political practice and on the other ‘the hare’ – changing markets, fast-moving technology and the increasingly conscious yet vulnerable youth.


Cover of the Book - Image courtesy: http://joaobiehl.net/will-to-live/ - Princeton University Press

Against this backdrop – ‘Will to Live’ addressed the very concerns that come to mind – as a ‘humanist’[6] – ethnography and an investigation into a policy measure could touch human lives and yet, attempt to understand the larger narrative of governance, global economy and political negotiations, public health and security and  questions relating to Equity and Rights . Throughout the text, I greatly appreciated Biehl’s deep respect for the power in humanity. In the preface, he cites a poem by João Cabral de Melo Neto – “you can learn that the human being is always the best measure, and the measure of the human is not death but life.”[7] It convinced me that this text is powerful and seeks to be only a means to an end; quite similar to what I hope to achieve as an anthropologist someday – “potential to become a mobilizing force in this world.”[8]

An aspect that I noticed early was of how carefully Biehl chooses to caption each sub-chapter in the book. E.g. in the Introduction ‘A New World of Health’ – the first caption is of ‘The Right to a Nonprojected Future.’ As a reader, I was alerted of the connotations it may have – legal, political, economic and futuristic.  Biehl then immediately explains how his work is deeply influenced by the economist, Albert Hirschman who “challenged social scientists to move beyond categorical prejudgments, beyond the sole search for general laws and orderly sequences of what is required for wider social and political transformation.” [9]

This gave ground when I further gauged his methodology – where he had to “move in time and space, back and forth” and also state that his fieldwork reminded him that “there is no short cut to understand the multiplicities of reality”.[10] His drive and focus is reaffirmed when he declares “Yet during my fieldwork I found myself returning from what I saw and heard with blood-shot eyes and pierced eardrums” and thus engaged photographer Torben Eskerod to capture ‘life’ where “words and numbers fell short.”[11]  Again, this personally engaged me – his willingness to mix the medium of research (e.g. a discipline like epidemiology) and personal engagement knowing that the subject of his work requires urgency. I felt he was ‘a man on a mission’, not to judge Brazil’s response to the pandemic but to explore and ‘engage the unexpected’.[12] To me, this endorsed exactly why ethnography on issues like these is important. To quote “Ethnography helps to uncover the circumstances and contradictions that are inherent in mobilizations like these – it complicates – gives way for abstractions, contingency, multiple interests and the unevenness of the political game.”[13]

Lastly, on method – I was also intrigued by the series of research questions he seeks to answer.[14] At the first glance, they seem heavy and ambitious for a single ethnography[15] – but I reconsidered my initial belief when I read the concluding chapter on ‘Global Public Health.’[16] In answering those research questions, he argues that “the book’s conclusion thus exposes the logics of dead ends and articulates the path to large-scale medical change, as well as their points of entry. At both the macro-and micro levels, we see a state of triage and a politics of survival crystallizing.”[17]

I am aware that Biehl’s work is the largest document that was assigned to us – and in the interest of keeping the points of review brief,  I shall list out the parts of the text that were of interest to me – but elucidate on the one aspect that finally engaged me the most.

The insight offered in ‘Persistent inequalities’ – followed by the narratives of the mix of AIDS patients he interviewed was absolutely gripping. Even as one is conscious of the objective reading required – I was engulfed by the powerful emotion of the narratives and photographs. The photographs could make one see how transforming the ARV therapy is to the face and countenance of a being.[18] Another particular aspect that is fascinating is of when he speaks of when an anthropologist returns to the field – you “witness the very temporality of politics, technology, money and survival.[19] It highlights, this discipline is dynamic – and brings one back to notion of what he calls ‘living in the state of flux’ or the ‘local economies of salvation.’[20]

I was also struck of how he aptly noted that in government circles – the policy makers had their jargons – ‘politicized were the concepts, thus the discursive practice needed to be critically assessed.’[21] Most of his observations are followed by deduction, not necessarily generalized or backed by theory – but rather a comparison to policy or some other evidence. This approach is almost scientific and palpable, for the topic area demands a non-moralistic tone. When I read the chapters on ‘Transnational Policy-Space’,[22] and the ‘Pharmaceuticalization of Public Health’,[23] it seemed  necessary, as I sensed his distrust for such a policy where multi-billion dollar pharmaceutical companies are entrusted with the lives of the Brazilian poor; yet he quotes and gives space to that ‘side of the story’. The approach became more significant, when I later read of how he articulates that the “will to live” was deeply connected to the ‘nexus of AIDS, Poverty and Politics.’[24] He does not merely state of how ‘having a house, a job, a family and security’ prolongs life – he shows it.

Finally, what clinched my own ‘engagement’ was this. As he criticises– “that numbers and statistics are intensely political[25] – he also articulates the thoughts I have in mind – which until now was difficult to frame as a question – “Where is the State? And on “the Vanishing civil society.”[26]

My own work experience of Policy-making in India – largely in the domain of socio-environmental issues and Gender-based rights, makes me wonder – What sort of state or economy are we? Welfare? Liberal? Neo-liberal? Pseudo-socialist or pseudo-capitalist? I have seen several stakeholders “participate” in the discussions and debate on the policy, not a single entity is willing to take ‘accountability’ for its ramifications. When Biehl quotes the activist Gerson Winkler,[27] I was reading from printed notes in a train and feeling at loss for the inability to ‘google’ him!

I realised that whether it is the ‘“successful” universal access to ARV policy in Brazil’ or ‘assessing Environment Impact Assessment projects in Gujarat – NGOs in political economies face a similar situation – “When one goes and visits patients (in my case victims of pollution) they ask for help as if one were the state, but where can one objectively refer them to? I am not the state. I am an NGO. Where is the state?”[28] The manner in which the single question encompassed the questions in my head was overwhelming. Addressing rights and responsibilities in this shifting state – on basic issues like access to resources, public health and Rights, are questions that I myself seek to understand in this “neo-liberal” economy India may be headed to. I was initially surprised by the comparisons I could make, only to comprehend that the deeper nuances of a discipline like Anthropology is to experience different paradigms, if only to map, compare, relate, engage and develop it further to other cultures and paradigms across the world.

On a concluding note, I was also pleased to learn how inter-disciplinary Anthropology is. Being introduced to Philosophy of Science previously helped as Biehl quotes from the work of Georges Canguilhem “decline of the idea of progress.”[29] I think it is apt that while attempting to comprehend this rich ethnographic, epidemiological and dynamic anthropological work – my own understanding into “the world of HIV” even the little experience I had as a Youth- advocate for Worlds AIDS Day was brought into perspective – “Predictions of progress turn today into tomorrow. But it is only when tomorrow comes that we can speak of yesterday.”[30] There were no “predictions” yet paradoxically it leaves the reader thinking on a predictive mode – as like Hirschman and Biehl write – I too have understood, that “I like to understand how things happen, how change actually takes place.”[31]

[1] For part which was assigned to us – as I not been able to get hold of the book from my Co-fellow as yet.

[2] The first class of Anthropology – Prof.­ Krishnamurthy at YIFP, 2011-12 where we sought to understand the ‘purpose’ or motivations behind a discipline like Anthropology.

[3] Referenced from my Class notes and a PowerPoint Slide of Prof. Krishnamurthy on January 4th, 2012

[4] This is of course, a strictly personal opinion stemming from the work experience I have had on Environment laws and Policy drafts , and how it seems directly motivated by industrial concerns.

[5] Ibid

[6] This is the precise term that Prof. Kenneth Foster used to describe my views while discussing upcoming Technology interventions in Education, for India. I quote it here, for both its irony and appropriateness.

[7] Poem titled ‘Education by Stone’ – João Cabral de Melo Neto, found in the Preface of ‘Will to Live’ by João Biehl

[8] Last line of the same quote as earlier referenced. Supra n.2

[9] João Biehl “Will to Live- AIDS Therapies and the Politics of Survival” Princeton University Press, 2007- Introduction at pg. 3 para 1.

[10] Biehl “Will to Live.”  Introduction – pg. 4 last paragraph

[11] Supra n. 10 – pg. 5 para.2

[12] Supra n. 9 – last line.

[13] Supra n.10 – pg. 11. Para 2

[14] Supra n.10 pg.5 last para till pg.6

[15] Esp. the last question “Which forms of health are sufficient to liberate life, wherever it is confined?” at pg.6

[16] As our readings jump straight to the Concluding chapter; the book obviously justifies his early questions.

[17] Biehl “Will to Live.”  Conclusion – pg. 377 at para 1.

[18] Possibly – this was Biehl’s design in bringing photographs as essential to his text – giving face to those marginalized.

[19] Biehl “Will to Live.”  Introduction – “The Politics of Survival” at pg.47 para1.

[20] Supra n.18 at pg.48. Para 2.

[21]  Biehl “Will to Live” Chapter One – Pharmaceutical Governance at pg.56 para 2.

[22] Biehl “Will to Live” Chapter One – A Transnational Policy-Space’ at pg. 64-68

[23] Biehl “Will to Live” Chapter One – ‘The Pharmaceuticalization of Public Health’ at pg. 97-101

[24] Sub-chapter in the Conclusion – at pg.396-399

[25] Biehl “Will to Live”- Conclusion – pg. 385 last line (Pharmaceutical Philanthropy and Equity)

[26] Biehl “Will to Live”- Conclusion – pg. 388 and 393 (Overview)

[27] Referred to by Biehl as the one who introduced him to “the world of AIDS in Brazil” in 1992 on pg. 390

[28] Supra n.25 at pg. 392 , para 2. (Where is the State?)

[29] Biehl, “Will to Live” Chapter One – at pg. 78. Para.2

[30] Ibid

[31] Biehl, “Will to Live” – Conclusion at pg. 406 para 2. Biehl makes a reference to the works of Albert Hirschman “A Bias for Hope.”

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