August 25, 2003

Vaccines and The Ethnographic Two-Step

Responding to a discussion of vaccines at Crooked Timber, I started thinking about how few public thinkers in the United States seem to have mastered an important habit of thought that I’ve come to call the “ethnographic two-step”, a tool that anthropology could contribute to public thought, but that mostly goes unused, even by anthropologists. (Something that Micaela di Leonardo observed some time ago.) For the most part, commentators and writers tend to resolve themselves towards one half of that two-step dance rather than follow the whole routine.

The two-step goes something like this: you have to understand why people do what they do from the inside out, but you also have to be willing to critically evaluate what they do and if necessary, judge it or condemn it. (Or for that matter, praise and seek to reproduce it if you find it laudable and applicable to others.)

I am not entirely sure it matters which of the steps you take first. You might see or hear of some practice or community that you are certain is illiberal, anti-democratic, repressive, or unfree, and then resolve to try and understand why it exists in the world. Or you might seek to understand the logic and ideas of some group or cultural form and then decide, having understood, that you find it repellant. I suspect that the latter is preferable, to approach an unknown with a sense of curiosity and allow judgement to emerge organically out of that investigation. I am sure, however, than anyone who wants to make a meaningful contribution to the deepening of knowledge and the achievement of lasting justice is obligated to do both things as part of the same overall effort.

The caricature of “cultural relativism”, most cuttingly articulated by Dinesh D’Souza, is usually crude in its intellectual history of the trend and simplistic in its assessment of the contemporary scene, but it scores points because it does identify, however poorly, a real habit of thought in public discourse in both the United States and Western Europe. What D’Souza calls “cultural relativism” comes from many sources, including modern libertarianism, old-style Burkean conservatism, certain varieties of anthropological analysis and a host of other sources. This way of thinking takes a human group, society, or institution and holds it off at a permanent distance, always exotic. It often amounts to a half-voiced, half-gestural view of the world that ends up sounding rather like Star Trek’s Prime Directive, a belief that intervention never changes anything for the better, and that cultures are what they are, and natural to themselves and of themselves, and not us, never us. The more conservative relativists apply this belief largely to domestic issues and groups, and the more liberal ones, usually to foreign or non-Western societies and practices. It is rare to find someone who views WASPs, Yanomani Indians, corporate boardrooms, Islamic fundamentalists, the Oval Office and biker gangs in New Jersey with the same dispassionately relativist eye.

On the other hand, on the contemporary US political scene, we have the neocons, the religious right, and the cultural left, all of whom are fervently consumed by a transformative project which takes little or no interest in understanding the inner worlds and sensibilities of the target of their wrathful vision. What’s wrong is wrong, and what’s right is right, and these constituences tend to take it for granted that the difference is obvious and that anyone who hesitates or seeks further understanding is willfully blind to that difference and therefore morally culpable themselves. It doesn’t matter to any of these groups why people do what they do—if what they are doing is wrong, their motives are assumed to be venal, self-serving, and volitionally wicked, inasmuch as there is any thought given at all to movtives.

The problem is that those who seek transformation have no real hope if they are unwilling to see the world the way that those they wish to transform see it, or more precisely, they leave themselves one avenue and one avenue only for realizing transformation, and that’s force, compulsion, coercion. More troops, more laws, more speech codes, more restrictions. Certainly that works now and again, but not very often and only in highly particular situations where the practices in question were largely legal or governmental in the first place.

Equally, the critique of the complex tendency towards relativism scores points because relativism, however intricate, tends to be both self-deceiving and morally hollow. It often blinds itself quite deliberately to the existing connections and mutualities that link an observer to the culture he or she wants to understand, and creates a false sense of Olympian distance. It often creates, allegedly in service to empathy, a two-tiered view of humanity where the “us” have moral and ethical obligations and standards and the “them” are innocent, prelapsarian, animals or children to whom “right” and “wrong” do not apply. Few relativists are true nihilists who reject ethics altogether, but they simultaneously make ethics a parochial, local matter that affects only “us”, while also ballooning “us” into a position of universality.

Take vaccines. On one hand, yes, when people come to a crypto-theological conclusion about something like vaccines, they now commonly reach for a quasi-psychotic confection of dissenting studies and evidence to create a rhetorical case for their decision. Many of those who resist vaccination in the contemporary US are clearly exploiting the willingness of everyone else in their community to vaccinate their children and accept this risk. (E.g., in a community where 99 children are vaccinated against pertussis, 1 child can forgo the vaccine without fear of pertussis and have no risk from the vaccine itself to boot). They place themselves outside the commonweal and make themselves the ethnographic exception, and then instrumentally misuse the rhetoric of science and the right to privacy to justify what is little more than parasitism. The refusal to vaccinate is at its worst when it comes cloaked in the remnants of left-leaning counterculturalism, because in that case it even pretends to a kind of phony communitarianism, a loyalty to some never-never land social world that is yet to come.

And yet. And yet.

There are two things that many scientists, doctors and policy-makers who express frustrations about these beliefs simply don’t understand. The first is, that while it may not be rational (or civic) to avoid vaccination (or many other things) based on the evidence available, it is rational to suspect that the evidentiary materials scientists and doctors are assembling may be suspect in their particulars or even in their broad outlines.

Doctors and public health officials do not instantly bow to the truth of their own data (witness their palpable collective unease about the body of evidence confirming that wine and other alcoholic drinks have benevolent effects when consumed in moderation) and sometimes their data also contains genuinely messy information about what is true and not true. The public grasps this, and it makes a lot of skepticism and willingness to ignore bodies of scientific evidence at least partially rational—especially in cases like autism or asthma, where the condition is poorly understood and where its rising incidence is admittedly mysterious. In the end, seen from the inside out, skepticism about science makes a good deal of practical, everyday sense, not because it is ill-informed, but the exact opposite, because of long experience and knowledge, and because science sometimes situates itself as a force outside of community and authoritative over it, not as a structure of reason that rises organically from the deep roots of our lives and times.

The other thing that many scientists and policymakers do not grasp when they decry public irrationality about gauging risks is that we don’t evaluate risks through probability. We evaluate risks through narrative. Meaning, we tell stories about the consequences of risking and losing and decide based on the qualitative evaluation of the tragedy or pain involved and the relative preventability of the events that would incur that pain. It is the meaning embedded in the stories, the interpretations of the world, the qualitative way we evaluate not just why things happen but how it feels when they happen, that makes all the difference, and ought to make all the difference.

This is what is happening with vaccination and autism. Parents tell stories in their own heads about what autism is and what is would mean, and those are very bad stories—a bright, ‘perfect’ child without any problems suddenly turned into a child who is cut off from emotional and intellectual connections with the world. They tell stories about what it would mean if it turned out one day in the future that something they did (vaccination) was what caused this thing to happen. The badness of that story is reason alone for a few parents to turn aside, and that’s perfectly understandable if incorrect—because it is how we actually (often correctly) evaluate the real meaning of probability in our lives, in terms of what we can choose to do or not do, but also how horrible or painful the consequences of the dice coming up badly would be. Seen from outside, dead is dead, but told from inside, most of us have deaths we'd prefer and deaths that terrify us. It doesn't matter if the risks of the two are the same.

Beyond that, every decision to not vaccinate has a local meaning and genesis that also requires some investigation, ranging from the conditions of a particular individual parent’s previous encounters with biomedicine or serious congenital conditions to entire communities of faith or practice trying to find a way to demarcate their distance from the ills they perceive in the wider society.

That’s a good example of the ethnographic two-step: a choice or practice can be both wrong and perfectly reasonable, immoral and sensible, repellent and legitimate. More importantly, it means that if you object to something and want to see it changed, you begin to have a roadmap towards persuasion that incorporates humility, deep understanding and ethical clarity. Then you’re not just stuck advocating more laws, harsher punishments, stronger use of force, and you’re not stuck portraying the object of your animus in increasingly inhuman and mechanistic terms, people who do what they do for reasons unknown and unknowable.