Part of review forum on “Higher Powers: Alcohol and After in Uganda’s Capital City”
In their profoundly sensitive, tri-authored, ethnography, Scherz, Mpanga, and Namirembe explore the specific kind of problem that alcohol is in Uganda. Their collaborative ethnography locates notions of health and the body in a broad landscape of healing, of which biomedicine is one--but only one-- part. As the chapters of Higher Powers unfold, describing four different modalities of healing, Scherz, Mpanga, and Namirembe generatively draw anthropology’s long-standing commitment to vernacular healing together with more recent Science and Technology Studies (STS)-inflected studies of the clinic.
The first chapter invites readers to see instances of destructive drinking within a broader history of the ways that making, distributing, sharing, and consuming alcohol have organized social, political, and economic life through an ethic of interdependence. In precolonial Buganda, the movement of traditional beer delineated gendered, and age-based, assemblages of power. Drinking (and allowing to drink) positioned the elite, facilitated relations with ancestors, and delineated responsibility for ensuring collective well-being. Alcohol, in other words, nourished capacity, agency, hierarchy, and communal ongoingness. It was a practice and a substance. Colonial histories of alcohol describe the commercialization of brewing, the emergence of class, and the processes through which modern subjects and selves were produced through racial capitalism. The bars that dot Kampala’s landscape today embody a continuity with this past. They remain sites where people, particularly men, build their lives through each other; seeking out companionship, laughter, and intimacy as well as converting material wealth into critical social relations over extended arcs of long friendships. This starting point enables the authors to show how problem drinking comes to be apprehended as a derangement or deformation of the flows that animate these social relations. Instead of nourishing social ties that allow one to navigate poverty and precarity, drinking becomes that which impoverishes and renders that individual and those he cares for more precarious.
The struggles with alcohol in this book are all the more palpable, because Scherz, Mpanga, and Namirembe refuse to reduce them to only biology. Rather, Higher Powers takes the work of healing in Uganda as a site for theorizing. In so doing, the book extends a growing conversation in anthropology examining the chronic in and beyond the clinic. In Kampala’s rehabilitations centers, the Chronic Relapsing Brain Disease (CRBD) model of addiction—developed and imported from the United States—shapes treatment and defines biomedicine’s version of the chronic. CRBD locates problem drinking as evidence of a kind of person—an addict—and destines a person to live in a state of suspended tension. As one counselor in Kampala commented “An addict can never truly be relaxed.” The addict is defined by their fight against the pull of alcohol and the constant threat of relapse. There is no release. Staff counsel people to avoid bars, advise them to break off relations with friends and families defined as “partners in crime,” and insist that their defining identity is always tied to this past. Stopping the flows that animate life though bars pushes these men into a tormented liminal space.
Through the beautiful and complicated story of their relationship with Maurice, the authors describe how these centers hail those striving to fashion modern selves. The approach of these centers stands in contrast to that of herbal medicine, Pentecostal deliverance, and the basamize guidance in accommodating spirits. The latter each challenge CRBD’s version of chronicity and offers a path to address problem drinking through an ethic of interdependence.
Herbalists locate treatment in a radical reworking of the desires that animate alcohol abuse. Through powerful emetics they strive to transform the experience of alcohol. These herbal medicines, put into one’s favorite alcohol for consumption, induce extreme vomiting, sometimes for days. In so doing they change the sensorium of the drinking. The nausea felt each time they smell this alcohol after the treatment raises feelings of fear and disgust. They can continue their socializing in bars, drinking nonalcoholic, often highly caffeinated drinks. The alcohol is circumscribed, not the person. Pentecostal deliverance and the call and response of spirits also offers the possibility of moving beyond the permanent state of suspended tension defined by CRBD models.
The incommensurability that structures these distinct modes of healing have a politics rooted in their investments in the forces that make up the world, and histories of struggle over what entities have the right to exist. This fact reveals itself not only in the specifics of treatments, but also in the different ways that each of these modalities address the complex relations between treatment and violence. Biomedical models force a commitment to the identity of an addict, isolating individuals for eternity from the spaces in which they might build social relations, find economic support, and cultivate communality. In contrast, the herbal medicine to address addiction catalyzes violent vomiting, and promises to change an individual’s sensorium thereby freeing them from dangerous attraction to alcohol. Deliverance requires a very real battle with Satan, in which one is at risk of losing everything, but also refuses the view that a history of problematic drinking fixes an individual’s identity as an addict for life. Different still are the sessions guided by the basamize in the last chapter of Higher Powers. Here the authors describe a nourishing, if rowdy, space for acceptance and accommodation to grow. Perhaps however these relations are not always as peaceable as the stories in this chapter might suggest. Ancestors after all can threaten the life of those who they demand take up “their medicine bag.”
I would love to hear the authors speak more about the relations they see between healing and violence. Each modality they describe seems to recognize that attending to destructive relations is itself painful and at times quite brutal. Is this then the space of ethics? Does attending to the diverse ways that Ugandans reflect on and labor over alcohol illustrate the violence of forging the modern self as the site of ethics, while simultaneously refusing to shrink from the dangers of forces that imagine an ethics of interdependence?
While the argument in Higher Powers makes an important contribution to studies of addiction and has profound implications for public health interventions, this ethnography will be generative for all anthropologists and other social scientists interested in questions of authorship and the politics of international research. The methods through which these three authors work together, elevate each other’s contributions, and find ways to collectively analyze and write offer a path through thorny questions of postcolonial of knowledge. In so doing, they offer methods to meaningfully unsettle the forms of inequality embedded in authorship.
