Bharat Jayram Venkat is Assistant Professor at the Institute for Society and Genetics and in the Department of History at the University of California, Los Angeles. His new book, At the Limits of Cure, draws on historical and ethnographic research on tuberculosis in India, exploring what it means to be cured and what it means for a cure to be partial, temporary, or selectively effective.
What led you to the study of cure and its limits?
My book, an anthropological history of tuberculosis in India, is about what it means to be cured—as well as what it means for cure to come undone. As is the case with many ethnographers, however, my fieldwork began elsewhere, with a focus on HIV treatment in a small clinic in the city of Chennai. As I discuss in the preface of the book, I was struck by the fact that the majority of deaths in the clinic were from tuberculosis rather than HIV—tuberculosis, a condition that I was repeatedly told was curable.
This became for me a kind of ethnographic problem: if many people were dying from a curable disease—and not necessarily for lack of treatment—what then did it mean to be cured? And on the flip side, what did it mean for a condition to be incurable? Suddenly, those staid dichotomies (curable v. incurable, curable v. terminal, curable v. chronic) felt inadequate to understanding what was going on in front of me. And my efforts to understand what was at stake in cure required me to go beyond clinical ethnography, to think historically about how cure had been shaped over the last century and a half.
Does your title imply a pessimism/disillusionment about the possibilities of cure, or how would you describe the tone and vision of your project?
Pessimism—I hope not! Disillusionment, perhaps. But I would say that more than simply dispelling illusions (which was, after all, what Susan Sontag was aiming for in her Illness as Metaphor and AIDS and Its Metaphors), we need to consider our illusions carefully. In the book, I make a methodological plea for imagination while simultaneously describing how many people have themselves imagined cure (and to be clear, imagination can include experience).
This is all to say—there’s no escaping illusion, fantasy, or imagination. There is, however, the possibility of actively forging something otherwise, through a rigorous use of imagination. That is the aim of the book: to sort through the detritus of history and present, to deliberately juxtapose these fragments to better understand how we have imagined cure, and how we might imagine it anew.
At The Limits of Cure is part of a series at Duke University Press called Critical Global Health: Evidence, Efficacy, Ethnography, whose intervention lies in “offering an alternative framework to ever-more dominant quantitative-based approaches to global health science and policy.” What kinds of ethnographic tools do you use in your project, and how do they enrich the study of medicine/cure?
My book draws on film, folklore, and fiction, as well as oral histories, archival research, and of course, ethnographic fieldwork. In this sense, it might be described as multisited, but I don’t think this goes far enough. To speak of multiple sites suggests that we might know where a site begins and ends—but when you follow a question or concept, you must go where it takes you. This for me has meant trying to understand how, where, and when cure has emerged, and what it has meant in each of these instantiations.
My proclivity as a researcher is to try to understand how something came to be: for example, an early-twentieth century tuberculosis sanatorium on the outskirts of Chennai, which had been transformed into an HIV hospital. Who had built this sanatorium, and why? What could this building, located at the periphery of one of India’s largest cities, tell me about the longer history of tuberculosis and its cures? And how might the history of Indian sanatoriums shed new light on our present moment, one in which we grapple with the spread of antibiotic resistance?
Your book has been lauded by critics for incorporating a number of genres and media, in fact, making it more than a strict ethnography. What are some of these traditions or bodies of work that you pull from, and what kinds of readers do you hope to draw in?
I’ve had a few people tell me that it’s a challenging book to place—not a conventional ethnography, nor a proper history of medicine. But I actually think it’s firmly part of a lineage of scholars whose work has deeply inspired me, and who themselves engage in a kind of promiscuity related to material, method, and mode. I’m thinking here of the work of members of my dissertation committee at Berkeley, including Lawrence Cohen and Stefania Pandolfo, as well as other scholars of science and medicine whom I deeply respect, such as Sarah Pinto, Warwick Anderson, Banu Subramaniam, and Michelle Murphy. Their work gave me the—maybe the right word is license?—to unabashedly engage with the world beyond what sometimes gets defined as a narrowly ethnographic ambit.
As an example, each chapter of the book begins with a quasi-folkloric or apocryphal scene, as a way to invite readers to engage with certain questions in unexpected places: for instance, how might the story of a child-saint curing an afflicted monarch come to illuminate or reorient the question of curative efficacy vis-à-vis the history of randomized controlled trials in India? Or what does an imagined train journey into the Himalayan foothills, pieced together from archival scraps, reveal about how cure might be mediated by the body’s enclosure from or openness to its environment?
So while the book might most readily speak to the concerns of cultural and medical anthropologists, historians of science and medicine, and scholars of South Asia, I hope that anyone interested in questions of method—and writing!—is drawn to this book.
How might your book on cure and “curability” resonate with current debates around vaccines, especially in the era of COVID-19, and the rise of anti-vaxxers (in the United States, at least)?
And not just vaccines! Now we have two potentially effective new antivirals from Merck and Pfizer. But we also have the Omicron variant.
I’ve been very hesitant to extend my work on tuberculosis for thinking about COVID. As I write in the introduction, “this book was not written for the quick excerption of ‘theory,’ for the canny lifting of a term or phrase that can be laid down wherever you may go.” But the sentence that follows might offer a way forward: “The method of the book is a plea for a renewed attention to scholarly form, specifically, to the kinds of juxtapositions (and contexts) we depend upon and demand.” In thinking about COVID, about antivirals and vaccinations, I think we need to understand why cure has failed to emerge as a critical concept, how the condition described as “long COVID” directs our attention to the limits of both prophylactic and curative responses, and what it might mean—especially with the rise of Omicron—to think about an ending. As I’ve argued in the book, there are no dearth of endings. So as a final note, I might suggest that we think carefully about the many endings, some that are deferred and others that come all too soon, that comprise this pandemic, as a global phenomenon that is nevertheless experienced in intensely specific ways. Many hoped that the development of a vaccine would be the end. Instead, it has proven to be only one of many endings.
There is, as I write, “no end to endings.”