Honolulu: University of Hawai‘i Press, 2013. xv, 323 pp. (Figures, B&W photos.) US$52.00, cloth. ISBN 978-0-8248-3682-5.
Anna Lora-Wainwright’s Fighting for Breath: Living Morally and Dying of Cancer in a Chinese Village provides an ethnographic account of how Chinese cancer sufferers and their family members alike make sense of cancer causality, struggle with medical treatment, and practice care and mourning. Based upon her fieldwork between 2004 and 2005, Lora-Wainwright focuses on the experiences of villagers, with special attention to Gandie and Uncle Wang—both cancer patients from Baoma village of Langzhong in Sichuan province. She not only recounts detailed narratives about cancer as individuals’ lived experience but also offers analyses that treat illness as collective life in the sense that the battle with cancer involves family negotiations and thus recapitulates moral-social life. Her bottom-up case studies outline “an emergent moral economy [of cancer] that combines past and present,” namely, the historical memory of socialism and contemporary experience with state capitalism are intertwined, especially as they clash inter-generationally (42).
The book is divided into three sections, each comprising two or three chapters. Part 1, “Foundations,” lays out a theoretical framework and situates the ethnographic site of Langzhong historically and geographically within China’s political economy. Taking a cue from Arthur Kleinman’s emphasis on the social nature of suffering, Lora-Wainwright in chapter 1 calls for a cross-examination of individual subjectivities and social interactions in the study of cancer in rural China. To understand forms of social relations, she emphasizes the concept of morality (especially family relations), placing it at the heart of her analysis. In the second chapter, Lora-Wainwright explains Langzhong’s situation as a cancer village, delineating its historical trajectory from Mao’s era to Deng’s reform and then to Hu and Wen’s post-socialist China.
Part 2, “Making Sense of Cancer,” seeks to trace the contending ways in which villagers perceive cancer etiology “within the intersecting contexts of the state, the family and local community, and the moral economy of the market” (92). In the first chapter, Lora-Wainwright analyzes three perceptions of cancer etiology: water pollution, strenuous labour work (xinku), and farm chemicals. First, the view about the causal relationship between polluted water and cancer, though well-reasoned, does not register with the villagers because the water problem has structural obstacles that the local officials are incapable of addressing due to financial conditions—hence a problem too common to mobilize local agency. The failure to politicize water, moreover, can be explained by the fact that two other perceptions of cancer cause—hard work and food chemicals—make better sense to the villagers. People had to sacrifice their health in harsh times to work hard for their families’ well-being. The villagers thus recuperate their historical memories of hard work and hardship to explain cancer. Lora-Wainwright suggests that this perceptual link enables the villagers to make the cancer victims into moral subjects. Food chemical as cancer cause also resonates with the villagers because it allows for their agency to avoid cancer by avoiding chemicals to grow foods for their own consumption. The remaining two chapters examine the discursive formations of blame (often gendered) and morality in the context of the village’s changing social reality. The emphasis is placed on how inter-generational differences—a result of China’s economic transition—restructure gender dynamics and perceptions of cancer cause.
Part 3, “Strategies of Care and Mourning,” investigates the various practices and strategies of care and mourning in order to “unpack family relations as always in process, renewed or challenged through social practices” (199). Chapter 1 takes on Gandie as its case study, examining how the extended family practices care and affection. Due to the financial situation and inter-generational divergence, family members differ in their care practices. In chapter 2, Lora-Wainwright first explains healthcare provision in both national and local contexts before arguing that the skepticism and rejection of marketized medicine reflects the family’s moral reasoning. Gandie’s rejection of expensive surgery, for instance, represents his care towards the family, “reproduc[ing] a moral universe in the face of market challenges” (228). In the last chapter, she examines how contested religious and ritual moralities change family relations in the course of mourning.
Lora-Wainwright’s monograph represents ethnography at its best in the sense that her bottom-up studies demonstrate local and inner workings of power relations otherwise not readily available to casual observers. As an ethnographer, she values human experience, not reducing individuals to mere data, because “an anthropology of cancer is not simply another form of cultural critique. This would deny the reality and poignancy of suffering” (262). Lora-Wainwright is persistent throughout the book in her humanistic sensitivity. Moreover, deploying Kleinman’s intersubjective framework in her treatment of suffering as socially negotiated, Lora-Wainwright views cancer as a crisis moment for reconstituting family relations. To help the reader make sense of social suffering, her heuristic use of morality and moral reasoning is highly effective. The book also enjoys a sufficient level of analysis. Lora-Wainwright’s cultural critique is sharp and nuanced. She engages rigorously with cultural critics like Susan Sontag and Pierrre Bourdieu.
The book, however, not only draws from cultural and social theory, but also uses China as a case to modify existing theories. In her effort to investigate consumption and health, for example, Lora-Wainwright, while benefitting from Bourdieu’s habitus, insists on using the Chinese concept of xiguan instead of habitus in order to better understand bodily habits in the Chinese context. This level of conceptual nuance and respect for local context should be applauded. One small reservation that I have concerns Lora-Wainwright’s conceptualization of morality in mostly confining it to family life. Although family relations are central, one may wonder about the extent to which the social and moral life among villagers figures into the political economy of morality. Social pressure and the concept of Chinese face (mianzi), for instance, might materially change the dynamics of family negotiations in cancer treatment. Regardless, Lora-Wainwright’s monograph makes a theoretically sophisticated and empirically nuanced contribution to medical anthropology and the ethnography of rural China. Although it focuses on one Chinese village, the cultural work the book performs will shed light on the moral complexity of contemporary Chinese society.
Hangping Xu
Stanford University, Stanford, USA
pp. 590-592