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Mysteries of blood

[Editor’s note: Janet Carsten was interviewed by Charles Stafford at the London School of Economics on 15 March 2017.]

AOTC: I know you’ve been doing a research project on blood, based in part on fieldwork in Penang, and you’ve just finished a book manuscript about this. I understand that as part of that work you actually witnessed surgery. I wonder if you could start by saying something about doing ethnography in a surgical theatre?

Janet Carsten: That was a bit of a one-off, actually. I am not a medical anthropologist but I was doing fieldwork in and out of hospitals in Penang. I hadn’t intended to watch surgery and it wasn’t part of the plan. But one day as I was walking into one of the hospitals where I was working I was hailed by a surgeon who was also responsible for me working in the hospital, as it happened. And he said “Actually, I’m doing some heart surgery this morning and maybe you’d like to come and watch.” I thought, ah, right, I’m supposed to say yes to that kind of question because I’m an anthropologist! That’s what you do when people ask you to do unexpected things. Basically I was attached to the clinical pathology labs and the people in the clinical pathology labs were also responsible for the heart and lung systems – the bypass machinery – that patientss are put on when they have heart surgery. And so I was kind of following the people from the clinical pathology labs.

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Illustration by Ed Linfoot/Visual Generation/Shutterstock

Anyway, this proved to be a fascinating experience, which I didn’t repeat. But I learned a lot from the one-off. It never occurred to me to really think about what happens when somebody’s heart is artificially stopped and their blood has to bypass the heart and go through a machine. It raises a very interesting set of issues. This was not a teaching hospital, but there were student nurses there who were witnessing the surgery, so the surgeon was asking them questions along the way – partly rhetorical, I think, for the fun of it. At a certain point, he asked these nursing students whether the patient was alive or dead. Predictably, they couldn’t really answer his question, they were a bit stumped. And of course it was a trick question because there is no answer. How do you know if somebody is alive or dead when they are on a bypass machine? And he said, “We don’t know. We hope this patient is alive, but we don’t know.”

And that led me to think a little bit more about the mystery that is blood, which became a strange sub-theme of my research. Here are all these people working in a very routinized, humdrum kind of way, doing diagnostic tests on blood, whatever, but every now and again someone – within this quite trained and technologized sphere of work – makes reference to the mystery that is blood. And what they meant to convey is that, of all the bodily substances, blood is the one that can tell you most about conditions of the body. When you have the routine blood tests it’s true that you also have urine tests or whatever. But blood tests are the thing. Most of the work that they do in these labs has to do with blood. And it also has this mysterious quality. Early accounts of blood transfusion are very interesting because they are about patients on the brink of death and they come to life – when they are transfused with blood.

So one of the themes of my book on this project is that if we have to answer the question “What is blood?”, the answer is that it’s mysterious. But also that, whatever it is, it’s the stuff of life. It is what animates us. And that leads to all sorts of other questions. Is blood itself alive, or is it not alive? These are labs where blood is sealed in packs and messed around with in all kinds of ways. But it still has these animating qualities. Part of the thread of this research has been about asking what blood is and why it has the enormous symbolic and metaphoric potential that it seems to have. Which, on the whole, as anthropologists we take for granted. But to me it’s not obvious. There are other substances – saliva, urine. Why is blood so special?

And of course I came to this from my interest in kinship. In European kinship, but also in many cultures around the world, blood is conceived as the stuff of kinship. The idea that blood is the thread of continuity between parents, or at least one parent, and their children is very common. And there are other ideas, of course, for example that if you kill somebody and you touch their blood – that this act will affect you in some deep way. That’s a very important idea in Malaysia: the blood of the murder victim has extraordinary powers and if the murderer comes into contact with it the murderer himself gets superhuman powers. So what originally attracted me to the whole subject was that both in European and Malay cultures blood is a very important symbol – of kinship and sacrifice and many other things. Why should that be so?

AOTC: To get back to your actual ethnography: as you know, there’s an old discussion in anthropology about how reflective people are, or are not, about given topics. You ask why they do the ritual and they say they have no idea. I wonder if you felt that this topic, in some sense, had special features when it came to your conversations with people in the field. Of course, you were dealing with particular kinds of people, who presumably were not the types you worked with in your previous fieldwork in rural areas. I’m basically wondering how reflective they were when it came to topics that were of interest to you, coming from the outside.

Janet Carsten: There were broadly two – in fact, more – types of people I came into contact with. One was blood donors in their rich variety, which meant many different kinds of people. And they have many different reasons for giving blood. Sometimes they are more or less obliged to do so by their work, e.g. the police and army are asked to give blood in a way that is not very easy to refuse. And there are regular blood donors who wander into the hospital and say “I want to give blood”, or who come after mass campaigns. I was interested in the motivations for that, and people were generally quite reflective on this topic. People do think about blood donation as a process. So that’s one type of person I was talking to on a regular basis.

And then the others were the people who worked in the lab, most of whom were medical lab technologists, so they have a very specific kind of training. But they have all kinds of other interests as well. And actually their work, from their point of view, is often not all that interesting. So these are intelligent and well-educated people, on the whole, and they are as full of speculations about the world around them as anybody else. They were quite interested in what I was doing. Actually, some of them were very skeptical when I said “I’m interested in how your work connects to the world outside”. Some of them would say that it doesn’t connect at all. The lab is a very enclosed space, as they see it, which in some ways it was. Whereas others were more ready to entertain the idea that there were all sorts of connections, and you could see that this affected the ways in which they worked.

Now, part of what I’ve aimed for with this book is to construct an ethnography of working life in a multi-ethnic context in Malaysia. This is interesting for me as a Malaysianist because most of the existing ethnography up until now – not all of it, but most of it – has been already pre-ethnicized. A Malay village, a Chinese temple, a Tamil plantation. The versions of ethnicity that come out of this approach are to some extent pre-scripted. Of course in Malaysia you can’t avoid ethnicity, or “race”, as it’s often referred to. But for most urban people now, they are working in multi-ethnic contexts. And I was interested in investigating that. In these labs, colleagues work in close cooperation with each other. When the lab managers hire people what they really look for are people who can work as part of a team. That’s what’s important to them. It’s to do with workload, the high workload, and the fact there are points of really high pressure. You need people who can get along with each other.

Anyway, we have some ethnography of Kuala Lumpur which is interesting, but there’s not that much ethnography that I know of that is just of people working together there. And then they’re working with these interesting bodily substances. So my idea, when I was planning the research, was to not talk about ethnicity, at least let’s not foreground that, let’s just see how it plays out in this context which is a rather special context.

AOTC: I wonder if the project has forced you to rethink what you thought you knew about Malaysia or Malayness, i.e. based on your work in a more traditional, rural context?

Janet Carsten: I think it did in a way. One of the things that really struck me in this context was that if you’re living in a Malay village, or working in a Chinese context, what you’re told all the time is how different people are. Chinese eat pork, Muslims don’t, Indians may be vegetarians. People hold different kinds of religious ideas, all sorts of stereotypes are shared. And to some extent you come across such ideas in the labs as well, which is interesting – often in a joking form. People do a lot of joking around those themes. Another thing that fascinated me is that there’s no food in the lab, for obvious reasons, but actually people are very concerned about food. They eat together a lot. And sometimes, in fact, there is food in the lab – not on the lab benches, but in a special area. So there’s a lot of stuff about eating.

And one of the things that really struck me – partly through eating with people but also through talking to them about other topics  – is that some of these supposedly ethnically specific practices, for example, what you eat, are actually incredibly translatable across cultural boundaries. And just as salient as the idea that “we do things differently” is the idea that “we might not do things differently”. When you think about it, this latter idea may seem obvious, but it hadn’t really occurred to me.  Take medical ideas about the body. There’s a lot of work on the history of Chinese medicine, and I’m not a specialist, but the ideas there about what blood is and does in the body, what animates the body, seem to me very translatable across cultural boundaries. And perhaps, in a way, that is just as worrying for most people as the idea that people and cultures are very different from each other.

AOTC: I’m not sure I understand – what is worrying?

Janet Carsten: If what people might call “othering” is an everyday process – one which we all engage in all the time in all parts of the world – then the kind of opposite idea, that the boundaries between us might just collapse, could well be a fundamental human worry. We might turn into those other people that we’ve strenuously persuaded ourselves are completely different from us.

When it came to writing up this project, I felt there should be two things in the book. One is what does this lens of blood, and these strange working spaces, tell us about Malaysia. So it is partly a story about ethnicity, and partly a story about class mobility – which is the story of the last 30 years in Malaysia and how that plays out in certain contexts. And then the other half of it is to ask what a ‘forensic’ anthropological examination of blood, as it were, can tell us more generally about the body, and kinship, and the symbolic work of blood – and why might this be more generalizable. These two stories connect, actually. Blood is the connecting medium, if you like, because of course at the back of my mind is the idea that blood in Europe has a powerful significance, and often a negative one. But in a place with a very different kind of history how would this play out?

AOTC: Now I’d like to ask you about the – not unrelated – big project you’re just starting now, but which is linked to some topics you’ve been thinking about for a long time. This is your new ERC project about marriage, based on different ethnographic case-studies in different locations around the world. The key point, as I understand it, is to think of marriage as a transformative thing in itself. So not just something that is transformed, which of course we think about a lot, but something that is itself a transformative agent. Could you explain what you have in mind?

Janet: Yes, so there are five different case studies: changing forms of middle class marriage in Penang, marriage and HIV/Aids in Botswana, migration and marriage between Taiwan and China, marriage under conditions of economic austerity in Athens, and contestations around gay marriage in Virginia. This project emerged from thinking about recent work in kinship studies. There has been a lot of work on reproductive technologies, adoption, children, etc. And it seemed curious to me – although, of course, there’s been a lot of anthropological work on marriage over years – that within the frame of ‘new kinship studies’ per se this topic has got somewhat left to the side. I think one reason for this is that we unthinkingly assume marriage to be a normative set of institutions. But all around us we see that marriage is being turned on its head, and in very different kinds of ways, and that’s important. This goes back to my work on Malay marriage a long time ago, thinking about it as an agent of transformation at the microscopic, individual, family level. If you ask “what does marriage do?”, well it introduces a new person into a family of persons that have grown up together, and that’s often very disruptive.

So marriage as a process historically is probably all about transformation, if you think of wider kinship frames. And it is interesting to look at how that occurs in different places. In all of our case-studies there are particular stresses or strains that have to do with wider society, and which therefore put marriage itself under strain. For example, marriage and HIV/Aids in Botswana – looking at the way in which marriage is endlessly postponed. This is actually part of a historical pattern in Botswana that has been well documented by anthropologists. But what’s happening under current conditions is interesting, or contestations around gay marriage in the US, or marriage and economic austerity in Greece. What does marriage mean under those particular conditions? These projects could diverge in a major way from each other, and perhaps they will. But we are going to try to keep them together in certain ways, partly through the themes we’re highlighting which are property, ritual and care. Stepping back from those themes, which in a way are quite classic ones in anthropology, we also want to think about marriage and temporality, which might be an overarching frame that helps us bring the case-studies together. Thinking about the history of marriage, but also what marriage does in terms of how people think about the past, the present and the future of their kinship lives.

It’s a bit difficult to say before we’ve actually done the work what will emerge from it, of course. But hopefully, because our case-studies are very different from each other in all sorts of ways, that will make it more interesting. It’s not as if they’ve been devised to be directly comparable, that’s not how the comparison will work. I think in all of them we’ll be able to say something about care, property and ritual forms, and also hopefully about temporality.

AOTC: But I can I please push you on this: just at the practical level, how will these notionally comparative ethnographic projects actually become comparative. In a practical sense, how are you coordinating that? Obviously there will be planning at the beginning. But is there a kind of calibration as you go on, to make sure everybody stays in the loop? Surely the ethnographic tendency is to be pulled in a hundred directions.

Janet Carsten: I think that’s fine. I see it as my job as the PI to try and have some overarching look, and to keep thinking about what draws these very different places together, and what would enable us to say something quite general about kinship processes and marriage at the end of it all. So partly there are practical things:  we’ll be in good communication throughout and I’ll visit each of the projects, which will help. But there’s also a lot of team-building at the beginning to really make that communication process seem easy and natural and not something that’s just a chore, so that we will want to communicate with each other. And obviously I’m doing a lot of thinking about how to manage this, it’s partly about what you build in the preparation stage. It’s much easier than it was thirty years ago, of course, it shouldn’t be that hard to share fieldwork material via a Dropbox folder, for example.

AOTC: And are you yourself doing new ethnography for this?

Janet Carsten: I’m doing new fieldwork related, again, to the social trends that have been dominant for the last thirty years in Malaysia. I’m going to be looking at middle class marriage in Penang. The trap I want to avoid is the pre-ethnicized thing we just discussed in relation to the project on blood. When people talk about marriage in Malaysia, it’s very difficult to avoid talking about Malay marriage, Chinese marriage, Indian marriage. Actually, I’m interested in just marriage, including middle class marriage. So avoiding all of that pre-ethnicization. Which of course isn’t really possible – but if you start out thinking that’s what you’re not interested in maybe something slightly different will come out. And Penang is an interesting place, anyway, because it has this very long history going back several hundred years of ethnic diversity, which is part of which makes it very special. So we’ll see! What kinds of mixing go on when it comes to marriage in Malaysia? Possibly not that much, but maybe a little bit.

AOTC: In putting this project together I wonder if there are any things you read or re-read that especially influenced your thinking, or that you read in a new light? You refer to Lévi-Strauss and so on in the application, but I wonder if there’s something you’ve read in the course of this about marriage or kinship more broadly that’s really shaped your thinking in some way.

Janet Carsten: There probably is. I think in the back of my mind Lévi-Strauss is indeed quite important – and that question, what happens when you don’t have the kind of system he was interested in anymore. His worked basically stopped with prescriptive marriage systems. Which leaves the question how you would put his approach together with a much more feminist influenced approach, which again is at the back of the marriage project and has to do with ideas about naturalization. I think there may be quite a lot of mileage – with the blood project too – in thinking about how things that we do appear natural, and how they’re made to appear natural. So marriage as Lévi-Strauss taught us is a cultural thing. It seems to be more or less universal, but the forms are very different. And so how are these forms naturalized? Although it isn’t written into the project, one of the things I was thinking about is ideas of bodily substance. Marriage often involves the idea that your bodily substance changes progressively when you marry, through sex or living together or eating together, whatever the processes are, and we’re interested in how that occurs. So an incorporative process in which outsiders become insiders. I’m quite interested in that. Property and care are important here too. And when it comes to property we don’t just mean dowry and brideprice payments, but all sorts of things: for example, houses, what happens inside houses, the furnishing of houses, the materialization of marriage, photographs, clothing, so that all might be part of it. And then processes of care. Married couples, as they live together, may take on obligations of care for each other or their children. So the bodily transformations that are attached to that might be of interest. And again it comes back to the idea that marriage at its heart is a transformative process – both at the micro level and at the social level, and thus politically as well. Marriage is part of the politics of the state, so it’s a very obvious and crucial link between the personal and the macro. In a wider sense then, marriage is fundamentally political – as is kinship more generally. And this has been been central to feminist understandings as well as to much older anthropological studies, but it sometimes gets submerged in our assumptions about how ‘modern’ societies work. We definitely want to push back against those assumptions.

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