Guest post by: Catia C. Confortini (Wellesley College), with Tiina Vaittinen (University of Tampere)
Today we post the second of a two-part piece based on a paper presented by Dr. Catia Confortini in Dakar, Senegal during the annual CIHA Blog Conference in December 2017. If you haven’t already read the first part, you can find it here. Finding that there was little engagement between Peace Research (PR) and questions of global health and feminism, the author, together with Dr. Tiina Vaittinen (University of Tampere, Finland) concluded that bringing together feminist PR and global health scholarship has the capacity to enrich both scholarly traditions. This paper represents a brief summary of their working conceptual framework with evidence drawn from Dr. Confortini’s research thus far. A different version of the arguments presented here will be published as the introduction to a co-edited volume entitled Gender, Global Health, and Violence: Feminist Perspectives on Peace and Disease (Rowman & Littlefield 2019). Building on the first part which examined the notions of structural violence and slow violence, especially in the context of breast cancer advocacy in Nigeria, today’s post turns to the concept of epistemic violence before exploring the concept of “slow peace.”
Epistemic Violence
As a further point to deepen our understanding of breast cancer as slow violence, in particular as regards invisibility, a focus on breast cancer as embodied also allows us to look into a third form of violence, epistemic violence. Epistemic violence is a term we borrow from post-colonial feminist scholar Gayatri Chakravorty Spivak and it is the violence of knowledge production, the harm inflicted through discourse, and it includes the distortions, stereotyping and generalizing of global south women’s conditions, as if they all lacked agency and needed saving. It is the violence of silencing. Epistemic violence is helpful conceptually as well as methodologically, because it compels us to look for silences, to identify violence done when our conceptual and discursive frameworks blind us to alternative world views and those who espouse them. In peace studies terms, we “other” those alternative views without engaging them. One way in which epistemic violence happens around breast cancer in Nigeria is through the assumptions made about the reasons used by global health practitioners and literature to explain why women do not seek biomedical help early.
At the international conferences and meetings that I attended, the word “stigma” was a ubiquitous explanation for late stage presentation, but it was never quite clearly defined. It became apparent to me that use of the word “stigma” as a catch-all reflects some assumptions about Nigerian, and more in general, African cultures, as “other,” static, and inferior to biomedical knowledge. The global health establishment assumes that “traditional cultures” or beliefs are harmful (and hence sources of violence) but fails to look introspectively at itself as a culture. Relevant for my argument here is that relying on an ill-specified notion of stigma is representative of epistemic violence to the extent in which patients’ experiences are silenced and assumed a priori to be harmful because at odds with rational, biomedically compliant, behavior. The assumption is that traditional healers cannot possibly match the superiority of biomedical knowledge.
While biomedical experts silence the voices of patients themselves by assuming that an ill-defined notion of stigma, and related “othering” of Nigerian culture is responsible for late stage presentation, for breast cancer advocates in Nigeria, the picture is a lot more complex. Focusing on the embodied realities of patients, Nigerian representatives of breast cancer organizations as well as Nigerian oncologists often talked about culture or cultural practices. Both lack of awareness of biomedical knowledge and reliance on traditional healers and religious practices were cited as reasons to delay seeking biomedical help, but the interviewees also recognized the wider social, political and economic barriers to early detection, citing economic strains, perceived lack of community or family support, difficulty in reaching hospitals, and poor patient-doctor communication, among other factors. In other words, late stage presentation for them reflects a number of entangled systemic constraints on women’s agency. Primary among those constraints are economic barriers. For example, several of the women members of a patient group, where I conducted participant observation were fired from their jobs after their diagnosis, and many of my interviewees cited economic hardship as a reason for lack of follow up or adherence to treatment. Moreover, traditional healers and Christian healing practices are much less costly than biomedical treatment.
I am not advocating here necessarily for alternative treatments to “conventional” western approaches, which afford the highest survival rates (but are not without critics and have not progressed us into a full understanding of the disease). As anthropologist Julie Livingston puts it, “while cancer with oncology [is] awful, cancer without oncology could be obscene”. But there is more to spiritual healing than cost or irrational or unscientific and unfounded faith, and breast cancer advocates in Nigeria know that.
What a focus on embodiment and epistemic violence tells us is first to pay attention to women who are often not included in the decision making about what is best for our bodies. This is in general. Notable at the World Cancer Congress in Paris last November, for example, was the near absence of patients’ voices from the vast majority of the panels. In particular in Nigeria, as in other postcolonial societies attention to embodiment means bringing together and paying attention to the wisdom of not only different bodies, but also to spiritual practices, to different understandings of mind/body/soul relations that come from Nigerian women. For all of the breast cancer groups I came in contact with in Nigeria, the spiritual element was strongly present, even as some drew sharp distinctions between traditional healers and Christian healing practices. Embodiment in other words also understand the embodied coping mechanisms that women employ to live with and through breast cancer.
In sum, the epistemic violence that silences narratives of women’s agency is disrupted by those acting in relationship with women with breast cancer. What is particularly interesting here, is that there also seem to be spaces of dialogue and listening between the two presumably separate and hierarchically ordered “camps” of healing, perhaps enacted by the particular embodied relations and environments of breast cancer care in the context of Nigeria. I will turn now to this and posit these spaces of agency as enactment of “slow peace.”
“Slow Peace”
Drawing on the work of Rob Nixon to describe the activities of women in “post-conflict” Northern Ireland, Mandi Donahoe has coined the phrase “slow peace.” She says that in juxtaposition to “slow violence,” slow peace is similarly out of sight, concealed in the banality of the everyday; it is not focused on one dramatic event, but rather happens across communities and across time, slowly; finally, just as slowly, it is contributing in an accretive way to the strengthening of communities.
I like to think of the practices of breast cancer advocates in Nigeria in similar way: through their focus on the embodied everyday needs and embodied voices of women with breast cancer, out of sight from the world of global health organizations; through their ongoing, banal work of providing wigs, hosting spiritual retreats, walks and marches, raising funds, reaching out to churches and markets, they contribute in an accretive way to deepen our understanding of breast cancer as violence, and to amplify the voices, wisdom, needs, and agency of women living with breast cancer in Nigeria.
As for peace research, this work points to the need to go beyond the metaphors and recognize concrete, embodied health as pivotal to the study of peace/violence. In this regard, this work is part of an emerging movement to make feminist approaches to peace research visible, not only as a question of “women” but as a wider question of the hierarchies between masculinities and femininities. After all, despite decades of feminist work, the patriarchal hierarchies in the field continue to render feminist perspectives on violence irrelevant for the disciplinary imagination. Consequently, also feminized questions such as public health, sickness, corporeality, and sexuality become overshadowed with the more masculine realms of peace and violence – such as armed conflict and war. Since health is always about the politics of gendered and sexualized bodies, we believe it is crucially important for feminist peace research to engage with the global health scholarship more directly and explicitly than before. In the context of health, PR can provide nuanced analyses of violence in particular empirical contexts, whereas the transnational world of global health can widen the horizons of what it means to study violence, peace and justice in the intersectionally gendered and embodied everyday. In other words, feminist peace research can make for better global health.
About the Authors
Dr. Catia Confortini
Dr. Catia C. Confortini is Associate Professor and Co-Director of the Peace & Justice Studies Program at Wellesley College in Massachusetts (USA). She is the author of Intelligent Compassion: Feminist Critical Methodology in the Women’s International League for Peace and Freedom (OUP, 2012); co-editor (with Tiina Vaittinen) of Gender Global Health and Violence: Feminist Perspectives on Peace and Disease (Rowman & Littlefield 2019); and co-editor (with Tarja Väyrynen, Élise Féron, Peace Meadie, and Swati Parashar) of The Handbook of Feminist Peace Research (Routledge 2020). Her current interests lie at the intersection of feminist peace research and global health. This research was made possible by a postdoctoral fellowship by the American Association of University Women.
Dr. Tina Vaittinen
Dr. Tiina Vaittinen is a postdoctoral researcher in Peace Research Institute TAPRI at the University of Tampere. Her research seeks to integrate Feminist Peace Research with Global Health as well as Social Policy. Thematically, she works in the intersections of the (bio)politics of migration, old age care, and different forms of violence and peace. Her most recent interests include various tabooed questions to do with global health and faeces, such as incontinence care and faecal microbiota transplantation. Her book The Global Biopolitical Economy of Needs: Migration, Care, Ageing Bodies is due to come out with Rowman and Littlefield in 2019.