On Suffering and Structural Violence: A View from Below

Author(s): Paul Farmer

Source: Race/Ethnicity: Multidisciplinary Global Contexts, Vol. 3, No. 1, Race and the Global
Politics of Health Inequity (Autumn, 2009), pp. 11-28
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On

and
Suffering
Violence:
Structural

A View

from

Below

Paul Farmer

is
veryone knows that suffering exists. The question
how to define it.Given that each person's pain has a
J?mmmi degree of reality for him or her that the pain of others
can surely never approach,
iswidespread
agreement on the sub
us
would
Almost
all
of
agree that premature and
ject possible?
painful illness, torture, and rape constitute extreme suffering.
I

Most would

also agree that insidious assaults on dignity, such as

racism and sexism, also cause great and unjust

institutionalized
injury.
Given

our consensus

on some of themore
forms
conspicuous
a
come to the fore.
of suffering,
number of corollary questions
Can we identify those most at risk of great suffering? Among
is it possible
to identify
those whose
suffering is not mortal,
those most likely to sustain permanent and disabling damage?
Are certain "event" assaults, such as torture or rape, more likely
to lead to late sequelae
than are sustained and insidious suffer
as the
or of racism? Under
ing, such
pain born of deep poverty
this latter rubric, are certain forms of discrimination demonstra
more noxious
than others?
bly
who take these as research questions
Anthropologists
study
both individual experience and the larger social matrix inwhich
in order to see how various
it is embedded
social
large-scale
forces come to be translated into personal distress and disease.
do social forces ranging from poverty to
By what mechanisms
racism become embodied as individual experience? This has been
the focus of most of my own research inHaiti, where political
and economic

forces have structured risk forAIDS,

tuberculosis,
most
other infectious and parasitic diseases. Social
and, indeed,
forces at work there have also structured risk formost forms of
extreme suffering, from hunger

to torture and rape.

From Daedalus, 125:1 (Winter, 1996), pp. 251-283. @1996 by theAmeri

can Academy of Arts and Sciences. Reprinted with the
permission of
the publisher, MIT Press Journals.

autumn

2009

11

? 2009 The Ohio State University /Office

ofMinority Affairs/The Kirwan Institute

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PAUL

Working
ical violence
one
sphere,
has
try
long

FARMER

in recent years polit

in contemporary Haiti, where
to
worst
the
has been added
poverty in the hemi
learns a great deal about suffering. In fact, the coun
constituted a sort of living laboratory for the study

of affliction, no matter how

peasant of today/' observed

it is defined.

"Life for the Haitian

some
Jean Weise

anthropologist
a rank
familiarity
twenty-five years ago, "is abject misery and
in 1991
When
with death."1 The situation has since worsened.
a "human
international health and population
devised
experts
measures
of human welfare
suffering index" by examining

to political
freedom, 27 of 141
ranging from life expectancy
"extreme
human
countries were
characterized
by
suffering."
one of them, Haiti, was
in
the
Western
hemi
located
Only
was
countries
in
In
the
world
three
suffering
sphere.
only
more extreme than that endured
inHaiti; each of
judged to be
these three countries is currently in themidst of an internation
ally recognized

civil war.

a recurrent and
in
expected condition
Suffering is certainly
life has felt like war.
Haiti's Central Plateau, where everyday
observed one young widow with
"You get up in themorning,"
four children, "and it's the fight for food and wood and water."
If initially struck by the austere beauty of the region's steep
come to see
mountains
and clement weather,
long-term visitors
manner
as
its inhabitants:
inmuch the same
the Central Plateau

a chalky and arid land hostile to the best efforts of the peasant
iswidespread
and so, con
farmers who live here. Landlessness
measures
reveal
the
All
standard
how ten
is
sequently,
hunger.
at
uous the peasantry's
is. Life expectancy
hold on survival
as
as
in
birth is less than fiftyyears,
many
large part because
two of every ten infants die before their first birthday. Tubercu
losis is the leading cause of death among adults; among chil
and tetanus ravage the under
dren, diarrheal disease, measles,
nourished.
But the experience of suffering, it is often noted, is not effec
or
tively conveyed by statistics
graphs. The "texture" of dire af

fliction is perhaps best felt in the gritty details of biography, and

so I introduce
the stories of Ac?phie
Joseph and Chouchou
are
and Chouchou
Louis.2 The stories of Ac?phie
anything but
as well as the political ana
For the epidemiologist
"anecdotal."
fashion. Millions
in exemplary
of
lyst, they suffered and died
can expect tomeet simi
circumstances
in
similar
people living
these victims, past and present, share are not
lar fates. What
personal
language,
occupying

do not share culture,

attributes?they
psychological
or race. Rather, what they share is the experience of
the bottom rung of the social ladder in inegalitarian

or

societies.3

stories illustrate
Louis's
Ac?phie
Joseph's and Chouchou
some of themechanisms
which
through
large-scale social forces
of
individual suffering.
hard
surfaces
the
into
sharp,
crystallize
Such suffering is structured by historically given (and often eco
and forces that conspire?whether
nomically driven) processes
as
ismore commonly the case, these
through routine, ritual, or,
RACE/ETHNICITY

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VOL.

3 /NO.

12

on

suffering

and

structural

violence:

a view

from

below

constrain agency4 For many, including most

surfaces?to
of my patients and informants, life choices are structured by
racism, sexism, political violence, and grinding poverty.

hard

Ac?phie's
Story
For thewound

of the daughter ofmy people ismy heart wounded,

Imourn, and dismay has taken hold ofme.
Is there no balm inGilead? Is thereno physician there?

Why thenhas thehealthof thedaughterofmy peoplenot been

restored?

thatmy head were waters, and my eyes a fountain of tears, that

1mightweep day and nightfor theslainof thedaughterofmy

people!
?Jeremiah

8:22-9.1

a
of fewer than fifteen hundred
Kay,
community
people,
an
road that cuts north and east into
stretches along
unpaved
Central Plateau.
the
Haiti's
Striking out from Port-au-Prince,
can take several hours to reach
it
The
journey gives
Kay
capital,
one an
is
impression of isolation, insularity. The impression
a
as the
owes its existence
con
to
project
misleading,
village
ceived in the Haitian
D.C.:
capital and drafted inWashington,
of peas
Kay is a settlement of refugees, substantially composed
more
ant farmers displaced
than thirty years ago by Haiti's
largest dam.
Before 1956, the village of Kay was situated in a fertile valley,
and through it ran the Riviere Artibonite. For generations,
thou

sands of families had farmed the broad and gently sloping

banks of the river, selling rice, bananas, millet, corn, and sugar
cane in
regional markets. Harvests were, by all reports, bounti
the valley was
life
there is now recalled as idyllic. When
ful;
flooded with the building of the dam, the majority of the local
was forced up into the stony hills on either side of
population
new
the
reservoir. By all the standard measures,
the "water
often
poor; the older people
refugees" became
exceedingly
blame their poverty on the massive
buttress dam a few miles
away, and bitterly note that it brought them neither electricity

nor

water.

In 1983, when

in the Central Plateau, AIDS,

I began working
an
although already afflicting
increasing number of city dwell
inmost areas as rural as Kay. Ac?phie
ers, was unknown
Joseph
was one of the first
to die of the new syndrome. But
villagers
her illness, which ended in 1991, was merely the latest in a string
of tragedies that she and her parents readily linked together in
a
now familiar to those who tend the re
long lamentation, by
sick.
gion's
The litany begins, usually, down in the valley hidden under
the still surface of the lake. Ac?phie's
parents came from fami
liesmaking a decent living by farming fertile tracts of land?their
"ancestors' gardens"?and
selling much of their produce. M. Jos
tilled
the
and
his
wife, a tall and wearily elegant wom
soil,
eph
an not
as
as
old
she looked, was a "Madame
Sarah," a
nearly
autumn

2009

13

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PAUL

FARMER

market woman.

"If itweren't
for the dam," M. Joseph assured
be just fine now. Ac?phie,
too." The Josephs' home
drowned
with
most
of
their
their crops,
along
belongings,
and the graves of their ancestors.
from the rising water, the Josephs built a miserable
Refugees
lean-to on a knoll of high land jutting into the new reservoir.
on their knoll for some years;
They remained poised
Ac?phie
and her twin brother were born there. I asked them what
in
duced
them to move up to Kay, to build a house on the hard
"we'd

me,
was

stone embankment

of a dusty road. "Our hut was

too near the
afraid one of the children
Joseph. "I was

replied M.
fall into the lake and drown. Their mother had to be
away selling; Iwas trying tomake a garden in this terrible soil.
There was no one to keep an eye on them."

water,"
would

attended primary school?a

and
banana-thatched
Ac?phie
the
open shelter inwhich children and young adults received
was
rudiments
of literacy?in
"She
the
nicest
of
the
Kay
one
was
recalled
of
her
classmates.
"And
she
sisters,"
Joseph
as pretty as she was nice."
Ac?phie's
beauty and her vulnera
as
as 1984.
have
her
sealed
fate
still in
bility may
early
Though
nineteen
itwas
school, she was
old;
years
primary
already
time for her to help generate income for her family, which was

sinking deeper and deeper into poverty. Ac?phie

began to help
her mother by carrying produce
to a local market on Friday
or with a
it takes over an hour and
mornings. On foot
donkey
a half to reach the market, and the road leads
right through
Peligre, the site of the dam and, until recently, a military bar
on Fri
racks. The soldiers liked towatch
the parade of women
Sometimes
day mornings.
fines; sometimes
imposed

they taxed them with haphazardly

flirtatious
they taxed them with

banter.

Such flirtation is seldom unwelcome,

at least to all appear
ances. In rural Haiti, entrenched poverty made
the soldiers?
so much more attractive.
the region's only salaried men?ever
for the Joseph fam
Hunger was again a near-daily occurrence
were
as
as
times
bad
the
those
after
the flooding of the
ily;
right
so
And
when
looks
valley.
Ac?phie's
good
caught the eye of
a
native of Belladere
Captain
Jacques Honor?t,
formerly sta
tioned

in Port-au-Prince,

she returned his gaze.

as did everyone in the area, thatHonor?t
had
knew,
Ac?phie
a wife and children. He was known, in fact, to have more than
one
was
taken in by his persis
regular partner. But Ac?phie
went
to
and
to
when
he
her
tence,
parents, a long-term li
speak
aison was, from the outset, seriously considered:
What would you have me do? I could tell that the old people
were uncomfortable, worried; but theydidn't say no. They didn't
tellme to stay away from him. Iwish they had, but how could
... I knew itwas a bad idea then, but I
they have known?
just
didn't know why. I never dreamed he would give me a bad ill
ness,

never!

I looked

around

and

saw

how

poor

how the old people were finished ...What would

do? Itwas a way out, that's how I saw it.
RACE/ETHNICITY

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we

all were,

you have me

VOL.

3 /NO.

14

on

suffering

structural

and

violence:

a view

from

below

and Honor?t were sexual partners only briefly?for

Ac?phie
less than a month, according toAc?phie.
Shortly thereafter,Hon
or?t fell illwith unexplained
fevers and kept to the company of
a moun
his wife in Peligre. As Ac?phie was
prensi
looking for
to
"main
the
soldier. Still, it
tried
about
man"?she
pal?a
forget
a few months
was
after they parted, that he
shocking to hear,

was

dead.

was

at a crucial juncture in her life. Returning

to
out of the question. After some casting about, she
went toMirebalais,
the nearest town, and began a course in
what she euphemistically
termed "cooking school." The school
an
ambitious
woman's
poor
just
?really
courtyard?prepared
for their inevitable turn as servants in the city.
girls like Ac?phie
Ac?phie
school was

Indeed, domestic service was one of the rare growth industries

inHaiti, and as much as Ac?phie's
proud mother hated to think
of her daughter reduced to servitude, she could offer no viable
alternative.
so

at age twenty-two, went off to Port-au

Ac?phie,
she found a job as a housekeeper
for a middle
Prince, where
class Haitian woman working
for the U.S. embassy. Ac?phie's
looks and manners kept her out of the backyard, the traditional
as the maid
servants: she was designated
milieu
of Haitian
in
to
addition
the
door
and the tel
answered
who,
cleaning,
was
not
received
ephone. Although
Ac?phie
paid well?she
tried to save a bit of money
for her par
$30 each month?she
And

ents and

siblings,

recalling

the hunger

gnawing

at her home

village.
Still looking for a moun prensipal, Ac?phie began seeing Blan
co Nerette, a young man with
own: Blan
origins identical to her
co's parents were also "water refugees" and Ac?phie had known
him when they were both attending the parochial school inKay.
Blanco had done well for himself, by Kay standards: he chauf
feured a small bus between the Central Plateau and the capital.
an
In a setting characterized
rate of greater
by
unemployment
than 60 percent, his job commanded
considerable
respect. He
the attention of Ac?phie.
to marry,
easily won
They planned

and started pooling their resources.

as a maid
had worked
for over three years when
Ac?phie
she discovered
that she was pregnant. When
she told Blanco, he
became skittish. Nor was her employer pleased:
it is considered
a pregnant servant. So
to
have
returned to
unsightly
Ac?phie
a
came
where
she
had
difficult
to see
pregnancy. Blanco
Kay,

her once or twice; they had a disagreement,

and then she heard
from
him.
the
birth
of
her
nothing
Following
daughter, Ac?phie
was
sapped by repeated infections. She was shortly thereafter
diagnosed with AIDS.

Soon Ac?phie's
lifewas consumed with managing
drench
sweats
and debilitating diarrhea, while attempting to
ing night
care for her first child. "We both need
diapers now," she re
marked bitterly towards the end of her life, faced each
day not
a
with
but
also
with
lassitude.
As she
diarrhea,
only
persistent
became more and more gaunt, some villagers
that
suggested
AUTUMN

2OO9

15

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PAUL

FARMER

was
the victim of sorcery. Others recalled her liaison
Ac?phie
with the soldier and her work as a servant in the city, both lo
risk factors for AIDS. Ac?phie
herself knew
cally considered
was
more apt to refer to herself
that she had AIDS, although she
a disorder
on
a ser
as
from
by her work as
suffering
brought
vant: "All that ironing, and then opening a refrigerator."
and her daughter.
But this is not simply the story of Ac?phie

There is Jacques Honorat's

firstwife, who each year grows thin
ner. After Honorat's
death, she found herself desperate, with no
means
of feeding her five hungry children, two of whom were
union was again with a soldier. Hono
also ill.Her subsequent
r?t had at least two other partners, both of them poor peasant
women,

in the Central

One isHIV
is still a handsome

Plateau.

positive

two

and has

young man, appar

sickly children. Blanco
to
in
roads
health
and
the
from Mirebalais
plying
ently
good
Portau-Prince. Who knows ifhe carries the virus? As an attrac
tive man with a paying job, he has plenty of girlfriends.
Nor is this simply the story of those infected with the virus.
twin brother was man
The pain ofMme.
Joseph and Ac?phie's
the anguish of her father.
ifestly intense, but few understood
Shortly after Ac?phie's

death, M.

Joseph hanged

himself.

Chouchou's

Story
"History shudders, pierced by events ofmassive public suffering.
Memory is haunted, stalked by theghosts of history's victims,
capriciously severed from life ingenocides, holocausts, and exter
mination camps. The cries of thehungry, the shrieks of political
prisoners, and the silent voices of "the oppressed echo slowly,
painfully through daily existence.
?Rebecca
Chopp, The Praxis of Suffering

Louis grew up not far from Kay in another small

Chouchou
of Haiti's
Central
in
the
steep and infertile highlands
village
Plateau. He attended primary school for a couple of years but
was
to drop out when his mother died. Then in his
obliged
an older sister in
Chouchou
joined his father and
early teens,
was nothing re
In
there
short,
tending their hillside gardens.
was
it
brief and harsh,
about Chouchou's
markable
childhood;
like most

in rural Haiti.

the 1980s, church activities formed Chouchou's

Throughout
sole distraction. These were hard years for the Haitian
poor,
beaten down by a family dictatorship well into its third decade.
father and son, ruled through violence,
The Duvaliers,
largely
conditions of existence were similar to
directed at people whose
Louis. Although many of them tried to flee,
that of Chouchou
thatHaitian
often by boat, U.S. policy maintained
asylum-seek
As
ers were "economic
part of a 1981 agreement be
refugees."
and Jean-Claude
tween the administrations
of Ronald Reagan
re
were
seas
on
the high
Duvalier,
summarily
refugees seized
the first ten years of the accord, 24,559
turned toHaiti. During
applied for political
were approved.
applications

Haitians

asylum

in the United

RACE/ETHNICITY

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VOL.

States; eight

3 /NO.

l6

ON

AND

SUFFERING

STRUCTURAL

A VIEW

VIOLENCE:

FROM

BELOW

movement
A growing Haitian pro-democracy
led, in Febru
to
must have
Louis
of
the
Duvalier.
Chouchou
ary 1986,
flight
Doc"
been about twenty years old when
fell, and he
"Baby
a small radio. "All he did," recalled
thereafter
shortly
acquired
his wife years later, "was work the land, listen to the radio, and
heard about
go to church." Itwas on the radio that Chouchou
the people who

Haiti,
handed

took over after Duvalier

was

Chouchou

distressed

fled. Like many in rural

that power had been

to hear

to themilitary, led by hardened

duvali?ristes. Itwas this
in 1916 had created the
army that the U.S. government, which
termed
bet for democracy."
modern Haitian
"Haiti's
best
army,
over
In the eighteen months
's departure,
Duvalier
following
in
U.S.
million
aid
the
hands
of
the
$200
junta.
passed through
In early 1989, Chouchou
inwith Chantai Brise, who
moved
was pregnant. They were
living together when Father Jean
then considered
the leader of the pro
Bertrand Aristide?by
his
for the presi
movement?declared
democracy
candidacy
elections of 1990. In
dency in the internationally monitored
of
December
that year almost 70 percent of the voters chose Fa
therAristide from a field of ten presidential
candidates.
and Chantai welcomed
Like most rural Haitians, Chouchou
Aristide's

election with

Haiti's
overwhelming
someone representing

great joy. For the first time, the poor?

majority, formerly silent?felt
they had
their interests in the presidential
palace.

are the reasons why the

military coup d'etat of Septem
ber 1991 stirred great anger in the countryside, where
the ma
was
soon
Haitians
of
live.
followed
sadness,
jority
Anger
by
then fear, as the country's repressive machinery,
dismantled
was
seven
re
the
of
months
Aristide's
tenure,
during
hastily
assembled under the patronage of the army.
was
In themonth after the coup, Chouchou
sitting in a truck
en route to the town of Hinche. Chouchou
offered for the con

These

sideration
pointed

of his fellow passengers

intended to say

call a pwen, a
other than what
it

what Haitians

remark

something
literally means. As they bounced
along, he began complaining
of the roads, observing
about the conditions
that, "if things
were as
have been repaired
they should be, these roads would
me
One
at no point in the
later
that
told
eyewitness
already."
commentary

was

Aristide's

name

invoked.

But Chouchou's

were

as veiled
complaints
recognized by his fellow passengers
one
the
for
Chouchou,
coup. Unfortunately
language deploring
was an out-of-uniform
of the passengers
soldier. At the next

the soldier had him seized and dragged

from the
checkpoint,
truck. There, a group of soldiers and their lackeys?their
at
tach?s, to use the epithet then in favor?immediately
began
in front of the other passengers;
beating Chouchou,
they contin
ued to beat him as they brought him to the military barracks in
Hinche. A scar on his right temple was a souvenir of his stay in

lasted several days.

after-effect of such episodes
of brutality
Perhaps
was that, in
marked
the
of
general, they
persecution,
beginning
not the end. In rural Haiti, during this time, any scrape with the
Hinche,

which

the worst

autumn

2009

17

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PAUL

FARMER

led to blacklisting.
For men
like Chou
(i.e., the military)
out
of
involved
the
local
attach?s
chou, staying
jail
keeping
he
did
this
and
his
home
But
Chou
happy,
by avoiding
village.
chou lived in fear of a second arrest, his wife later told me, and
law

his fears proved to be well-founded.

was visiting his sister when
On January 22,1992, Chouchou
he was arrested by two attach?s. No reason was given for the
sister regarded as ominous
the seizure
arrest, and Chouchou's
of the young man's watch and radio. He was roughly marched

to the nearest military checkpoint, where he was

tortured by
and the attach?s. One area resident later told us that the
screams made her children weep with terror.
prisoner's
soldiers

was
in a ditch to die. The
January 25, Chouchou
dumped
to
took
the
trouble
circulate
the canard that he
army scarcely
some
had stolen
bananas.
(The Haitian
press, by then thor
even broadcast
not
did
this false version of
muzzled,
oughly
to
Relatives
carried
Chouchou
back
Chantai
and their
events.)
on the
cover of
the
of
under
daughter
night. By early
morning
On

was
I arrived, Chouchou
January 26, when
scarcely recogniz
able. His face, and especially his left temple, was misshapen,
swollen, and lacerated; his right temple was also scarred. His
mouth was a pool of dark, coagulated
blood. His neck was pe
his
throat
collared
with
swollen,
bruises, the traces of a
culiarly
were
His
chest
and
butt.
sides
gun
badly bruised, and he had
several

fractured ribs. His

That was

genitals had been mutilated.

his front side; presumably,
the brunt of the beat
from behind. Chouchou's
back and thighs were

ings came
striped with deep
skin flayed down

the
lash marks. His buttocks were macerated,
to the exposed gluteal muscles.
Some of these
to be infected.
stigmata appeared
Chouchou
coughed up more than a liter of blood in his ago
nal moments. Given his respiratory difficulties and the amount
of blood he coughed up, it is likely that the beatings caused him

to bleed, slowly at first, then catastrophically,

into his lungs. His
not
him
his
it
head
had
robbed
of
faculties, although
injuries
so.
It
been
him
had
done
took
Chou
better
for
have
they
might
chou

three days

to die.

Sense of Suffering
Explaining Versus Making
The pain in our shoulder comes
You say,from the damp; and this is also the reason
For the stain on thewall of ourflat.
So tell us:

Where does the damp come from?

?Bertholt

Brecht

Are these stories of suffering emblematic of something other

than two tragic and premature deaths? If so, how representative
is each of these experiences?
Little about Ac?phie's
story is
in
it
into
relief
I
it
detail
have
told
because
many
brings
unique;
not only her options, but those of
of the forces constraining
most Haitian women.
Such, in any case, ismy opinion after car
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VOL.

3 /NO.

l8

ON

SUFFERING

AND

STRUCTURAL

VIOLENCE:

A VIEW

FROM

BELOW

There is a deadly
ing for dozens of poor women with AIDS.
in their stories: young women?or
monotony
teenaged girls?
an escape
who were driven to Port-au-Prince
by the lure of
as a do
from the harshest poverty; once in the city, each worked
none
women
to
in
find
The
financial
mestic;
security.
managed
terviewed were

aspect
straightforward about the nonvoluntary
of their sexual activity: in their opinions,
they had been driven
into unfavorable
unions by poverty.5 Indeed, such testimony

call into question facile notions of "consensual

sex."
about the murder
Louis?
of Chouchou
International
more than three thousand
human
rights groups estimate that
were
Haitians
killed in the year after the September
1991 coup
that overthrew Haiti's
first democratically
elected government.
fell
Nearly all of those killed were civilians who, like Chouchou,
should

What

of military or paramilitary
forces. The vast ma
were
or urban
of
victims
like
Chouchou,
poor peasants,
jority
are
slum dwellers.
here
cited
conservative
esti
(The figures
or
am
sure
no
I
ever
came
that
observer
mates;
quite
journalist
into the hands

to count the body of Chouchou

Louis.)6
in a sense,
and Chouchou
was,
Thus, the agony of Ac?phie
"modal" suffering. InHaiti, AIDS
and political violence are two
leading causes of death among young adults. These afflictions
were not the result of accident or of force
were the
majeure;
they
or
direct
of
human
When
the Ar
indirect,
consequence,
agency
tibonite Valley was flooded, depriving
families like the Josephs
of their land, a human decision was behind it;when theHaitian
army was endowed with money and unfettered power, human
decisions were behind that, too. In fact, some of the same deci
sion-makers may have been involved in both cases.
If bureaucrats

to have unconstrained
and soldiers seemed
over
lives
of
the
the
rural
the
and
sway
agency of Ac?phie
poor,
at
Chouchou
curbed
turn.
These
was, correspondingly,
every

forces
grim biographies
suggest that the social and economic
to shape
that have helped
the AIDS
in
are,
every
epidemic
death and to the
sense, the same forces that led to Chouchou's
itwas eclipsed. What
ismore, both
larger repression inwhich
were "at risk" of such a fate
met
before
the soldiers
long
they
who altered their destinies. They were both, from the outset,
victims of structural violence.
certain kinds of suffering are readily observable?and
While
the subject of countless films, novels, and poems?structural
vi
olence all too often defeats those who would
it. There
describe
are at least three reasons
so. First, there is the "exoti
why this is
cization" of suffering as lurid as that endured
and
by Ac?phie
The suffering of individuals whose
lives and strug
our
own
move
to
recall
tends
us; the suffering of those who
gles
are distanced, whether
by geography, gender, "race," or culture,
is sometimes
less affecting.

Chouchou.

there is the sheer weight

of the suffering, which
Second,
makes
it all themore difficult to render:
of suffer
"Knowledge
cannot
be
in
and
facts
ing
pure
conveyed
figures, reportings
that objectify the suffering of countless persons. The horror of
autumn

2009

19

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PAUL

FARMER

suffering is not only its immensity but the faces of the anony
mous victims who have little voice, let alone
rights, in history."7
and distribution
of suffering are still
Third, the dynamics

fortunate, can alleviate

Physicians, when
poorly understood.
its distribution requires
the suffering of the sick. But explaining
more minds, more resources. Case studies of individuals
reveal
us what
or many
one
to
tell
suffering, they
happens
people; but
in
to explain suffering, one must embed
individual biography
the larger matrix of culture, history, and political economy.
In short, it is one thing tomake sense of extreme suffering?
a universal activity,
quite another to explain it.Life
surely?and
as those of
as
such
and Chouchou?who
experiences
Ac?phie
in
Haitians
shared
similar
social
conditions?
poverty
living

in ethnography
is
if their representativeness
are to be embed
These local understandings
the
ded, in turn, in the larger-scale historical
system of which
a
forces that dic
fieldwork site is part.8 The social and economic

must be embedded
to be understood.

tate life choices inHaiti's Central Plateau

affect many millions
and it is in the context of these global forces that
of individuals,
context of
receives its appropriate
the suffering of individuals
interpretation.
Similar
insights

are

central to liberation
theology, which
In The
takes the suffering of the poor as its central problematic.
notes that, "In a variety of
Praxis of Suffering, Rebecca Chopp
forms, liberation theology speaks with those who, through their

the meaning
and truth of human
suffering, call into question
most
and unlike much
previous
theologies,
history."9 Unlike
to use
liberation theology has attempted
modern
philosophy,
social analysis to both explain and deplore human suffering. Its
the suffering of the
key texts bring into relief not merely
of the earth, but also the forces that promote that suf
wretched
Boff, in commenting on one of
fering. The theologian Leonardo
to the structural
notes
that it "moves
these texts,
immediately
the systems, structures,
analysis of these forces and denounces
the rich get
that 'create a situation where
and mechanisms
richer at the expense of the poor, who get even poorer.'"10
in reflection on
In short, few liberation theologians
engage
to
its
mechanisms.
understand
without
attempting
suffering
connections. Robert McAfee
Theirs is a theology that underlines
the poor inmind when,
the Uruguayan
Jesuit Juan Luis Segundo, he ob
paraphrasing
serves that "the world
that is satisfying to us is the same world

Brown

has

these connections

that is utterly devastating

and also

to them."11

of Suffering
Models
"Events ofmassive, public suffering defy quantitative analysis.
How can one really understand statistics citing the death of six
million Jews or graphs of third-world starvation? Do numbers re
that these
ally reveal the agony, the interruption, the questions
our
nature
lives and
individual
to
the
and
victims put
of
meaning
as a whole?"
life
?Rebecca
Chopp, The Praxis of Suffering

Multiaxial

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VOL.

/NO.

20

on

suffering

and

a view

violence:

structural

from

BELOW

we discern the nature of structural violence and

might
to human suffering? Can we devise an
its
contribution
explore
one
with
analytic model,
explanatory and predictive power, for
a
argue
suffering in global context? Some would
understanding
How

that this task, though daunting, is both urgent and feasible. Our
of AIDS and political violence inHaiti sug
cursory examination
broad. As
that
must,
first, be geographically
gests
analysis
we
as
it
is
the
world
know
noted,
becoming
increasingly inter
connected. A corollary of this belief is that extreme suffering?
on a
as in genocide?is
seldom di
grand scale,
especially when
vorced from the actions of the powerful.12 The analysis must also

us of
be historically deep?not
merely deep enough to remind
events and decisions
such as those which deprived Ac?phie
of
her land and founded the Haitian military, but deep enough to
are the descendants
remember that modern
of a
day Haitians
from Africa in order to provide us with sugar,
people kidnapped
coffee, and cotton and to enrich a few in a mercantilist economy.
Factors

including gender, ethnicity ("race"), and socioeco

status may each be shown to play a role in rendering in
to extreme human suffering.
and groups vulnerable
dividuals
nomic

But

in most

power.

settings
Simultaneous

these

factors have

consideration

limited

of various

explanatory
social "axes" is

imperative in efforts to discern a political economy of brutality.

in
such social factors are differentially weighted
Furthermore,
different settings and at different times, as even brief considera
tion of their contributions
to extreme suffering suggests.

The Axis of Gender

Louis
shared, as noted, a
Ac?phie
Joseph and Chouchou
similar social status, and each died after contact with
the
Haitian
of AIDS

military.
whereas

But gender helps to explain why Ac?phie died

Chouchou
died from torture. Gender
inequal

ismuch
ity also helps to explain why the suffering of Ac?phie
more
that
than
of
the
Chouchou.
commonplace
Throughout
are confronted with sexism, an
that
world, women
ideology
them as inferior tomen. When,
in 1974, a group of
designates
feminist anthropologists

the status ofwomen

living in
in
that,
every society
disparate
settings,
institu
studied, men dominated
political, legal, and economic
tions to varying degrees;
in no culture was the status ofwomen

several

surveyed

they found

less superior, to that ofmen.13 This

genuinely coordinate, much
that women's
power differential has meant
rights may be vio
lated in innumerable ways. Although male victims are
clearly
in studies of torture, the much more common
preponderant
en
crimes of domestic violence and rape are almost
exclusively
dured by females. In the United States, the number of such ag

sexual assaults by both intimates

gressions is staggering. When
and strangers are considered,
"one in four women has been the
victim of a completed
has been
rape and one in four women
to
commu
the
of
recent
results
physically battered, according
studies."14
nity-based
autumn

2009

21

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PAUL

FARMER

Inmost settings, however, gender alone does not define risk

for such assaults on dignity. It is poor women who bear the
brunt of these assaults.15 This is true not only of domestic vio
lence and rape, but also of AIDS
and its distribution, as anthro
pologist Martha Ward points out:
The collection of statistics by ethnicity rather than by socio-eco
nomic status obscures the fact that themajority ofwomen with
AIDS in theUnited States are poor. Women are at risk forHIV
not because
or speak Spanish;
they are African-American
women are at risk because poverty is the
primary and deter

mining condition of their lives.16

can
Similarly, only women
experience maternal mortality, a
cause of
around
the
world.
More
than half a million
anguish
women die each year in childbirth, but not all women
are at in
outcomes
creased risk of adverse
in pregnancy.
In 1985, the

World

Health Organization
estimated
that maternal mortality
150 times higher in developing
is, on average, approximately
countries than in developed
nations.
In Haiti, where maternal
as
as
is
fourteen
hundred
deaths per one hun
mortality
high
dred thousand
live births?almost
times higher
five hundred
than in thewealthy countries?these
tered among the poor.17

deaths

are almost all

regis

The Axis of "Race" or Ethnicity

idea of race, which
to be a biologically
is considered
in
enormous
social currency. Racial
classifi
significant term, has
cations have been used
to deprive
certain groups
of basic
The

rights, and therefore have an important place in considerations

of human suffering. In South Africa, for years a living labora
tory for the study of the long-term effects of racism, epidemiol

rate among blacks may

ogists report that the infant mortality
as
as
ten times higher than among whites. For South
much
be
cause of increased rates of mor
African blacks, the proximate

is lack of access to resources: "Poverty re

bidity and mortality
mains
the primary cause of the prevalence
of many diseases
and widespread
and
malnutrition
among black South
hunger
is seen in the uneven distri
Africans."18 And social inequality
bution of poverty.

Significant mortality differentials between blacks and whites

are also registered in the United States, which shares with South
coun
Africa the distinction of being the only two industrialized
status. In
tries failing to record mortality data by socioeconomic
States, in 1988, life expectancy at birth was 75.5 years
forwhites and 69.5 years for blacks. Accordingly,
there has been
a certain amount of discussion
about race differentials inmor
com
recently
tality, but public health expert Vicente Navarro
on
about
the
of
class
dif
silence"
the
"deafening
topic
plained
theUnited

in the United States, where "race is used

ferentials inmortality
as a substitute for class." But in 1986, on "one of the few occa
sions that theU.S. government
collected information on mortal
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22

ON

SUFFERING

AND

STRUCTURAL

VIOLENCE:

A VIEW

FROM

BELOW

disease) by class, the re

ity rates (for heart and cerebrovascular
indicators
of class one might
sults showed
whatever
that, by
or
of
choose
income,
education,
(level
occupation),
mortality
rates are related to social class."19 Indeed, for themajor causes of

class differ
disease),
(heart disease and cerebrovascular
race differentials.
than
entials were
"The
larger
significantly
between
whites
differentials
and
blacks,"
growing mortality

death

"cannot be understood
concludes,
by looking only at
are
race; they
part and parcel of larger mortality differentials
class differentials."20 The sociologist William
JuliusWilson made
a similar
in
his
landmark
The
study,
point
Declining Significance

Navarro

ofRace. He argues that "trained and educated blacks, like trained

and educated whites, will continue to enjoy the advantages
and
an
is
of
It
their
the
class
status."21
black
poor?and
privileges

analysis of the mechanisms

being left out.

of their impoverishment?that

are

The Conflation of Structural Violence

and Cultural Difference
Awareness

of cultural differences has long complicated

dis
ar
of human
Some
have
suffering.
anthropologists
thatwhat seem to outside observers to be obvious assaults

cussions

gued
on
in fact be long-standing
cultural institutions
dignity may
a
valued
Often-cited
range from fe
by
highly
society.
examples
to
male circumcision
in the Sudan
in the Philip
head-hunting

are
pines. Such discussions
invariably linked to the concept of
cultural relativism, which has a long and checkered history in
Is every culture a law unto itself and a law unto
anthropology.
other
than
itself? In recent decades,
confidence in reflex
nothing
cultural relativism faltered as anthropologists
turned their at
to
tention
societies" characterized
"complex
by extremely ine
found themselves unwilling
galitarian social structures. Many
to condone social inequity merely because
itwas buttressed by
cultural beliefs, no matter how ancient. Cultural relativism was
as a part of a broader
also questioned
critique of anthropology
citizens
the
of
former
colonies.22
by
But this rethinking has not yet eroded a tendency, registered
inmany of the social sciences but perhaps
in an
particularly
to
confuse
structural
violence
with
cultural
differ
thropology,
ence. Many
are the
in which poverty and in
ethnographies
a
end
the
of
results
equality,
long process of impoverishment,
are conflated with "otherness."
is not
Very often, such myopia
a
as
of
but
Talal
has
Asad
motives,
rather,
really
question
sug
our "mode of
and objectifying alien soci
gested,
perceiving
eties."23 Part of the problem may be theways
inwhich
the term
is used.

"The idea of culture," explains one

authority
a book on the
in
approvingly
subject, "places the researcher in a
position of equality with his subjects: each 'belongs to a cul
"culture"

ture.'"24 The

comforting
has usually
autumn

2009

tragedy, of course, is that this equality, however

to the researcher, is
entirely illusory. Anthropology
"studied down" steep gradients of power.
23

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PAUL

Such

illusions

misreadings?most
tural difference?are

FARMER

an important means by which other

notably the conflation of poverty and cul
sustained. They suggest that the anthro

suggest

pologist and "his" subject, being from different cultures, are of

different worlds and of different times.25 These sorts ofmisread
a
are
ings, innocent enough within academia,
finding more in
is becoming
sidious utility within elite culture, which
increas
even
of
cultural
and
transnational.
relativism,
ingly
Concepts
to
the
different
reinstate
of
cultures
and
arguments
dignity
some
of
the
assimilated
have
been
"races,"
very agen
easily
by
extreme
cies that perpetuate
of cultural con
suffering.26Abuses
in discussions
of suffering in
insidious
cepts are particularly
more specifically: cultural
general and of human rights abuses
difference is one of several forms of essentialism used to explain
away assaults on dignity and suffering in general. Practices, in
or "in their na
cluding torture, are said to be "in their culture"
or the perpetra
either
victims
ture"?"their"
the
designating
tors, or both, as may be expedient.
even
Such analytic abuses are rarely questioned,
though sys
that
temic studies of extreme suffering would
the con
suggest
an
limited
in ex
role
of
have
culture
should
cept
increasingly
of?and
of
the
The
distribution
misery.
interpretation
plaining
is usually patterned along
justifications for?suffering
lines, but this, Iwould
argue, is another question.

cultural

and Extreme Suffering

At night I listen to theirphantoms
shouting inmy ear

Structural Violence

shaking me out of lethargy

issuing me commands

I thinkof theirtatteredlives
feverishhands
of their
ours.
reaching out to seize
It's not that they're begging

they're demanding
us to break up our sleep
they've earned the right to order
come
to
awake
to shake offonce and for all this lassitude.

?Claribel
Alegr?a
"Visitas Nocturnas"

characteristic, whether social or biologi

Any distinguishing
as
can
serve
and thus as a cause
cal,
pretext for discrimination,
each of the above factors, however, it
of suffering. In discussing
is clear that no single axis can fully define increased risk for ex
treme human suffering. Efforts to attribute explanatory efficacy
to one variable
lead to immodest claims of causality, forwealth
individual women,
often protected
gays, and
as
from the suffering and adverse outcomes
assaults on dignity. Similarly, poverty can often

and power have

ethnic minorities
sociated with

efface the "protective"

effects of status based

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on

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VOL.

race, or

3 /NO.

24

ON

SUFFERING

sexual

AND

VIOLENCE:

STRUCTURAL

A VIEW

FROM

BELOW

orientation.

from Brazil,

Boff and Clodovis

Leonardo
Boff, writing
insist on the primacy of the economic:

We have to observe that the socioeconomically oppressed (the

poor) do not simply exist alongside other oppressed groups,
take the three
such as blacks, indigenous peoples, women?to
in
Third
World.
the
the
No,
major categories
"class-oppressed"
?the

the

poor?are

socioeconomically

infrastructural

expres

sion of the process of oppression. The other groups represent

"superstructural" expressions of oppression and because of this
are deeply conditioned by the infra structural. It is one thing to
be a black taxi-driver, quite another to be a black football idol; it
is one

thing

to be

a woman

working

as

a domestic

servant,

quite another to be the firstlady of the land; it is one thing to be

an Amerindian
thrown off your land, quite another to be an
Amerindian

None

owning

your

of this is to deny
countries

in the wealthy
point ismerely

own

farm.27

the ill effects of sexism or racism, even

of North America
and Europe.
The

to call formore

yses of power and privilege

suffer and inwhat ways.

fine-grained
in discussions

and systemic anal

of who
is likely to

The capacity to suffer is, clearly, part of being human. But

not all suffering is equal, in spite of pernicious
and often self
One
that
otherwise.
of the un
suggest
serving identity politics

fortunate sequelae of identity politics has been the obscuring of

structural violence, which metes out injuries of vastly different
of severity is important, at least to
severity. Careful assessment

who must practice triage and referral daily. What

re
to be taken care of first and with what
needs
suffering
to speak of extreme human suffering, and
sources? It is possible
an inordinate share of this sort of
pain is currently endured by

physicians,

illness and prema

living in poverty. Take, for example,
ture death, inmany places in theworld
the leading cause of ex
treme suffering. In a striking departure
from previous, staid re
now
the
World
Health
that
ports,
Organization
acknowledges
is
the
world's
killer:
its
wields
de
poverty
greatest
"Poverty
mo
structive influence at every stage of human
from
the
life,
those

ment

to the grave. It conspires with the most

of conception
and
to bring a wretched
diseases
existence to all
painful
deadly
those who suffer from it."28
As the twentieth century draws to a close, the world's
poor
are the chief victims of structural violence?a
violence which

has

thus far defied

the analysis of many seeking to understand

and distribution
of extreme suffering. Why might
this be so? One answer is that the poor are not
more
only
likely
to suffer; they are also more
to
have their suffering si
likely
the nature

lenced. As Chilean
theologian Pablo Richard, noting the fall of
the Berlin Wall, has warned,
"We are aware that another gigan
ticwall is being constructed in the Third World, to hide the real
the rich and poor is
ity of the poor majorities. A wall between
so
not
that
does
and
annoy the powerful
poverty
being built,
the poor are obliged to die in the silence of history"29

autumn

2009

25

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PAUL

FARMER

The task at hand, if this silence is to be broken, is to

identify
the forces conspiring to promote
suffering, with the understand
in different settings.
ing that these will be differentially weighted
In so doing, we stand a chance to discern the
forces motrices of ex
treme
A
on
sound
the dynamics and
analytic purchase
suffering.

distribution

of such affliction is, perhaps, a prerequisite

to pre
it.Then, at last, theremay be
hope

venting or, at least, assuaging

of finding a balm inGilead.30

Acknowledgments
I have

the usual

and

Saussy
constructive
Bertrand,
Rhatigan,

debts

to faithful readers

such

as Haun

the
Jim Yong Kim, but wish also to acknowledge
criticisms of this issue's
editors and of Didi

Dahl,
Johanna Daily,
Jonathan Mann,
Ophelia
and
Vinh
Kim
Joyce Bendremer,
Nguyen.

Joe

Endnotes
1. JeanWeise, "The Interaction ofWestern and Indigenous Medi
cine inHaiti in Regard to Tuberculosis/' Ph.D. Dissertation, Depart
ment of Anthropology, University of North Carolina at
Chapel Hill,
1971.
2. The names of theHaitians cited here have been changed, as have
the names of their home villages.

3. For a recent review of the effectsof inegalitarian social structures

on the health of wealthier populations, see Michael Marmot, "Social
Differentials inHealth Within and Between Populations," Daedalus 123
(4) (Fall 1994): 197-216.
4. Some would argue that the relationship between individual
agency and supraindividual structures forms the central problematic
of contemporary social theory. I have tried, in this essay, to avoid what
Pierre Bourdieu has termed "the absurd opposition between individ
ual and society," and I acknowledge the influence of Bourdieu, who
has

contributed

enormously

to the debate

on

structure

and

For

agency.

a concise statement of his (often revised) views on this

subject, see
Pierre Bourdieu, In Other Words: Essays Towards a Reflexive Sociology
(Cambridge: Polity, 1990). That a supple and fundamentally non-de
terministicmodel of agency would have such a deterministic?and
is largely a reflection ofmy topic, suffering, and
pessimistic?"feel"
fieldwork
site.
my
5. Paul Farmer, "Culture, Poverty, and theDynamics ofHIV Trans
mission in Rural Haiti," inHan ten Brummelhuis and Gilbert Herdt,
eds., Culture and Sexual Risk: Anthropological Perspectives onAIDS (New
York: Gordon and Breach, 1995), 3-28.

6. For an overview of the human rights situation during the recent

coup, see Americas Watch and the National Coalition forHaitian
Refugees, Silencing a People: The Destruction of Civil Society inHaiti
(New York: Human Rights Watch,1993) and William O'Neill, "The
Roots ofHuman Rights Violations inHaiti," Georgetown Immigration
Law Journal 7 (1) (1993): 87-117. I have reviewed these and other re
ports in Paul Farmer, The Uses ofHaiti (Monroe, Maine: Common
Courage, 1994).
7. Rebecca Chopp,
1986), 2.

The Praxis of Suffering (Maryknoll, N.Y: Orbis,

RACE/ETHNICITY

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20

SUFFERING

ON

AND

STRUCTURAL

VIOLENCE:

A VIEW

FROM

BELOW

8. This argument ismade at greater length in "AIDS and the An

thropology of Suffering," inPaul Farmer,AIDS and Accusation: Haiti and
theGeography ofBlame (Berkeley, Calif.: University of California Press,
1992). The term "historical system" is used following Immanuel Waller

stein, who

for many

cales?Haiti's

years

Central

has

Plateau,

that
argued
for
example?are

even

the most

part

lo
far-flung
of the same
social

and economic nexus: "by the late nineteenth century, for the first time
ever, there existed only one historical system on the globe. We are still in
that situation today." See Immanuel Wallerstein, "World-Systems Anal
ysis," in Social Theory Today, ed. Anthony Giddens and Jonathan Turner
(Stanford, Calif.: Stanford University Press, 1985), 318. See also Im
manuel Wallerstein, TheModern World-System: Capitalist Agriculture and
theOrigins of theEuropean World-Economy in theSixteenth Century (San
Diego, Calif.: Academic Press, 1974). The weakness of these analyses is,
of course,

their extreme

divorce

from personal

experience.

9. Chopp, The Praxis of Suffering,2. See also theworks of Gustavo

Gutierrez, who has written a great deal about themeaning of suffering
in the twentieth century: for example Gustavo Gutierrez, A Theology of
Liberation (Maryknoll, N.Y.: Orbis, 1973) and Gustavo Gutierrez, The
Power of thePoor inHistory (Maryknoll, N.Y.: Orbis, 1983). For anthro
pological studies of liberation theology in social context, see the ethno
graphies by John Burdick, Lookingfor God in Brazil (Berkeley, Calif.:
University of California Press,1993) and Roger Lancaster, Thanks to
God and theRevolution (New York: Columbia University Press, 1988).
10. From the Puebla document, cited inPaul Farmer, "Medicine and
Social Justice: Insights from Liberation Theology," America 173 (2)
(1995): 14.

11.Robert McAfee Brown, Liberation Theology: An IntroductoryGuide

(Louisville, Ky: Westminster, 1993), 44.
12. The political economy of genocide is explored by Christopher
Simpson in The Splendid Blond Beast: Money, Law, and Genocide in the
Twentieth Century (New York: Grove Press, 1993). See also G?tz Aly,
Peter Chroust, and Christian Pross, Cleansing the Fatherland: Nazi
Medicine and Racial Hygiene (Baltimore,Md.: JohnsHopkins University
Press, 1994). As regards the transnational political economy of human
rights abuses, see the two-volume study by Noam Chomsky and Ed
ward S. Herman, The Washington Connection and Third World Fascism
and After theCataclysm (Boston, Mass.: South End Press, 1979).
13.Michelle Rosaldo and Louise Lamphere, eds., Women, Culture,
and Society (Stanford, Calif.: Stanford University Press, 197A).
14.Mary Koss, Paul Koss, and JoyWoodruff, "Deleterious Effects of
Criminal Victimization onWomen's Health and Medical Utilization,"
Archives of InternalMedicine 151 (1991): 342.
15.

It is

important

to note,

however,

that upper

class/caste

women

are inmany societies also subject to laws that

virtually efface marital
rape. The study by Koss, Koss, and Woodruff includes this crime with
other forms of criminal victimization, but it is only through commu
nity-based surveys that such information is collected.

16.Martha Ward, "A Different Disease: HIV/AIDS

and Health Care
forWomen in Poverty," Culture,Medicine and Psychiatry 17 (4) (1993):
414.
17.World Health Organization, "Maternal
Mortality: Helping Wom
en Off theRoad toDeath," WHO Chronicle 40 (1985): 175-83.

18. Elena Nightingale, Kari Hannibal, JackGeiger, Lawrence Hart

mann, Robert Lawrence, and Jeanne Spurlock, "Apartheid Medicine:
Health and Human Rights in South Africa," Journal of theAmerican
Medical Association 264 (16) (1990): 2098. The italics are mine. For a
more

in-depth

AUTUMN

2OO9

account,

and

a more

complicated

view

of

the mecha

27

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PAUL

FARMER

nisms by which apartheid and the South African economy are related
to disease causation, see Randall Packard, White Plague, Black Labor: Tu
berculosis and thePolitical Economy ofHealth and Disease in South Africa
(Berkeley, Calif.: University of California Press, 1989).
19. "Vicente

"Race

Navarro,

or Class

versus

Race

and

Class:

Mortal

ityDifferentials in theUnited States," The Lancet 336 (1990): 1238.

20. Ibid.,1240.
21. William JuliusWilson, The Declining Significance ofRace: Blacks
and Changing American Institutions, 2nd ed. (Chicago, 111.:
University of
Chicago Press, 1980), 178.
22. See the studies by Elvin Hatch, Culture andMorality: The Relativ
ity of Values inAnthropology (New York: Columbia University Press,
1983), and by Ernest Gellner, Relativism and theSocial Sciences (Cam
bridge: Cambridge University Press, 1985).
23. Talal Asad, ed., Anthropology and theColonial Encounter (London:
Ithaca Press,1975), 17.

24. Roy Wagner, The Invention of Culture (Englewood Cliffs, N.J.:

Prentice-Hall,1975), 2.
is
25. Johannes Fabian has argued that this "denial of coevalness"
much ingrained in our discipline. Not to be dismissed as an issue of
style, such a denial contributes to the blindness of the anthropologist:
"Either he submits to the condition of coevalness and produces ethno
graphic knowledge, or he deludes himself into temporal distance and
misses the object of his search." See Johannes Fabian, Time and the
Other: How AnthropologyMakes itsObject (New York: Columbia Uni
versity Press, 1983). See also the compelling essay by Orin Starn,
and theWar in Peru," in
"Missing the Revolution: Anthropologists
Cultural
Anthropology (Durham, N.C.:
George Marcus, ed., Rereading
Duke University Press, 1992), 152-80.
26. For a penetrating examination of the appropriation of identity
politics by big business, see the essay by L. A. Kauffman, "The Diver
sityGame," The Village Voice, 31 August 1993.
27. Leonardo Boff and Clodovis Boff, Introducing Liberation Theology
(Maryknoll, N.Y: Orbis Books, 1987), 29.

28. World Health Organization, Bridging theGaps (Geneva: World

Health Organization, 1995), 5.
Brave New World Order: Must
29. Cited by JackNelson-Pallmeyer,
We Pledge Allegiance? (Maryknoll, N.Y: Orbis, 1992), 14.
30.

Editors'

note:

Paul

Farmer's

paper

was

not

one

of

the papers

on "Social Suffering." Itwas

presented at the Bellagio Conference
licited by the editors after thatmeeting took place.

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