Indigenous Bodies, Cells, and Genes: Biomedicalization and Embodied Resistance in Native American Literature 9781000194111, 1000194116

Citation preview

Indigenous Bodies, Cells, and Genes

This book explores Native American literary responses to biomedical discourses and biomedicalization processes as they circulate in social and cultural contexts. Native American communities resist reductivism of biomedicine that excludes Indigenous (and non-​ Western) epistemologies and instead draw attention to how illness, healing, treatment, and genetic research are socially constructed and dependent on inherently racialist thinking. This volume highlights how interventions into the hegemony of biomedicine are vigorously addressed in Native American literature. The book covers tuberculosis and diabetes epidemics, the emergence of Native American DNA, discoveries in biotechnology, and the problematics of a biomedical model of psychiatry. The book analyzes the works of Madonna Swan, Louise Erdrich, Sherman Alexie, LeAnne Howe, Linda Hogan, Heid E. Erdrich, Elissa Washuta and Frances Washburn. The book will appeal to scholars of Native American and Indigenous Studies, as well as to others with an interest in literature and medicine. Joanna Ziarkowska is a Native American Studies scholar at the Institute of English Studies, University of Warsaw, Poland, where she teaches courses devoted to Native American literature, Literature and Medicine, and Film Studies.

Routledge Research in Transnational Indigenous Perspectives Series editors: Birgit Däwes, Karsten Fitz, and Sabine N. Meyer

Routledge Research in Transnational Indigenous Perspectives features scholarly work exploring both Indigenous perspectives that are explicitly transnational and transnational perspectives on Indigenous topics. As such, it is committed to fostering and presenting high-​quality research in the area of Indigenous Studies, addressing historical and contemporary political, social, economic, and cultural issues concerning the Indigenous peoples of North and South America, Europe, Australasia, and the larger Pacific region. The series is thus not limited to one particular methodological approach, but looks at the highly dynamic and growing field of Indigenous Studies that is of central interest for a range of different disciplines. Members of the series’ advisory board include Chadwick Allen (Ohio State University); Philip J. Deloria (University of Michigan); Christian Feest (em., Johann-​Wolfgang Goethe University Frankfurt); Hsinya Huang (National Sun Yat-​Sen University). The series considers contributions from a wide range of areas in the field of Indigenous Studies. These include but are not limited to: • • • • • • • • •

Indigenous literatures, film, performance, music, and visual arts Indigenous peoples and the law, settler imperialism, rights, and human  rights Indigenous histories, politics, knowledges, and religion Representations of Indigenous peoples in non-​Indigenous cultural productions Indigenous peoples and the museum Indigenous languages Gender/​Queer Indigenous Studies Transnational flows of Indigenous ideas and cultures Methodological issues in Indigenous Studies

Native American Survivance, Memory, and Futurity The Gerald Vizenor Continuum Edited by Birgit Däwes and Alexandra Hauke Indigenous Bodies, Cells, and Genes Biomedicalization and Embodied Resistance in Native American Literature Joanna Ziarkowska

Indigenous Bodies, Cells, and Genes Biomedicalization and Embodied Resistance in Native American Literature Joanna Ziarkowska

First published 2021 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 52 Vanderbilt Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2021 Joanna Ziarkowska The right of Joanna Ziarkowska to be identified as author of this work has been asserted by her in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing-​in-​Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-​in-​Publication Data Names: Ziarkowska, Joanna, author. Title: Indigenous bodies, cells, and genes : biomedicalization and embodied resistance in Native American literature / Joanna Ziarkowska. Description: London ; New York, NY : Routledge, 2021. | Includes bibliographical references and index. Identifiers: LCCN 2020018070 (print) | LCCN 2020018071 (ebook) Subjects: LCSH: American literature–Indian authors–History and criticism. | Indians in literature. | Health in literature. | Medicine in literature. | Indians of North America–Health and hygiene–Sociological aspects. | Indians of North America–Social conditions. Classification: LCC PS153.I52 Z53 2021 (print) | LCC PS153.I52 (ebook) | DDC 810.9/897–dc23 LC record available at https://lccn.loc.gov/2020018070 LC ebook record available at https://lccn.loc.gov/2020018071 ISBN: 978-​0-​367-​47852-​0  (hbk) ISBN: 978-​1-​003-​03689-​0  (ebk) Typeset in Times New Roman by Newgen Publishing UK

Contents

Acknowledgments  Introduction –​Indigenizing biomedicalization: community, relationality, and embodied resistance in Native American literature 

vii

1

PART I

Tuberculosis 

23

1 Virgin soil theory, boarding schools, and medical experimentation: a history of tuberculosis among Native Americans 

25

2 Tuberculosis, biopower, and embodied resistance in Madonna Swan: A Lakota Woman’s Story, as told through Mark S. Pierre and Louise Erdrich’s LaRose 

55

PART II

Diabetes 

89

3 Developing Indigenous models of diabetes: from genetic fatalism to community-​based approaches 

91

4 Beyond the biomedical model of diabetes: settler colonialism, traditional foodways, and historical trauma in Sherman Alexie’s selected works and LeAnne Howe’s Miko Kings: An Indian Baseball Story 

109

vi Contents PART III

Blood and genes 

131

5 From blood memory to genetic memory, and the emergence of Native American DNA: a story of biocolonialism at the turn of the millennium 

133

6 “We remember our ancestors and their lives deep in our bodily cells”: mapping history in space and genes in Linda Hogan’s autobiographical writing 

156

PART IV

Indigenizing biomedicalization 

173

7 The traffic of cells and ideas: Heid E. Erdrich’s biotechnological poetry 

175

8 Biomedical psychiatry, Native American identity, and the politics of visibility in Elissa Washuta’s My Body Is a Book of Rules 

202

Coda 

228

Bibliography  Index 

236 266

Acknowledgments

This book would not have been possible without various forms of support that I received over the years of work on the project. Most significantly, I have been the beneficiary of the Fulbright Senior Award (2018/​2019), which took me to the University of California, Berkeley (UCB), where I spent a very productive and wonderful year devoted solely to this project. I am immensely grateful to Prof. Hertha D. Sweet Wong for her support, guidance, and care. The supportive environment that Prof. Wong created is second to none: I have greatly benefitted from our regular conversations over coffee. My heartfelt thanks go to Prof. Beth Piatote, who had faith in this project and shared her invaluable feedback. Prof. Piatote’s seminar, which I attended during the summer semester, was one of the most inspiring experiences at UCB. I would also like to thank my home university, the University of Warsaw, for readily granting me academic leave to pursue this project. I am very grateful to Prof. Marek Paryż, who has always been very supportive and understanding. Special thanks go to my colleagues and friends –​Justyna Włodarczyk, Zuzanna Ładyga, Anna Pochmara, Justyna Wierzchowska –​who have always been there for me when I needed them and whose exemplary academic commitment have always been a source of inspiration. I have to call out special thanks to Ewa Łuczak, who long time ago encouraged me to pursue an academic career and has since remained a wonderful friend. I have received wholehearted support from Native American Studies scholars from Europe whom I  contacted at conferences, asking for feedback, and clarification of their own research. Many of them have become my very good friends. I am very grateful to Rebecca Tillett, Jacqueline Fear-​ Segal, David Stirrup, James Mackay, Sharon Holm, Padraig Kirwan, Anna M. Brígido Corachán, and Silvia Martínez-​Falquina. I wish to make special mention of the kindness, support, and sharp analysis offered by my friend Ewelina Bańka, who has always been a great intellectual inspiration. I would like to extend my thanks to Prof. Andrea Herrera for her generous friendship and years of unwavering support. I am also very grateful to Prof. Gwen N.  Westerman, the Director of Native American Literature Symposium, for all her work and enthusiasm put in the organization of the annual conference which has become a platform for

newgenprepdf

viii Acknowledgments an exchange of ideas for Native American Studies scholars. Many thanks to Prof. Gordon Henry, who enthusiastically accepted my invitation to Poland and shared his stories with my students at the University of Warsaw. Words of gratitude are also directed to my precious friend and brilliant film director Tamara Perkins and her daughter Maya. Tamara and Maya offered their kindness and support when me and my family needed them most. My daily conversations with Tamara were an important source of inspiration, intellectual stimulus, and fun. Finally, I would like to thank my family for their ongoing support of the endeavor and willingness to relocate to California. Piotr and Ida, you are the source of my energy. To my mom, for patiently serving as a babysitter and petsitter. To my dad, who would be proud of me if he were here with us. To my sister Hanna and her partner Julek, for picking up the phone at the strangest hours. To my parents-​in-​law, for their love and tremendous support. To my cats, Pucek and Kazia, for surviving a year of separation from our family. And PQ, I’m so happy that our paths crossed.

Introduction Indigenizing biomedicalization: community, relationality, and embodied resistance in Native American literature

In Laguna Pueblo writer Leslie Marmon Silko’s monumental Almanac of the Dead (1991), medicine, with its practices and technologies, is connected in problematic ways to oppressive discourses of power associated with heteropatriarchy, racism, and capitalism. Several of Silko’s characters employ medical knowledge and technology in capitalist enterprises that commodify human bodies and create racist and classist hierarchies defining who counts as desirable in the social structure.1 For instance, Serlo, who believes himself to be a descendent of European aristocracy, is fascinated with genetic engineering and is dedicated to the project of producing a pure-​blooded master race. Those who do not qualify as sangre pura, racially inferior, will be eliminated with deadly designer viruses. Trigg, the founder of Bio-​Materials, Inc., a plasma donor center that functions as a cover-​up for a body parts business, recruits his donors from among Tucson people of color and the poor whose subjectivities are erased in the process of human body commodification facilitated by biomedical technologies. In the myriad stories unfolded in Almanac, medicine is a powerful profit-​oriented institution which, Rebecca Tillett claims, is “constructed to create and preserve profoundly hierarchical ‘discourses of difference,’ ” thus demonstrating its complicity “in the kinds of violent control of human bodies that are evident in communal or national acts of misogyny or racism” (20, 21). Almanac’s preoccupation with biomedicine, the production of biomedical knowledge, and biomedical technologies signaled a recognition of the urgent need to demonstrate their widespread participation in the social and economic oppression of Indigenous people in the USA and worldwide. Silko’s literary depictions of abusive and incompetent doctors, poor access to health care, unethical application of biotechnologies, and rampant commercialization of medical services offer apt commentaries on health disparities in Native American communities, well documented in numerous studies.2 Yet, Silko is not alone in her exploration of how medicine operates as an institution and a system of knowledge; how it addresses, or fails to address, the health problems of Native Americans; and, more importantly, how it urgently needs to be more compatible with or open to non-​Western cultural contexts to provide better services to patients of color. Such concerns were

2 Introduction voiced as early as in the eighteenth century in the writings of, for instance, the Mohegan Indian and Presbyterian minister Samson Occom. In “A Sermon, Preached at the Execution of Moses Paul, An Indian,” Occom employed Native and Christian conceptions of illness and healing to demonstrate how both Indians and colonists could be cured of physical and spiritual illnesses. By doing so, Occom complicated the boundaries between colonial and Indigenous medical knowledges (Wisecup 163–​4). In the nineteenth century, Charles Eastman, a Santee Dakota physician, often expressed his views on Native American health and healing practices. More recently, Standing Rock Sioux historian Vine Deloria Jr. offered a collection of stories about traditional medicine men and their healing practices in The World We Used to Live In: Remembering the Powers of the Medicine Men.3 Similarly, Native American literature of the late twentieth and twenty-​first centuries engages in discussions about interactions and tensions between Western and Indigenous medical knowledges and practices. Often it documents the crisis in access to healthcare services and its long-​term consequences in Indian Country4 as well as the lack of “understanding and sensitivity regarding attitudes and beliefs about [the] health care” of Indigenous patients (Guadagnolo 211). The diabetes epidemic, high tuberculosis rates, insufficient funding for AIDS prevention programs, poor access to mental health services, and calls to challenge the domination of Western paradigms in medical practices, to name a few examples, feature prominently in literary renditions of contemporary American Indian life and have become an important component of decolonization agendas and analyses of the mechanisms of settler colonialism. Even more importantly, beginning with Silko’s Almanac, Native American literary texts confront ethical challenges posed by biotechnologies, research on human genome and human tissues, and the politics of production and dissemination of bioscientific knowledge. In the era of massive human genome research projects such as the Human Genome Diversity Project (HGDP) and the rise of population genetics, Indigenous communities have been intensively targeted as desired research subjects and simultaneously ignored as partners in and contributors to bioscientific debates. Indigenous Bodies, Cells, and Genes:  Biomedicalization and Embodied Resistance in Native American Literature traces Native American literary responses to how biomedical discourses have reached a state in which they are now able to “control, manage, engineer, reshape, and modulate the very vital capacities of human beings as living creatures,” or, in other words, engage in what Nikolas Rose refers to as the politics of “life itself ” (The Politics 3). Biomedicine, contingent on an empirical identification of symptoms and formulation of diagnoses in a biochemical framework, tends to downplay historical and cultural contexts that contribute to the understanding of biomedical concepts such as health, illness, disease etiology, and appropriate choice of treatment. Native American communities resist the reductivism of biomedicine that excludes Indigenous (and non-​Western) epistemologies and, instead, draw attention to how illness, healing, treatment, and objectives of genetic

Introduction  3 research are socially constructed and dependent on inherently racist thinking (even if the category of “race” is no longer part of scientific discourses). As Science and Technology Studies scholar Sheila Jasanoff reminds us, “Science and technology operate, in short, as political agents” (“Ordering” 14; emphasis in original). These interventions into biomedicine’s hegemonic position as the only ideologically neutral and effective response to illness are vigorously addressed in Native American literature; a fact that testifies to the validity of these concerns for Indigenous people in the USA as a part of decolonization and cultural sovereignty efforts. Although political sovereignty, derived from treaties signed between American Indian tribes and the US government and constrained by Native people’s peculiar legal status of “domestic dependent nations,”5 remains a pressing and highly disputed topic in Native American Studies, the issue of cultural sovereignty is no less important in delineating the boundaries of contemporary social and political life in Indian Country. According to Comanche tribal leader, Wallace Coffey, “Cultural sovereignty is the essence of our [Native American] being. It’s what we are as Indian people” (qtd. in Tsosie, “Introduction” 2). Coffey and Yaqui legal scholar Rebecca Tsosie elaborate on this definition, stating that … it is up to Native people to articulate the affirmative content of their inherent sovereignty. In so doing, we must create our own internal appraisal of what “sovereignty” means, what “autonomy” means, and what rights, duties, and responsibilities are entailed in our relationships between and among ourselves, our Ancestors, our future generations, and the external society. This requires us to learn and understand the philosophies that undergird Native world views. It requires us to articulate the appropriate norms of governance and the contours of our own social order, from both a political and spiritual perspective. (Tsosie, “Introduction” 2–​3) This book is informed by the conviction that activities and practices dedicated to well-​ being, choices of treatment, and understanding of illness are components of cultural sovereignty, and must reflect and respect American Indian epistemologies to create a culturally sensitive system of health care and research agendas. As Lavonna L. Lovern and Carol Locust affirm, Most Native American cultures have a high degree of integration between their religious beliefs and their beliefs about health. Healing cannot be separated from culture, sacred narratives, or religion, nor can the social behavior of the Indians be separated from these things. (77) Thus, biomedicine on its own is unable to respond to Native people’s needs to articulate and shape healthcare politics and responses to biomedical research.

4 Introduction Expanding biomedical discourses through an introduction of traditional Indigenous wisdom and practices as well as historical contexts constitutes a contemporary form of resistance to settler colonialism and a claim to cultural sovereignty. This book seeks to illustrate and analyze these forms of resistance and invitations to constructive dialogue with biomedicine as a powerful discourse of subjugation and control. Indigenous Bodies, Cells, and Genes is inspired by previous studies of interactions between Western and Indigenous views on illness and medicine. In the colonial context, Joyce E. Chaplin’s Subject Matter: Technology, the Body, and Science on the Anglo-​American Frontier, 1500–​1676 and Cristobal Silva’s Miraculous Plagues: An Epidemiology of Early New England Narrative provide insightful analyses of the significant roles that ideas about bodies, diseases, and medicines served in the colonization of the American continent and the creation of discourses that justified the theft of Indigenous lands and supported claims about Native people’s technological inferiority. Chaplin’s analysis pointedly demonstrates how the “Great Dying,” namely the devastating epidemics among Native Americans in the sixteenth and seventeenth centuries, dramatically transformed English colonists’ ideas about Indian people’s technologies, which they did not deem inferior at the beginning of contact, contrary to what was originally assumed (9). Cristobal Silva, by linking discourses of epidemiology and mapping, draws attention to “the spatial and temporal trajectories of epidemics,” and traces “the dynamic interplay of disease, migration, immunology, and colonialism” (13). Both point to processes of how the meaning of epidemics and illnesses are constructed. These insights help illuminate the understanding of more recent models of epidemics and biomedical research. Kelly Wisecup’s Medical Encounters:  Knowledge and Identity in Early American Literatures expands the analysis to the late eighteenth century and, in one chapter, concentrates entirely on Native American writings. More importantly, however, Wisecup eloquently establishes early medical writing in the colonies as a product of complex interactions among and mediations of European, Native, and African views on diseases and their treatment. Medical Encounters demonstrates that “early American medical writing –​the textual manifestation of the medical knowledge communicated in cross-​cultural encounters  –​was shaped by Native, African, and colonial responses to medicines and diseases in the New World” (4). Wisecup argues that, contrary to popular belief, there were many points of convergence among colonists’, Native and African medical knowledges  –​a fact that was denied for a number of ideological reasons rather than unobserved. Referring to colonial and twentieth-​century contexts, David S. Jones’s Rationalizing Epidemics:  Meanings and Uses of American Indian Mortality since 1600 demonstrates how medical discourse is deeply implicated in colonialist projects. Jones examines the ways colonists and later inhabitants of a newly created country explained the high mortality rates of their Native neighbors. With the use of medical theory, economics, race relations, politics,

Introduction  5 and social theory, Rationalizing Epidemics persuasively demonstrates how health disparities “were produced by social forces, interpreted through social biases, and used to perpetuate social advantage” (7). What these inspirational studies succinctly illustrate is the complexity of the processes that produce medical narratives of health and illness and the need to include Indigenous perspectives that provide important interventions into the belief that biomedicine is ideologically transparent. Finally, Ann Folwell Stanford’s Bodies in a Broken World:  Women Novelists of Color and the Politics of Medicine draws attention to how interrogations of medicine and medical knowledge’s assumed neutrality constitute a conspicuous theme in literature by African American, Native American, and Latinx writers, thus providing a point of departure for my analyses.

Listing inspirations and influences Biomedicalization and biopolitics My explorations of disparate trajectories of Native writers’ investment in biomedical discourses and practices have demonstrated how these narratives engage a number of contexts and issues that are as diverse as health disparities and ethical dilemmas posed by genome research. To accommodate such a panoply of themes, I have decided to adopt the framework of biomedicalization, as defined by Adele Clarke and colleagues in “Biomedicalization:  Techno­ scientific Transformations of Health, Illness, and U.S. Biomedicine.” The concept of biomedicalization allows one to expand the scope of the analysis, look beyond the popular motif of medicine as a discriminatory institution, and include responses to rapidly emerging phenomena such as genome research, the commodification of human bodies, the rise of biocapital, or “the imbrication of capital with the biological sciences and technologies” (Clarke et al., “Biomedicalization: A Theoretical” 7), the corporate nature of health services and biomedicine’s forceful entry into the field of psychiatry. Moreover, Clarke and colleagues’ arguments draw attention to how processes of biomedicalization, while often giving rise to moral dilemmas, introduce changes in approaches to health and embodiment that produce positive effects. Thus, the concept of biomedicalization is used in Indigenous Bodies, Cells, and Genes as a theoretical and organizational framework to account for the diversity and complexity of biomedical phenomena in Native American literature. In their seminal 2003 essay, “Biomedicalization:  Technoscientific Transformations of Health, Illness, and U.S. Biomedicine,” Adele E. Clarke and colleagues identified an interesting pattern of transformations in the constitution, practices, and organization of medicine spurred by biotechnological innovations. This array of changes and new phenomena, referred to as biomedicalization, is described as “the increasingly complex, multisited, multidirectional processes of medicalization that today are being both

6 Introduction extended and reconstituted through the emergent social forms and practices of a highly and increasingly technoscientific biomedicine” (162). The prefix “bio-​” announces transformations in both human and nonhuman agents facilitated through technoscientific innovations such as molecular biology, biotechnologies, genome research, and medical technologies. According to Clarke and colleagues, biomedicalization is co-​constituted through five central (and overlapping) processes: major political economic shifts; a new focus on health and risk and surveillance biomedicines; the technoscientization of biomedicine; transformations of the production, distribution, and consumption of biomedical knowledges; and transformations of bodies and identities. (166) These processes redirect emphasis from bodies to molecular levels of analysis, a shift that is also announced in the title of this book and which involves reconceptualizing agency, personhood, illness identities, and embodiment. It is not only a new perspective on bodies, tissues, cells, and genes that biomedicalization generates, but also their commodification into bioproducts in a bioeconomy of desired objects of study in the burgeoning research on human genome and DNA sequencing. These concerns about genomic research are particularly relevant to Indigenous people who first of all object to the often illicit practices of obtaining their DNA samples, and, second, fear that the knowledge produced from such projects, rarely negotiated with Indigenous epistemologies, will be used to challenge tribal sovereignties. Drawing on Michel Foucault’s concept of biopolitics and its later reinterpretations, Clarke and colleagues draw attention to how biomedicalization assumes control over production of biomedical knowledge, how this knowledge is in turn disseminated through practices and institutions directly and indirectly related to medical services and biotechnological research, and, finally, how it is continuously challenged and mediated by individual responses to biomedicine’s hold on processes of self-​definition and experiences of health and illness. With such a ubiquitous presence, biomedicalization penetrates everyday practices on individual and institutional levels. “In laboratories, schools, homes, and hospitals today,” the authors write, workers and people as patients and as providers/​health system workers are responding to and negotiating biomedicalization processes, attempting to shape new technoscientific innovations and organizational forms to meet their own needs. … In practice, the forces of biomedicalization are at once furthered, resisted, mediated, and ignored as varying levels of personnel respond to their constraints and make their own pragmatic negotiations within the institutions and in the situations in which

Introduction  7 they must act. … As a result, the larger forces of biomedicalization are shaped, deflected, transformed, and even contradicted. (166) Indeed, as Clarke and colleagues further elaborate in the introduction to their 2010 edited volume on the theory and practices of biomedicalization, Bio­ medicalization: Technoscience, Health, and Illness in the U.S., these changes coalesce around questions about the extent to which biosciences influence contemporary understanding of “what is life,” or using Nikolas Rose’s term, “life itself ” and create new ethical dilemmas (4–​14). Clarke and colleagues’ explorations of biomedicalization draw attention to the continuing relevance of Michael Foucault’s concepts of biopower and biopolitics. When combined with information technologies and manifested as “technogovernance,” biomedicalization and biopolitics may indeed be perceived as mechanisms of control over bodies, their behavior, and physiological processes (“Biomedicalization:  A Theoretical” 24–​7). As the authors affirm, “biopolitics … can be understood as forming an emergent and already dense theoretical web within which biomedicalization and its five key processes make deeper sense” (“Biomedicalization:  A Theoretical” 10), thus transforming it into an indispensable tool for explaining processes related to biomedical discourses and practices. While some critics, for instance la paperson and Eve Tuck (Unangax), object to the use of biopolitics in Indigenous Studies as it is derived from and refers to Western neoliberal contexts,6 there is a growing body of criticism that exemplifies productive uses of Foucault’s concepts for Indigenous cultural productions. One of the first Indigenous interrogations of biopolitics came from Goenpul scholar Aileen Moreton-​Robinson in her essay “Toward a New Research Agenda? Foucault, Whiteness, and Indigenous Sovereignty.” The question of interconnections between biopolitics and Indigenous sovereignty was further developed by Scott Lauria Morgensen in “The Biopolitics of Settler Colonialism:  Right Here, Right Now.” Mark Rifkin in “Indigenizing Agamben:  Rethinking Sovereignty in Light of the ‘Peculiar’ Status of Native Peoples,” offers an insightful analysis of Native tribes’ legal status combining Foucault’s and Giorgio Agamben’s theories. The 2018 special issue of American Indian Culture and Research Journal, edited by René Dietrich, was entirely devoted to the discussion of settler colonial biopolitics in global contexts.7 Finally, Athabascan scholar Dian Million’s Therapeutic Nations: Healing in an Age of Indigenous Human Rights unequivocally establishes biopolitics as part and parcel of analyses of settler colonialism. Million affirms the indispensability of Foucault’s insights as a knowledge that Indigenous scholars need to be familiar with and understand. “Western ‘rational’ governance,” writes Million, has lifted the process of life, minute details, and biological facts and incorporated them into data by which our lives are managed and increasingly understood. These figures, images, knowledges become the proofs

8 Introduction for the social science mob assessments of our assimilation or our ongoing degradation and deterioration within democracy, numbers to track, to manage and define our difference in multiculturalism. (Therapeutic 29) It is precisely the usefulness of biopolitics in discussing the biomedicalization processes from the position of colonized people’s contexts that is demonstrated in this book. While I do not build my analyses solely on the basis of biopolitical theory, I nevertheless draw attention to its strong presence in the discussion of the tuberculosis epidemic among Native Americans at the end of the nineteenth century. Apart from emphasizing the continuing relevance of biopolitical agendas, the framework of biomedicalization illuminates new trajectories of developments in biomedicine. Less than ten years after formulating their first thesis, Clarke and colleagues admit that “biomedicalization theory has traveled widely” (“Biomedicalization: A Theoretical” 24). New insights into biomedicalization trace how it concerns individuals, not only institutions, in negotiating concepts of health and illness, thus mobilizing patients to actively influence treatment processes and legislative frameworks. Moreover, biomedicalization illustrates conceptual changes concerning treatment protocols and theorizes what they entail on an ideological level. For instance, as Clarke and colleagues reveal, … at the turn of the twenty-​ first century, Western biomedicine is attempting to co-​ opt and incorporate many elements of alternative medicines. As understandings of health and healing systems from other cultures have spread, and as people knowing such systems have migrated globally, there have been interesting nomenclature shifts in Western medical fields, from considering “other” people’s health/​life/​healing systems as “superstitions” to “culture-​ based healing systems” to “alternative medicines.” (“Biomedicalization” 179) It is precisely this privileging of culturally centered health and illness paradigms that are at the core of this book. Such examples illustrate how biomedicalization can also be seen as a positive force, delineating “new forms of agency, empowerment, … resistance, responsibility … citizenship, subjectivity, and morality” (“Biomedicalization” 185), thus complicating the image of biomedicine as unequivocally oppressive and drawing attention to the multilayered and multidirectional nature of responses to biomedical discourses. Tracing multiple trajectories in which biomedicalization develops as a theory and practice, Clarke and colleagues draw attention to blank spaces that still require critical attention. While biomedicalization has been analyzed through the lens of gender dynamics, “Little work has explicitly addressed

Introduction  9 race, class, and medicalization theory” (“Biomedicalization:  A Theoretical” 28; emphasis in original). The most common engagements relate to health inequalities and the mechanisms of how certain groups are excluded from medicine, or “undermedicalized” (28). To address the intersections of race and class through the biomedicalization framework, the authors introduce the concept of “stratified medicalization” which: … emphasizes the selectivity and strategic nature of biomedicalization, its unequal (and sometimes unintended) effects across populations, and how these may exacerbate rather than ameliorate social inequalities along many different dimensions. More broadly, we theorize that exclusion, inclusion, and the embeddedness of race, class, gender, and other sites of inequality dwell in the very structures and processes of biomedicalization  –​in the very ways that technoscience is itself inherently social. Thus biomedicalization carries within itself the ideological, social, and cultural infrastructures that support and maintain racial and class inequalities. (“Biomedicalization: A Theoretical” 29; emphasis in original) Indigenous Bodies, Cells, and Genes intends to fill this critical void by analyzing selected manifestations of biomedicalization in the Native American context and from Native American perspectives. This book demonstrates how (stratified) biomedicalization maintains infrastructures of social and class inequality and, more importantly, how it is vigorously challenged by discourses of Indigenous literatures derived from tribal epistemologies. Finally, my analyses of Native American literature through the prism of biomedicalization are informed by the way this theory inspires and fosters interdisciplinary work. As Clarke and colleagues emphasize, their main intention is to “produce and sustain cross-​disciplinary provocations” (“Biomedicalization:  A Theoretical” 42). Since biomedicalization criticism emerges at the intersections of “medical sociology, medical anthropology, medical history, political science, economics and new science, technology, and medicine studies” (42), Indigenous Bodies, Cells, and Genes analyzes literary texts vis-​ à-​ vis interdisciplinary discourses and Indigenous epistemologies to illuminate their myriad points of convergence. In this sense, this book is intended to be a multilayered narrative of biomedicine’s presence in Native American contexts. American Indian Literary Nationalism and Communitism Indigenous perspectives on illness, medicine, and human life inform analyses of responses to biomedicalization and, thus, “privilege Native voices” (Womack 4). This derivation of theoretical tools from Native American experience and tribal knowledges has been known as American Indian Literary Nationalism. It is successfully promoted and eloquently developed

10 Introduction by Robert Warrior (Osage), Craig S.  Womack (Creek-​Cherokee), and Jace Weaver (Cherokee descent) among others, and represented in the works of Elizabeth Cook-​Lynn (Dakota).8 This nationalist approach rests on the idea that since literary texts by Native writers arise out of specific tribal contexts, critical analyses should accordingly be built upon tribally centered concepts. Other methodologies can be found useful in developing an argument; however, it is tribal theories that are of primary importance. Moreover, tribally specific interpretations emphasize national agendas and struggles for the recognition of tribal sovereignties of various American Indian nations. In the words of Weaver, Womack, and Warrior, American Indian Literary Nationalism has two prongs: The first relates to the consideration of Native American literary output as separate and distinct from other national literatures. The second deals with a criticism of that literature that supports not only its distinct identity but also sees itself as attempting to serve the interests of indigenes and their communities, in particular the support of Native nations and their own separate sovereignties (15) As Craig S. Womack asserts in his influential Red on Red: Native American Literary Separatism, literary criticism of American Indian texts “emphasizes Native resistance movements against colonialism, confronts racism, discusses sovereignty and Native nationalism, seeks connections between literature and liberation struggles, and, finally roots literature in land and culture” (11). Thus, this approach sees Native American literary productions as contingent on tribal cultures and communities. As a non-​Native scholar, I  do not claim to possess thorough knowledge of the tribal cultures represented by the works of Native writers analyzed in the following chapters. Nor am I directly connected to Native communities. I do, though, strongly support literary criticism committed “to Native community within the context of knowledge production, and … ethos of social responsibility” (Ch. Teuton 199). Thus, in my analyses, I continually emphasize the ways in which Native literatures “bear some kind of relationship to communities … from which they originate” (Womack 4). My prioritizing of Native literature’s commitment to Indigenous communities is informed by Jace Weaver’s concept of “communitism.” As Weaver explains, the term communitism is formed by a combination of the words “community” and “activism.” Literature is communitist to the extent that it has a proactive commitment to Native community, including … “wider community” of Creation itself. In communities that have too often been fractured and rendered dysfunctional by the effects of more than 500 years of colonialism, to promote communitist values means to participate in the healing of the grief

Introduction  11 and sense of exile felt by Native communities and the pained individuals in them. (That xiii) Recognizing and respecting the centrality of communal values in Native cultures, Indigenous Bodies, Cells, and Genes demonstrates how expanding on the biomedicalization theory by including Indigenous epistemologies and ontologies contributes to communities that are often in need of a deeper understanding and culturally sensitive descriptions of their health problems. This is particularly evident in my discussion of the diabetes epidemic in Indian Country as well as controversies connected to genome research. More recently, Native American Studies has been interested in establishing international connections with the Indigenous world as is manifested by the creation of the Native American and Indigenous Studies Association in 2007.9 The concept of “indigenism” has become synonymous with transnational coalitions of Indigenous people, thus emphasizing the importance of intertribal and pan-​tribal connections. While there exist numerous contexts​ and culture-​related differences among Indigenous groups around the world, Taiaiake Alfred (Kahnawake Mohawk) and Jeff Corntassel (Cherokee) define the category of Indigenous people in the following way:10 The communities, clans, nations and tribes we call Indigenous peoples are just that: Indigenous to the lands they inhabit, in contrast to and in contention with the colonial societies and states that have spread out from Europe and other centres of empire. It is this oppositional, place-​based existence, along with the consciousness of being in struggle against the dispossessing and demeaning fact of colonization by foreign peoples, that fundamentally distinguishes Indigenous peoples from other peoples of the world. (597; emphasis in original) The 2007 United Nations Declaration on the Rights of Indigenous People, the establishment of Indigenous Studies as an academic discipline, and the growing network of international coalitions exemplified by Indigenous support given to the #NoDAPL movement at Standing Rock11 are just some of the examples of how indigeneity has become politically significant. This shift also manifests itself on the level of literary criticism. In her Mapping the Americas:  The Transnational Politics of Contemporary Native Culture, Shari M.  Huhndorf employs the framework of transnationalism, described as “alliances among tribes and social structures and practices that transcend their boundaries, as well as processes on a global scale such as colonialism and capitalism” (2). According to Huhndorf, a move away from a purely nationalist agenda makes “possible a critical analysis of the ways in which colonization has reshaped Native, societies, culture, and modes of resistance, as well as an examination of the challenges that indigeneity poses

12 Introduction to global capitalism, empire, and the colonial nation-​state” (3).12 Indeed, the employment of a transnational framework allows us to trace the mechanisms of settler colonialism across the world and identify patterns of Indigenous resistance. Similarly, this book demonstrates the transnational dimension of biomedicalization in the context of genomic research on Indigenous populations conducted to study human evolution patterns. The mechanisms of objectification of Indigenous research subjects follow the same patterns across the world. Indigenous methodologies and relationality Privileging Native epistemologies in reconsiderations of biomedicalization in Native American literature has also drawn attention to the emerging body of works devoted to Indigenous methodologies in the humanities and Science and Technology studies (STS). Following Ngāti Porou and Ngāti Awa scholar Linda Tuhiwai Smith’s Decolonizing Methodologies: Research and Indigenous People, these new research paradigms emerge out of tribal contexts and see the researcher as well as the researched people and/​ or objects as a part of a larger network of interconnections, thus formulating methodologies that are relational rather than focused on an isolated object of inquiry. These include, for example, Margaret Kovach’s Indigenous Methodologies:  Characteristics, Conversations, and Contexts (Plains Cree and Saulteaux), Bagele Chilisa’s Indigenous Research Methodologies (Botswana), Shawn Wilson’s Research Is Ceremony:  Indigenous Research Methods (Opaskwayak Cree), Gregory Cajete’s Native Science:  Natural Laws of Interdependence (Tewa from Santa Clara Pueblo), Laurelyn Whitt’s Science, Colonialism, and Indigenous Peoples: The Cultural Politics of Law and Knowledge, and more recently, Decolonizing Research:  Indigenous Storywork as Methodology, edited by Jo-​ ann Archibald (Q’um Xiiem), Jenny Bol Jun Lee-​Morgan (Waikato, Ngāti Mahuta Māori), and Jason De Santolo (Garrwa and Barunggam Australian Aboriginal descent). It is precisely the concept of relationality, highly conspicuous in the abovementioned works, which I see as critical in underscoring Indigenous perspectives in the analyses of the biomedicalization processes. Relationality rests at the core of Indigenous ontologies and epistemologies. As Aileen Moreton-​Robinson succinctly explains, Relationality is grounded in a holistic conception of the inter-​connectedness and inter-​substantiation between and among all living things and the earth, which is inhabited by a world of ancestors and creator beings. It informs our epistemological and ethical premise that social research should begin with an awareness of our proper relationships with the world we inhabit, and is conducted with respect, responsibility, generosity, obligation, and reciprocity. (“Relationality” 71)

Introduction  13 Any kind of Indigenous research is thus understood as “social” since “the social is relational, involving the interconnectedness of what people are doing and experiencing as the outcome of actions in the actualities of their lives and lands” (71). Similarly, in Shawn Wilson’s Research Is Ceremony, knowledge is produced in the process of conversations, posing questions, and arriving at answers that are authored by all participants of the discussion. Such a process again underscores the importance of community and ethical bases of knowledge production and exchange (84–​95). As Margaret Kovach elucidates: Relational responsibilities exist between the Indigenous researcher and the Indigenous community; the Indigenous community and the researcher; the Indigenous researcher and the Indigenous academic community; non-​ Indigenous researchers and the Indigenous community; and between the academic community and Indigenous methodologies. Specific responsibilities will depend upon the particular relationship. They may include guidance, direction, and evaluation. They may include conversation, support, and collegiality. Responsibility implies knowledge and action. It seeks to genuinely serve others, and is inseparable from respect and reciprocity. (178) Likewise, Indigenous Bodies, Cells, and Genes embraces the concept of relationality to challenge biomedicine’s insistence on separating patients from their social and cultural contexts. As my analyses demonstrate, Indigenous ontologies and epistemologies emphasize the communal and relational characters of experiences of illness and healing, thus creating a discourse contingent on reciprocity and participation. Indigenous bodies and embodied resistance With its wide application, biomedicalization theory confines attention to human bodies and their myriad transformations and destabilizations generated by the rise of technosciences and subsequent “lifestyle” improvement technologies. Clarke and colleagues draw attention to how biomedicalization processes are taking control of definitions and management of bodily norms to meet the goals of technoscientific projects and profit optimization practices in biomedicine. “This new regime of biomedical governance,” they write, “allows the further stratified customization of medical services, technologies, and pharmaceuticals to ‘manage’ such differences, thus further biomedicalizing them” (“Biomedicalization” 181). With the use of technosciences, biomedicalization is seen as capable of reconfiguring definitions of race, ethnicity, and gender and, hence, of manipulating their ideological content accordingly. This is especially evident in the field of genomic research and population genetics where the category of race is erased on

14 Introduction a linguistic level but remains an important tool of categorizing populations (Reardon, Race 45–​73). My exploration of Native American literary responses to biomedicalization brings to light how Indigenous bodies intervene in biomedicalization discourses, demonstrating how the body carries more than merely biochemical information and is, rather, inscribed with historical and cultural content. Indigenous Bodies, Cells, and Genes traces various complex mechanisms by which Indigenous people produce narratives about colonization and resist its institutions and practices. On the one hand, the Indigenous body becomes a text narrating the aggressions of colonization and subjugation: Tuberculosis-​ ridden bodies of boarding school students, diabetic bodies longing for traditional foodways, or bodies objectified in biomedical research. On the other hand, however, these colonized bodies do not remain passive and subservient. Instead, as Michi Saagiig Nishnaabeg scholar Leanne Betasamosake Simpson asserts, they resist by embodying the politics of decolonization in everyday practices. Members of Indigenous nations, Simpson continues, “live in [their] bodies as Indigenous political orders in every way possible … [and] re-​create Indigenous practices inside [their] homes… ” (191). Thus, the people are capable of enacting political change and drawing attention to alternative ways of knowledge production through embodiment. This is precisely the ability that Tahltan artist Peter Morin emphasizes in his performances: The body is a resonant chamber, a place for the articulation and amplification of many experiences. Colonization has interrupted this resonance. It has interrupted indigenous knowledge production and history. Our indigenous bodies have retained, despite countless years of contact with the colonial project, a strong ability to articulate its connection to indigenous history. (71) This book refers to such powerful acts of embodiment as embodied resistance and demonstrates how it destabilizes biomedicalization processes by constructing the body as relational to kin, community, traditional knowledge systems, and the land as well as dedicated to tribal sovereignty. Indigenous Bodies, Cells, and Genes traces the presence of biomedicalization discourses in Native American literary texts and, by privileging Indigenous perspectives, offers interventions into how biomedicalization is theorized and assessed. The book is thematically divided into four parts, each consisting of two chapters:  “Tuberculosis,” “Diabetes,” “Blood and Genes,” and “Indigenizing Biomedicalization.” Chapter  1 delves into the prebiomedicalization era and the second half of the nineteenth century, when American public health officials and educators launched a crusade against tuberculosis. Around 1900, when the TB mortality rates among the general population had fallen significantly, the crusade was announced a success. It was not, however, true in Indian Country, where American Indians suffered

Introduction  15 disproportionally from the disease and were offered little or no treatment. To explain the staggering mortality rates in Native communities, physicians and scientists adopted racially based theories of Indian susceptibility to the disease. Known as “virgin soil” theory, the hypothesis was used as an ideological tool to prove Indian physical and mental inferiority and, thus, to justify the theft of tribal lands as well as to show a correspondence between (white people’s) resistance to tuberculosis and a higher level of civilizational progress. Since Indians, due to their racial makeup, were doomed to perish, little was done to fight the tuberculosis epidemic on Indian reservations. This racialist discourse is traced in medical publications of the era that identify Native Americans as responsible for their poor health conditions and simultaneously pass over in silence the historical and political factors that contributed to high tuberculosis mortality rates. At the same time, boarding schools for Native American children, established in the second half of the nineteenth century to expedite Indian assimilation into the US society, greatly contributed to the rise in infections. Indeed, Indian boarding schools, overcrowded and with substandard conditions, became instruments of cultural and physical extermination. Chapter  2 applies the framework of Foucauldian biopolitics to analyze the role of boarding schools in the spread of tuberculosis epidemics and, in consequence, the disintegration of Native families in Madonna Swan:  A Lakota Woman’s Story, as told through Mark S. Pierre and Louise Erdrich’s novel LaRose. Both texts depict tuberculosis as a bodily inscription of settler-​colonialism. However, Native characters challenge such instrumental treatment and by devising techniques of corporeal empowerment transform Indigenous bodies into narratives of survivance, as famously defined by Anishinaabeg writer Gerald Vizenor.13 The characters in both texts experience institutionalization in Indian boarding schools and TB sanatoria for Native Americans, and their stories demonstrate how they manage to reintegrate with their communities, despite the violence of acculturation. Irrespective of high tuberculosis mortality rates, the disease is normalized in Native families and communities so that rituals of everyday life, so important in preserving kinship relations, continue and thrive. Chapter  3, opening the “Diabetes” part, concentrates on the high diabetes rates in Native American communities and illuminates the ways in which biomedicine, by suppressing nonmedical contexts, tends to downplay the significance of social and cultural factors in the emergence of health disparities. It is especially evident in the “all genes all the time” approach that is dedicated solely to the “pursuit of high-​tech gene mapping strategies” (Fausto-​Sterling 24). As Biology and Gender Studies Professor Anne Fausto-​Sterling asserts, … so-​ called essential hypertension, the health scourge of African Americans, is in some sense a natural physiological response to the deprivations and stresses of being a person of color in America. In other

16 Introduction words, it is not that different biological processes underlie disease formation in different races, but that different life experience activates physiological processes common to all, but less provoked in some. (26; emphasis in original) Fausto-​Sterling’s claim seems relevant in the context of Native American diabetes as well. In the second half of the twentieth century, with the advent of biotechnologies spurred by the discovery of the DNA structure in 1953, many biomedical theories attempting to identify the source of this epidemic focused on genetic explanations. The most famous example, James Neel’s “thrifty gene hypothesis” located diabetic susceptibility in genes that in precontact times ensured the survival of hunter-​gatherer communities, often suffering from periods of food insufficiency. In the present times of food abundance, these genes “malfunction” and lead to the development of diabetes. Though found erroneous, Neel’s hypothesis dominated the scientific world for many years. More importantly, however, it successfully silenced debates about complex historical and social factors that might significantly influence high diabetes rates in Native American communities. Recent culturally oriented approaches represent diabetes as a phenomenon that preempts biomedical definitions, raise questions about the physical and psychological consequences of ongoing colonialism in the USA, and promote the most effective technologies of treatment drawn from Indigenous views on illness and healing. This explanation of diabetes rates among American Indians includes discussions of the transgenerational trauma caused by off-​reservation boarding schools and a long history of colonization in general. The need to reconfigure discourses about diabetes in Native communities informs my reading of Spokane/​Coeur d’Alene writer Sherman Alexie’s selected poems and short stories and Choctaw writer LeAnne Howe’s Miko Kings:  An Indian Baseball Story in Chapter  4. Alexie and Howe identify a connection between diabetes and historical trauma that, in the recent scholarship by Eduardo and Bonnie Duran and Maria Yellow Horse Brave Heart, is often referred to as intergenerational trauma. Both Alexie’s and Howe’s texts anticipate spaces of resistance to biomedical models of diabetes. In his discussion of diabetes, Alexie makes interesting connections between the illness and food choices, which are often directly linked to class status and informed by a long history of settler colonialism. However, his treatment of diabetes, while important in drawing attention to the diabetes crisis, insists that his characters cannot escape the disease, and hence creates a sense of genetic determinism. On the other hand, Howe’s Miko Kings theorizes diabetes away from a biomedical model, with special emphasis on tribally specific histories and the intergenerational trauma model. Nevertheless, both writers successfully expand the perspective on diabetes etiology and connect diabetes debates to ethical questions about the quality of health care offered to minority patients as well as to the theme of providing care as seen from a perspective of Indigenous philosophies.

Introduction  17 The third part, “Blood and genes,” traces a shift from blood to gene/​DNA imagery to connote familial and cultural connections, and the controversies of genomic research in Native American communities. Chapter  5 offers an analysis of the concept of blood memory, as famously expressed by Kiowa writer N. Scott Momaday, its entanglements with the federal policy of blood quantum and its gradual transition to genetic memory as a vehicle of cultural identity. The proliferation of genetic imagery coincides with the rise of DNA discourses in popular and scientific contexts, and with the growing interest in the study of human population migratory patterns, which rely heavily on genetic samples obtained from Indigenous people. The emergence of “Native American DNA,” brilliantly discussed by Sisseton Wahpeton Oyate Science and Technology scholar Kim TallBear in her Native American DNA: Tribal Belonging and the False Promise of Genetic Science, draws attention to new technologies of objectification of Indigenous bodies, and is a yet another example of Western science’s usurpation of the status of objective knowledge and universal value. Chapter  6 analyzes Chickasaw writer Linda Hogan’s autobiographical writings Dwellings and The Woman Who Watches Over the World in the context of this conceptual shift and TallBear’s insights about the dangers of genetic testing and research. Describing her relationship to her Chickasaw heritage, Hogan frequently employs blood and gene metaphors. While Hogan conflates blood and DNA imagery  –​a discursive act that TallBear warns is potentially misleading –​she successfully creates a concept of Native American identity contingent on Native history that is inherently tied to land –​to sacred geography, which Vine Deloria claims is organically alive –​and transmitted through blood and cells. Such formulations of history and identity account for the fundamental importance of factors such as biological relatedness, connection to land, and a shared experience of historical trauma. The last part, “Indigenizing biomedicalization,” offers suggestions of possible sites of exploration rather than a thorough analysis of a selected biomedical phenomenon. With such a huge array of contexts impacted by biomedicalization (either positively or negatively), the last two chapters are illustrations of how to pursue these questions further. Chapter  7 analyzes Ojibwe poet Heid E.  Erdrich’s work as an example of biotechnological poetry that daringly poses questions about the role of biotechnologies in Native American lives. Erdrich’s uses of biotechnologies and genetic research are indeed captivating as she employs them to expand meanings and definitions of indigeneity. She weaves into her poetry discourses of microchimerism (maternal–​fetal cellular traffic) and demonstrates how they are compatible with her Ojibwe traditions of privileging interconnectedness and constructing relational identities. Thus, Erdrich counters popular stereotypes representing Indigenous people as anti-​(Western)scientific. Moreover, the chapter demonstrates how Erdrich addresses ethical dilemmas posed by biomedicalization, for example, DNA ancestry testing used to authenticate Native American identity, genomic research in Indigenous communities, and

18 Introduction frequent examples of biopiracy. Her poetry directly addresses controversies of the Native American Grave Protection and Repatriation Act of 1990 and the continued mishandling of Indigenous human remains, often by scientists. Erdrich’s engagement of biotechnologies demonstrates Native people’s involvement in contemporary scientific discourses and ensuing debates about ethical conduct and the future of genomic research. Finally, Chapter 8 investigates the effects of biomedicalization of psychiatry and the consequent transformation of a therapy-​centered field into a discipline extensively reliant on pharmacotherapies and standardization of diagnoses. The tensions inherent in construing psychiatry as a part of biomedicine are explored vis-​à-​vis Cowlitz writer Elissa Washuta’s My Body Is a Book of Rules. Diagnosed with bipolar disorder, the narrator of the collected essays attempts to find comfort and order in a biomedical description of her condition. The rigidity and assumed objectivity of scientific language helps her to understand and to cope better with the condition and social stigma associated with a mental illness. However, Washuta feels ambivalent about the reductionism of biopsychiatry and its inability to account for the full spectrum of what constitutes mental and emotional processes. Moreover, Washuta puts to test biomedical metaphors, discussed in earlier chapters, such as “history in DNA,” to see how they relate to her complex Indian/​white heritage. She explores the tensions between her mixed identity, plainly white appearance, and popular expectations about who serves as an example of a “real” Indian. In the process, she finds biomedical metaphors inadequate and problematic, and concludes that her Indian identity is predicated upon an establishment of meaningful relationships with her Indian relatives and her becoming a part of the tribe. Thus, Washuta’s text, though characterized by fluency in biomedical discourse, underscores the significance of communitism and ethics of relationality in the processes of healing. My Body Is a Book of Rules perhaps most poignantly draws attention to the necessity of respecting and including social and cultural factors in devising strategies of the most effective health care in culturally diverse societies. Indigenous Bodies, Cells, and Genes surely does not exhaust the discussion about the rich and fascinating engagements of biomedical and biotechnological discourses in Native American literature. There are many other grave problems such as alcoholism, addiction, and high suicide rates. That they were not included in this book does not mean they are less pressing. On the contrary, I  believe that they deserve book-​length attention since all these biomedicine-​related issues are critically incorporated in debates about Indigenous sovereignties, self-​determination, cultural survival, and decolonization practices. While changes brought about by biomedicalization, the (ab)use of biotechnologies and technosciences often coalesce around themes such as health disparities, structural discrimination, and biocolonialism, I am very much inspired by Native environmental anthropologist Elizabeth Hoover and her lecture delivered at University of California, Berkeley, in March

Introduction  19 2019. Talking about the PCB contamination in the Akwesasne community in New  York State and Canadian Ontario and Quebec, Hoover mentioned the high diabetes rates in the community, which, as recent research has found, can be related to PCBs (Hoover, The River 232–​3). She was careful to caution her audience to remember that behind the grim statistics there are people who are defending their traditional lifestyles and foodways, and see their culture as alive, not in decline. It is, thus, of extreme importance to move away from “damage-​centered research, which focuses on documenting loss in an effort to explain underachievement or failure” (273). Instead, it is worth celebrating survivance, to use Anishinabee writer Gerald Vizenor’s term. Many of the literary texts analyzed in this book fully subscribe to this claim and demonstrate creative and constructive uses of biotechnological knowledge and research.

Note on terminology Following the practice of many Native and non-​ Native scholars, I  use “Native American,” “American Indian,” “Indian,” and “Indigenous” more or less interchangeably. I am aware that “Indian” is a perhaps more contested term. However, there are Native American writers and scholars who embrace it as a term of empowerment and therefore I  have also decided to use it. Whenever I refer to the global context, I use “Indigenous” to draw attention to the possibility of transglobal coalitions formed through various decolonization projects. “Indigenous” is capitalized to make a distinction between the broader dictionary definition of the word and out of respect to peoples for whom it is important to emphasize their political and colonial situations derived from colonization. To show respect to Native writers, cultures, and communities that I write about, I include tribal affiliations.

Notes 1 I address the functions of medical discourse in Almanac of the Dead in Joanna Ziarkowska, “Disease, Disability, and Human Debris:  The Politics of Medical Discourse in Silko’s Almanac,” Howling for Justice:  New Perspectives on Leslie Marmon Silko’s Almanac of the Dead, edited by Rebecca Tillett (Tucson: University of Arizona Press, 2014), pp. 56–​68. See also ­chapter 7 in Ann Folwell Stanford, Bodies in a Broken World: Women Novelists of Color and the Politics of Medicine (Chapel Hill:  University of North Carolina Press, 2003)  and Rebecca Tillett, Otherwise, Revolution! Leslie Marmon Silko’s Almanac of the Dead (New York: Bloomsbury Academic, 2018). 2 See for example, Melissa E. Lewis and Laurelle L. Myhra, “Integrated Care with Indigenous Populations: Considering the Role of Health Care Systems in Health Disparities,” Journal of Health Care for the Poor and Underserved, vol. 29 no.  3, 2018, pp. 1083–​107 and Donald Warne and Denise Lajimodiere, “American Indian Health Disparities:  Psychosocial Influences,” Social & Personality Psychology Compass, vol. 9, no. 10, Oct. 2015, pp. 567–​79.

20 Introduction 3 See Samson Occom, “When he drowned his reason” and “A Sermon, Preached at the Execution of Moses Paul, An Indian (1772),” in The Collected Writings of Samson Occom, Mohegan:  Leadership and Literature in Eighteenth-​Century America, ed. Joanna Brooks (Oxford: Oxford University Press, 2006), Charles Eastman’s “The Medicine Man’s Practice,” Pharmaceutical Era, vol. 52, 1919, pp.  281, and Vine Deloria Jr., The World We Used to Live In: Remembering the Powers of the Medicine Men (Golden: Fulcrum Publishing, 2006). 4 In a legal context, Indian Country is defined as “all land within the limits of any Indian reservation under the jurisdiction of the United States government, notwithstanding the issuance of any patent, and, including rights-​of-​way running through the reservation, (b) all dependent Indian communities within the borders of the United States whether within the original or subsequently acquired territory thereof, and whether within or without the limits of a state, and (c) all Indian allotments, the Indian titles to which have not been extinguished, including rights-​ of-​way running through the same” (qtd. in Nielsen and Jarratt-​Snider 18). I use the term in an expanded sense to include Indigenous urban communities that constitute important centers of Indigenous cultures and activism. 5 While sovereignty is embedded in the US constitution and federal law, it is still vigorously debated. Many Native scholars see it as an open-​ended, evolving, and dynamic process rather than a fixed definition. There are also voices articulating the sentiment that, due to its European origins, it is an inadequate term in Native American contexts. For more see, for example, Taiaiake Alfred, Peace, Power, Righteousness: An Indigenous Manifesto (Don Mills, Ont.: Oxford University Press, 1999), Joanne Barker, Native Acts:  Law, Recognition, and Cultural Authenticity (Durham:  Duke University Press, 2011), Joanne Barker, editor, Sovereignty Matters:  Locations of Contestation and Possibility in Indigenous Struggles for Self-​Determination (Norman: University of Oklahoma Press, 2005), Stephanie Nohelani Teves, Andrea Smith, and Michelle H. Raheja, editors, Native Studies Keywords (Tucson:  University of Arizona Press, 2015), David E. Wilkins, and Tsianina Lomawaima, Uneven Ground: American Indian Sovereignty and Federal Law (Norman:  University of Oklahoma Press, 2001), and Craig S. Womack, Daniel Heath Justice, and Christopher B. Teuton, editors Reasoning Together:  The Native Critics Collective (Norman:  University of Oklahoma Press, 2008). 6 See Eve Tuck, “Breaking up with Deleuze: Desire and Valuing the Irreconcilable,” International Journal of Qualitative Studies in Education (QSE), vol. 23, no.  5, Sept. 2010, pp.  635–​50 and la paperson, A Third University Is Possible (Minneapolis: University of Minnesota Press, 2017). la paperson (K. Wayne Yang) advocates the use of Achille Mbembe’s concept of necropolitics instead. See Achille Mbembe, “Necropolitics,” Public Culture, vol. 15, no. 1, 2003, pp. 11–​40. 7 See Aileen Moreton-​ Robinson, “Toward a New Research Agenda? Foucault, Whiteness, and Indigenous Sovereignty,” Journal of Sociology, vol. 42, no. 4, 2006, pp. 383–​95, Scott Lauria Morgensen’s “The Biopolitics of Settler Colonialism: Right Here, Right Now,” Settler Colonial Studies, vol. 1, no.  1, 2011, pp.  52–​76, Mark Rifkin, “Indigenizing Agamben: Rethinking Sovereignty in Light of the ‘Peculiar’ Status of Native Peoples,” Cultural Critique, no. 73, 2009, pp. 88–​124, and American Indian Culture and Research, vol. 42, no. 2, 2018, entirely devoted to the issue of biopolitics in Indigenous contexts.

Introduction  21 8 See, for example, Elizabeth Cook-​ Lynn, New Indians, Old Wars (Chicago: University of Illinois Press, 2007) and Why I Can’t Read Wallace Stegner and Other Essays (Madison: University of Wisconsin, 1996), Greg Sarris, Keeping Slug Woman Alive: A Holistic Approach to American Indian Texts (Berkeley, CA: University of California Press, 1993), Robert Allen Warrior, Tribal Secrets: Recovering American Indian Intellectual Traditions (Minneapolis: University of Minnesota Press, 1995), Jace Weaver, That the People Might Live: Native American Literatures and Native American Community (New  York:  Oxford University Press, 1997), Jace Weaver, Craig S.  Womack, and Robert Warrior, American Indian Literary Nationalism (Albuquerque:  University of New Mexico Press, 2005), and Craig S.  Womack, Red on Red:  Native American Literary Separatism (Minneapolis:  University of Minnesota Press, 1999). 9 The Native American and Indigenous Studies Association organizes an annual conference which provides an opportunity and a place for Indigenous scholars from around the world to share and exchange ideas. The NAIS publishes an interdisciplinary journal Native American and Indigenous Studies Journal. See //​www. naisa.org/​. 10 For a definition of Indigenous people and a discussion of indigeneity as a global phenomenon, see Ronald Niezen, The Origins of Indigenism: Human Rights and the Politics of Identity (Berkeley, CA: University of California Press, 2003). 11 For more on transnational Indigenous support of #NoDAPL and the Standing Rock reservation’s protest see Nick Estes, Our History Is the Future: Standing Rock versus the Dakota Access Pipeline, and the Long Tradition of Indigenous Resistance (London: Verso, 2019) and Nick Estes and Jaskiran Dhillon, editors, Standing with Standing Rock: Voices from the #NoDAPL Movement (Minneapolis: University of Minnesota Press, 2019). 12 Huhndorf talks about continuities and contradictions between nationalist and transnationalist positions, thus refraining from presenting them as binary pairs (Mapping 2). Similarly, Lisa Brooks (Abenaki) advocates the continuity between transnational and intertribal traditions in Native Northeast (“Digging” 243). 13 Gerald Vizenor defines survivance as “an active sense of presence, the continuance of Native stories … [which] are renunciations of dominance, tragedy, and victimry” (Manifest vii).

Part I

Tuberculosis

1  Virgin soil theory, boarding schools, and medical experimentation A history of tuberculosis among Native Americans

We cannot solve the Indian problem without Indians. We cannot educate their children unless they are kept alive. Cato Sells, Commissioner of Indian Affairs, addressing the Congress of Indian Progress in August 1915

In 1911, an Indian man walked out of the rugged foothills of Mount Lassen in northern California. The man, later to be known as Ishi, the last Yahi, devastated by exhaustion and starvation, was arrested in a butcher’s slaughterhouse near Oroville, California, for attempting to obtain some meat. Not knowing what to do with the “wild man,” the local sheriff contacted the Bureau of Indian Affairs. As Ishi was awaiting his fate in jail, the press published enthusiastic articles about this “Least Civilized Man” and “Last Lost Indian,” giving little attention to the genocide of Indigenous people in California which wiped out the Yahi and other Indian tribes (B. Lindsay 351). As Nancy Scheper-​Hughes points out, “By 1860 American military attacks had taken the lives of 4267 Native Californians, but these were not the worst” (104). The worst were the assaults initiated during the Gold Rush and carried out by the civilian population. In fact, it was the fate of Ishi’s tribe: between 1865 and 1871, 5 massacres by whites killed nearly 200 Yahis (B. Lindsay 355).1 After some deliberations, the Bureau allowed Alfred Kroeber, the first professor of Anthropology Department at University of California, Berkeley, to place Ishi in the Anthropological Museum of the University of California in San Francisco and study him. Once there, Ishi was turned into an exhibit and an object of study. His medical records meticulously log measurements of his body parts and, in a gesture of erasing his agency, his activities are rendered in the passive voice: “Ishi was moved to Berkeley, where he was studied by Dr. E. Sapir” and then “he was returned to the University Hospital in San Francisco” (Pope 198; emphasis added). Throughout his life, he was observed, gawked at, poked at and continuously forced to pose for photographs. As Gerald Vizenor writes, “The spirit of this Native hunter captured almost a century ago has been sustained as cultural property” (“Mister” 363). When in 1915 he was hospitalized for tuberculosis (TB), he

26 Tuberculosis had been already ravaged by the disease, undernourished, and suffered from a painful cough. Yet, physician Saxton Pope, responsible for Ishi’s health, failed to notice his patient’s decline and convinced him to pose for another photograph: I coaxed him to get out of bed and to let me take his picture once more. He was always happy to be photographed, and accommodated me. It was only after the picture was developed that I recognized to what a pitiful condition he had been reduced. (205) In 1915, Ishi was so severely affected by tuberculosis that he was transferred to the university hospital where he died in March 1916. Despite his wishes, his body was autopsied and his brain was removed and sent to the Smithsonian Institution. The story I am about to unfold in this chapter is not about Ishi though. Yet, Ishi’s life serves as a powerful illustration of the tuberculosis epidemic in the late nineteenth century and the first half of the twentieth century in Native American communities. According to (pseudo)scientific theories of the era, he was expected to succumb as Indians, due to their racial makeup, lacked susceptibility to TB. Thus, when social reformers and activists announced the victory in the crusade against germs and tuberculosis at the beginning of the twentieth century, Native Americans were quietly dying of the disease, not included in the discourse of triumphant statistics. This chapter offers a historical overview of the TB epidemic among Native Americans but it is by no means a comprehensive history. Rather, it is meant to provide a context for understanding the social and political mechanism of allowing the epidemic to continue. As Cristobal Silva rightly observes, narratives of epidemics –​who is susceptible to which diseases, who is immune, and why some diseases continue to afflict certain groups –​reveal ideological assumptions structuring social and geographic spaces as well as criteria for national belonging (19–​27).2 Similarly, many scholars have demonstrated3 how tuberculosis expanded beyond medical contexts and in the second half of the nineteenth century acquired different cultural meanings. Indeed, the consumptive myth4 dominated popular imagination and associated the disease with physical attractiveness and intellectual refinement. In the United States, tuberculosis meant different things for white middle-​class and working-​ class Americans, the poor, immigrants, and African Americans. With a better understanding of TB as a bacterial infection along with national informational campaigns, occurrences of tuberculosis began to fall at the beginning of the twentieth century. However, this was not the case for American Indians who suffered disproportionately from the disease. To understand this phenomenon, physicians and scientists devised theories based on racial susceptibility to tuberculosis. This chapter offers a presentation of such views and emphasizes their improbable longevity, even in the face of scientific findings

Virgin soil theory  27 proving otherwise. The racialist foundation of discourse surrounding tuberculosis in Native communities is directly traced in medical publications of the era which portray Indians as not only racially prone to contract tuberculosis but also as responsible for their poor health due to unhygienic conditions on reservations. At the same, the authors of such claims downplay or completely silence historical and political contexts that led to this crisis. The spread of the tuberculosis epidemic coincided with concentrated efforts to assimilate Indigenous population into mainstream American society. Ironically, a system of federal boarding schools created for this purpose greatly contributed to the spiking number of tuberculosis cases. As Rachel E.  Wilbur and colleagues observe, “The harsh environment present in these schools often contributed to poor health and was particularly well suited to the spread of communicable disease” (106). This, combined with a lack of adequate medical facilities, fueled the epidemic. Indeed, with assimilationist agendas surpassing health concerns, Indian boarding schools became instruments of cultural and physical extermination, and constituted an important chapter in a history of tuberculosis among Native Americans.5 The alarming morbidity and mortality rates were, however, easily justified with the conviction that Native Americans are genetically inferior and thus susceptible to the disease. Considering the late nineteenth and early twentieth centuries as the moments of gradual institutionalization of medical knowledge and practices,6 efforts to treat tuberculosis in Native American communities reveal medicine’s entanglements with racially driven and therapeutically dubious research.7 While neglected as TB patients, Indigenous bodies became the center of attention of scientists and medical practitioners in their long journey to find a cure for the disease. A story of controversies surrounding the efficacy of the Bacillus Calmette-​Guérin (BCG) vaccine and attempts to refine thoracoplasty as a surgical therapy for TB illuminate how presumed racial inferiority of Native Americans transformed them into ideal research objects.

TB: biomedical definitions In its long medical and cultural history, tuberculosis, or TB, has accumulated a myriad of designations which shifted and changed as a more thorough understanding of the disease was being gained:  consumption, the wasting disease, phthisis, graveyard cough, the white plague, and the white death. While tubercles characteristic of the disease can develop in different tissues throughout the body (e.g., tuberculosis of the lymph nodes is called tuberculosis lymphadenitis, the bones, osteoarticular tuberculosis, or Potts Disease), it is pulmonary tuberculosis that became the emblematic image of the infection. Tuberculosis is caused by the bacteria Mycobacterium tuberculosis (MTB), which is an oxygen-​seeking organism and, therefore, its growth is most successful in tissues with high oxygen content, for instance, in lungs. MTB is an intracellular pathogen and it infects cells of the immune system. It is also

28 Tuberculosis a slow-​growing organism that develops thick cell walls containing glycolipids and lipids. This unique property renders it almost impenetrable for assault. Moreover, MTB is difficult to grow in a laboratory setting and is resistant to long exposures of acids and alkalis, and more importantly, to antibiotics like penicillin, which successfully fights bacteria by precisely destroying their cell coat. Tuberculosis is contagious and is spread through airborne transmission. When an infected person coughs, sneezes, sighs, or laughs, small respiratory droplets containing MTB are released into the air. It is enough to inhale only a few droplets to become infected. The most common symptoms of pulmonary tuberculosis are well-​documented and include a chronic cough, coughing up sputum and blood, pain in the chest, weakness and fatigue, weight loss, fever, and sweating at night. Untreated or when combined with other serious conditions such as HIV/​AIDS, tuberculosis can lead to death. As many scholars and physicians observe, despite the widespread assumption that TB was eliminated in the twentieth century, the disease has returned with a vengeance, or rather, it has never been gone (L. Adams 123–​4, Bynum 4, Yancey 46–​51, McMillen, Discovering 2).

TB in the United States In the Preface to his acclaimed A Treatise on Pulmonary Consumption published in 1835, James Clark, an expert on the condition and physician-​in-​ ordinary for Queen Victoria, refers to pulmonary consumption as “the most destructive of all human maladies” (viii). “In this country and over the whole temperate region of Europe and America,” he continues, “tuberculosis disease of the lungs causes probably a fifth-​part of the whole mortality; and in some districts, and even in whole countries, the proportion is much larger” (14). Indeed, the year 1800 saw the highest rate of deaths from tuberculosis, which was probably the main cause of death in the USA, with, for instance more than 25  percent of deaths in New  York City between 1810 and 1815 attributed to consumption (Murray 1181). The interest in tracing consumption coincided with the creation of the new republic, in which good health of its citizens confirmed the newly created country’s exceptionalism (Feldberg 83). As Georgina D. Feldberg asserts, “Statistics about disease formed part of [the] efforts to construct a national identity, for healthfulness seemed as fundamental a characteristic of the country as liberty” (12). Moreover, approaches to tuberculosis treatment and prevention, as they emerged in medical and public writings and practices at the beginning of the nineteenth century, demonstrated the professionalization of American medicine, the emulation of middle-​class lifestyle as a national model, and the complex interconnections among tuberculosis, race, and gender discourses.8 For a long time, as demonstrated in numerous medical publications of the era, consumption was believed to be a hereditary disease. S. W. Gold confidently asserted in the pages of the Boston Medical and Surgical Journal in 1835, “That the opinion of hereditary or family predisposition, generally

Virgin soil theory  29 entertained by writers on this subject, is correct, I  have no doubt” (183). The belief was so strong that, even with Robert Koch’s identification of tubercle bacillus in 1882 as responsible for tuberculosis, American physicians remained skeptical as to the significance of this discovery. Rather than hailing Koch’s announcement as a medical breakthrough, they continued to turn for etiology of the disease to gender, race, and environmental factors, drawing on a metaphor of seed and soil. This skepticism was repeated over 40 years later with the introduction of the BCG vaccine. Despite promising research results from Europe and Canada, the medical establishment was reluctant to embrace the new medicine and instead voiced concerns about its safety. As Feldberg explains, both episodes illustrate an insistence on creating uniquely American scientific rigor and American physicians’ determination to “carve out a research style that would mold institutionalized medical science to both national and middle-​class interests” (128). With the omnipresence of infection, medical and public debates concentrated on methods aimed at eradicating tuberculosis from the social body of the nation. Since no miracle cure was available, TB prevention was to be achieved through mass education. As many scholars observe, not coincidently, embedded in the anti-​TB campaign was an ideal of middle-​class behavior and values, here promoted, with the help of the germ theory, as an objective and scientific method of remaining healthy (Abrams 417–​20, Feldberg 81–​124; Tomes, “Epidemic” 629–​31; Tomes, The Gospel 113–​34). Nancy Tomes strongly asserts that anti-​TB campaigns served more than a medical purpose of mass-​education about communicability of the disease. Through effective advertising and marketing methods, they became “a vehicle for pushing a wide range of societal reforms aimed at easing the dislocations of urbanization and industrialization” (Tomes, “Epidemic” 631).9 The intended social change clearly defined the components of the national body vis-​à-​vis the widely defined “other” which did not comply with prescribed regulations of private life. As Feldberg writes, In the campaign … reformer physicians had discovered a way of simultaneously fighting disease and inculcating middle class values. They demonstrated that those who worked steadily, cared for their health, shunned self-​ indulgence, valued self-​ discipline, and took pride in maintaining their independence and self-​sufficiency were less susceptible to tuberculosis than those who did not. (122) Despite a relative decline of TB cases in the white population at the beginning of the twentieth century, the rhetoric of the TB campaign still evoked a situation of immediate national crisis, and, thus justified extreme approaches. Proponents of eugenics quickly identified immigrants as a source of TB and TB predispositions, and called for restrictions on immigration.10 As early as 1893, Lawrence Flick, the founder of Pennsylvania Society for the

30 Tuberculosis Prevention of Tuberculosis,11 in his Practical Measures for the Prevention of Tuberculosis, strongly asserted that “International immigration of persons suffering from tuberculosis should be entirely stopped” (18). In the 1920s, the Eugenics Record Office12 regularly issued memos and bulletins warning against immigrants who imported with them TB and other communicable diseases (Feldberg 106). Immigrant workers were often represented as lacking in proper hygiene and thus posing a threat to national health. Popular images were filled with “ ‘hordes’ of unwashed immigrants with large families [who] sought entrance into the American social body” (Ott 67). Equally stringent language and, consequently, practices were applied to domestic individuals who refused to comply with the new standards of behavior. Indeed, technologies of TB prevention redefined the boundaries of state intervention by introducing mandatory reporting of TB cases and contemplating proposals to incarcerate the infected. To some extent, TB sanatoria performed the function of removing from the social space TB patients who threatened the health of the nation. Sheila Rothman observed, “The stakes were so high as to justify the most exceptional intrusions of state authority into the life of the individual,” allowing officials to know who and where the infected were (188).13 The scope of application of TB discourses, beyond the medical model of diagnosis and treatment, is indeed impressive. TB lent itself to a number of ideologically driven causes and projects, and was used to define national political and social agendas. In the pre-​Civil War time, before Koch announced his discovery, the discussion of susceptibility to consumption served to emphasize differences between the North and the South. Feldberg writes about consumption’s multiple uses: Though Northerners and Southerners agreed that a hot, humid, climate –​ and the habits of life it inspired –​fostered agues, malaria, yellow fever, and a host of other peculiar diseases, Northerners used this evidence to bolster their claims to superiority, while Southerners traditionally employed it in the cause of distinctiveness. (19) In equally passionate discussions about gender roles, the threat of TB was used to stop women’s emancipatory projects and their consequent encroachment into the public sphere. In the 1920s, American physicians strongly chastised women for departing from traditional roles and instead adapting multiple roles of student, employee, mother, and wife, which clearly, in their view, increased the chance of contracting TB (Feldberg 112). S. Adolphus Knopf, an attending physician at the Riverside Hospital and Sanatorium in New York City, identified a link between high mortality rate in women to their “insane desire … [t]‌o attain a boyish appearance” and reject traditional clothing which covered larger areas of the body (qtd. in Feldberg 113). Flappers, with their visibly redefined ideas about female

Virgin soil theory  31 roles and sexuality, were thus portrayed as shirking their duties to the race and exposing themselves willingly to the danger of TB.14 Ironically, at the same time, as an analysis of college health programs reveals, despite the fact that TB was more prevalent among the female college population, the  preventive measures concentrated mostly on male college students as they were “considered more socially valuable than were white females or blacks” (Prescott 770). Nowhere is the ideological use of tuberculosis more prominent than in racial discourses of the nineteenth and early twentieth century. As mentioned earlier, immigrants were quickly identified as the cultural and racial other and their conspicuous presence, especially in urban areas, was portrayed as a threat to public health. The Irish and eastern European Jews were continually accused of being carriers of various diseases as well as the Chinese, whose immigration was sharply limited in 1882 by the passing of the Chinese Exclusion Act. Similarly, discussions on tuberculosis prevalence among African Americans revolved around race and its practices. Since African Americans were conceived to be physiologically different from whites, many physicians believed that consumption in blacks was an entirely different disease. As S. A. Cartwright asserted in the New Orleans Medical and Surgical Journal, The seat of negro consumption is not in the lungs, stomach, liver, or any organ of the body, but in the mind, and its cause is generally mismanagement or bad government on the part of the master, and superstition on the part of the negro. (qtd. in Ott 18–​19) Alternatively, as Jess Wagoner observes, blackness was characterized as an evolutionary disability which made African Americans predisposed to tuberculosis. In a statement from a meeting of the Tennessee State Medical Association, we clearly see this conflation of race, heredity, and tuberculosis discourses:  “It is principally the yellow Negro that shows the enormous death-​rate from tuberculosis today. … [They have] a poor hereditary foundation, one lacking in natural resistant qualities” (510). At the beginning of the twentieth century, these conflicting arguments were enriched by those of the importance of environmental factors. In The Philadelphia Negro, W. E. B. Du Bois identified consumption as the main cause of death in the African ​American population and emphasized the living conditions as an important factor: The strikingly excessive rate [of death] here is that of consumption, which is the most fatal disease for Negros. Bad ventilation, lack of outdoor life for women and children, poor protection against dampness and cold are undoubtedly the chief causes of this excessive death rate. (160)

32 Tuberculosis Yet, despite high prevalence of tuberculosis, black patients were repeatedly segregated and refused to be admitted to hospitals for white patients (Bates 292). For instance, in Newport News, Virginia, black patients were placed in the city jail until 1914 when the black hospital Whittaker Memorial Hospital was constructed (Gamble 12).15 As it will be shown in the next section, the history of tuberculosis among Native Americans is a testament to similar discriminatory protocols. However, while after the Civil War, African Americans constituted a conspicuous urban population in northern cities, their health situation could not entirely be ignored. Conversely, Native Americans, consisting of a large adult population hoarded on poverty-​stricken reservations and children who were forcefully removed to boarding schools, had the highest mortality rates from tuberculosis in the country and were dying forgotten with virtually no medical help.

TB in Indian Country The beginning of the twentieth century saw the peak of TB crusade toward educating the public about the disease as well as inculcating white middle-​ class values. Antispitting legislation, mandatory reporting of the infected by physicians, and the creation of the National Association for the Study and Prevention of Tuberculosis to coordinate the anti-​TB efforts were all part of a scheme to build a nationwide public health program. While it is questionable if it is the campaign alone that produced these positive results, Tomes notes in The Gospel of Germs that indeed “death rates for tuberculosis were declining from the heights of the early nineteenth century” (115).16 At the same time, though, Native Americans were suffering disproportionately from tuberculosis, with death rates highly surpassing those of the white population. In 1913, the estimated rate of tuberculosis among whites was 12.1 percent, while among American Indians it was 35.4  percent (James 144). The unfolding tragedy was not addressed in public debates of the era since the illusory success of the TB crusade, better understanding of the etiology of the disease after Koch’s discovery as well as a wide belief in the efficacy of sanatorium treatment created an image of TB as possible to control. The situation continued well into the first half of the twentieth century: when in 1951 Walsh McDermott, one of the leading American TB researchers and an editor of the American Review of Tuberculosis, learnt about extremely high numbers of untreated tuberculosis cases on the Navajo reservation, he was genuinely shocked. As David S. Jones remarks, “McDermott’s ignorance demonstrates how easily American Indian ill health could be forgotten” (“The Health Care” 760). The same amnesia is detectable in contemporary research on cultural and social meanings of tuberculosis in the USA in the nineteenth and the first half of the twentieth centuries. Race intersecting with tuberculosis discourse is usually illustrated in discussions of East European immigrants and African Americans, with no or little space devoted to Native Americans. While it is understandable that the topic of tuberculosis is wide

Virgin soil theory  33 in scope and no project can do justice to its complexity, the conspicuous erasure of Native Americans is indeed disturbing: Katherine Ott, in her very engaging book Fevered Lives: Tuberculosis in American Culture since 1870, briefly mentions autobiographical story of Madonna Swan from Cheyenne River Sioux Reservation, in which she gives an account of her stay at a TB sanatorium for Native Americans;17 an index in Barbara Bates’s Bargaining for Life: A Social History of Tuberculosis, 1876–​1938 does not even include an entry for Native Americans; and Cynthia Connolly, in Saving Sickly Children:  The Tuberculosis Preventorium in American Life, 1909–​ 1970, laments the situation of Indian children forcefully taken to boarding schools in one paragraph. These examples well illustrate how Native Americans, with TB rates on an increase, did not fit a triumphant narrative of TB containment through education and prevention. Indeed, they inhabited a parallel realm where TB remained a serious problem beyond the space of public health concerns. In the nineteenth century and the early decades of the twentieth century, research on TB among Native Americans was scarce and elementary. Poor record keeping and misdiagnosis were common, further complicating identification of the epidemic (McMillen, Discovering 29). However, an analysis of selected historical sources gives a sense of the severity of the situation. In 1878, Dr. Weirick reported that “consumption and scrofula are the prevailing diseases” at Cheyenne River (qtd. in Jones, Rationalizing 128). In a report titled “Tuberculosis among the North American Indians” from 1923, the authors provide a summary of literature devoted to the topic of incidence of TB on Indian reservations from the late nineteenth century. For instance, Dr. Percy W. Matthews, after 21 years of observations, in a paper delivered in 1886, quotes the consumption rate per 1,000 among reservation Indians in 13 different states: “Nevada, 45; California, 70; Colorado, 107; Nebraska, 150; Montana, 176; Dakota, 200; Oregon, 240; Idaho, 250; Washington, 302; Michigan, 333; Wisconsin, 361; New York, 625” (National Tuberculosis Association, 11). At the turn of the century, Smithsonian anthropologist Aleš Hrdlička, reported about differences in tuberculosis cases among different tribes in Physiological and Medical Observations among the Indians of Southwestern United States and Northern Mexico (Jones, “The Health Care” 755). The first reports from physicians and the Bureau of Indian Affairs (BIA) superintendents about high TB rates on reservations were vague, dispassionate, and characterized by a failure to recognize the scale of the problem. This fact is well illustrated by a comment made by a doctor among the Winnebagoes who observed that the “prevailing disease is tuberculosis, which is slowly, but surely, solving the Indian problem” (qtd. in McMillen, Discovering 19). In the meantime, even though Edward Ayer, in the correspondence to the Board of Indian Commissioners, writes that “The question of tuberculosis and other diseases among them [Native Americans] is very serious and steps should be taken immediately by the Governor to help eradicate them” (7), no comprehensive solutions are considered.

34 Tuberculosis It was not until the publication of The Problem of Indian Administration in 1928, commonly known as the Meriam Report, after its main author, that the scope of the problem became known for the wider public to produce controversies and initiate action. The text is a painful reading in indifference, incompetence, and inadequacy in providing basic medical and social services on Indian reservations. In a chapter devoted to deaths attributed to tuberculosis, we read: With all the known inadequacy of the reports, the Indian Service statistics … show more than seven times as many deaths from tuberculosis in each 1000 of the estimated Indian population as reported in each 1000 of the general population in the death registration area. The Indian tuberculosis death rate is 6.3 as compared with 0.87 for the registration area. The Indian death rate from tuberculosis in Arizona, 15.1, is more than seventeen times as high as the general rate for the country as a whole. (201; emphasis added) In several parts devoted to different areas of administration, the Meriam Report revealed that TB was the main cause of deaths on reservations, and, moreover, it documented extreme, nationwide Indian poverty and malnutrition, all caused by, as the authors emphasized, the US policies toward Native Americans, especially the Dawes Allotment Act of 1887, which effectively led to a dissolution of tribal lifestyles.18 While the Meriam report did reveal the scale of health problems on Indian reservations and the extent to which off-​reservation Indian boarding schools contributed to creation of trachoma19 and TB epidemics, it took another decade for rigorous research and an effective treatment plan to develop. In 1942, a group of TB specialists still complained that “In order to combat a problem through a program of control, the extent of the problem must first be known” (qtd. in McMillen, “The Red Man” 615). Not only was little known about TB on Indian reservations but also little was done to change the situation. BIA had almost no funding, too few reservation doctors and inadequate medical equipment to engage in a serious epidemiological study.20 The only change that occurred since the first reports of Indian TB at the end of the nineteenth century was the fact that the situation was openly lamented in public health discourse. In 1949, the editors of the American Journal of Public Health referred to Native American health as an “Indian massacre” (qtd. in McMillen, “The Red Man” 616).

Explaining TB with race Despite inconsistencies in diagnostic practices and poor record keeping, the incomplete and yet  alarming data concerning high incidence rates of TB among Native Americans did reach American physicians and scientists. When in 1908 in Washington D.C., Aleš Hrdlička presented his findings on

Virgin soil theory  35 Indian tuberculosis at the International Congress on Tuberculosis, his presentation inspired a lot of interest (Jones, Rationalizing 171). What followed were numerous theories explaining this phenomenon. However, it was not until the 1930s that serious epidemiological research began and, therefore, as Christian W. McMillen observes, these first theories were based on “speculation, anecdotal observation, limited clinical research, and the common wisdom of the times” (Discovering 19). Inevitably, the most popular theories revolved around the concept of race, as understood at that time, and utilized three explanatory models: racial susceptibility, virgin soil, and blood quantum. Once TB was identified as the major problem on Indian reservations, the most popular theory that quickly emerged suggested that susceptibility to the disease was an inherent element of Indian bodies. The comment of William Coe, the physician at Yakama, best characterized this methodology. In 1887, Coe noted that Native Americans’ “powers of resisting disease are inferior to any race of whom I have any knowledge” (qtd. in McMillen, Discovering 19). Such views were widely shared by reservation physicians in the 1920s, as they corresponded with a shared belief in the idea of the vanishing Indian so conspicuous in public debates about the fate of Native Americans and widely inseminated in popular culture, with Edward Curtis’s photographs serving as a telling example.21 Indians, as a dying race, were to make room for the expanding American civilization and their high susceptibility to TB was just proving the point (McMillen, Discovering 20). A variation of the racial susceptibility theory that emerged in the late nineteenth century and dominated the early twentieth century thinking about TB among Native Americans employed the metaphor of the virgin soil. In simple language, it posited that Indians, as “primitive” people, had not been previously exposed to TB and were, therefore, the “virgin soil.”22 According to S. Lyle Cummins, the most famous and, as it later became clear, unfaltering proponent of racial susceptibility to TB, The expression “virgin soil” in connexion with tuberculosis is generally used to describe the unprotected state of persons belonging to isolated communities so far cut off from human agglomerations as to have escaped all effective contact with the tubercle bacillus. The marked susceptibility of such persons when exposed to infection is generally admitted, and is quite similar to the susceptibility of wild animals when first domesticated or brought into confinement. (39) Apart from providing a reasonable-​sounding explanation of the epidemiological phenomenon, the theory directly corresponded with racially oriented views on solving the “Indian problem” in the assimilationist era.23 After the required time of exposure to TB, Indian resistance to the disease was expected to “catch up” with civilization, mirroring the process of cultural assimilation exemplified by off-​ reservation boarding school policies (McMillen, “The

36 Tuberculosis Red Man” 621). The virgin soil theory proved so appealing to physicians as well as politicians and administrators responsible for Indian affairs that, when in the late 1920s and 1930s new research on TB provided convincing arguments seriously challenging racial variations in TB prevalence, Cummins and his supporters disputed the new findings. Researchers such as Dr. H. N. Davis working in Moshi in the Kilimanjaro Region in the 1920s, Charles Wilcocks in Tanganyika, John Burrows in Sudan, R. J. Matthews in Zanzibar, and finally B.  A. Dormer in South Africa, all concluded that Indigenous populations were by no means “virgin soil” and must have been in contact with TB for centuries.24 Thus, race was not a factor in discussing TB susceptibility in Indigenous peoples. This new approach gradually gained prominence among American scientists. James Townsend, director of health at the BIA, for instance, posed a question about the correlation between TB and poverty, thus downplaying the importance of race. Another early opponent of the virgin soil theory, Charles Laffer, the physician in the Warm Springs Agency, wrote in 1910 that he no longer believed that “the Indian ‘is more susceptible’ or has ‘less resisting power’ to tuberculosis than the white man. On the contrary, I am convinced that whites, living under similar conditions, would have a higher mortality and morbidity rate” (qtd. in McMillen, “The Red” 632). However, for Cummins and his followers, in McMillen’s words, “race transcended all” (Discovering 44), even sound scientific research. Not only did race refuse to give way to more scientific explanations, but it also expanded its presence in the discussion of TB prevalence in Indigenous communities in the form of blood quantum. Widely applied in Indian administration since the 1887 General Allotment Act, the concept of blood quantum25 helped to strengthen a connection between race and disease, despite its scientifically questionable grounds. To begin with, blood quantum was difficult if not, in many cases, impossible to calculate. The myriad examples of how the BIA officials themselves got lost in navigating the muddy waters of blood quantum calculations only proves the point.26 The identification of “full bloods” and “mixed bloods” was needed by the BIA to determine who was capable of holding private property. Mixed bloods were believed to be more advanced in their journey to assimilation and later, during the Indian New Deal,27 as more progressive and willing to embrace new reforms than “full bloods.” It is highly surprising then, that blood quantum made its successful entry into epidemiological studies. Following the same logic, “full bloods” were seen as more susceptible to TB since they possessed “more” Indian blood which, as we remember, was “virgin soil” for MTB. The only solution to the problem, as physician Z. T. Daniel postulated, was interbreeding with other groups: They will continue to die everywhere they go, of tuberculosis, until the race is so thoroughly crossed by “foreign blood” that it will stamp out the tubercle bacillus, and when that is done the Indian race in its original purity will be no more. (qtd. in Jones, Rationalizing 136)

Virgin soil theory  37 Even more startlingly, there were scholars such as H. J. Warner, working for the BIA and US Public Health Service, as well as Esmond Long, a respected pathologist, who embarked on a task to find a link between the degree of Indian blood and the disease, and who claimed to have found one (McMillen, Discovering 31). Repeating the success of the virgin soil theory, the use of blood quantum in epidemiological research became an expected standard for many years to follow. The application of race in TB studies was also marked by the conflation of racial and cultural categories, which in turn produced claims about Native people’s responsibility for contracting TB. In cases when blood quantum was rejected as a factor, cultural practices took over as determining high incidence rates. O.  M. Chapman, summarizing his conclusions on TB among Indian tribes, wrote In almost every feature of their existence where sanitary matters are involved they are aggressive violators and consequently losers at every point of contact. The excessive mortality is but the sum total of all these influences combined –​is the measure of their transgressions. (qtd. in Jones, Rationalizing 135) As David S. Jones remarks, these attempts to place responsibility for tuberculosis on Native Americans mirror earlier behavioral explanations of Native American deaths from smallpox (135).28 This aggressive strategy of emphasizing unsanitary conditions of life on reservations, while at the same time ignoring the factors that had created them, reveals the foundations of settler-​ colonialism that justifies its operations with white supremacy. Whether with the use of hereditary explanation, virgin soil, or blood quantum, it is always inevitably racialized Indigenous bodies that are responsible for the disease and the conditions that increase its incidence. The cure, according to physicians and social reformers, comes in the form of assimilation through cultural education. Ironically, the educational project of creating off-​reservation boarding schools will become the very source of contagion for otherwise healthy Indigenous students.

“Education for extinction”: TB and boarding schools The title of David Wallace Adams’s thorough study of off-​ reservation boarding schools, Education for Extinction:  American Indians and the Boarding School Experience, 1875–​ 1928,29 aptly summarizes the agenda behind the establishment of an elaborate system of Indian education. Removed from their parents and cultures, Indian children were to be educated, in Captain Richard Henry Pratt’s famous words, “to kill the Indian and save the man” (260) and thus elevated to another, higher level in the civilizational hierarchy. However, Adams’s title communicates a more complex meaning than the ideological project of eradicating Indiannes and

38 Tuberculosis producing compliant Americanized subjects. Considering high TB mortality rates among Native Americans and, as many scholars agree,30 the leading role that boarding schools played in the dissemination of the disease, “extinction,” with its radical connotations, may as well literally stand for physical elimination. While the first attempts of offering education to Indigenous people date back to missionary schools in colonial times,31 it was the second half of the nineteenth century that saw the birth of the idea to separate Indian children from their families and cultures and place them in boarding schools located outside of reservations. Extensive educational programs seemed to be the most reasonable solution to the “Indian problem,” which, contrary to so many predictions, did not disappear with the completion of the colonial conquest. Indeed, in the words of Carl Schurz, Secretary of the Interior in 1877–​1881, Native peoples had “this stern alternative: extermination or civilization” (qtd. in A. Smith, “Boarding” 90). Out of the two choices, the former one seemed more humane and, more importantly, more cost-​efficient. As Andrea Smith writes, Schurz “concluded that it would cost a million dollars to kill an Indian in warfare, whereas it cost only $1,200 to school an Indian child for eight years” (90). Debates about the shape of federal Indian education emphasized the importance of English as well as agricultural and vocational training. Many policy makers voiced a need to abandon already existing day schools for Indian children located near reservations, as they proved inefficient in the grand civilizing project. Edward P. Smith, Commissioner of Indian Affairs, stated in 1873 that it was “well-​nigh impossible to teach Indian children the English language when they spend twenty hours out of the twenty-​four in the wigwam, using only their native tongue” (qtd. in Trafzer et  al., 12). Then, between 1875 and 1878, Lieutenant (later Capitan) Richard Henry Pratt conducted his experiment of “educating” and “civilizing” 72 Cheyenne, Kiowa, Comanche, Arapaho, and Caddo Indian prisoners in Fort Marion, Florida (Adams 36–​51).32 Encouraged by his “success,” Pratt lobbied that military barracks in Carlie be transformed into an Indian boarding school under his supervision. His request was granted and, thus, in 1879 the first off-​reservation boarding school, Carlie Indian School, was established.33 From the moment of its inception, the system of federal boarding schools suffered from insufficient provisions as well as incompetence and notorious nepotism in Indian service. The emerging boarding schools were underfunded, understaffed, overcrowded, and generally unsuitable to serve the growing population of students. Not only did the schools offer appalling living conditions, but also, due to complete disregard for students’ health, became the sources of many contagious diseases. In the first ten years of admitting Native American students at Hampton Institute, “one of every eleven students died (31 of 304) at school and one of every five died … soon after returning home” (DeJong, “Unless” 256). Around 1915

Virgin soil theory  39 three out of ten Indian boarding school students were infected with trachoma, and the Indian tuberculosis incidence rate was four times the non-​Indian rate. The Indian rates of measles, chicken pox, mumps, smallpox, and other contagious diseases were double or triple the national rates. (DeJong, “Unless” 258)34 What quickly become clear from an analysis of decision-​making processes in the Indian service, Native children’s health and well-​being were repeatedly sacrificed in the name of ideological and political agendas, incompetency, emphasis on cost-​efficiency, and complete disregard for Indian lives. For instance, William Jones, Commissioner of Indian Affairs between 1897 and 1904, continuously advocated filling boarding schools to full capacity in order to accelerate the work of assimilation (Child, Boarding 56). As a result, agents recruited children that were too young, too old, and, more importantly, suffering from infectious diseases such as trachoma and tuberculosis, and who inevitably passed their diseases to healthy students. Jones did not include health concerns in his policies as he firmly believed tuberculosis was hereditary and, hence, there was little the Indian Office could do to prevent the disease (J. Keller, Empty 155). Alternatively, Indian service physicians attributed “the tuberculosis epidemic to the prevalence of ‘ignorance and superstition’ over faith in modern medicine” (Child, Boarding 62). This shocking disregard for students’ health supports Andrew Woolford’s claim about applicability of the term “genocide” to boarding school policies: How could schools dedicated to transforming Indigenous children appear so blasé about their deaths? This question deserves more intensive investigation … but one cannot wonder if, at least during certain periods of boarding school history, Indigenous children were not considered fully human prior to their supposed civilization. (238) If students’ health problems were mentioned at all, it was due to the political and social problems boarding schools created for white Americans rather than out of consideration for rising mortality rates. As David DeJong observes, disease-​infected schools were gradually becoming a moral and political problem. On the one hand, students’ mortality rates did not correspond well to America’s civilizing mission of educating Indigenous population. On the other hand, Indigenous parents were more and more unwilling to enroll their children in boarding schools, knowing well how many children died in educational institutions (“Unless” 268). In fact, Native community members were the first to conclude that boarding schools might be the reasons of their children’s declining health (Child, Boarding 64–​6, My Grandfather 140). Another perspective credits that what was at stake from the government’s position was the protection of the increasing non-​Native,

40 Tuberculosis white population as settlers were encroaching on reservation lands (DeJong, “Unless” 268). Despite attempts to ignore health issues, the growing criticism of the Indian Services was becoming more widespread, voiced by reformers, humanitarians, and “friends” of the Indians. As one anonymous reformer wrote: “Of what use is education to an Indian with consumption? An Indian child learns to read and write, contracts trachoma, is sent home and goes blind. How does that education benefit the blind Indian?” (qtd. in DeJong “Unless” 263). A thorough description of living, educational, social, and health conditions was revealed in 1928 with the publication of the Meriam Report, which exhaustively examined the shortcoming of Indian Service administration. As Woolford observes, the report “was remarkable for offering drastic criticisms of Indigenous education at a time when retrogressive views of Indigenous peoples persisted and were dominant in many regions” (81). In chapters devoted to health and education, the authors continuously mention poor conditions of buildings in which schools are located, overcrowding of dormitories (“In a few instances, two children were in a single bed, not because they preferred it to keep warm during the cold nights, but because no room was left to place additional beds” [316]), inadequate bathing facilities, malnutrition (“Generally speaking, however, the children are not given a balanced ration, and in some instances the food supplied is actually insufficient in quantity” [327]), pervasive homesickness, overload of physical work, routinization, military discipline, lack of recreational activities, and complete negation of family life (392–​3). Moreover, the Meriam Report does not shy away from an open criticism of running education on the cheap: Cheapness in education is expensive. Boarding schools that are operated on a per capita cost for all purposes of something over two hundred dollars a year and feed their children from eleven to eighteen cents worth of food a day may fairly be said to be operated below any reasonable standard of health and decency. (348) While the report did not entirely dismiss the idea of the state’s intervention into Indigenous lives, it did emphasize Native agency and values of Native traditions and beliefs. The recommendations presented in the Meriam Report, and those concerning health, will to some degree be implemented in the 1930s, with the appointment of the new Commissioner of Indian Affairs, John Collier.35

“People should not work in dirty dark or dusty places and should keep clean and eat only wholesome and nourishing food”: TB treatment in Indian Country Considering the quality of living conditions in boarding schools as well as the quantity and nutritional value of food offered to Indian students, this piece

Virgin soil theory  41 of advice on how to avoid tuberculosis seems at best unrealistic, if not ridiculous. The quote comes from “An Essay on Tuberculosis,” authored by Bertha Bissonette, a fourth-​grade student at the Oglala Indian Training School. It was published in 1913 in The Oglala Light, a journal run by students. Interestingly, “Manual on Tuberculosis: Its Cause, Prevention, and Treatment,” published three years earlier, provides clues as to the source of knowledge that Bertha disseminates in her essay. “Specially prepared to give to the Indian in the simplest of the facts which he should know in regard to tuberculosis, and to show him in a practical way how to modify his home conditions so as to prevent the spread of the disease” and “intended to be placed in the hands of every Indian pupil in Indian school” (2), the text, authored by Joseph A. Murphy, Medical Supervisor for US Indian Services, provides numerous “useful” comments on TB prevention. Following an instructive photograph of a microspore and a drawing of what tubercle bacillus looks like, readers learn that Cleanliness of the body, of clothing, of the home, of food, and of everything with which we come in contact is an important way of keeping our surroundings free from disease germs. In this way diseases caused by these germs are prevented. Soap and hot water, frequently used, is sufficient to kill or remove many tuberculosis germs which may lodge in our homes or on our clothes or bodies. (8) The booklet is concluded with a series of photographs demonstrating how Indian housing conditions may be improved by transitioning to “civilized” types of houses. Replicating the rhetoric of the national anti-​TB campaign, these informational texts, apart from the educational agenda of TB prevention, perform another important function, namely demonstrating how assimilation into American society through the adoption of Western hygienic standards is a yet another step in the long path to civilization. In documents from the early twentieth century, this juxtaposition of American hygiene and Native disregard for it, one of the most often repeated narratives, was enveloped in utter silence as to the historical and political circumstances that created unhealthy living conditions in the first place. In the proceedings from the annual Lake Mohonk Conference of Friends of the Indian and Other Dependent Peoples, Rev. Frank Hall Wright observes that “The Indian expectorates in and about the tepees. He has no idea of the laws of hygiene, and of course we must expect that deadly disease to spread among them. So sometimes the finest specimens are afflicted” (“Health” 38–​9). During the same conference four years later, Joseph A.  Murphy concedes that “Tuberculosis has long been known as a house disease, and the Indian home of to-​day is the place of infection of the younger generation” (“Health” 42). Evidently, TB prevention programs on reservations and in boarding schools were completely divorced from the social and cultural contexts of the people to whom they were addressed.

42 Tuberculosis If prevention attempts are unrealistic and seriously flawed by racialist thinking, what can be said about actual TB treatment offered to Native people at the beginning of the twentieth century? As David DeJong extensively documents, the Indian service failed miserably in providing Indians with health services, a provision guaranteed in many treaties signed between the US government and tribes.36 Insufficient funding and a reluctance of Congress to accept an increase in Indian health spending created, in the words of one critic, “a deplorable … and disgraceful situation” (“If You” 19–​20).37 In 1888, there were only 4 Indian hospitals, 81 physicians, and no nurses employed in the Indian service. In 1900, there were 5 hospitals and 21 nurses, but the number of physicians decreased to 74. In 1918, when some attempts to improve the situation had been taken, the number of hospitals rose to 87 and the total medical personnel combined was 295. Still, as DeJong demonstrates, it was hardly enough to combat high mortality and morbidity rates in Indian Country (“If You” 12, 19–​43). Again, authors of the Meriam Report chose an apt metaphor to describe the situation: “The Indian medical service has been starved throughout its history and does not offer any opportunity for reductions in a wisely directed general policy of economy” (225; emphasis added). The lack of funding as well as personnel shortages translated into inadequate treatment methods or no treatment at all. Even though the beginning of the twentieth century saw an increase in Indian hospitals, they were used only at 43 percent of their capacity (Meriam 275). The conclusion, however, is not that the Indian Service fully satisfied the need to hospitalize Native patients. On the contrary, the Merriam Report concludes that “scores of Indians are not receiving the hospital attention they need” (276), since hospital buildings are often inadequately situated making it impossible for patients to reach them. Likewise, little was done to take into account cultural contexts which helped explain why many Native people resisted hospitalization (DeJong, “If You” 10). Once an Indigenous patient did reach a hospital, they were seldom cured of ailments that called for hospitalization in the first place. While, in the case of tuberculosis, an effective treatment did not appear until 1943 when streptomycin was isolated (Bynum 193), in American hospitals there were several procedures in use which promised relief from some of the symptoms as well as eliminated tubercle bacillus from the sputum. However, lung collapse therapies such as pneumothorax and thoracoplasty as well as crushing the phrenic nerve, or phrenectomy (Bynum 152–​9), required surgical skills and adequate medical equipment, all absent in Indian hospitals (Meriam 298). As the Meriam Report reveals, “Special hospital equipment, such as X-​ray, clinical laboratory, and special treatment facilities is generally lacking. At the present time no hospital has an X-​ray unit” (282). In such a context, even a correct diagnosis of infections posed a challenge. Apart from hospitalization, the BIA offered treatment in Indian sanatoria as equivalent institutions for whites did not admit Indigenous patients. The first attempt to open an Indian TB sanatorium occurred in 1904 when

Virgin soil theory  43 Commissioner William A. Jones asked Congress for appropriate provisions. His request was not granted. As Brenda Child observes, The sanatorium was an expensive institution compared to the boarding school, which relied so heavily on student labor to keep costs down. Children in the sanatorium schools could not be expected to work, and they would also require doctors, nurses, as well as teachers. (Boarding 63)38 By 1915, the BIA had opened 4 school sanatoria with a capacity of 222, which clearly did not meet the needs (Boarding 63). The mortality rates at these institutions speak volumes about quality and efficacy of the treatment.39 In the East Farm Sanatorium in Phoenix, Arizona, created in 1909, during the first 14 years of its operation, more than 14 percent of tubercular children died (DeJong, “Unless” 266). The Sioux Sanatorium in Rapid City, South Dakota, transformed from a boarding school in 1933 and known among Indians as “Sioux San,” “was a deplorable institution that Indians viewed as the equivalent of death” (Archuleta et al. 39). A TB sanatorium as a total institution as well as an idyllic realm of recuperation has been extensively analyzed.40 Indian sanatoria, however, depart drastically from the reality of Thomas Mann’s Magic Mountain. “No sanatorium in the Indian Service meets the minimum requirements of the American Sanatorium Association,” thus begins a section devoted to TB sanatoria in the Meriam Report. The authors again compile a long list of offences against the health of Indian patients: inadequate buildings; insufficient personnel, often with no training in tuberculosis; relying on patients’ labor; no separation of bed space; and no isolation units (291–​5). It is, therefore, not surprising that around 1950, “when TB rates in the general U.S.  population was at a historic low, and racial explanation [of TB] were in steep decline, TB among Indians was alarmingly high” (McMillen, “The Red Man” 616). Clearly, neither underfunded Indian hospitals nor sanatoria effectively coped with the TB epidemic. However, the high number of Native American patients often provided other opportunities, namely that of experimental medical research.

Experimenting on Indigenous bodies? Thoracoplasty and the BCG vaccine Faced with questionable efficiency of sanatoria treatment, doctors explored the potential of developing surgical techniques of fighting tuberculosis. One such procedure, thoracoplasty, first conducted in Canada in 1912, belonged to the category of collapse therapies that, before the advent of chemotherapy, was widely applied in the tuberculosis treatment. It involves the resection of ribs from the chest wall to permanently collapse tuberculosis cavities. Thoracoplasty began to receive greater attention in the USA at the time of the Great Influenza epidemic of 1917–​18. Medical practitioners responded

44 Tuberculosis with enthusiasm to this new procedure as it was seen as a practical alternative for prolonged (and more often than was admitted, ineffective) sanatorium treatment. The most enthusiastic American proponent of thoracoplasty, John Alexander of the University of Michigan, applied the procedure in a large number of patients and gradually refined his surgical technique (Cook 876). It is difficult to unequivocally assess effectiveness of the procedure. While it does lead to the collapse of the lung and, when followed by drug therapies, often results in elimination of tuberculosis bacteria, the resultant complications are serious and, therefore, nowadays thoracoplasty is not recommended as a choice for treatment for tuberculosis (Copeland 32; Hopkins et  al. 181; Refsum 287–​93). With the growing enthusiasm for surgical solutions to tuberculosis in the 1900s, thoracoplasty emerged as a groundbreaking and necessary treatment. Its effectiveness was unchallenged and its merits widely praised, with Physician Norman Bethune stating that it is “a medal to be pinned on the battle-​scarred veteran after a bloody campaign” (qtd. in Ott 153). However, before physicians devised the least invasive methods of collapsing the lungs, tuberculous bodies, frequently nonwhite and underprivileged economically and socially, provided ample material for experiments. As Maureen Lux demonstrates, experimental thoracoplasty was routinely performed at the Charles Camsell Indian Hospital in Canada, where in 1945 thoracic surgeon Herbert Meltzer was appointed as the main medical superintendent. Between July 1949 and August 1954, Meltzer performed thoracoplasty on 324 patients, most frequently with local anesthesia only. In response to criticism about a lack of concern for his patients, Meltzer replied that, “The argument that patients suffer mental torture under local anesthesia cannot be entertained. Mild hypnosis counteracts mental strain almost completely” (qtd. in Lux 63). However, the trauma of surgery seems to be severe for 16-​year-​old Dave Melting Tallow from Siksika (Blackfoot), who observed the removal of his ribs: They took a saw. I was awake and I could hear the saw. … They got part way and then told me, “Now we are breaking the ribs off.” … When they did that it felt like somebody hit you inside the chest. And they did that three times. When they broke it off that’s when it hurt. Felt like somebody hit me with a fist inside my chest. (qtd. in Lux 64) While Katherine Ott claims that thoracoplasty’s moment of fame was rather brief and ended with the advent of chemotherapy in the 1940s (153), it was not the case for many Native American patients even as late as in the 1950s.41 The next step of Indian administration to approach the TB epidemic was an experiment with the BCG vaccine. As the Meriam Report revealed, in the first decade of the twentieth century, tuberculosis combined with extreme poverty and malnutrition decimated Native population. A  substantial change in the BIA approach to the TB

Virgin soil theory  45 epidemic came in 1933 with the appointment of John Collier as Commissioner of Indian Affairs and the introduction of Indian New Deal. In his efforts to control the disease, Collier issued an invitation to the scientific community and in 1934, James Townsend, the BIA’s director of health, appointed Dr. Joseph Aronson, a leading tuberculosis specialist from the Phipps Institute at the University of Pennsylvania, as chief medical researcher in the Indian Service. Assisted by Dr. Esmond Long, a trained pathologist, Aronson was to evaluate treatment methods for tuberculosis (DeJong, “If You” 99). To correctly assess the scale of the problem, new diagnostic and surveillance methods were employed: home visits, examining families with multiple TB cases, identifying “spreaders,” designing spot maps, and extensively using X-​ray technologies. Having undertaken, in Townsend’s words, “the most important studies in the control of tuberculosis that has ever been conducted in this country” (qtd. in McMillen, Discovering 74), the scientists and administrators unanimously agreed that a serious intervention is needed. At that time, the BCG vaccine loomed as a promise of an effective solution.42 Bacillus Calmette-​ Guérin, named for the two French biologists who developed the vaccine in 1908, or BCG, is an attenuated derivative of the tubercle bacillus and the only vaccine available so far in TB prophylactic. As Christian McMillen calculates, Since it first began to be used in France in the 1920s an estimated 4.5 billion people have received it. Millions still receive it today. … The geographical reach of the vaccine is impressive; no other of the populated world has been spared. (Discovering 74) And yet, despite its massive application, there is no scientific consensus as to its value and efficacy. Trials conducted on the vaccine produced results from 0 to 80  percent efficacy (McMillen, Discovering 75). Nevertheless, many countries such as French-​ speaking Quebec in Canada, Germany, many Scandinavian countries, Austria, Greece, Hungary, Poland, and Italy (Bynum 177–​8) enthusiastically embraced BCG, thus giving voice to the world’s desperate hope to find a successful method to control the spread of TB (McMillen, Discovering 74–​5). The existence of the opposing camp, the skeptics, that includes the USA, affords a glimpse into the complex politics of production of medical knowledge and its authentication. In the USA, reactions to BCG vaccine repeated the logic of skepticism to Koch’s discovery from 1882.43 Likewise, American scientists and physicians insisted on testing the vaccine themselves and according to their own scientific standards. This emphasis on producing their own methodologies and verification methods reveals a competitive relationship with their French counterparts as well as a need to design a uniquely American research style (Feldberg 128).44 Moreover, despite critiques of French research methodologies, American physicians fervently voiced concerns about safety of the

46 Tuberculosis vaccine. The infamous Lübeck Tragedy served as a powerful argument. Between 1927 and 1929, 250 infants received BCG in Lübeck, Germany. Initially, children suffered no side effects, but then, in the summer of 1929, they began to develop active tuberculosis. Within 1 year, 71 of the vaccinated group had died. As it was later revealed, in this particular case, a contaminated strain of the vaccine was used, an accident that was never again repeated. However, the tragedy was extensively used by BCG opponents who continuously resurrected the Lübeck story to support their anti-​vaccine claims (Feldberg 145–​52). To put an end to speculation and sensationalism, a reliable appraisal of BCG conducted by American scientists was needed. The appallingly high rates of TB on Indian reservations created a context for testing the efficacy of BCG. As McMillen puts it, “Desperation brought BCG to Indian country” (Discovering 77).45 The idea of vaccinating Native infants was first introduced to M. C. Guthrie, then director of health for the BIA, who in turn arose interest of Kendall Emerson, director of the National Tuberculosis Association. With the appointment of the new director of health, James Townsend, who enthusiastically embraced the project, preparations for the experiment began. In 1935, Aronson spent a month traveling in the American Southwest to choose appropriate reservations and populations. Since around 70 percent of Indians reacted positively to tuberculin tests,46 it was agreed that BCG will not help those already suffering from the disease but may significantly reduce the rate of new cases. Again, questions about safety were invoked (the Lübeck Tragedy) as well ethical dimensions of running an experimental trial on Native Americans (McMillen, Discovering,  76–​9). The search for ideal communities identified the following communities:  Pima, Shoshone, Arapaho, Chippewa, Sioux, Tlingit, Haida, and Tsimshian, from the diverse geographic regions of Arizona, Wyoming, North and South Dakota, and Alaska. By the spring of 1938, exactly 1,559 children had been vaccinated and 1,460 had been selected as a control group (McMillen, Discovering 80). In 1946, Aronson published his results and concluded that BCG had worked. DeJong summarizes, “four of the 1,565 vaccinated children had died of tuberculosis versus twenty-​eight of the 1,460 children in the control group” (“If You” 99).47 However, Aronson’s conclusions were not accepted without criticism.48 Among the myriad of criticisms leveled at Aronson and his team, the most common and persistent one considered the exclusion of social and economic factors in his research and the question to what extent the falling mortality rates that he observed could be attributed to the improvement of living conditions. What the trial did achieve, though, was the reaffirmation of the belief that “tuberculosis could not be understood in simply bacterial or physiological terms” (Feldberg 172). Nevertheless, despite controversies, Aronson recommended the widespread use of BCG, a protocol that was never adopted in neither Indian reservations nor the entire USA.49 As mentioned earlier, ethical concerns were part of the discussion about BCG trials in Indian Country. Researchers were aware that their attempts might be seen as an opportunity to abuse Native American people’s situation.

Virgin soil theory  47 Strong criticism came from Oliver La Farge, director of the American Indian Defense Association, who rightly pointed out that “The Indians, an underprivileged people, complicated by malnutrition, abysmal sanitary conditions, having a staggering death rate, are absolutely not proper subjects for experimentation of this type” (qtd. in McMillen, Discovering 77; emphasis in original). A failed trachoma control experiment on the Navajo reservation, as a result of which many Native patients had been permanently blinded, still lingered on the horizon.50 However, the language of discussion revealed the researchers’ sense of racial superiority and a tendency to reduce Indigenous bodies to objects of scientific study. The question of consent, for example, which would normally be sought, was initially rejected by Esmond Long, who claimed “our clients would not understand our explanations and it would only arouse suspicions” (qtd. in McMillen, Discovering 77).51 Hence, it seems understandable why in Decolonizing Methodologies, Linda Tuhiwai Smith famously stated that the word “ ‘research’ is probably one of the dirtiest words in the indigenous world’s vocabulary” (1). Such concerns did not lose their relevance even many years after the initial BCG trail. In 1993, Naomi Aronson, the granddaughter of Joseph Aronson, published a 56-​year follow-​up research study aimed to determine the long-​term efficacy of the 1935 BCG vaccine. The collection of original data and medical reports drew attention of Native communities in Southeast Alaska and inspired a critical analysis of the original as well as the follow-​up study from an ethical perspective. As Tlingit/​Haida/​Tsimshian scholar Eleanor Louise Hadden demonstrates, in neither of the studies the consent of the research subjects was sought. In personal interviews concerning the 1935 study, many interviewees expressed surprise as to the project’s purpose. One person stated that they “just got shots, but didn’t know what they were for”; similarly, the parents of one participant also expressed their confusion: “Neither I nor my husband ever gave our consent to this ‘experiment’ nor did we even know this was done at the time it was done to our daughters” (70). The consent form from the follow-​up study did not offer an explanation or a rationale of the study either. Rather, it informed participants that since they had participated in the original study, now their medical records might be reviewed again. Moreover, it stated that they “voluntarily participated in this study for at least 20 years and society has already benefited from your past participation and will gain additional benefit from the information you provide now” (qtd. in Hadden 69).52 In reference to the original study, Hadden also questions the therapeutic value of the experiment. While indeed TB mortality rates fell, the results were inconclusive, and Native people still disproportionately suffered from tuberculosis. Joseph Aronson believed in the vaccine’s efficacy but no BCG policies were ever implemented.53 Hadden, thus, posed an important question: If the hope is that research subjects will benefit from the results, how did Native communities benefit from both studies? (71). Sadly, the follow-​up study, ironically led by Aronson’s granddaughter, demonstrated that, despite developing ethical protocols, little had been changed in the way Native people were objectified in medical research.

48 Tuberculosis

TB in the twenty-​first century There is no closure to this story as tuberculosis has never been completely eradicated. According to the World Health Organization’s report from 2017, 10 million people fell ill with TB, and 1.6 million died from the disease (“Tuberculosis”). As Paul Farmer succinctly puts it, “ ‘forgotten plague’ [as TB was referred to at the end of the twentieth century] was forgotten in large part because it ceased to bother the wealthy” (185). When, in 1910, physician John N.  Alley, working on the Nez Perce reservation, completed his annual report for North Idaho Indian Agency Superintendent Oscar H. Lipps, he wrote “At least seventy-​five percent of the Nez Perce Indians have tuberculosis in some form … [and] hardly a family … is free from the disease” (qtd. in James 144–​5). At the beginning of the twentieth century, with TB rates in white population significantly falling, such reports from Indian reservations were disturbing and common. Almost a century later, the tuberculosis crisis, while less acute, was by no means resolved. Native Americans and Alaskan Natives experienced the lowest decrease in TB cases, and the incidence rate for this group is still significantly higher than for white Americans, aptly illustrating existing health disparities (Schneider 878). However, after almost a century of racialized theories explaining the problem of tuberculosis in Indigenous communities, it has become clear that the disease is strongly connected with social and historical factors. In Canada, in 2008, the Assembly of First Nations, Inuit Tapiriit Kanatami, and international tuberculosis experts met to discuss a strategy for “reducing the burden of TB among Indigenous people globally” and more efficient monitoring of TB cases in these groups to better understand an interplay of conditions that creates high incidence rates (Bloss et al. 678). More importantly, social and economic realities were acknowledged as contributing factors, illustrating a need for a paradigm shift. Tuberculosis cannot be viewed solely in a biomedical context. The story of tuberculosis is inextricably a story of social and economic realities.

Notes 1 On the genocide of California Indians, see Brendan C.  Lindsay, Murder State: California’s Native American Genocide, 1846–​ 1873 (Lincoln:  University of Nebraska Press, 2012). For more on Ishi’s story, see David R. Collins and Kristen Bergren, Ishi: The Last of His People (Greensboro, NC: Morgan Reynolds, 2000); Karl Kroeber and Clifton B.  Kroeber, editors, Ishi in Three Centuries (Lincoln: University of Nebraska Press, 2003); Theodora Kroeber, Ishi in Two Worlds: A Biography of the Last Wild Indian in North America (Berkeley, CA: University of California Press, 2004); Orin Starn, Ishi’s Brain: In Search of America’s Last “Wild” Indian (New York: Norton, 2004). 2 In Miraculous Plagues, Cristobal Silva also draws attention to how his reading of epidemiology as a narrative enters a dialogue with Priscilla Wald’s concept of imagined immunities. 3 See David S.  Barnes, The Making of a Social Disease:  Tuberculosis in Nineteenth-​Century France (Berkeley, CA:  University of California Press, 1995); Barry R.  Bloom, editor, Tuberculosis:  Pathogenesis, Protection, and

Virgin soil theory  49









Control (Washington, D.C.:  American Society for Microbiology, 1994); Helen Bynum, Spitting Blood: The History of Tuberculosis (Oxford: Oxford University Press, 2012); Thomas M.  Daniel, Captain of Death:  The Story of Tuberculosis (Rochester:  University of Rochester Press, 1997); Thomas Dormandy, The White Death: A History of Tuberculosis (New York: New York University Press, 2000); Georgina D. Feldberg, Disease and Class: Tuberculosis and the Shaping of Modern North American Society (New Brunswick, NJ: Rutgers University Press, 1995); Diane Price Herndl, Invalid Women: Figuring Feminine Illness in American Fiction and Culture, 1840–​ 1940 (Chapel Hill:  University of North Carolina Press, 1993); R. Y. Keers, Pulmonary Tuberculosis: A Journey Down the Centuries (London: Baillière Tindall, 1978); Clark Lawlor, Consumption and Literature: The Making of the Romantic Disease (Basingstoke:  Palgrave MacMillan, 2006); Christian W.  McMillen, Discovering Tuberculosis:  A Global History, 1900 to the Present (New Haven:  Yale University Press, 2015); Katherine Ott, Fevered Lives:  Tuberculosis in American Culture since 1870 (Cambridge, MA:  Harvard University Press, 1996); Barbara Gutmann Rosenkrantz, editor, From Consumption to Tuberculosis: A Documentary History (New York: Garland Publishing, 1994); Susan Sontag, Illness as Metaphor (New York: Farrar, Straus and Giroux, 1977); Michael E. Teller, The Tuberculosis Movement: A Public Health Campaign in the Progressive Era (New  York:  Greenwood Press, 1988); Athena Vrettos, Somatic Fictions: Imagining Illness in Victorian Culture (Stanford, CA: Stanford University Press, 1995); and Diane Yancey, Tuberculosis (Minneapolis: Twenty-​First Century Medical Library, 2008). 4 Before the discovery of Mycobacterium tuberculosis by Robert Koch in 1882, tuberculosis (TB) was referred to as consumption, thus alluding to how the illness gradually consumed the body. Koch’s discovery changed the understanding of the disease. 5 The same claim can be made about residential schools in Canada. See Jean Barman, and Jan Hare, Good Intentions Gone Awry:  Emma Crosby and the Methodist Mission on the Northwest Coast (Vancouver: University of British Columbia Press, 2007); Constance Deiter, From Our Mothers’ Arms: The Intergenerational Impact of Residential Schools in Saskatchewan (Toronto: United Church Publishing House, 1999); Andrew Woolfred, This Benevolent Experiment (Lincoln:  University of Nebraska Press, 2015). 6 See Adele E. Clarke et al., “Charting (Bio)Medicine and (Bio)Medicalization in the United States, 1890-​Present,” Biomedicalization:  Technoscience, Health, and Illness in the U.S., edited by Adele E.  Clarke (Durham, NC:  Duke University Press, 2010), pp. 90–​103. 7 On ethically ambiguous medical research on human subjects see c­hapter  2 in Terri Kapsalis, Public Privates:  Performing Gynecology from Both Ends of the Speculum (Durham, NC: Duke University Press, 1997); Paul A.  Lombardo and Gregory M Dorr, “Eugenics, Medical Education, and the Public Health Service:  Another Perspective on the Tuskegee Syphilis Experiment,” Bulletin of the History of Medicine, vol. 80, no.  2, 2006, pp.  291–​316; Susan M.  Reverby, ed. Examining Tuskegee:  The Infamous Syphilis Study and Its Legacy (Chapel Hill:  The University of North Carolina Press, 2013); Todd Tucker, The Great Starvation Experiment:  Ancel Keys and the Men Who Starved for Science (Minneapolis: University of Minnesota Press, 2007); and Harriet A. Washington, Medical Apartheid:  The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York: Doubleday, 2006).

50 Tuberculosis 8 These themes are thoroughly explored in Georgina D.  Feldberg, Disease and Class:  Tuberculosis and the Shaping of Modern North American Society (New Brunswick: Rutgers University Press, 1995). 9 Drawing on the germ theory and Koch’s discovery, the anti-​TB campaign intensely concentrated on spitting as a habit to be eradicated, even it entailed the introduction of appropriate legislation. For more on anti-​TB campaigns, see Jeanne E. Abrams, “ ‘Spitting Is Dangerous, Indecent, and Against the Law!’: Legislating Health Behavior during the American Tuberculosis Crusade,” Journal of the History of Medicine and Allied Sciences, vol. 68, no. 3, July 2013, pp. 416–​50 and ­chapter 5 in Nancy Tomes’s The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge: Harvard University Press, 1998). 10 For more on eugenics in American culture and literature, see Ewa Barbara Luczak’s excellent Breeding and Eugenics in the American Literary Imagination:  Heredity Rules in the Twentieth Century (New York: Palgrave Macmillan, 2015). 11 For more on Lawrence Flick and his work see Barbara Bates, Bargaining for Life:  A Social History of Tuberculosis, 1876–​1938 (Philadelphia:  University of Pennsylvania Press, 2015). 12 Eugenics Record Office, located in Cold Spring Harbor, New York, was a research institute dedicated to collecting and processing biological and social information about the American population. For more information see http://​library.cshl.edu/​ special-​collections/​eugenics. 13 The problem of the acceptable extent of the state’s intervention into individual freedoms remains a relevant one in the context of TB treatment. When in the 1980s, the USA and New York City in particular witnessed an alarming increase in tuberculosis rates, legal and ethical questions about detention of infectious individuals as well as the use of DOT (Directly Observed Therapy) with noncompliant patients returned as especially relevant in creating effective public health protocols. For more, see Richard Coker, From Chaos to Coercion: Detention and the Control of Tuberculosis (New York: St. Martin’s Press, 2000). 14 For more on American physicians’ attempts to rhetorically intervene in female emancipation, see Feldberg 112–​18. 15 On the history of the Black Hospitals movement, see Vanessa Northington Gamble, Making a Place for Ourselves: The Black Hospital Movement, 1920–​1945 (New York: Oxford University Press, 1995). 16 Scientists argue that the reasons for this decline are not necessarily attributed to the campaign’s efforts. Ironically, the anti-​TB campaign was at its peak when the death rates had already fallen for white population (Tomes, The Gospel 115; Tomes, “Epidemic” 629–​38; Feldberg, Disease and Class). 17 Madonna Swan:  A Lakota Woman’s Story by Mark St. Pierre is thoroughly analyzed in Chapter 2. 18 The Dawes Allotment Act is discussed in detail in Chapter 4. 19 Trachoma is a bacterial infection caused by Chlamydia trachomatis (Ct). Infection with Ct results in follicular and papillary inflammation. Repeated incidents of infection and inflammation can lead to scarring and may eventually cause eye lashes to turn inward and abrade the globe of the eye. Abrasion from eye lashes can cause opacification of the cornea. Untreated trachoma may lead to blindness (Handley et al. 2). 20 The obligation to provide health services to Indian nations is found in many treaties signed with the US government. David DeJong writes that “Of 389 ratified

Virgin soil theory  51 treaties, 31 (12%) contain provisions specifically related to Indian health care: 28 providing for a physician and 9 providing for a hospital” (“If You Knew” 5). As DeJong documents, usually, appropriations for these purposes were increased only when the lack of proper health care on Indian reservations was revealed to the public. The Indian Health Service, which provides free health services to tribal citizens, was established in 1955. More on the development of Indian Health Service see David H.  DeJong, Plagues, Politics, and Policy:  A Chronicle of the Indian Health Service, 1955–​2008 (Lanham: Lexington Books, 2011). 21 See Mick Gidley, Edward S.  Curtis and the North American Indian, Incorporated (New  York:  Cambridge University Press, 1998); Christopher M.  Lyman, The Vanishing Race and Other Illusions:  Photographs of Indians by Edward S.  Curtis (New  York:  Pantheon Books, 1982); and Shamoon Zamir, “Native Agency and the Making of The North American Indian: Alexander B. Upshaw and Edward S. Curtis,” The American Indian Quarterly, vol. 31 no. 4, 2007, pp. 613–​53. 22 For a long time, it was believed that TB was introduced to North America from Europe. However, this view was seriously challenged with the discovery of skeletal remains with deformities characteristic for tuberculosis in a Peruvian mummy as well as remains found in the Huron territory in southern Ontario. Since then, it is believed that TB pathogens had been present in precontact Americas (Young 57–​9; Ramenofsky et  al. 242–​3). See also Jones, Rationalizing  126–​8. 23 The assimilation period in American Indian history is broadly defined as beginning in 1879 with the opening of Carlisle Indian Industrial School and ending around 1934 when the Wheeler-​Howard Act, or the Indian Reorganization Act was passed. 24 For more on research challenging the virgin soil theory and on the decline of racial explanation, see McMillen, Discovering Tuberculosis,  37–​56. 25 Blood quantum is discussed in detail in Chapter 5. 26 For instance, when hired by the BIA to lead a TB unit, Joseph Aronson inquired how to calculate blood quantum for his epidemiological data. In a response that he received, he was instructed to calculate down to the 16s when necessary but the correspondence never included the instructions how to do this (McMillen, Discovering,  32–​3). 27 Indian New Deal is associated with the Indian Reorganization Act of 1934 initiated by the Commissioner of Indian Affairs, John Collier. Its goal was to reverse the effects of forced assimilation and encourage and support tribal self-​organization. 28 For more details, see Chapters 3 and 4 in Jones’s Rationalizing Epidemics. 29 See David Wallace Adams, Education for Extinction: American Indians and the Boarding School Experience, 1875–​1928 (Lawrence: University Press of Kansas, 1995); Margaret L.  Archuleta, Brenda J.  Child, and Tsianina Lomawaima, editors, Away From Home: American Indian Boarding School Experiences, 1879–​ 2000 (Phoenix:  The Heard Museum, 2000); Brenda J.  Child, Boarding School Seasons: American Indian Families, 1900–​1940 (Lincoln: University of Nebraska Press, 1998); Clifford E.  Trafzer, Jean A.  Keller, and Lorene Sisquoc, editors, Boarding School Blues:  Revisiting American Indian Educational Experiences (Lincoln:  University of Nebraska Press, 2006); and Andrew Woolford, This Benevolent Experiment:  Indigenous Boarding Schools, Genocide, and Redress in Canada and the United States (Lincoln: University of Nebraska Press, 2015).

52 Tuberculosis 30 See David H. DeJong, “Unless They Are Kept Alive: Federal Indian Schools and Student Health, 1878–​1918,” The American Indian Quarterly, vol. 31, no. 2, Spring 2007, pp. 256–​82; and K. Tsianina Lomawaima, They Called It Prairie Light: The Story of Chilocco Indian School (Lincoln: University of Nebraska Press, 1994). 31 For more, see the introductory chapter in Clifford E.  Trafzer, Jean A.  Keller, and Lorene Sisquoc, editors, Boarding School Blues: Revisiting American Indian Educational Experiences (Lincoln:  University of Nebraska Press, 2006)  and Margaret Connell Szasz, Indian Education in the American Colonies, 1607–​1783 (Albuquerque: University of New Mexico Press, 1988). 32 Following the Red River wars in Oklahoma and Texas in 1875, the most sought Indian chiefs were captured and imprisoned at Fort Sill, Oklahoma. The President’s Attorney General stated that it was illegal to try them under a military commission as the state could not declare war on its own wards. Therefore, the prisoners were sent to Fort Marion, Florida, for permanent imprisonment. There, Captain Pratt began his “experiment” with educating and civilizing “his” prisoners, who were later released by the War Department and sent to Hampton Institute (D. Lindsey 27–​33). For the Fort Marion experience from an Indigenous perspective, see Diane Glancy, Fort Marion Prisoners and the Trauma of Native Education (Lincoln: University of Nebraska Press, 2014). 33 Since then, the number of boarding schools rose significantly. As Adams demonstrates, in 1880, there were already 60 boarding schools; in 1885, 114; in 1890, 140 and 1895 saw the largest number of off-​reservation boarding schools, 157 (58). 34 TB analyses for individual schools consistently show higher mortality and morbidity rates than in general population. See e.g., Rachel Wilbur et al. for a case study of Haskell Institute. 35 For more on Collier’s administration, see L. C. Kelly, The Assault on Assimilation: John Collier and the Origins of Indian Policy Reform (Albuquerque: University of New Mexico Press, 1963); and Kenneth R. Philip, John Collier’s Crusade for Indian Reform, 1920–​1954 (Tucson: University of Arizona Press, 1977). 36 On treaty provisions related to health care, see David H. DeJong, “If You Knew the Conditions”  5–​6. 37 As David Jones observes, despite its slowly growing budget at the turn of the century, the BIA did not significantly increase its spending on health services. A  disproportionate amount of the BIA budget was spent on education (Rationalizing 161). 38 As the Meriam Report later revealed, children in sanatoria were forced to work (298). 39 As Robert Trennert observes, to improve statistics, the common practice in Indian Sanatoria was to admit only mild cases and send home patients with advanced tuberculosis (71). 40 See Stacie Burke, Building Resistance:  Children, Tuberculosis, and the Toronto Sanatorium (Montreal: McGill-​Queen’s University Press, 2018); Flurin Condrau, “Beyond the Total Institution:  Towards a Reinterpretation of the Tuberculosis Sanatorium,” Tuberculosis Then and Now:  Current Issues in the History of an Infectious Disease, edited by Flurin Condrau and Michael Worboys (Montreal: McGill-​Queen’s University Press, 2010) pp. 72–​99; Flurin Condrau, “ ‘Who Is the Captain of All These Men of Death?’:  The Social Structure of a Tuberculosis

Virgin soil theory  53 Sanatorium in Postwar Germany,” Journal of Interdisciplinary History, vol. 32 no. 2, 2001, pp. 243–​62; Robert A. Trennert, “The Federal Government and Indian Health in the Southwest: Tuberculosis and the Phoenix East Farm Sanatorium, 1909–​1955,” Pacific Historical Review, vol. 65, no. 1, Feb. 1996, pp. 61–​84. 41 Madonna Swan (Lakota), whose story is presented in Chapter  2, underwent thoracoplasty in Sanator in the early 1950s. 42 For a detailed discussion of the BCG vaccine experiment among Native Americans and BCG vaccine in general, see Young 62–​5 and Christian McMillen’s Discovering Tuberculosis. In his work, McMillen includes a thorough analysis of global use of the vaccine and mass resistance to BCG in India in the late 1940s. 43 See Georgina D. Feldberg, Disease and Class, Chapter 4. 44 For a thorough analysis of American reactions to BCG, see Chapters 4 and 5 in Georgina D. Feldberg’s Disease and Class. 45 From the researchers’ perspective, Native Americans were a perfect population for this type of study: high incidence rate, isolated, and living in a contained space, thus easy to follow. 46 Tubercle test is based on the body’s immune response to infection. It involves injecting a small amount of liquid filtered from weakened, nonvirulent tubercle bacillus (termed purified protein derivative, or PPD) under the skin of the forearm or administering it with a multipronged device, the former method known as the Mantoux test. When the body is infected by an unknown substance, it reacts by forming antibodies. The most common symptoms of reaction are pain, swelling, and reddening of the infected area. The antibodies remain for a long time and reinfection by the same agent will trigger the same reaction. In the tubercle test, if a red welt appears on the arm within 72 hours of the test’s administration, it is a clear indication of a positive reaction, which implies that the TB infection had occurred in the past (Yancey 62–​3). 47 There still no consensus as to BCG’s efficacy. Therefore, in Discovering Tuberculosis, McMillen concludes that “it’s possible that the BCG vaccine is the world’s largest failed medical intervention” (118). On the other hand, a follow-​up study of the original trial among Native Americans conducted between 1992 and 1998 confirmed Aronson’s conclusions about the vaccine’s efficacy and demonstrated its long-​term value; Naomi E. Aronson et al., “Long-​term Efficacy of BCG Vaccine in American Indians and Alaska Natives A 60-​Year Follow-​up Study,” JAMA, vol. 291, no. 17, May 5, 2004, pp. 2086–​91. 48 See Feldberg, Disease and Class 168–​74; and McMillen, Discovering Tuberculosis 71–​83. 49 Today, American Center for Disease Control and Prevention in very cautious about recommending BCG. See https://​www.cdc.gov/​tb/​topic/​basics/​vaccines. htm?CDC_​AA_​refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fvpd%2 Ftb%2Fpublic%2Findex.html (accessed April 22, 2019). 50 See Todd Benson, “Blinded with Science: American Indians, the Office of Indian Affairs, and the Federal Campaign against Trachoma, 1924–​1927,” American Indian Culture and Research Journal, vol. 23, no. 3, 1999, pp. 119–​42. 51 A comprehensive policy of informed consent was created in the Belmont Report in 1979. However, in 1935 when Aronson was beginning his study, commonly accepted ethics was to obtain consent from subjects (Hadden 67–​8).

54 Tuberculosis 52 The claim that research on Native American people is beneficial for the entire society is further explored in Chapters 5 and 6 in the context of genetic studies. 53 Hadden writes about one notable exception: “In 1952 and in 1956, Alaska’s territorial governor, Ernest Gruening, asked that the vaccine be given to the Alaskan children who had a negative PPD [were not previously infected], as well as to all newborns. …” Since the experiment was still underway, Aronson’s approval had to be obtained first (72).

2  Tuberculosis, biopower, and embodied resistance in Madonna Swan: A Lakota Woman’s Story, as told through Mark S. Pierre and Louise Erdrich’s LaRose

At the turn of the nineteenth and twentieth centuries, when tuberculosis mortality and morbidity rates were falling, Native American suffering from the disease was massive and frequently ignored. The story of the TB epidemic in Indigenous communities is a site of convergence where politics dictated by racialized thinking, settler colonial agendas, aggressive assimilationist projects, and medicalization create a nonmilitary strategy of physical and cultural genocide. As demonstrated in the previous chapter, this mechanism was present when scientists and medical doctors attempted to explain high TB rates in Native communities:  rather than take into consideration ostensibly important historical and social factors, they identified racial inferiority as a cause of the epidemic. The interconnections between ideologically motivated federal Indian policies, such as the creation of off-​reservation boarding schools, and the absence of significant medical intervention are pointedly addressed in two seemingly unrelated works: Madonna Swan: A Lakota Woman’s Story, as told through Mark S. Pierre and Louise Erdrich’s LaRose. I argue that both texts first, rightly identify the tuberculosis epidemic as being responsible for the reorganization and often disruption of traditional kinship structures in Native communities, which bears severe consequences for the preservation of cultural sovereignty, and second, identify the institution of boarding schools as directly responsible for the spread of the epidemic. Moreover, both texts illustrate the way medicine is implicated in settler colonial practices and thus participates in what Michel Foucault refers to as biopower. While the scourge of tuberculosis creates an appalling image of population decimation and ensuing cultural loss, Madonna Swan and LaRose insist on a strong anticolonial response to genocidal practices. Tuberculosis is represented as a settler colonial inscription on Indigenous bodies and a part of biocolonialism concentrated on the extraction of biomaterial. The characters in both texts experience institutionalization and forced acculturation in Indian boarding schools and sanatoria, and their stories demonstrate how they manage to reintegrate with their communities, despite the violence of acculturation. Even though tuberculosis could not be cured at that time, it became normalized in Native families and communities so that rituals of everyday life, so important in preserving kinship relations, continued and

56 Tuberculosis throve. Furthermore, this chapter demonstrates the prominence of Indigenous bodies in settler colonialist projects, which extend beyond the creation of ideological contents but are also invested in the production of medical knowledge and cultural appropriation. Both, and with similar examples, Madonna Sawn and LaRose engage the history of medical experimentation and the theft of Indigenous bodies and cultural artifacts, conducted in the name of science as defined by Western epistemologies.

Madonna Swan: A Lakota Woman’s Story, as told through Mark St. Pierre The body as a site of colonization and resurgence Published in 1991, Madonna Swan is the product of a six-​year collaboration between Madonna Mary Swan and Mark St. Pierre, then Professor of Sociology, Anthropology, and Creative Writing at Regis University. St. Pierre was introduced to Madonna when conducting interviews with her mother, a Lakota elder, Lucy Josephine High Pine-​Swan. Some of the recorded events date back to the 1880s and include memories of Madonna’s maternal grandmother, Julia Brave Eagle High Pine. The main storyline revolves around Madonna’s life: her childhood in the traditional Lakota family; contracting tuberculosis and the resultant forced six-​year stay at the Sioux Sanatorium; successful treatment at Sanator, a sanatorium for white patients in Custer, South Dakota; her later marriage; and her career in education. The problems of collaborated autobiographies have been extensively explored by scholars in Native American Studies,1 and, indeed, they become apparent in the Preface to the book, in which St. Pierre explains his methodology: Between 1976 and 1981 I recorded triplicate versions of these stories, and in the writing process edited the stories into a unified vignette, pulling the best aspects from the three versions. … The stories were then arranged in a loose chronological order, creating a sense of a story line. (xix; emphasis added) While, as Sandra Sprayberry observes in the review of the book, St. Pierre seems “well-​intentioned” in his project (110), a number of questions arise about the ideological underpinnings of an editing process intent on creating a chronological composition. Equally problematic is the inclusion of explanatory endnotes. Embedded in the methodologies of anthropology as an academic discipline, the endnotes provide explanations of Lakota culture and, thus, situate their author as the cultural and linguistic authority in the field. It is not Madonna who provides a context to her story but St. Pierre who claims to know which parts of her narrative are “the best,” how to arrange them, and where an explanation is needed.

Tuberculosis, biopower, embodied resistance  57 However, while undoubtedly a highly mediated text, Madonna Swan offers an opportunity to demonstrate the embodied dimension of settler colonial practices, which inflict violence on and reshape Indigenous lands and bodies. More importantly, however, Madonna’s story elucidates how Indigenous bodies resist such violent inscriptions of colonialization and dispossession and instead become texts of cultural resurgence and regeneration. While Madonna Swan is structured (by St. Pierre) as an exceptional story of survival with a thematic division of “before TB/​after TB,” Seneca scholar Penelope Kelsey insists that Madonna Swan serves as a powerful example of Lakota decolonization struggles. The community’s shifting reaction to tuberculosis testifies to “a reclamation and revivification of traditional values around kinship and illness in the present and future” (“Disability” 196). If Swan’s story is exceptional, it is not her overcoming of tuberculosis which, in the context of the grim statistics presented in the first chapter, is indeed a rare event, but her refusal to be acculturated and used as a narrative of the vanishing Indian, testifying to Western civilization’s inevitable progress. Indeed, the opening lines of Madonna’s story emphasize her familial bonds and situate her in the context of the Lakota community: I, Madonna Mary Swan Abdalla, was born to the union of James Hart Swan and Lucy Josephine High Pine-​Swan, September 12, 1928. I  was the fifth child of ten children born to this family. Only five of the ten children survived until adulthood. … From the children that died, it might seem that we had it very bad, but we didn’t. We were born to a very strong mother whose love and patience more than made up for everything we were without. (St. Pierre 3) The vignettes collected in the first part document Madonna’s childhood and her social development in relation to family and community members. If the insistence on chronology is clearly St. Pierre’s influence, the episodic structure of the stories as well as their ties to specific places and characters rather than time frames testify to Madonna’s preoccupation with developing her narrative vis-​à-​vis Lakota epistemologies. While she is the main protagonist of the recounted events, it is the communal perspective, often rendered by a shift from the pronoun “I” to “we,” that filters the story and emphasizes the relational character of Lakota social structures. As Pekka Hämäläinen observes in his comprehensive history of the Lakota people, Kinship ties emanated outward in concentric circles from nuclear families to extended families, to thióšpayes, to oyátes, to the Očhéthi Šakówiŋ, and, through wólakȟota, to non-​Lakotas willing to embrace the Lakota ethos and way of being. This was a voluntary and intensely intimate social order whose primary unit was a thióšpaye, a tight-​knit kin group

58 Tuberculosis of roughly ten to twenty extended families occupying a distinct section of the Lakota domain. (200) This closely knit and well-​defined structure was at the same time flexible and open to change when the situation required adaptation, which will become evident later with the example of how Madonna’s community responded to the TB epidemic. In the stories relating Madonna’s childhood, the centrality of community manifests itself in the way everyday responsibilities and the transmission of knowledge depend on family and kinship ties. For instance, when Madonna comments on moving to Bull Creek, she affirms that “We like living with our aunt and uncle … There were more women to help with the house chores, so we got to spend more time with Mom” (10). The presence of an extended family contributes to raising a young generation dedicated to family and Lakota values. Similarly, multigenerational structures of families ensure the continuity of traditions. All family members are responsible for teaching children about kinship relations and providing knowledge about societal structure and a sense of connection with ancestors as well as nonhuman beings (Cook-​Lynn, New 94; Kelsey, Tribal 27–​8; Powers 62–​3; Walker 6). In the story about Madonna’s first menstruation and the ceremonies marking the event, it is grandmother Julia with her instructions about cultural beliefs and practices surrounding the moment of Ishna Ti Cha Lowan (becoming a woman) who emerges as the main protagonist of the story (St. Pierre 40–​3). It is only through grandma Julia’s knowledge that Madonna becomes a part of generations of young Lakota women who learn about their place in the world. This sense of being grounded in an extended family and community provides Madonna with a sense of safety and belonging, which in turn makes it possible to refer to her childhood as “the happy times” (27). These descriptions of early-​twentieth-​century Lakota life are not, however, excessively idealistic. Madonna does not shrink from sharing stories about poverty and her father’s alcoholism and violence, and thus avoids simplifications in the rendition of the Lakota life. Moreover, as Kelsey rightly observes, illness and death are common occurrences in Madonna’s childhood and are not removed from the narrative as causes of imbalance in the community life. On the contrary, they do not disrupt either the kinship ties or the entire communal structure (“Disability” 196). The first chapter is in fact dedicated to documenting births as well as deaths in the Swan family, thus demonstrating to what a large extent they are normalized and perceived as inevitable elements of life. Invariably, it is the entire kinship structure that helps people overcome emotional and social crises. This balanced approach is later destroyed by boarding schools and the resultant disruption of kinship ties. The removal of children from their families, the spread of TB, and the impossibility of containing the epidemic disrupt traditional approaches to illness and disability that emphasize the

Tuberculosis, biopower, embodied resistance  59 inclusion of all members, regardless of their physical or mental state. Thus, the process through which Madonna becomes reintegrated into the family and community structure later in the narrative is, according to Kelsey, an act of decolonization, “a fight for a simultaneously corporeal and cultural survival” (“Disability” 197; emphasis in original).2

Educating minds, infecting bodies Ironically, it is Lucy High-​Pine’s dream of educating her daughter in a “white man’s” school that leads to Madonna contracting tuberculosis. Married at 16, Lucy never had the chance to complete her education, which she describes to her daughter as a lost opportunity:  “So you see, I was young, too young… I want you to finish high school and be a nurse or something that you want –​something so you could make your own way in this world with your brains and education” (St. Pierre 22–​3). Hence, despite initial reluctance, Madonna is enrolled at Immaculate Conception boarding school on the Crow Creek reservation. In 1942, she and a number of students help fight a prairie fire that burns infected livestock and, as a result, they become sick via inhalation of airborne tuberculosis bacteria. Soon, the first symptoms begin to appear. Like many students before her, Madonna became infected with tuberculosis in a boarding school, a fact which provides a compelling context for interpreting TB as a disease of colonization. In Madonna’s narrative, the language of tuberculosis symptoms replicates the imagery of colonialist invasion, the loss of land, and the disintegration of community structures. The bodies of Indigenous students, ravaged by the disease, underweight and coughing blood, become illustrations of the violence of colonization. Soon after the fire, Madonna realizes that she has lost a lot of weight, has constant pain in the chest, and is prone to catching colds very often. Other girls complain of similar symptoms which Madonna meticulously documents: [Ramona Jewett] was playing on the swings one warm fall day, and someone was pushing her back and forth. Suddenly, she fell off the swing, landing hard on her back. She started bleeding from her mouth. … (52) [Seeking Land] just started hemorrhaging one day, and before they could get her to the hospital in Fort Thompson, she was dead. … (52) We were practicing one day when she [Rosie St. Pierre, Madonna’s friend] jumped to catch a rebound. When she came down, she dropped the ball and grabbed hard at her chest. “Something popped in here!” She said, pointing to her ribs. Pretty soon blood started coming from her mouth. … (52)

60 Tuberculosis [Rita His Chases] was from Kennel, on Standing Rock. Suddenly one evening she started to hemorrhage. The farthest they got her was the infirmary. She was dead before they got her there! (54) Because the school’s staff, Catholic nuns, constantly downplay the seriousness of the situation, these violent deaths seem sudden and unexpected to Madonna and her friends. Worried by her weight-​loss, Madonna asks one of the sisters whether she indeed looks skinny to which she receives the following reassurance: “Maybe, but don’t worry, you’ll gain it back soon” (51). When one of the girls starts hemorrhaging, “The Sisters said there was nothing wrong with her, so they let her go back to classes in a couple of days” (52).3 This refusal to acknowledge the epidemic mirrors a similar gesture of downplaying the extent of the genocide of Indigenous populations since the beginning of colonization. It is also a part of a long-​term strategy of rendering Indigenous bodies expendable if they fail assimilationist efforts.

The stigma of diagnosis In 1944, Madonna’s condition deteriorates; her cough is worse and more painful and she loses so much weight that performing her daily activities becomes impossible. The Sisters send her to Fort Thomson to see a doctor. X-​rays and sputum tests reveal tuberculosis, which for Madonna, having already witnessed so many deaths, can have meant only one thing: “My heart sank. I was going to die” (61). However, apart from the fear of dying, the TB diagnosis carries another important implication, that of social stigma. As Erving Goffman has observed in his seminal work, social stigma can be understood as a spoiled social identity, a situation in which an individual possesses characteristics that strongly deviate from what society perceives as a norm. However, since stigma reformulates contexts of interpersonal interactions, it should be explored through “a language of relationships, not attributes” (12). Indeed, Madonna feels acutely how the diagnosis redefines her status in the community: “To have TB was a big disgrace in those days” (St. Pierre 63).4 The diagnosis brands the body as polluted and unworthy to be included in the communal structure. Moreover, this corporeal marking of an invisible infection is translated into the visible language of red flags placed on TB victims’ houses by tribal police, thus becoming a palpable manifestation of a “spoiled identity.”5 In Madonna’s community tuberculosis is associated with leprosy, which successfully transforms the sick into pariahs. The intimacy of a closely knit community structure makes it easy to identify the infected persons and relegate them to the status of the “untouchable”: They treated those that got TB and their families like they were lepers. Those that didn’t have it told their children to stay away from the kids who had TB in their home … (63)

Tuberculosis, biopower, embodied resistance  61 There were and are a lot of people who think they can catch the disease from those that had TB. … Often people won’t drink out of clean glasses at my house or drink from a cup I give them. My sister-​in-​law won’t let the grandchildren over to my house. That’s one of the things I  feared most back in the san, that I will always have to go through life like a leper. (171) The language surrounding leprous/​ tubercular bodies evokes the imagery of contagion and pest infestation. When Madonna’s brother, Orby Swan, is diagnosed with tuberculosis in its terminal stage, the agency doctor describes his body as “infested with TB” (99), thus equating a tubercular (and Indigenous) body with the abject.6 A  similar note is present in Madonna’s letter to her fiancé, Levi In The Woods, in which she decides to terminate their relationship due to her illness: Don’t come and see me; I am very contagious. I could spread my germ to you or anybody that comes near me. I  won’t be able to see you. … I guess this is the end of our childhood dreams of getting together, of getting married. I’m a disgrace to all humanity now that I’ve caught tuberculosis. (85) In another instance, she exclaims: “I’m such a disgrace to my family. I feel so dirty and ashamed” (67). Reverberating in this assumption of responsibility for her disease is another association surrounding tuberculosis in the Lakota community, namely that of moral degeneration and sexual transgression. Madonna reports how for some people TB, “chanhu sica [bad lungs], as it was called in Indian … was the same as syphilis [or] … some kind of social disease” (64). According to Penelope Kelsey, this misunderstanding of tuberculosis as a sexually transmitted disease stems from the absence of tuberculosis epidemics in prereservation period (“Disability” 206). While there were cases of tuberculosis infections in precolonial times,7 they never reached epidemic proportions. Colonization and subsequent changes in Indigenous lifestyles caused by the loss of land and traditional foodways, to name just two factors, created optimal condition for Mycobacterium tuberculosis to thrive. Moreover, the fact that so many Indian students contracted TB in boarding schools, that is in the white man’s institution, created a suspicion of sexual contacts with colonizers (and, in short, sexual pollution and moral degeneration) (“Disability” 206–​7).8 As a consequence, the inscription of tuberculosis on Madonna’s body acquires multiple significations. First, with the visible “wasting” of the body, it marks her as an outcast in a community traditionally reliant on inclusiveness, thus demonstrating the extent to which settler colonialism negatively affects tribal societies. Second, the interpretation of TB as a sexually transmitted disease and simultaneously a disease introduced by the white man points to how colonization is also as a violent act of sexual conquest.

62 Tuberculosis

“The right to make live and to let die”: tuberculosis, Sioux San, and biopolitics Once diagnosed in 1944, Madonna is taken to Sioux Sanatorium (or Sioux San) in Rapid City, South Dakota, where she remains for the next six years. Between 1944 and 1947, she is forced to stay indoors and forbidden to visit her family. Madonna’s story of her stay at the sanatorium testifies to the porous border separating practices of institutionalization and incarceration of Indigenous bodies, which, when infected and hence dangerous, are regarded as failed efforts of the educational/​ acculturational campaign. Second, with its emphasis on regimes of control rather than treatment, Sioux San becomes a telling illustration of complementary technologies of Foucauldian biopower: disciplining of bodies and regularization of populations.9 In descriptions of her sanatorium life, Madonna consistently uses the vocabulary of incarceration. Upon arrival, her first thought is that “the place … was to be a prison for me for more years than I could have imagined” (St. Pierre 69). Soon, she learns that the terminally ill are placed in private buildings on the east side of the main building to which the patients refer as “death row” (76). Moreover, replicating the military organization of boarding schools which similarly serve as institutions of incarceration, each day at the sanatorium follows the same routine with meals, treatment, and activities at designated hours. Patients are forbidden to wear their own clothes and are instead given striped pajamas, an irony that is not lost on Madonna: We wore pajamas and house coats all the time; [we] dressed all alike, like the inmates at the penitentiary in Sioux Falls, all dressed in stripes. I guess that was intended to keep us from escaping. If we could escape, we could not go far. Of course, our regular clothes were locked away. (74) If striped uniforms-​like-​pajamas signify criminalization of illness (and indigeneity), the restriction on Indigenous bodies’ mobility constructs Sioux San as a space of a quarantine, which, not unlike reservations, attempts to limit the spread of Native people and cultures. This criminalization and containment of bodies are literal, palpable experiences and, inevitably, produce a sense of dehumanization and elimination from social life: Living in the san would make you feel like an outcast with some filthy disease like leprosy. We couldn’t go outside. We were allowed only to stand out on the little balconies and look across to Rapid City, watching people go about their daily lives, enjoying life. From 1944, through 1945 and 1946, until 1947, we were not allowed to go outdoors, not stand on the ground. (80)

Tuberculosis, biopower, embodied resistance  63 The incarcerating rather than therapeutic character of Sioux San becomes more pronounced when Madonna compares it with Sanator, a sanatorium for white patients where she is later placed. From the beginning, Madonna’s narrative about Sanator drastically departs from the rhetoric used to illustrate disciplinary practices in Sioux San. This difference is announced on the level of architectural design as well as by an allusion to TB sanatoria of the turn of the century, “fashioned after German health spas and resorts, attempted to rehabilitate consumptives by … enforcing rigorous regimens of outdoor activity” (Feldberg 52). Upon arrival, Madonna observes that, “The grounds were pretty, with trees and flowers and all. The patients were walking the grounds with their own clothes on” (108). This contrast between a site of incarceration and a site of specialized medicine is further sharpened by the way medical staff behave toward their patients. At Sioux San, “The nurse and staff were kind, for the most part, but they were afraid of, afraid of our disease; they seldom touched us and always wore masks” (73), which clearly illustrates how infected Indigenous bodies are seen as a source of contagion. Madonna’s first observation about the medical personnel at Sanator is that they do not wear masks and her doctor, Dr.  Meyers, sits close to her and comfortingly touches her shoulder, which Madonna registers as a departure from a tendency to treat her body as infected, racially inferior, and subject to the rules of containment. This establishment of a doctor–​patient relationship and the attention given to her emotional needs are conspicuously absent from Madonna’s narrative about Sioux San. The operations of Sioux San rest on a combination of disciplinary regimes and an illusion of medical treatment, which in consequence lead to high mortality rates among the patients. On the first day at the sanatorium, Madonna is greeted by an old acquaintance, Margaret Halfred, who is her cousin’s girlfriend. At 30, Margaret “was very skinny, her skin was yellow, and she was in a wheelchair” (70) and she is the first person whose death Madonna will witness in the coming years. “When I saw her that first night,” Madonna says, “I realized this [Sioux San] was a place for people to die” (71). The definition of the sanatorium as “a place to die” calls to mind Michael Foucault’s famous insights on biopolitics and the emerging modes of administering life rather than taking it away (as was the case up till the end of the eighteenth century). In his discussion of biopower in the lectures delivered in Collège de France in 1975–​6, Foucault expands his concept of the anatomo-​clinical method of exercising “power over the body in an individualizing mode,” developed in The Birth of the Clinic, with a discussion of a second mode of power, namely a “massifying” mode which is “directed not at man-​as-​body but man-​ as-​species” (“Society” 243). This new method is referred to by Foucault as the “ ‘biopolitics’ of the human race” (243) and is concerned with “the population as political problem, as a problem that is at once scientific and political, as a biological problem and as power’s problem” (245). The emergence of biopolitics was marked, according to Foucault, by a transformation in the nineteenth century of the sovereignty’s power to “take life or let live”

64 Tuberculosis into “the right to make live and to let die” (“Society” 241). When Madonna realizes that Sioux San is a place to die, she draws attention to how a medical institution, ostensibly designed to heal, is in fact an instrument of incarceration, and, in the long run, of “letting” certain (Indigenous) populations die. This process is rationalized through racial hierarchies:  “The fact that the other dies does not mean simply that I  live in the sense that his death guarantees my safety,” writes Foucault. “[T]‌he death of the other, the death of the bad race, of the inferior race (or the degenerate, or the abnormal) is something that will make life in general healthier: healthier and purer” (255). The functioning of the biopower mode is facilitated by medicine, which “is a power-​knowledge that can be applied to both the body and the population, both the organism and biological processes, and it will therefore have both disciplinary effects and regulatory effects” (“Society” 252). Indeed, an analysis of the treatment regimes offered at Sioux San lucidly demonstrates how Indigenous patients are, to use Lisa Diedrich’s words, “regularized out of existence” (18).10 The concept of “letting die” is best epitomized by the ridiculously futile therapies offered at Sioux San. The main form of treatment is bean bag therapy, which is intended to produce the effects of artificial pneumothorax: Therapy was when they made us lie down, and they would put bean bags on our chests. I was prescribed four pounds of bean bags for my therapy. I guess the bags were supposed to partially collapse our lungs and kill the germ by cutting down on the amount of oxygen the germ got. It never did that, kill the germ, even though we did this every day for years. (St. Pierre 75) Another treatment is “cod-​liver oil mixed with the tomato juice” which the patients receive every day (75). These specious therapies produce no results. Moreover, the fact that sicker patients are never separated from healthier ones and the latter are charged with the task of taking care of the former and, as a result, keep reinfecting one another, raises the question of whether the therapies offered were even expected to be effective, or rather were seen as secondary to the economic reality of personnel shortages. No one is cured and no one is released alive: “There were no patients going out on leave or dismissed in 1944 or 1945. Not until 1946 did the first few patients leave alive. Death was the only way anybody left before that, and there were many” (74). Madonna keeps a diary documenting every death and when later in 1950, she compares her notes with those of another patient, they count 500 deaths:  “That was only a count of the deaths we heard of and did not include those who died at the san that we didn’t hear of, or those that went home and later died, or those who ran away and died” (74). With no medical intervention into the tuberculosis epidemic, Sioux San becomes a site of state-​sanctioned elimination of Indigenous bodies through the mode of biopower, of “letting die.” “When I say ‘killing,’ ” writes Foucault,

Tuberculosis, biopower, embodied resistance  65 I obviously do not mean simply murder as such, but also every form of indirect murder:  the fact of exposing someone to death, increasing the risk of death for some people, or, quite simply, political death, expulsion, rejection, and so on. (256) Or, as in this case, death from a lack of adequate medical treatment that is available elsewhere. The story of Madonna’s admittance to Sanator, where she finally receives effective treatment, is a yet another chapter in the biopolitical construction of Indigenous bodies as racial populations. Seeing how her fellow patients die without ever receiving help, Madonna escapes from Sioux San. Her father, James, refuses to send her back and instead attempts to place her in Sanator, which, like many state and county sanatoria at that time, refuses to admit Native American patients (Abel and Reifel 101). To get her in, James Swan needs the approval of the state attorney for Zieback County, Don Coleman, and county judge, Hank Burgey. Not surprisingly, Coleman adamantly refuses to sign the papers:  “The Sioux San is for Indians, that’s where she belongs! She doesn’t belong in Sanator. That Sanatorium over there is for white people!” (St. Pierre 107; emphasis added). By invoking invisible yet solid lines between Indian reservations, boarding schools and sanatoria and spaces and institutions designed for white Americans, Coleman subscribes to the logic of “letting die” certain, unwanted populations. The state attorney’s refusal to allow Madonna admission to Sanator serves as a poignant example of how the law participates in biopolitical practices. The requirement of the approval introduces a context in which Native Americans are subjected to US laws specifically designed to exclude them from certain legal, social, and cultural categories. Indeed, Mark Riffkin, in his excellent essay “Indigenizing Agamben,” by analyzing the logic of such laws, applies Giorgio Agamben’s reworking of biopolitics and his concept of the “state of exception.” In Homo Sacer, Agamben draws attention to the distinction between zoē, “the simple fact of living common to all living beings (animals, men, or gods)” and bios, “the form or way of living proper to an individual or a group” (1). According to Agamben, what differentiates modernity and the structure of the state from antiquity is the attention given to bios, the bare life, and the attempts to regulate it and situate it at the heart of sovereign powers. In fact, modern sovereignty relies on the construction of this apolitical natural life that, at the same time, lies outside of the political sphere. This condition Agamben calls “the state of exception”: The relation of exception is a relation of ban. He who has been banned is not, in fact, simply set outside the law and made indifferent to it but rather abandoned by it, that is, exposed and threatened on the threshold in which life and law, outside and inside, become indistinguishable. (28; emphasis in original)

66 Tuberculosis In analyzing the rhetorical gesture of defining Native Americans’ legal status as “peculiar,”11 Riffkin draws attention to how US legal ramifications shaped by discourses of racial difference create a state of exception in which Indigenous bodies are simultaneously expected to submit themselves to the law and reminded that they are outside its protective zone (90–​1). When James Swan challenges Coleman’s refusal, he attempts to evoke the same logic of belonging which supposedly excludes Native Americans from the national narrative. He emphasizes a long history of Indian participation in practices which have the power of authenticating narratives of national membership: God damn you white sons of bitches! Why in hell didn’t you tell us that when World War II came along? Why didn’t you tell us then, that was just a “white man’s” war? Many of them “Indians” didn’t come home. Many of those “Indian” boys died. I had two boys that served this country, and one of them is dead. So we could have freedom speech, freedom of religion, and freedom to live our lives the way we want to! You can’t tell me I can’t take my daughter over there! (107) Using the rhetoric of the body politic as defined by a common struggle to defend democratic values, James articulates his right to be included, to belong in the society for which his son died. Moreover, by alluding to the Indian Citizenship Act of 1924,12 James suggests that American law, a guarantee of equality, applies to him as well as his daughter. However, as the Sanator episode amply demonstrates, the state of exception cannot be circumvented: James fails to convince Coleman that the laws give access to effective medical treatment to Native patients. The only thing he can do is to appeal to a representative of the legal system who is more willing to sign the required documents: South Dakota Governor, Sigurd Anderson.13 While the strategy reveals James’s skill in navigating the hierarchies of the white man’s legal structures, it nevertheless fails to change the power dynamics. It is clear that Madonna is admitted to Sanator only as an exception to the existing rule.

TB as a trope of colonization The fact that Madonna contracts tuberculosis in a missionary school illustrates a common pattern of the spread of the infection in the second half of the nineteenth century and up till the 1940s. As Commissioner of Indian Affairs between 1897 and 1905 William Jones observed, to his utter shock, “the high rate of disease [TB] in Indian schools [was] caused in part by taking healthy children from an open village life and confining them in overcrowded schoolrooms and more particularly dormitories” (DeJong, “Unless” 265). Thus, not only cutting children’s long hair and forcing them to wear uniforms but also endangering their health are seen as acts of settler colonial violence

Tuberculosis, biopower, embodied resistance  67 upon Indigenous bodies. Not only Native cultures, languages, and lifestyles were targeted: the body itself became a site of colonization. As mentioned earlier, Madonna Swan abounds in descriptions of how tuberculosis wastes and exhausts the body. The way the disease slowly but surely takes its grip on the life of the Native patients mirrors the gradual encroachment on Indigenous lands by the USA. “I just kept bleeding and coughing,” Madonna says, “drowning in my own blood. I gasped for air between coughs, my ribs ached and my eyes watered. I felt as if a tight band was crushing my chest, tightening down on my lungs” (90). The 1950 photograph of Madonna taken after her escape from Sioux San shows a decimated, underweight body on the brink of death. Soon, her presence on the reservation is discovered by the authorities and Dr. Fleishman, the agency doctor, threatens to place red flags on her family’s house. The Indigenous tubercular body immediately evokes a state of emergency and calls for the practices of containment. The motif of tuberculosis as a trope of colonization is also present in Madonna’s narrative about Sanator, which ultimately is a place where she is cured. She undergoes a number of procedures, all unavailable at Sioux San, and when they fail, Madonna is offered thoracoplasty that (in combination with antibiotics) turns out to be effective. However, if tuberculosis is read as a colonizers’ inscription on the Indigenous body, Madonna’s arduous recuperation from the invasive operation aptly demonstrates the physical and affective effort to fight colonization. The description of the operation and her postoperative condition evoke images of corporeal violence which bring to mind outrageous land seizures and assaults on tribal sovereignties perpetrated by the settler state: The doctors had taken all my ribs out on one side, so I didn’t have any support for my spine or head. I couldn’t sit up because I didn’t have any control of my head. My neck and left arm were completely paralyzed. All I did was lay in bed, and they would crank me up. I was numb from my fingertip to my shoulder all this time. (117) Considering the seriousness of the violence done to Madonna’s body, her gradual recuperation and her regaining of control over her body and mental stability, is interpreted as a victory over the illness and in effect over colonization. As Kelsey observes, the decolonizing struggle becomes externalized on Madonna’s body as a successful recovery which extends beyond its medical understanding (203–​4). While Sanator is indeed the place where Madonna receives specialized medical help and is cured, it is also a site where medicine’s involvement in racist and colonialist practices becomes more pronounced. Dr. Meyers offers Madonna thoracoplasty,14 an experimental surgery, that, as he claims, has not been tried in the USA before.15 The argument he uses to convince her is the respect bestowed on those who “do something for humanity,” thus adding her

68 Tuberculosis case to a long history of experimentation on nonwhite bodies and unequal distribution of medical knowledge.16 In the 1950s, obtaining consent from patients before conducting any experimental procedures belonged to common medical ethics practice (Hadden 67). However, the reality in medical institutions of the time was often drastically different. As one physician observed, In 1945, ’50, the doctor … was king or queen. It never occurred to a doctor to ask for consent for anything. Doctors weren’t in the habit of telling the patients anything (either). They were in charge and nobody questioned their authority. (qtd. in Faden 357) Indeed, while Dr. Meyers seeks Madonna’s consent and informs her about the complexity of thoracoplasty, he is less sincere in the assessment of his success. It is years later before he admits that Madonna’s loss of mobility in her left hand might have been caused by his “accidentally [having cut] some muscles or damaged a nerve” (120). What is, however, always present in the discussion of the surgical treatment, is his enthusiasm about experimental possibilities. He constantly uses the argument about “doing something for humanity,” and later he reiterates the same logic when convincing Madonna that the debilitating surgery was not pointless: “We are so grateful for we learned from your surgery! You were the first brave one. We are already making many changes in our technique because of you and those other brave ones who went first” (121). In his words, Madonna’s disability, curved spine, and resultant decreased mobility, is justified in the name of the production of scientific knowledge.17 Moreover, Madonna’s case illustrates the importance of not only informed consent to suggested treatment, but also its long-​term implications and side effects. When Madonna regains her independence as a cured person, in February 1956, she marries Jay Abdalla and together they return to the reservation. It is then that Madonna, to her great surprise and despair, learns that due to tuberculosis treatment, she cannot have children: I didn’t know then that I  couldn’t have children, or maybe I  wouldn’t have gotten married. It wasn’t until years later that a Dr. Praeger told me I couldn’t have any children. He said it was all the medicine and drugs I had taken when I had TB. (St. Pierre 133) Madonna never again returns to this subject in her narrative. However, regardless of whether it is either her choice or St. Pierre’s editing, the silence that envelops the moment when she learns about TB therapy’s toll on her body is clearly dramatic. While the necessity of the treatment is beyond doubt, the fact that Madonna has never been informed about the possible

Tuberculosis, biopower, embodied resistance  69 effect on her reproductive system is a flagrant example of how medicine exerts power through the controlled dissemination (or a refusal to do so) of medical knowledge about one’s body. If the quality of treatment that Madonna received at Sioux San in 1940s testifies to state-​sanctioned policies of neglect of Native American health, the 1960s and 1970s reveal even further involvement of medicine in the practices of biopolitics. As explored by a number of scholars, it was during that time that an unprecedented number of Native American women were subject to forced and nonconsensual sterilization.18 D. Marie Ralstin-​Lewis estimates that between 1968 and 1982, approximately 42  percent of Native woman of childbearing age were sterilized (71–​2). It is impossible to say how many of these procedures were forced; however, as numerous stories demonstrate, many Indigenous women were sterilized when admitted for conditions not requiring such interventions, appendectomies for example, and the decision was made by medical professionals on the basis of racial, economic, and social factors. While Madonna’s case does not belong to this story, her lack of knowledge about the possible loss of reproductive options as a result of her TB treatment is yet another manifestation of how medicine and medical institutions are implicated in eugenic and genocidal practices targeted at selected, nonwhite populations.

Madonna and Lakota community’s embodied resistance In the Preface to the book, St. Pierre emphasizes the importance of Madonna’s victory over tuberculosis and hence the exceptional character of her story. However, as Kelsey rightly observes, Madonna Swan’s illustration of the Lakota community’s revitalization of traditional approaches to the ill deserves equal attention. I further suggest that Madonna’s decision to return to the reservation and dedicate herself to social work as well as the decolonizing practices in the educational system are important parts of this revitalization agenda. The healing of Madonna’s body mirrors the community’s regenerative powers and the ability to preserve cultural continuity. Indeed, the chapter describing Madonna’s Easter break at Cherry Creek and her stay at home after the escape from Sioux San emphasize both her sense of being physically healed and her feeling that she has been reintegrated into the body of the kinship structure. While from the medical perspective, Madonna’s TB is not cured at this point, it is her newly regained vitality and optimism that inform her assessment of her condition. The narrative unravels these two interdependent stories of Madonna’s well-​ being and the community’s generous welcome:  “I was beginning to feel like Donna again,” she enthusiastically proclaims. “I looked in the mirror. I looked good, I  thought  –​Yes! The best I’ve looked in years, or maybe ever!” (93). Her attractive appearance and regained sense of femininity convince Madonna that tuberculosis can indeed be cured and she can be returned to her family. This conviction is further affirmed by the community’s enthusiastic reaction, documented by a long list of people who come to welcome Madonna.

70 Tuberculosis Reverberating in these descriptions is the disappearance of the social stigma associated with tuberculosis: They didn’t act frightened of me –​they made me feel so good. We had a happy dinner of wojapi, wigliunkagapi, wastunkala, all kinds of things, foods we never had at the sanitarium. … People came and went all day every day, always to see Donna and wish me well. (93) If, as I demonstrated earlier, TB is a trope of colonization and its effect on Indigenous bodies and societies, Madonna’s sense of feeling healthy and her communal reintegration constitute an act of resistance. In their study of Lakota approaches to health and healing, Richard W.  Voss and colleagues observe that “Pre-​reservation Lakota society had sophisticated methods for providing for the material needs of its members, specifically insuring that widows, children, and the disabled were fed and cared for, and that good social relations and social order were protected and maintained” (“Wo’Lakol Kiciyapi” 84). Since the primary social orientation was toward tribalism rather than individualism in its Western understanding, Madonna is not abandoned. On the contrary, the community’s insistence that the ill and disabled are not excluded ensures social harmony and defies colonial impositions on traditional values. After successful TB treatment at Sanator, Madonna returns to Cherry Creek. While clearly St. Pierre is interested in emphasizing Madonna’s “life after TB,” this aspect of her life gradually recedes to the background of the narrative. What seems more important for Madonna is the reality of life on the reservation. Her stories, again structured around particular family and kinship members, are punctuated by moments of happiness as well as hardships. As with the presentation of her family in the first part, Madonna is far from romanticizing her culture and does not shy away from discussing corruption in the tribal government.19 Hence, it is not ruminations on Madonna’s TB experience but the story of the reintegration into and service for the Lakota community that put Madonna in control of the narrative. As a Head Start program teacher, Madonna provides instruction in Lakota language and traditions which is highly appreciated by community members. Despite years of trauma at Sioux San, she finds satisfaction and fulfillment in her life: I loved my work at Head Start. It was as if, despite my tuberculosis and my not being able to be a nurse, go to school, or do the things I  had dreamed of, I was finally doing something that made me feel happy. (St. Pierre 164) In their research on the concept of “social work” in Lakota culture, Voss and colleagues observe that it had no precedent in precolonial times. However,

Tuberculosis, biopower, embodied resistance  71 as effects of settler colonialism spread into multiple spheres of Lakota life, social workers not only gained acceptance but also became indispensable for culture. The most important function of “social work is that it compels social work educators and practitioners to begin ‘indigenizing’ our own consciousness, not only about the ‘missing chapter’ in our introductory textbooks, but the fundamental influence of Western materialism and Eurocentrism on our thinking” (“Wo’Lakol Kiciyapi” 84). Thus, the fact that Madonna participates in the creation of a tribal educational program where Indigenous knowledge is valued and appreciated is perhaps the most tangible proof of a failure of assimilationist agendas of boarding schools and sanatoria. Madonna takes an active role in the life of the community and serves on the board of the Tri-​ Community Development Cooperative and as a member of the tribal hiring, firing, and grievance community. In 1983, she is awarded the title of Native American Woman of the Year. If TB is read as the colonizers’ inscription on the Indigenous body, Madonna’s determination to heal successfully erases these markings of subjugation and, instead, demonstrates Lakota culture’s continuity in the postcontact context. Finally, Madonna’s decolonization practice is visible on the discursive and structural level of her narrative. Despite St. Pierre’s editing, Madonna Swan is an Indigenous text in its attention to Lakota aesthetics and epistemologies. The form of the book, while chronological in the presentation of events, follows the structure of oral storytelling. It is full of digressions and stories that relate to other events and family members or that function as educational material, such as the story about different forms of bravery told by Madonna’s mother before surgery. Moreover, the text includes the Lakota language as spoken by the people in the community and many things are referred to in Lakota, followed by St. Pierre’s translation. While many of the events take place outside of the reservation, the comments and judgments Madonna provide are filtered by Lakota sensibilities and moral norms. As Kelsey posits, Madonna extensively interacts with the non-​Indian world without compromising her Native identity (“Disability” 209). The colonization of her body by tuberculosis mirrors the colonization of Lakota lands and cultures and, therefore, her heroic recuperation and meaningful life in the community illustrate embodied resistance at work.

Louise Erdrich’s LaRose and embodied resistance Published in 2016, LaRose, Louise Erdrich’s fifteenth novel, opens with the death of a five-​year-​old child. Landreaux Iron mistakes his neighbors’ son, Dusty, for a deer and shoots him. Following traditional Ojibwe law, Emmaline and Landreaux offer to send their youngest son, five-​year-​old LaRose, to live with Nora and Peter Ravich, Dusty’s parents. “Our son will be your son now. … It’s the old way” (16), they say. From now on, the fates of the two families will become permanently entangled in an emotionally charged arrangement of double-​custody redefining concepts of kinship and belonging. With the

72 Tuberculosis Irons’ powerful act, Erdrich illustrates the impossibility of delivering justice, as defined by American law, in the context of loss, and an alternative of coming to terms with the tragedy in the form of traditional Ojibwe law, which, instead of retribution or revenge, called for by Nora, offers replacement and the resultant redefinition and extension of kinship relations.20 The resurgence of traditional Indigenous law is merely one of myriad motifs developed in Erdrich’s emotionally captivating novel. The boy transferred to the Ravich family carries the name LaRose, which is “a name both innocent and powerful, and had belonged to the family’s healers. … There had been a LaRose in each generation of Emmaline’s family for over a hundred years” (Erdrich 11). Following the stories of earlier LaRoses, Erdrich’s novel engages with the history of American Indian education, the trauma of boarding schools, and the question of how the wounds of forceful acculturation and institutionalized violence can be healed. It is also a story of cultural and physical survivance, the survival of Indigenous bodies, and the continuity of Native traditions and spiritual practices, or, as Anishinaabe scholar Margaret Noodin puts it in a review of the novel, a demonstration of how “old stories [are] made new, and [how] stories of the present stretch to connect with the past” (223).21 This continuity is also contained in Erdrich’s family history, which she weaves into the very fabric of the text. Her maternal grandfather, Patrick Gourneau, attended one of the Indian boarding schools and it is his handwriting exercise executed as a schoolboy that is used on the novel’s cover. Patrick survived the boarding school and later became tribal chairman of the Turtle Mountain Band of Chippewa Indians in North Dakota, of which Erdrich is a registered member (Kirch 87).22 Documenting the boarding school experiences of women carrying the name LaRose, Erdrich continues the theme of how tuberculosis becomes a bodily inscription of the settler colonial state’s biopolitical practices. In its emphasis on the physical suffering of Indigenous bodies and their desperate efforts to fight tuberculosis and live, LaRose mirrors Madonna Swan’s dedication to creating a critical space in which empowering narratives of Indigenous survival emerge. The two texts are similar in their emphasis on survivance in the face of the grim reality of a health crisis that, according of the logic of biopolitical practices, is not properly addressed to prevent population loss. Moreover, I  argue that, through the story of the first LaRose, whose remains are stolen by scientists, Erdrich insists on the importance of the biomedical components of the settler colonial project. While Native cultures are to be eliminated, Indigenous bodies (and their remains) become objectified as artifacts and medical exhibits that on the one hand authenticate the triumphant narrative of civilizational progress and racial superiority and, on the other hand, fulfill the fantasy of aboriginal American identity. Erdrich’s investigations into the interconnections between the establishment of boarding schools and the spread of tuberculosis demonstrate how Indigenous bodies are important targets of colonial activities in the same manner that Native epistemologies and ontologies are rendered incompatible with the

Tuberculosis, biopower, embodied resistance  73 American narrative of national belonging. Commenting on the continued relevance of these concerns, Erdrich alludes to the Native American Grave Protection and Repatriation Act (NAGPRA), passed in 1990, and the fact that it is continually challenged by the scientific establishment, thus demonstrating the prevailing dominance of biopolitical thinking and the unwavering significance of biocolonialism23 as a form of racial, cultural, and economic subjugation.

Tuberculosis in boarding schools LaRose was not the first novel in which Erdrich engaged with the history of Indian boarding schools. Love Medicine (1984), Tracks (1988), The Last Report on the Miracles at Little No Horse (2001), Four Souls (2004), The Painted Drum (2006), The Plague of Doves (2008), and The Round House (2012) all deal with boarding school characters and themes. Interestingly, throughout her career, Erdrich consistently complicates the narrative of Indian education during the assimilationist era. Considering the findings of the Meriam Report, it is only natural to imagine boarding schools as an oppressive site of violent assimilationist efforts. Erdrich is, however, well aware of the complex factors and conditions that created Indigenous students’ responses to the schools they attended. As Miriam Schacht demonstrates, Erdrich does not shy away from unexpected and controversial portrayals in which “boarding schools … function as safe havens for children who face uncertain situations at home … [and extend beyond] their historical role in breaking up Native communities” (63).24 Indeed, many scholars in the field emphasize this more complex context, drawing attention to how schools created new kinship structures, shaped students’ interactions, and united them in subversive practices.25 For instance, K. Tsianina Lomawaima (Mvskoke / Creek) observes that policy makers did not foresee that by placing children from a variety of cultural groups together pan-​Indian identity would be reinforced, which emerged as an important cohesive concept (They 129). Economic factors also played a role in assessing Indigenous parents’ decisions to send their children to off-​reservation schools. As Brenda Child observes, Hundreds of Indian families across the United States sought out boarding schools for their children as a strategy of family preservation rather than a commitment to assimilation principles, making the 1930s the decade of highest student population in the once detested Indian schools. (My Grandfather’s 176) In LaRose, when in 1967, Romeo Puyat is sent to a boarding school, it is a life-​ saving solution that provides the boy with a stable environment. Abandoned by his parents, “burned, bruised, starved, thought mentally deficient” (Erdrich 156), Romeo turns out to be one of the smartest students and develops meaningful relationships with teachers and fellow-​students.

74 Tuberculosis Undeniably, to accurately assess the impacts of boarding school system more factors need to be considered than merely its assimilationist agenda. In LaRose, Erdrich makes two central claims about the institution of boarding schools. First, the federal project’s ideological underpinnings often outweighed seemingly obvious educational purposes. Second, boarding schools played a part in spreading TB, which reveals their active involvement in the logic of Foucauldian biopower. Indeed, to document the rhetoric of nineteenth-​century racism, LaRose Peace, the grandmother of the boy LaRose, preserves paper clippings from The Aberdeen Saturday Pioneer in which Frank Baum, mostly known to the world as the author of Wizard of Oz, published his infamous editorials in 1888 and 1891: The Whites by law of conquest, by justice of civilization, are Masters of the American continent, and the best safety of the frontier settlements will be secured by the total annihilation of the few remaining Indians. … Having wronged them for centuries we had better, in order to protect our civilization, follow it up be one more wrong and wipe these untamed and untamable creatures from the face of earth. (Erdrich  70–​1) The second LaRose is recruited by none other than Richard H. Pratt to his new school in Carlisle, where he will be “immersing the Indians in our civilization and … holding them there until they are thoroughly soaked” (199; emphasis in original). All LaRoses will remember the military regime: days punctuated by the sound of bells,26 hard work, and the omnipresence of death: children dying from tuberculosis, or sent home to die there. The interrelation of boarding schools and biopower becomes apparent when their curriculum is read against Indigenous land-​based epistemologies. The teachings given to the second LaRose by her mother reflect the interdependence of all living and nonliving creatures which is the basis of harmonious life and survival. In a lengthy section tellingly titled “What She Learnt,” using a discourse of compulsive enumeration, Erdrich juxtaposes two kinds of education the second LaRose received from her mother and at school: Before the first LaRose died, she had taught her daughter how to find guardian spirits in each place they walked, how to heal people with songs, with plants, what lichens to eat in an extremity of hunger, how to set snares, jig fish, tie nets, net fish, create fire out of stick and curls of birchbark pots. … How to carve a pipe bowl, burn the center of a sumac branch for the stem, how to make tobacco, make pemmican, how to harvest wild rice, dance, winnow, parch, and store it, and make tobacco for your pipe. She taught her how to make mittens, leggings, makazinan, a dress, a drum, a coat, a carry sack from the stomach of an elk, a caribou, a woods buffalo. (198–​9)

Tuberculosis, biopower, embodied resistance  75 She learned American history and the levels of civilization ancient to modern, which culminated in men like Captain Richard Pratt. She learned how to survive on bread and water, then coffee, gravy, and bread… She learned how to sew with a machine. How to imagine her own mouth sewed shut. For speaking Anishinaabe. She learned how to endure being beaten with a board. How to eat with a fork, a spoon, how to lard bread correctly with a knife, how to grow vegetables, how to steal them… She learned to stink, learned to itch, learned to boil her underwear for lice and wash only once a week, once every two weeks, three. … She learned how to watch her friends die quickly from measles or choking from pneumonia or shrieking from the agony of encephalitic meningitis. (200–​1) The incongruity of the two educational projects is enormous. It quickly becomes apparent that Indigenous teachings, land-​ based, relevant, and related to the space from which they emerge, constitute a summary of a lifeworld, an epistemology manifested in how people live. As many Indian people argue, “education, schooling, and the pursuit of knowledge have always been part of their lives and cultures” (Trafzer et al. 5). Carlisle’s education, on the other hand, since it does not emanate from spatial epistemology but from a desire to conquer Indigenous lands, consists of skills needed to produce obedient workers unable to challenge land theft. Moreover, the Carlisle example illustrates how an ideological agenda distorts an understanding of what constitutes education. Like Indian sanatoria where patients are not cured, boarding schools do not provide practical education needed to survive outside of the school economy. Upon returning home, students often discover there are few employment opportunities for farmers, shoemakers, harness makers, or for printers; ideals of American domesticity, so diligently taught to Indian girls, find little application outside of the school context. The skills of domestic servants, essential to ensure the operation of constantly underfunded schools, are of little use on reservations (Lomawaima, They 99; Lomawaima and McCarty 50–​ 1). As Nez Perce scholar and writer Beth Piatote succinctly points out, “Federal vocational and domestic education for Indian women was an exercise in power, a reconstruction of her very body, appearance, manners, skills, and habits. Federal educators hoped to manufacture civilized and obedient souls in civilized and obedient bodies” (Domestic 7). Erdrich is also acutely aware how the education system inscribes its practices on Indigenous bodies. The civilizing mission entails not only molding Indian minds but also their bodies. The transition from reservation world to the school’s military regime occurs immediately upon arrival and astonishes with the intensity of its zeal to eradicate all things Indian: Children are stripped of their clothes and issued institutional uniforms. Next, their Indian names, “a highly visible symbol of tribal identity within the boarding

76 Tuberculosis school confine” (Child, Boarding 29), are substituted with American ones.27 In perhaps the most ideologically powerful gesture of cultural genocide, children’s hair is shaved to sever their connection to tribal identities. In LaRose, Mrs. Peace remembers her arrival at Fort Totem, North Dakota: There were hundreds of children from all over as far as Fort Berthold, so hundreds and hundreds of those first years. Where did the braids go? Into our mattresses? We slept on our hair, you think? Or if they burned our hair you would remember the smell. (Erdrich 70) By invoking the image of the Nazi concentration camps, the third LaRose captures the mass-​scale of cultural and bodily violence whose aim was the visible and thus unchallenged transformation/​ advancement from savages to (second-​class) American citizens. Captain Richard Pratt quickly comprehended the impact of providing a visual illustration of his educational attempts and the attractions of the new medium of photography. “Before/​ after” photographs, representing students shortly after arrival, still in reservation clothes, and then in a school uniform and with cropped hair, were used as promotional materials to authenticate and popularize the assimilationist project, and attract potential benefactors (Adams, Education 47). In highly controlled settings and poses, Indigenous bodies served as illustrations that, with properly funneled efforts, Indians “could become human” (70). More importantly, however, what I  argue constitutes an important element of tracing biopower in settler colonialism is how Erdrich deliberately underscores the connection between the spread of the tuberculosis epidemic and boarding schools. As demonstrated in the previous chapter, achieving high enrollment levels was often prioritized over students’ health. Moreover, in representing mycobacteria as parasites feeding on animals and later humans that had existed on the American continent long before European settlement, Erdrich refutes racist theories of virgin soil and racial susceptibility.28 The poetic description of the ancient being presents it as living next to other organisms and frequently unsuccessful in its power to infect. “It was ancient and had risen from the boiling earth,” we learn from the omniscient narrator: It had slept, falling dormant in the dust, rising in mist. Tuberculosis had flown in a dizzy rush to unite with warm life. It was in each new world, and every old world. First it loved animals, then it loved people too. Sometimes it landed in a jailhouse of human tissue, walled off from the nourishing fronds of the body. Sometimes it bolted, ran free, tunneled through bones, or elaborated lungs into fancy lace. Sometimes it could go anywhere. Sometimes it came to nothing. (Erdrich 187)

Tuberculosis, biopower, embodied resistance  77 Emphasizing Mycobacterium tuberculosis’s spread through multiple sources and venues of development, Erdrich refutes arguments that it originated in Europe and the resultant theories of Native American susceptibility to tuberculosis. However, if colonizers were not responsible for bringing the pathogen to America, they did create conditions in which the bacteria thrived and its spread reached epidemic promotions: One night after prayer at the mission school, where the first LaRose, the Flower, slept with other girls in rows, in a room coldly bitter except of breath, tuberculosis flew suddenly from between a thin girl’s parted lips. In the icy wind that creaked through a bent window sash it drifted over Alice Anakward. Hovered over her sister Mary. It dipped and spun toward the sloping bump of LaRose under a woolen blanket, but the current of air dropped it suddenly. The old being perished on the iron railing of her bed. Then a sister being tumbled explosively forward in a droplet of Alice’s cough, vaulted over the railing of LaRose’s bed, swooned downward in the intake of her breath. (Erdrich 187) Crowded in poorly heated and ventilated bedrooms, malnourished and overworked children easily contracted tuberculosis and kept reinfecting one another. On returning home, many of them infected their family members and relatives. Indeed, this is the story of the first LaRose. A survivor of colonial violence, the first LaRose is recruited by a family of Presbyterian missionaries to a boarding school in Michigan. It is at the school where tuberculosis, “the ancient one,” secures its grip on her body and the bodies of her descendants. When LaRose returns from the school and marries Wolfred Roberts, a shop clerk, her routine life, punctuated by child births, and moments of happiness, is controlled by the whims of the disease, the moments of its latency, and exacerbation. However, LaRose’s body learns to contain the disease and to fiercely fight it while oscillating between states of well-​being and deterioration. The anthropomorphized bacteria emerge as a worthy opponent in the fight over LaRose’s life: Then one spring day she collapsed again, spilling a bucket of cold water, and lay wet in the cold grass, wracked, furious, foaming bright arterial blood. Yet again, though, she recovered, grew strong. She fooled the ancient being and wrested from it ten more years. Finally, in its ecstasy to live, the being seized her. It sank hot iron knives into her bones. (192) Like Madonna, LaRose fights tuberculosis, just as she fights all settler-​state acculturation efforts. She teaches her children Ojibwe, and passes on knowledge about medicinal plants, and how to bead and tell stories. LaRose’s striving for physical survival thus mirrors her efforts to protect Ojibwe culture.

78 Tuberculosis By portraying four successive LaRoses suffering from tuberculosis, Erdrich pointedly demonstrates the scope of the TB epidemic, the reluctance to contain it, and embodied resistance to settler colonial practices. In the narration of tuberculosis in the Ojibwe community, rather than relying on the language of statistical data, Erdrich evokes the disease’s emotional toll:  tuberculosis “was a disease of infinite cruelty that made a mother pass it to her children before she died” (72). When Mrs. LaRose Peace, Emmaline’s mother, looks at a group photograph from her boarding school, “Rows and rows of children in stiff clothing … before a large brick building” (70), what we see are “rows and rows of children” already or soon to be infected by tuberculosis, later carrying the disease home and infecting others. In view of the systemic negligence of Indian health, the photograph is a blatant illustration of the settler state’s biopolitical practices. On the other hand, the line of LaRoses demonstrates how life continued despite the disease: [The second] LaRose got tuberculosis like her own mother, and like the first LaRose fought it off again and again. Lived long enough to become the mother of the third LaRose, who … bore the fourth LaRose… The fourth LaRose also became the grandmother of the last LaRose. (290) Erdrich reveals how tuberculosis becomes normalized in Indigenous communities in the same way as it is normalized in Madonna’s story.29 The most palpable manifestation of this process in the novel is the description of the Iron family’s house: Landreaux and Emmaline’s house contained the original cabin from 1846, built in desperation as snow fell on their ancestors. … The entire first family –​babies, mothers, uncles, children, aunts, grandparents –​had passed around tuberculosis, diphtheria, sorrow, endless tea, hilarious and sacred, dirty, magical stories. They had lived and died in what was now the living room, and there has always been a LaRose. (86–​7) That “passing tuberculosis” is mentioned alongside “passing tea and hilarious stories” and the old structure of the house is contained within the new one illustrates how Native people struggled with tuberculosis for generations and yet managed to survive, both physically and culturally. By normalization strategies, I do not intend to downplay the severity of the tuberculosis epidemic in Native American communities. Rather, my intention is to draw attention to their determination to thrive, physically and culturally, despite the scourge of the disease, which is best expressed in the fact that the story of tuberculosis in the original LaRose’s family finally ends on a triumphant note: Mrs. Peace will not die of TB. In 1952, she was admitted to a sanatorium and successfully treated with isoniazid. Unlike Madonna, who experienced the horror of

Tuberculosis, biopower, embodied resistance  79 both boarding school and Indian sanatorium, Mrs. Peace is saved by the most recent medical inventions which “astonishingly cured the incurable” (Erdrich 72). Thus, belief that there will be no Indian tuberculosis survivors is disrupted.

“We rifle their graves, measure their skulls, and analyze their bones” The interconnections between settler colonialism, biopower, and more recently biomedicalization become apparent in the motif of the first LaRose and her death from tuberculosis. When her condition deteriorates, Wolfred, in a desperate effort to prolong her life, takes her to St. Paul, where Dr. Haniford Ames offers innovative cave treatment for tuberculosis. The figure of Dr. Ames is inspired by John Croghan (1790–​1849), physician and entrepreneur, who attempted to profit from research into innovative TB treatment. The reference to Croghan calls up a long and frustrating history of ineffective preantibiotics tuberculosis treatment, its limited availability to Native patients, and the commercialization of medical products and services (Ott 87–​99). More importantly, however, LaRose’s death and the theft of her body hint at a history of medicine’s involvement in the settler state’s genocidal practices conducted in the name of pursuit of scientific knowledge. That the justifications used in this fictional mid-​nineteenth-​century scenario are eerily similar to those used today demonstrate the power-​related nature of the rhetoric used to defend the study of Indigenous human remains as scientific data. The innovative treatment Wolfred believes will help LaRose is based on the idea that “The purity and mineral health of the air in caves was curative” (193). In 1839, Croghan acquired 2000 acres of the Green River area where the Mammoth Cave was located and quickly realized the entrepreneurial potential of the site (Parke 232–​3). In a letter to Victor Gifford Audubon from 1841, he shares the idea of advertising life in the cave as a cure for “pulmonary affections, chronic rheumatism, … [and] any chronic complaint” (qtd. in Thomas et al. 329; emphasis in original). The first tuberculous patient to live in the cave was William J. Mitchell of Glasgow, Kentucky in 1842. Despite feeling “very much relieved,” he died the following winter. The next participant in the experiment, J. W. Harper of South Carolina, never left the cave and was buried in a cemetery close to it (Thomas et al. 333). Soon, it became clear that staying in the cave harmed rather than cured tuberculosis victims. Unperturbed, Croghan moved on to transform Mammoth Cave into a tourist attraction. In this, he was more successful,30 however, the irony remains that he died of tuberculosis in 1849. The fictional Dr. Haniford Ames does not want to let LaRose undergo his experimental treatment. Following the beliefs of his contemporaries about Indian susceptibility to tuberculosis, he is “certain she could not be cured” (Erdrich 193). However, Wolfred insists and hands over all their savings. Ames is intrigued by LaRose who reminds him of his sister, also a tuberculosis victim, and so he becomes dedicated to her case. Various therapies –​ laudanum, artificial pneumothorax, and a diet of fish in cream sauce –​seem

80 Tuberculosis to bring positive results but LaRose dies in her cave room. When Wolfred arrives, he cannot retrieve her body, which is claimed by Ames as a research object. Wolfred returns home devastated, repeating a confusing message to his children: “Stolen. Your mother was stolen” (197). For over a century, consequently, Wolfred and then the next LaRoses, write letters to demand the return of LaRose’s remains. The collection of copies of letters sent and replies received forms an archive of the settler-​state’s continued denial of tribal rights to decide about their dead and the same state’s consistent use of arguments defending the tremendous value of “objective” scientific research: Letters from Dr.  Ames politely refusing Wolfred’s requests attested to the value of her body in the name of science. Her bones demonstrated the unique susceptibility of Indians to this disease, and also how long she’d fought it. Over and over, her body had walled off and contained the disease. She had been, said the doctor, a remarkable specimen of humanity. (206) Ames’s argument aptly illustrates what Clayton Dumont demonstrates in relation to contemporary resistance to the repatriation of Native remains under NAGPRA:  “Scientific claims are made in the pursuit of what is ‘truthful,’ ‘objective,’ and thus extrapolitical. … Scientific epistemology is often taken to be the only legitimate method of understanding” (109, 110; emphasis in original). That theories of racial susceptibility to tuberculosis were finally refuted in the first half of the twentieth century as having no scientific grounds only illustrates the highly unstable and politicized nature of what is presented as “objective science.” Once Dr. Ames completes his research, he “take[s]‌LaRose on the road as an illustration for his scientific lectures on the progress of tuberculosis” (Erdrich 206). Even though the consulted lawyer claims that Ames has no right to use the remains as an exhibit, LaRose is not returned to her family. Instead, “her chipped incisor, fractured and knit skull, injuries from the vicious kick of a dissolute fur trader, as well as her tubercular bones” (206) are moved from one institution to another, from a display to a drawer next to the bones of other Indians  –​some taken from burial scaffolds, some dug out of burial mounds, some turned up when fields were plowed, highways constructed, the foundations of houses or banks or hospitals or hotels and swimming pools dug and built. (206) The argument against the return is always the same: “The historical society refused to return the bones because, wrote the president, the bones of Wolfred’s wife were an important part of the history of Ames County” (206).

Tuberculosis, biopower, embodied resistance  81 The story of the first LaRose allows Erdrich to illustrate the persistence of scientific arguments against repatriation of Indigenous remains and how tribal rights under NAGPRA are consistently challenged. Though many criticized it for inadequately representing Indigenous worldviews and failing to address the entire complexity of the problem,31 NAGPRA was the result of a long-​term struggle to protect sacred and burial sites and to repatriate human remains, funerary, and sacred objects.32 The importance of the act can only be illustrated by the fact that when inventories were prepared to assess the scope of its application, there were more than 180,000 human remains in the possession of museums and federal agencies, with an additional 18,000 in the Smithsonian Institution alone (Trope 21). Moreover, as Erdrich makes clear, it is important to consider the origins of these inventoried collections. While the rationale behind their creation was (pseudo)scientific, a large part constitutes what Dumont calls “the morbid spoils of war” (“The Politics” 112). In 1868, when the Army Medical Museum was being developed, the Surgeon General of the United States, at the urging of Dr. Samuel Morton, author of Crania Americana (1839), ordered troops to help commence a craniological collection (Trope 22). Thus, as Dumont writes, “This beheading of dead warriors as they lay on battlefields and the robbing of surrounding Indian cemeteries was justified as ‘aid in the progress of anthropological science’ ” (“The Politics” 112). The enthusiasm for collecting Indian remains and sacred objects only intensified, which is well demonstrated in Daniel Brinton’s 1895 presidential address to the American Association for the Advancement of Science: The generations of the past escape … personal investigation, but not our pursuit. We rifle their graves, measure their skulls, and analyze their bones; we carry to our museums the utensils and weapons, the gods and jewels, which sad and loving hands laid beside them; we dig up the foundations of their houses and cart off the monuments which their proud kings set up. Nothing is sacred to us; and yet nothing to us is vile or worthless. (qtd. in Pensley 42) When the novel opens, it is 1999 and the original LaRose’s remains have still not been returned. Three years earlier, in July 1996, the remains of a prehistoric man, later dubbed Kennewick Man, were discovered near Kennewick, Washington, and what ensued was a 20-​year-​long legal and ideological dispute over the scope of NAGPRA provisions and the question of who wields the power over determining Native ancestry. Even though the dispute ended with the repatriation and reburial of the remains, it was only possible when Native ancestry was proved with genetic testing.33 This and other examples illustrate the tenacity of the belief in science done in the name of all humanity, with “all humanity” consistently defined in a manner which excludes non-​Western epistemologies.

82 Tuberculosis

Practicing embodied resistance Madonna Swan and LaRose draw attention to similar processes of resistance to settler colonialism and the use of biopower in colonialist projects. Both consciously engage with a long history of Indian boarding schools and sanatoria and their role in creating a tuberculosis epidemic on reservations. Specifically, they illustrate how the tuberculosis epidemic did not unfold in a solely biomedical context; rather, it was artificially produced or at least facilitated through consistent decisions to neglect Indian health as documented in the Meriam Report. Both emphasize the corporeal dimension of settler colonialism and its biopolitical insistence of rewriting Indigenous bodies so that they become easily managed by and absorbed into the main national body. Finally, both texts consciously address questions about optimizing techniques of resistance to such practices and the identification of the most productive spaces for their realization. In Madonna Swan’s narrative and Erdrich’s novel, tuberculosis is evoked not only on a macroscale as a synonym of demographic annihilation, but also as a condition that causes real, physical suffering to the individual body. The disease becomes inscribed on Indigenous bodies as an act of colonization and domination: an ideological repossession, first of lands, then of bodies. However, both writers choose to read the fight against tuberculosis as a gesture of decolonization. Hence, an urge to live, to survive, to bear children becomes an idiom of personal and cultural survival and constitutes a blow to biopolitical projects of population control. The survival of Indigenous bodies and the deconstruction of institutions implicated in the spread of the epidemic (boarding schools and sanatoria) are empowering examples of embodied resistance. Finally, both Madonna Swan and LaRose address the important theme of the Indigenous body as an object of research and fascination. In the texts, tuberculosis is used as a rationale for medical research and for the longevity of the construction of science as an objective and apolitical methodology in providing justification to ethically dubious practices. The motif of Madonna’s surgery, while indirectly leading to recovery from tuberculosis, raises questions about informed consent in medical research and the ethics of vulnerable groups participating in such projects.34 Similarly, the story of the original LaRose’s remains illustrates the relevance of the problem to challenges to NAGPRA, the use of genetic research to validate antirepartition claims, and other contemporary forms of biocolonialism which will be further explored in the following chapters.

Notes 1 On Native American autobiography, see Laura J.  Beard, “Teaching Native Autobiographies as Acts of Narrative Resistance,” Pedagogy, vol. 11 no. 1, 2011, pp. 109–​34; William Bloodworth, “Varieties of American Indian Autobiography,” MELUS, vol. 5, no.  3, 1978, pp.  67–​81; J.  Browdy de Hernandez, “Writing (for)

Tuberculosis, biopower, embodied resistance  83 Survival:  Continuity and Change in Four Contemporary Native American Women’s Autobiographies” Wicazo Sa Review, vol. 10, no.  2, 1994, pp.  40–​62; Margaret M.  Bruchac, et  al., Savage Kin:  Indigenous Informants and American Anthropologists (Tucson:  University of Arizona Press, 2018); H.  David Brumble III, American Indian Autobiography (Berkeley, CA: University of California Press, 1988); Arnold Krupat, For Those Who Come After:  A Study of Native American Autobiography (Berkeley, CA: California University Press, 1985); Arnold Krupat, “The Indian Autobiography:  Origins, Type, and Function,” American Literature, vol. 53, no. 1, 1981, pp. 22–​42; Mick McAllister, “Native Sources: American Indian Autobiography,” Western American Literature, vol. 32, no.  1, 1997, pp.  3–​ 23; Theodore Rios and Kathleen Mullen Sands, Telling a Good One: The Process of a Native American Collaborative Biography (Lincoln: University of Nebraska Press, 2000); Kathleen Mullen Sands, “Collaboration or Colonialism:  Text and Process in Native American Women’s Autobiographies,” MELUS, vol. 22, no.  4, 1997, pp.  39–​59; Sarah E.  Turner, “ ‘Spider Woman’s Granddaughter’:  Autobiographic al Writings by Native American Women,” MELUS, vol. 22, no. 4, 1997, pp. 109–​ 32; Tish Eshelle Twomey, “More Than One Way to Tell a Story:  Rethinking the Place of Genre in Native American Autobiography and the Personal Essay” Studies in American Indian Literatures, vol. 19, no.  2, 2007, pp.  22–​51; Edward Charles Valandra, “The As-​Told-​To Native [Auto]biography: Whose Voice Is Speaking?,” Wicazo Sa Review, vol. 20, no. 2, 2005, pp. 103–​19; Mark Wallace, “Black Hawk’s ‘An Autobiography’:  The Production and Use of an ‘Indian’ Voice,” American Indian Quarterly, vol. 18, no.  4, 1994, pp.  481–​94; Hertha Dawn Wong, “Native American Life Writing,” The Cambridge Companion to Native American Literature, edited by Joy Porter and Kenneth M. Roemer (Cambridge: Cambridge University Press, 2005, pp.  125–​44); Hertha Dawn Wong, Sending My Heart Back Across the Years:  Tradition and Innovation in Native Autobiography (New  York:  Oxford University Press, 1992). 2 Swan also discusses the importance of kinship in healing practices. As Richard Voss et al. observe, “Family members actively participate in a ceremonial life which revolves around the wo’ope or ‘natural law of creation’ which includes the behaviors and attitudes for right living” (80). For more on traditional medicine men see Vine Deloria Jr., The World We Used to Live In: Remembering the Powers of the Medicine Men (Golden: Fulcrum Publishing, 2006). 3 While students did indeed often conceal symptoms such as chest pains and the nuns did not have medical training, the number of hemorrhages at Immaculate Conception was quite substantial and difficult to dismiss as diagnostically insignificant. In the 1940s, the scale of the TB epidemic among Native Americans was known to the public so the sisters’ ignorance of the symptoms seemed grossly problematic. 4 In his study conducted on Pine Ridge Reservation in the 1960s, Thomas Lewis observed that “In the opinion of some Lakota patients and their families, this infectious disorder [TB] was evidence of a shameful character defect, a deliberate personal failure to carry out responsibilities, an unwillingness to support one’s children and to meet family obligations. Individual patients were shamed and hectored in the community” (157). 5 What comes to mind in this context is Esmond Long’s suggestion from 1935 that, to better control TB cases on Navajo reservation, those Navajos who had been tested for TB be tattooed (McMillen, “The Red” 634).

84 Tuberculosis 6 The way Orby’s body is described effectively illustrates Julia Kristeva’s use of the term abject. In The Powers of Horrors, she defines abjection as both a state and a process, the condition/​position of being deemed loathsome, repulsive, and the very process of such an evaluation (2). 7 See endnote 22 in Chapter 1. 8 On how colonists used sexual violence as a tool of genocide, see Andrea Smith, Conquest:  Sexual Violence and American Indian Genocide, (Cambridge, MA: South End Press, 2005); on how colonists believed that syphilis originated in the Americas and how Samson Occom (Mohegan) refigured such narratives see Kelly Wisecup, Medical Encounters: Knowledge and Identity in Early American Literatures, (Amherst: University of Massachusetts Press, 2013). 9 See Michel Foucault, The History of Sexuality. Volume I:  An Introduction, translated by Robert Hurley, (New York: Pantheon Books 1978) and “Society Must Be Defended”: Lectures at the Collège de France, 1975–​76, edited by Mauro Bertani and Alessandro Fontana, translated by David Macey, (New York: Picador, 2003). 10 As Diedrich rightly points out, this tactic of letting certain populations die, preferably away from the general population, was applied in the early age of the AIDS epidemic (176–7n20). 11 The three most important legal cases that state that Indian tribes are not “foreign nations” but “domestic dependent nations” are Cherokee Nation v.  Georgia, 30 U.S. 1 (1831), U.S.  v.  Kagama, 118 U.S. 375 (1886), and Oliphant v.  Suquamish Indian Tribe, 435 U.S. 191 (1978). 12 The Indian Citizenship Act of 1924 established birthright citizenship for every Native American. Some tribes, for example, the Iroquois, refused to accept it, claiming that they already had citizenship in their own nations. Previously, access to citizenship was uneven and often tied to the Dawes Allotment Act, conversion to Christianity, and fluency in English (Piatote, “The Indian” 45). 13 In the endnote, St. Pierre quotes a telephone conversation with Anderson in which he admits that he had seen many cases when Native patients were refused admittance to hospitals and sanatoria for white patients, and that he was always willing to help fight racism in medical institutions (197n18). 14 Thoracoplasty and experiments conducted on Indigenous bodies to perfect the procedure are discussed in Chapter 1. 15 This statement about the novelty of the procedure seems problematic. In the USA, John Alexander described thoracoplasty as early as 1936. Perhaps Dr.  Meyers meant a refined form of the surgery, presented at a tuberculosis conference in New York which he was going to attend. See John Alexander, “Some Advances in the Technic of Thoracoplasty.” Annals of Surgery, vol. 104, no. 4, 1936, pp. 545–​ 51. Erling Refsum wrote about Alexander’s experiments with thoracoplasty from as early as 1925 (51). 16 See c­hapter  2 in Terri Kapsalis, Public Privates:  Performing Gynecology from Both Ends of the Speculum (Durham, NC: Duke University Press, 1997); Paul A.  Lombardo, and Gregory M Dorr, “Eugenics, Medical Education, and the Public Health Service: Another Perspective on the Tuskegee Syphilis Experiment,” Bulletin of the History of Medicine, vol. 80, no.  2, 2006, pp.  291–​316; Susan M.  Reverby, Examining Tuskegee:  The Infamous Syphilis Study and Its Legacy (Chapel Hill: The University of North Carolina Press, 2013); Todd Tucker, The Great Starvation Experiment:  Ancel Keys and the Men Who Starved for Science (Minneapolis: University of Minnesota Press, 2007); and Harriet A. Washington,

Tuberculosis, biopower, embodied resistance  85 Medical Apartheid:  The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York: Doubleday, 2006). 17 The same logic was applied in justifying genomic research with Indigenous communities. The topic is discussed at length in Chapter 5. 18 See for example, Barbara Gurr, Reproductive Justice: The Politics of Health Care for Native American Women (New Brunswick: Rutgers University Press, 2014), Rebecca M.  Kluchin, Fit to Be Tied:  Sterilization and Reproductive Rights in America, 1950–​1980 (New Brunswick Rutgers University Press, 2009); Marie Ralston-​Lewis, “The Continuing Struggle against Genocide: Indigenous Women’s Reproductive Rights,” Wicazo Sa Review, vol. 20, no. 1, Spring 2005, pp. 71–​95, Philip Reilly, The Surgical Solution: A History of Involuntary Sterilization in the United States (Baltimore: Johns Hopkins University Press, 1991); Andrea Smith, “Better Dead than Pregnant: The Colonization of Native Women’s Reproductive Health,” Policing the National Body:  Race, Gender, and Criminalization, edited by Jael Silliman and Anannya Bhattacharjee (Boston: South End Press, 2002), pp. 123–​46; Sally J. Torpy, “Native American Women and Coerced Sterilization: On the Trail of Tears in the 1970s,” American Indian Culture and Research Journal, vol. 24, no. 2, 2000, pp. 1–​22. For sterilization of women in Canada, see Karen Stote, An Act of Genocide: Colonialism and the Sterilization of Aboriginal Women, (Halifax and Winnipeg: Fernwood Publishing, 2015). 19 Madonna’s story concerns the Cattle Rehabilitation Program, sponsored by the BIA and introduced during the early part of Frank Ducheneaux’s 30-​year term as a chairman. Ducheneaux is said to have been a controversial figure, admired by some for his innovative ideas and accused by others of a tyrannical approach to tribal administration (St. Pierre 199n7, 9). 20 A critique of American law as responsible for the erosion of Indigenous sovereignty and the perpetuation of violence against Indigenous women is the topic of Erdrich’s excellent The Round House (2012). The novel won the National Book Award. 21 For more recent criticism on Erdrich, see for example, Jacob Bender and Lydia Maunz-​Breese, “Louise Erdrich’s The Round House, the Wiindigoo, and Star Trek: The Next Generation,” The American Indian Quarterly, vol. 42 no. 2, 2018, pp. 141–​61; Mary Paniccia Carden, “ ‘The Unkillable Mother’: Sovereignty and Survivance in Louise Erdrich’s The Round House,” Studies in American Indian Literatures, vol. 30 no.  1, 2018, pp.  94–​116; Seema Kurup, “From Revenge to Restorative Justice in Louise Erdrich’s The Plague of Doves, The Round House, and LaRose,” American Revenge Narratives:  A Collection of Critical Essays, edited by Kyle Wiggins, (New York: Palgrave Macmillan, 2018), pp.  99–​117; Seema Kurup and Linda Wagner-​Martin, editors, Understanding Louise Erdrich, (Columbia: University of South Carolina Press, 2015), Sarah Parker and Wilson Kaiser, “Native American Literature and L’Écriture Féminine: The Case of Louise Erdrich,” Tulsa Studies in Women’s Literature, vol. 36 no.  1, 2017, pp.  151–​73; David Stirrup, Louise Erdrich, (Manchester: Manchester University Press, 2010); and Cynthia R.  Wallace, “A Cloud of Unknowing:  Agonistic Anticolonial Ethics in Louise Erdrich’s The Last Report on the Miracles at Little No Horse,” Contemporary Literature, vol. 59 no. 4, 2018, pp. 447–​79. 22 LaRose’s cover with Patrick Gourneau’s handwriting was designed by Erdrich’s daughter, Aza Erdrich, an accomplished artist and graphic designer. To see Aza Erdrich Abe’s works go to “Aza Erdich Abe,” http://​azaerdrich.com/​about-​ba.

86 Tuberculosis 23 Genetic research as a form of biocolonialism is discussed at length in Chapter 5. 24 Schacht is correct to point out that while Erdrich is not expected to provide a comprehensive summary of boarding schools history, it is important to provide wider context, especially in class environment (63). Like Erdrich, K.  Tsianina Lomawaima and Jeffrey Ostler complicate the reading of the boarding schools era and provide a more nuanced portrayal of Captain Richard Pratt. See K. Tsianina Lomawaima and Jeffrey Ostler, “Reconsidering Richard Henry Pratt:  Cultural Genocide and Native Liberation in an Era of Racial Oppression,” Journal of American Indian Education, vol. 57, no. 1, 2018, pp. 79–​100. 25 For more, see David Wallace Adams, “Beyond Bleakness:  The Brighter Side of Indian Boarding Schools, 1870–​ 1940,” Boarding School Blues:  Revisiting American Indian Educational Experiences, edited by Clifford E.  Trafzer, et  al., (Lincoln:  University of Nebraska Press, 2006), pp.  35–​64; and Brenda J.  Child, “The Boarding School as Metaphor,” Journal of American Indian Education, vol. 57, no. 1, Spring 2018, pp. 37–​57. 26 In Education of Extinction, Adams says the overwhelming frequency of bell ringing is an example of “relentless regimentation” of time: “As every new recruit soon discovered, nearly every aspect of his day-​to-​day existence –​eating, sleeping, working, learning, praying  –​would be rigidly scheduled, the hours of the day intermittently punctuated by a seemingly endless number of bugles and bells demanding this or that response” (117). 27 For more on the politics of giving Indian students new names, see David Wallace Adams, Education for Extinction:  American Indians and the Boarding School Experience, 1875–​1928 (Lawrence: University Press of Kansas, 1995), pp. 100–​6. 28 The virgin soil theory blaming the TB epidemic among Native American on racial susceptibility to the disease is discussed in Chapter 1. 29 Note that this never occurs with TB patients of white middle-​class background. As Ott, Feldman, and Sontag demonstrate, for white middle-​class patients, having TB meant assuming a specific sick role, the identity of an invalid or a sanatorium patient, with all efforts of “managing” the disease situated at the very center of everyday activities. Obviously, Indigenous TB victims, like other economically disadvantaged groups, could not afford to assume this sick role. 30 There is an interesting racial subtext to Croghan’s success: transforming Mammoth Cave into a profit-​bringing tourist attraction was only possible thanks to extensive mapping of the cave, done by Stephen Bishop, African-​American slave acquired by Croghan together with the land. Bishop was fearless in his explorations and remembered as a charismatic guide. He and his family were emancipated after Croghan’s death (Hudson 94). 31 See Manley A.  Begay, Jr., “The Native American Graves Protection and Repatriation Act after Twenty Years:  A View from Indigenous Country,” 44 Arizona State Law Journal, vol. 625, 2012, pp. 625–​38; and D. S. Pensley, “The Native American Graves Protection and Repatriation Act (1990):  Where the Native Voice Is Missing,” Wicazo Sa Review, vol. 20 no. 2, 2005, pp. 37–​64. 32 See Sangita Chari, and Jaime M.  N. Lavallee, editors, Accomplishing NAGPRA: Perspectives on the Intent, Impact, and Future of the Native American Graves Protection and Repatriation Act, (Corvallis: Oregon State University Press, 2013); Edward D. Melillo, “Make No Bones about It: The Need to Reform the Native American Graves Protection and Repatriation Act,” Quinnipiac Probation Law Journal, vol. 30, no. 2, 2017, pp. 149–​64; and Jace Weaver, “Indian Presence

Tuberculosis, biopower, embodied resistance  87 with No Indians Present: NAGPRA and Its Discontents,” Wicazo Sa Review, vol. 12, no. 2, Autumn, 1997, pp. 13–​30. 33 See Heather Burke, Claire Smith, and et al., editors, Kennewick Man: Perspectives on the Ancient One (Walnut Creek, CA:  Left Coast Press, 2008); Katherine W.  Kirkpatrick, Mysterious Bones:  The Story of Kennewick Man (New York: Holiday House, 2011); Douglas Owsley and Richard L. Jantz, Kennewick Man: The Scientific Investigation of an Ancient American Skeleton (Texas A&M University Press, 2014); and David Hurst Thomas, Skull Wars: Kennewick Man, Archaeology, and the Battle for Native American Identity (New York: Basic Books, 2000). 34 Leslie P.  Francis defines “vulnerability” in the context of medical ethics as “a reduced ability” to protect oneself. Vulnerable groups include children, pregnant women, racial and ethnic minorities, people with disabilities or impaired cognition, the elderly, or people in poverty. Difficulties in protecting themselves stem from: (1) lack of decisional capacity (e.g., children), (2) lack of resources to obtain adequate health care (e.g., people in poverty), and (3) a history of past injustice (e.g., African Americans and Native Americans) (163).

Part II

Diabetes

3  Developing Indigenous models of diabetes From genetic fatalism to community-​ based approaches

In Global Report on Diabetes, published in 2016 by the World Health Organization, contributors assert that “Globally, an estimated 422  million adults were living with diabetes in 2014, compared to 108  million in 1980. The global prevalence (age-​standardized) of diabetes has nearly doubled since 1980, rising from 4.7% to 8.5% in the adult population” (World Health Organization). Similarly, alarming diabetes rates are recorded in Native American communities in the USA. According to the data published by the Office of Minority Health, a part of the US Department of Health and Human Services, American Indians and Alaska Natives are 2.4 times more likely than white adults to be diagnosed with diabetes and die from diabetes-​ related complications (“Diabetes”). For many Native people, a diabetes diagnosis is experienced as an inescapable destiny rather than a potentiality. Devon Mihesuah (Choctaw) dismally reports that “Indigenous Arizona students in [her] Northern Arizona University classroom [talk] about ‘when’ they develop type 2 diabetes, not ‘if,’ because every person in their family has the disease. They expect no other outcome than to become sick” (“Indigenous” 56). In this chapter, I  demonstrate the drawbacks of biomedical models of explaining diabetes in Native communities which extensively rely on insights from genetic research. The aim of such research is to identify genes responsible for developing the disease and indirectly implicate patients as responsible for their condition. Recent anthropological and psychological studies probing into the problem of diabetes prevalence among Native Americans consistently report how biomedical models fail to take into account other contributing factors such as cultural and historical contexts. In contrast to what allopathic medicine asserts, culturally oriented approaches represent diabetes as a phenomenon that preempts biomedical definitions and instead raises questions about physical and psychological consequences of ongoing colonialism in the USA. Moreover, the most effective technologies of treatment are drawn from Indigenous views on illness and healing. Such an approach invites a discussion of issues as diverse as the transgenerational trauma caused by off-​reservation boarding schools and a long history of settler colonialism in general; quality of health care offered to American Indian patients and health sovereignty; a need to adopt culturally sensitive healing and prevention strategies devised

92 Diabetes in cooperation with Indigenous communities; and the value of traditional knowledge about healing practices such as healing ceremonies, the importance of tribal healers and storytellers, as well as a return to traditional diets.

Diabetes and Native Americans What is diabetes and what makes it so difficult to control? According to the World Health Organization, diabetes is defined as a disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels. (“Diabetes. Fact sheet”) The scientific community recognizes three types of diabetes but it is Type 2, formerly called noninsulin-​dependent or adult-​onset, that is increasing worldwide and is responsible for most cases of blindness, kidney failure, heart attack, stroke, and lower limb amputations. In 2015 alone, an estimated 1.6  million deaths worldwide were directly caused by diabetes (“Diabetes. Fact sheet”). That diabetes strikes various ethnic populations differently was first discovered in the 1960s when the National Institute of Diabetes and Digestive and Kidney Diseases was conducting a survey on studies of rheumatoid arthritis among the Blackfeet of Montana and the Pima Indians of Arizona. It was revealed that the Pima population demonstrated unusually high rates of diabetes. What followed was a series of diabetes studies of the Pima people designed to locate a connection between susceptibility to the disease and genetic makeup. Later in the 1990s, the results of further epidemiological studies, community surveys, and the information collected in the data systems of the IHS, the Centers for Disease Control and Prevention (CDC), and the U.S. Renal Data System of the National Institutes of Health (NIH) clearly indicated that “the susceptibility to Type 2 diabetes presented marked differences according to ethnic groups” (Busatta 2) and that Native Americans and Alaska Natives appeared to be the most affected. Indeed, the data published by the American Diabetes Association speaks volumes about ethnic disparities in diabetes distribution. In 2015, it was estimated that the number of American adults diagnosed with diabetes reached 30.3  million or 9.4 percent of the US population whereas, the same indicator for Native American/​Alaska Native population was almost 16  percent (“Statistics”). The tribes that have the largest number of diagnosed patients are the Tohono O’odham population (almost 50 percent) and the Pima people (75 percent). In the Oklahoma Cherokee Nation, at least 66  percent of the people are

Developing Indigenous models of diabetes  93 overweight and obese and, thus, more likely to be diagnosed with diabetes in the future (Mihesuah, “Diabetes” 1).

Diabetes and the geneticization of Native Americans With the identification of Native Americans as one of the most severely affected populations, there followed a number of studies dedicated to the identification of a single gene or genes responsible for developing diabetes. The Pima people, as a relatively homogenous group inhabiting remote areas of southern Arizona, quickly became a popular object of study for epidemiologists, geneticists, and diabetes specialists (Smith et  al. 407). As Carolyn Smith-​Morris bitterly observes, “Pima Indians are better known around the world for their diabetes than for their culture and history” (34). Even though numerous studies aimed at locating diabetes genes failed to produce conclusive results, thus suggesting that diabetes etiology might be an immensely complex problem, in 1962, geneticist James Neel postulated a “thrifty genotype hypothesis” as an explanation for the increase of diabetes in modern society and in Indigenous populations in particular. Neel posits that some human groups evolved “thrifty genes” in order to maximize the use of calories and store them as fat, an extremely useful mechanism of survival in harsh environments with frequent periods of food scarcity. When humans with “thrifty” genes consume diets rich in fat and carbohydrates such as the modern Western diet, they are more likely to become obese and as a consequence develop Type 2 diabetes (Neel qtd. in Sahota 824). In other words, once a survival strategy, in modern times the thrifty gene “has now become maladaptive; that is, the ability to store fat has become a disadvantage with modern patterns of food consumption leading to diabetes” (Ferreira, “Slipping” 77). Neel’s hypothesis immediately captured imagination of scientists from various fields. Not only did it offer a plausible, as it then seemed, explanation of the diabetic epidemic, but it also established a connection between genetic and cultural factors in diabetes studies. While, as Steve Ferzacca observes, Neel’s reference to cultural contexts was not prominent in his article, other scientists overemphasized it and thus inadvertently “provided a framework for the establishment of … a set of interrelationships foundational to the biological, archaeological, and sociocultural anthropology” of diabetes (414). Such an approach situates diabetes in a wider context and analyzes it as a combination of genetic makeup and cultural change. For instance, Jennie Joe and Robert Young in their edited collection with the telling title, Diabetes as a Disease of Civilization, posit in their introduction that “diabetes is a new disease among Indian peoples and is the consequence of drastic lifestyle and cultural changes since World War II” (7–​8).1 Thus, Neel’s theory, originally concentrated on an identification of genetic factors in diabetes etiology, inadvertently suggested an importance of cultural and historical elements.

94 Diabetes While Neel’s hypothesis sparked research in sociocultural anthropology of diabetes, its insistence on a genetic factor or “ethnic heritage” also contributed to the geneticization of diabetes among Native Americans and, in extreme cases, the creation of discourses of “genetic fatalism.” Geneticization, as Yin Paradies and colleagues remind us, “is a process by which priority is given to differences between individuals based on their genetic distinctiveness” (206). It may manifest itself conceptually when using genetic terminology to define concepts relevant for scientific research; institutionally, when genetic expertise is endorsed as capable of dealing with medical and social problems; culturally, when genetic thinking leads to a change in social attitudes, and philosophically, when genetic imagery is used to define human identity and interrelations. In its most extreme forms, geneticization is transformed into “genetic fatalism” in which genetic makeup is seen as determining and unalterable (Paradies et  al. 206). As Paradies and colleagues rightly observe, “geneticization appeals to dominant ideas of individuality and related notions of personal responsibility for health. Through geneticization, the public health gaze is misfocused onto individual biophysical risk factors and away from social, environmental, and ecological factors” (206). Moreover, this direct association of individuals with potential diseases, identified in their genes, leads to redefining of the concept of personhood. Nikolas Rose writes about an emergence of a category of “genetically risky individuals” or persons “at genetic risk” whose career prospects and family life may be seriously affected by the knowledge acquired from genetic testing. While Rose does not agree with grim predictions about how genetic determinism may dominate social and political life, he nevertheless acknowledges the ways it reorganizes ideas about personal responsibility and agency (Rose 106–​30). Ironically, while the “thrifty genome” hypothesis has indeed dominated academic research on diabetes prevalence in Native Americans and Alaska Natives, its validity has never been proved. As scientists have been eagerly searching for a gene responsible for diabetes, their attempts have not produced satisfactory results. Diabetes eludes simple definitions and appears to evolve from a combination of biomedical and social factors. Moreover, as many scientists claim, through thorough analysis, Neel’s hypothesis itself appears to lack consistency. For instance, Yin Paradies and colleagues rightly point out that the identification of the thrifty gene with hunter-​gather populations who experienced periods of famine is not consistent with the findings concerning diabetes distribution in Indigenous communities. The Pima people, “the leitmotif ” of the thrifty genome hypothesis, had been involved in agriculture for over 2,000 years, which suggests that they did not experience prolonged phases of food shortage. On the other hand, some hunter-​gather societies rarely experienced feast-​and-​famine cycles. Even though Nauruans and other Pacific people enjoyed food abundance all-​year-​round, they now suffer from high rates of diabetes (211–​12).2 Moreover, Flavia Busatta draws attention to one of the most problematic aspects of the hypothesis:

Developing Indigenous models of diabetes  95 One of the major problems of thrifty genotype theory was that its “expression” manifested itself very quickly while it is known that genetic change is not a rapid process. The dramatic changes in lifestyle of the Pima, Nauruans and Aborigines in recent decades (the hypothesized environmental trigger of the thrifty genotype theory) were not sufficient to justify a genetic “change.” Moreover if a genetic cause is at work, then the prevalence in genetic groups should be relatively predictable. This is not the case. (122) Finally, in an article published in 1999, Neel himself retracted the ideas contained in his original hypothesis: [T]‌he results of the studies done in those groups [Native American groups] give no support to the notion that the high frequency of NIDDM [non-​ insulin dependent diabetes] in reservation Amerindians might be due simply to an ethnic predisposition –​rather, it must predominantly reflect lifestyle changes. (qtd. in Sahota 824) Nevertheless, despite its shortcomings, the hypothesis has taken a life of its own and as Paradies and colleagues rightly point out, “[T]‌he racialized TGH [thrifty genome hypothesis] … retains currency in popular scientific circles, as well as in fields as diverse as epidemiology, anthropology, psychology, and genetics” and it continues to be examined in a range of ongoing research on Indigenous people (211).

Your genes are not your destiny In research and popular discourses on diabetes among Native Americans, it is precisely this focus on ethnogenetic risk factors that has gained prominence over the years and produced serious social and psychological consequences. As Mariana Leal Ferreira explains, the very idea of “Indian heritage” being responsible for diabetes is emotionally and ideologically charged and negatively affects mechanisms responsible for positive self-​image, body-​imagery, and a sense of empowerment. That the concept of the thrifty gene has dominated popular vocabulary about diabetes in Indian Country and convincingly puts the blame on Indigenous patients is observable in numerous ethnographic and anthropological studies. In one of the interviews conducted by Leal Fereirra, a Yurok outreach worker at the US Indian Health Services in California states that “To say that I am Native American means I am or will be diabetic” (“Slipping” 77). Puneet Chawla Sahota analyzed perceptions of diabetes among Native Americans in a tribal community3 and concluded that the majority of respondents felt “embarrassed/​stigmatized,” “worrying about the future,” and “having a sense of self-​blame for diabetes and feeling

96 Diabetes hopeless,” all of which are best illustrated in statements such as diabetes is “our fault” and “we’re all destined to be diabetics” (828). Moreover, in the same study, she demonstrates how the thrifty genome hypothesis has penetrated the language of community members and negatively affected their self-​perceptions as “being genetically at risk,” thus doomed to become diabetic (830–​1). Similarly, in his study of the Pima people’s responses to diabetes prevalence, David Kozak talks about a transformation in the emotional and psychological approach to the condition which he calls “surrender.” “Surrender is an emotion,” Kozak writes, whereby individuals and a segment of a community feel unable to control what they perceive as an inevitable fact of life that lies outside of their direct influence. … [T]‌hey have created a hypothetical life history of themselves where they expect to be sickened by, and to die from, diabetes because the weight of day-​to-​day experience throughout their lifetime reveals this to be an appropriate and accurate assessment of reality. (349) Such discourse, a fine example of genetic fatalism and determinism, clearly erases historical and cultural contexts of diabetic prevalence in Indian communities and renders Indigenous diabetic patients as, first of all, responsible for their condition and, secondly, inactive and deprived of agency in the processes of diabetes treatment and prevention. The most serious harm associated with an uncritical and indiscriminate application of the thrifty gene hypothesis is downplaying the impact of historical and social factors contributing to high levels of diabetes in Indian Country. As Carolyn Smith-​Morris observes, Genetic contributions to modern rates of diabetes have been overemphasized in the past, contributing to a sense that this disease is inevitable in Native American populations. It is rarer to see political-​economic factors addressed, although it is possible for programs to deal with structural issues even if they cannot resolve them. (34) Situating diabetes in a historical context, Jo C. Scheder observes that diabetes and other chronic diseases are often called “diseases of civilization” but they should be referred to as diseases of colonialism –​and that’s a very big difference. We consider our world to be ‘post-​colonial’ –​a convenient but misleading label, marking a change in the official location of governance. Colonialism does not end with changes in government, however, and the residual effects on psyche and spirit do not evaporate/​dissipate with time. (“The Spirit’s” 338)

Developing Indigenous models of diabetes  97 As Mariana Leal Ferreira and Gretchen Chesley Lang observe, recently medical anthropologists, health professionals, activists, and Native community members have voiced a need for constructing a diabetes paradigm which relates this ailment to macrolevel politics and economics and describes it as “a psychological response to adverse, traumatic or stressful life experiences, rather than a disease in itself ” (“Introduction” 13). Indeed, numerous studies confirm a correlation between an experience of colonization and consequent stress associated with forced acculturation and chronic diseases such as diabetes. In her article on social inequality and migrant farmworkers, Scheder draws attention to the correlations between diabetes and prolonged stress caused by factors such as a loss of traditional lifestyles, cultural separation, anxiety, depression, and poor quality of life, all experienced by colonized and displaces people worldwide (“A Sickly” 282–​3). Likewise, Michael Marmot and Richard Wilkinson provide “good evidence” that the “disruptive effect of stressors, such as life events” or trauma exert a significant impact on “existing medical conditions, including diabetes and rheumatoid arthritis” (14). Moreover, Lisa Lefler and Roseanna Belt’s study on the Cherokee people’s responses to diabetes aptly illustrates how the situation of ongoing colonization contributes to the loss of well-being and development of chronic diseases. In the words of one community member: “It is very clear that when we start talking about the experiences of our ancestors, we can feel within our own bodies the pain of what happened many years ago as though we were there” (71). In narratives about Native American history, BIA boarding school policy emerges as the most often quoted aspect of the traumatic past influencing the physical and psychological health of Native Americans (Duran, Duran, “Postcolonial” 33–​4; Duran, Duran, Brave Heart et al. 344; Grayshield et  al. 301). Similarly, in her work with the Yurok community in California, Mariana Leal Ferreira identifies a direct connection between diabetes and past traumatic experiences, the forced removal to a boarding school being one of the most influential one. Leal Ferreira has conducted a number of interviews with Mollie Ruud, a Yurok fisherwoman born in the late 1920s, who locates the origins of her diabetes in the traumatic boarding school experience: I just can’t get over all the beatings and rapings we went through in boarding school. I have nightmares. The children screamed at night, little children missing their parents. We were beaten up for any little thing we did, even for being hungry. We were kept locked up in a dark room if we spilled anything, slapped in the face for speaking Indian, beaten up if we dared to look the matrons in the eye. It was just horrible. My blood sugars go up just because I am thinking about it. In fact, I got diabetes when I learned that my son was going to be sent to Chemawa. It is just like being sent to prison. (“Love” 368). What is striking in Ms. Rudd’s accounts is how the distance between the past moment of the boarding school experience and the present moment

98 Diabetes collapse as the event of trauma is painfully reenacted on an emotional and a biochemical level. Indeed, Native people well understand that the etiology of diabetes is more complex than the one presented in biomedical models. In her insightful and fascinating study of the PCBs contamination of land and water in the Mohawk community in the area of the St. Lawrence River in northern New York State and Canada, Elizabeth Hoover (Mohawk/​Mi’kmaq) demonstrates how community members reject explanations of high diabetes rates which put the blame on “individual non-​compliant bodies” (The River 23). While indeed genetic determinism has penetrated everyday metaphors, the Mohawks rightly4 locate the causes of the epidemic in the environmental contamination that drastically changed their fish-​based diets. As one community member put it, “It’s like a chain reaction.” The contamination caused by PCBs by the General Motors plant5 led to the contamination of water and fish which then needed to be eliminated from people’s diets; as a result, people rely more on (often unhealthy) food from grocery stores, which has led to an increase in diabetes rates in the community (235–​41). Thus, the example clearly shows how “[u]‌nderstanding a condition like diabetes in a place like Akwesasne necessarily entails examining the ecosocial history of the community” (249).

Diabetes, settler colonialism, and the loss of traditional foodways One of the most salient examples of how the rise of diabetes occurrence is integrally related to historical trauma is the transformation of traditional foodways as a result of settler colonialism. Forced removals, the theft of lands, acculturation policies, and the eradication of Indigenous cultures and languages, apart from emotional and spiritual toll, drastically transformed Native diets available for tribal people. As Devon Mihesuah observes, “Historical trauma also accounts for dietary choices. … [Native people’s] grief is unresolved because they feel the effects of their ancestors’ sufferings” (“Indigenous” 55–​6). Thus, in the context when the consequences of settler colonialism are ever-​present, diabetes cannot be understood through a biomedical framework only. In Eating the Landscape, Enrique Salmón (Rarámuri) begins a story of his tribe’s foodways with a seemingly insignificant childhood memory of his grandmother explaining medicinal properties of fruit and herbs collected in the family yard. In no time, however, Salmón grasps the significance that these stories carried: I learned the names of plants, their uses, and their place in Rarámuri culture, philosophy, and cosmology. I understood them to be relatives and living beings with emotions and lives of their own. … In short, my family led me into the traditional ecological knowledge of the Rarámuri. (1–​2)

Developing Indigenous models of diabetes  99 Salmón is one of numerous Indigenous scholars who emphasizes the fact that traditional foodways are derived from Indigenous lifeways and are an expression of a healthy, balanced life.6 “Traditional foodways,” writes Michael Milburn (Mi’kmaq), “are based on an intimate and spiritual connection to the land and entail a reciprocal relationship that must be actively maintained. Related skills involve agricultural sciences and ecosystem management, food processing, and botany” (421). There is no clear distinction between food and medicine and the two together create a coherent system of knowledge (Milburn 411). Traditional foodways were shaped by the environment where tribes existed and illustrated a sustainable use of resources found on the American continent. Considering this relationship of interdependence between the land and its people who inhabited it, it is not surprising that with the encroachment of Western civilization, this delicate balance was first threatened and then destroyed by the settlers’ excessive use of resources, decimation of species, and finally removal of tribal people from their traditional lands and forced acculturation. The rupture in nutritional continuity further led to a loss of traditional lifestyles, spiritual practices, and poverty, as it was, for instance, in the case of the Karuk Tribe of California who, having been deprived of their riverine food sources, today “are among the hungriest and poorest people in the state,” with 42 percent of the population living in the Klamath River area receiving some kind of government food assistance (Norgaard et al. 23–​4).7 What contributed significantly to the destruction of traditional foodways was the creation of off-​reservation boarding schools operated by the BIA.8 When acquiring food supplies for Indian students, little concern was given to their nutritious value, the main criteria being low cost and long shelf life. Incorporation of students’ traditional diets was never taken into consideration because it was antithetical to the entire assimilationist project. Therefore, the food that was most often served to students included white flour, white rice, beans, and beef and pork, all items with little nutritional value but rich in calories (J. Keller, “When” 22). Even with the better understanding of a relationship between nutrition and health, off-​reservation schools continued to be dominated by fat-​laden and rich-​in-​calories food. Patty Talahongva (Hopi) was sent to the Phoenix Indian School in 1978 when she was 16. The food served to students was provided by the BIA through a food distribution program established by the Agricultural Act of 1949. It mostly included canned or dehydrated products to achieve a long shelf life. “I recall our P.I. [Phoenix Indian School] breakfasts,” writes Talahongva. Scrambled eggs were always served floating in yellow murky water, because they had been made from dehydrated eggs. Gravy and bread rolls were frequently on the menu, which included a lot of dishes loaded with carbohydrates. I do not recall a salad bar or fresh vegetables on the menu.

100 Diabetes Sack lunches packed for student activities had thick slices of bologna and an equally thick slice of cheese between two slices of white bread. (145–​6) Today, the US Department of Agriculture provides food items free of charge to Native families in need of assistance through Food Distribution Program on Indian Reservations. Sadly, the same type of products is provided: “canned meats, canned beans, canned vegetables, canned soups, canned fruits, bottled juices, cereals, rice, dried pasta, flours, processed cheese food, powdered egg mix, shelf stable milk, buttery spread, and vegetable oil” (Vantrease 57). All of these items contribute to the rise of many diet-​related diseases including diabetes.9 With the loss of access to traditional foods as a yet another direct result of settler colonialism, emerging food sovereignty movements across the world become important acts of decolonization agendas and create a network of Indigenous coalitions. The concept of food sovereignty was first developed in Latin America by La Via Campesina, “an international group of peasant and small-​scale farmers who sought to articulate a common response to neoliberalism and the dominant market economy, and to defend their rights to land and seeds” (Hoover “You” 32).10 It entered international policy debates at the Rome World Food Conference in the NGO response to the Rome Declaration on World Food Security in 1996. In its simplest formulations, it “demands rights for food producers (who are also consumers) to have more decision-​making authority in the food system” (Trauger, “Putting” 1), and food sovereigntists “position themselves against the corporate food regime in order to expand the meaning of human rights to include a ‘Right to Food’ as guaranteed by the United Nations Declaration on Human Rights” (Trauger, We Want 2). In the Native American context, food sovereignty is inextricably tied to land sovereignty (return of traditional land base), access to traditional hunting and gathering grounds as guaranteed by treaty rights,11 and the restoration of Indigenous foodways by facilitating easy access of traditional foods to tribal members. As Mihesuah posits, Native American food sovereignty is more than just about the disruption of a corporate hegemony over food production and distribution; instead, at its core it advocates that promoting traditional foodways is integral to becoming aware of their [Native people] tribes’ history, learning their language, and becoming politically active, all of which will contribute toward building pride and shaping their identity as Indigenous people. (“Indigenous” 60–​61) Even more importantly, Indigenous food sovereignty focuses on the rights to the land as well as responsibilities to it, including culturally, ecologically, and spiritually appropriate relationships with elements of those [land] systems (Hoover, “You” 39).

Developing Indigenous models of diabetes  101 Thus, food sovereignty in the Native context is first of all a project aimed at the well-being of tribal communities and the regeneration of their cultures. In the words of Hoover, “The production, consumption, and distribution of culturally appropriate food should be accomplished while strengthening community, livelihoods, and environmental sustainability” (“You” 33). Even a cursory look at the map of the Indian Country documenting food activism provides an insight into regenerative and community-​building projects dedicated to the restoration of traditional foodways. For instance, Diné Inc., a nonprofit organization, is working to preserve Navajo identity through food and thus improve the health of the people. The Decolonizing Diet Project is a study focused on the relationship between Indigenous people and foods from the Great Lakes Region (Mihesuah “Indigenous” 61). The Pueblo Food Experiment is a project conducted in 2013, in which the artist Roxanne Swentzel (Santa Clara Pueblo) convinced 14 people to shift to a traditional diet. The participants resigned from beef, processed sugar and white flour, and after three months, their medical results considerably improved. Nephi Craig (Apache/​Navajo) is a chef with national recognition who promotes Indigenous foods and recipes (Talahongva 150).12 More recently, Elizabeth Hoover’s ambitious and fascinating project “From Garden Warriors to Good Seeds: Indigenizing the Local Food Movement,” documents her three-​month journey in 2014 in search of Native communities actively involved in growing and popularizing good Native food.13 These and other examples illustrate the multidimensionality of food politics and how it is engaged in decolonizing practices. As Roxanne Swentzel observes, “Our [Native] bodies have been colonized in more ways than just the land. The food is an invasion. Let’s take ourselves back” (qtd. in Talahongva 149). Such examples constitute a powerful call to construct productive images of food consumption in Indian Country and provide counter-​narratives of food as medicine rather than poison. This motif is further taken up in the next chapter in an analysis of Sherman Alexie’s selected work.

Indigenous frameworks for understanding diabetes Considerations of social, cultural, physical, and psychological consequences of living under settler colonialism demonstrate how diabetes and other chronic diseases may be seen as a condition resulting from a combination of factors rather than a faulty genome which automatically puts the blame on ethnic groups associated with it. As Eduardo Duran, Bonnie Duran, and Maria Yellow Horse Brave Heart postulate, “The creation and expansion of America produced an inevitable disintegration of the rationality of everyday Native American life. This disintegration is at the root of many present-​day social and health problems” (62). Analyzing diabetes in the context of colonialism and consequent cultural genocide allows us to view this ailment as one of many manifestations of historical trauma. In the studies of Native American communities, historical trauma is defined as

102 Diabetes multigenerational and cumulative over time; it extends beyond the life span. Historical trauma response has been identified and delineated as a constellation of features in reaction to the multigenerational, collective, historical, and cumulative psychic wounding over time, both over life span and across generations. (Duran, Duran, Brave Heart et al. 342) Such an understanding of historical trauma, or transgenerational trauma, is a well-​established concept in psychology as well as in cultural and literary studies mostly associated with Holocaust studies (e.g., the work of Dominic LaCapra) and trauma studies (e.g., the work of Cathy Caruth).14 While the concept of transgenerational trauma is well known in Native philosophies (Duran, Duran, Brave Heart 60), the theoretical framework of Holocaust studies and studies of post-traumatic stress disorder (PTSD) fails to approach the phenomenon in a culturally sensitive and therapeutically effective manner. What is needed is a decolonization of medical and theoretical practices in order to make room for Indigenous perspectives (Duran 5–​ 7). As Tom Ball and Theresa O’Nell vividly observe, “to use Euro-​American nosology, namely PTSD, with Native Americans who are suffering from the repeated assaults of historical traumas is like trying to force square pegs into round holes” (336). This need to construct a methodological framework derived from Indigenous philosophies is a priority for a number of scholars and medical practitioners. Eduardo Duran proposes the concept of “the soul wound,” which, as he explains, had always existed in Native philosophies to describe a loss of balance and harmony caused by external factors. The concept gained prominence in the 1970s when Native American people from central California frequently used it to describe the problems present in their communities. The pervasive theme was the harm inflicted to tribal communities by colonization and its effects were often pictured as a spiritual injury, “the soul wound” (Duran, Duran, Yellow Horse 64). “It is apparent,” write Eduardo Duran and Bonnie Duran, that the psyche of the community recognized the wounding of the environment, and that this awareness in turn was perceived as a wounding of the psyche. Harmony had become discord and the community’s unconscious perception was that the world was unfriendly and hostile. The problems that were manifested and verbalized were merely symptoms of a deeper wound –​the soul wound. (26) Drawing from Holocaust and trauma studies’ models, Maria Yellow Horse Brave Heart (Hunkpapa/​Oglala Lakota) introduces a concept of “historical unresolved grief ” which emphasizes the significance of social and

Developing Indigenous models of diabetes  103 historical factors in the creation of social pathology in Native American communities. “Like children of Jewish Holocaust survivors,” writes Yellow Horse Brave Heart, “subsequent generations of American Indians also have a pervasive sense of pain from what happened to their ancestors and incomplete mourning of those losses” (“The American Indian” 5). In her model, Yellow Horse Brave Heart includes events such as the settler colonialist invasion, the loss of land-​base and traditional lifestyle, violence of boarding schools and uprootedness caused by relocation programs of the 1950s. In a similarly culturally oriented project aimed to analyze Native American parents’ perceptions of traumatic historical events, Les Whitbeck and colleagues developed the Historical Loss Scale (HLS) and the Historical Loss Associated Symptoms Scale (HLASS) to theorize the impact of historical trauma on psychological and physical wellbeing in Native families and communities (124–​7). What Whitbeck and colleagues’ findings pointedly illustrate is that the “holocaust” is not over for many American Indian people. The threats to their way of life and culture have been ongoing, the losses progressive as each generation passes away. These losses are so salient because they are not truly “historical” in the sense that they are now in the past. Rather they are “historical” in the sense that they began a long time ago. (128) Inspired by these findings, O’Nell and Ball propose the creation of historical trauma genograms based on conversations with tribal elders to construct culturally sensitive therapeutic models. The genograms, in O’Nell and Ball’s study illustrating the history of the Umatilla and Klamath tribes, begin, to the scholars’ initial surprise, not with the coming of the white man but with the true starting point –​ creation. The tribal consultants also directed us to draw the history in a circle, rather than in a linear form, and to place the events on the circle in a counterclockwise direction, the sacred direction for these tribes. Historical traumas, they told us, are part of the larger story of the tribes, and that story is grounded in spiritual truth. (347) What O’Nell and Ball achieve in their study is a possible therapeutic and counselling model that is derived from Indigenous knowledge base and may serve as a healing tool too. More importantly, as the authors observe, historical trauma genograms may be “used to train nontribal personnel who come to work for a tribe to better understand the population with whom they are working” (353), thus destabilizing the hegemony of purely biomedical approach.

104 Diabetes Such redefinitions of an experience of illness and suffering, with an emphasis on patients’ cultural and individual contexts as well as their agency in the choice of and approach to treatment, are not new in medical humanities and narrative medicine. In The Illness Narrative published in 1988, Arthur Kleinman writes about the “personal and social meanings of illness” and the shortcomings of the biomedical model as the only tool in approaching and treating patients (3, 9). In a number of case studies, Kleinman persuasively demonstrates how the experiences of illness and healing are shaped by the patient’s cultural, social, and emotional contexts based on gender, class, religious beliefs, and family involvement (or the lack thereof) in the healing process. It is, therefore, surprising that the need to employ such a multidirectional approach, a foundational element in Indigenous knowledges, has been voiced by Western medicine professionals only recently. The most often critiqued approach of traditional medicine, namely the practice of reducing the experience of illness to biomedical diagnosis and treatment focused on a patient divorced from her social and cultural environment, is juxtaposed by Indigenous privileging of kinship relations as structuring individual and communal life. As a result, diabetes treatment and prevention programs emphasize the fact that diabetes is an ailment that affects entire communities rather than individual patients and healing processes and also involves recognition of one’s place in a network of relations and interdependencies. Such approaches often concentrate on traditional lifestyles, beliefs, and treatments. A good case in point is a study of a correlation between diabetes and apathy conducted by Amanda Carlson and colleagues who utilize the principles of community-​based participatory research (CBPR)15 to draw attention to “the unique ethical situation presented by the history and sovereignty of A[merican] I[ndian] nations” (772). The methodology of community-​based participatory research relies on building collaborative relations with studied communities whose members are invited to plan the research and evaluate its findings. Carlson and colleagues demonstrate that tribal members who report more involvement in traditional and cultural activities are less likely to suffer from feelings of apathy (777). This and similar studies illustrate the need to recognize differences between Western and Indigenous approaches to illness and healing and the importance of engaging Indigenous communities in constructing the most effective therapies and prevention programs. As Puneet Chawla Sahota rightly observes, “Research that takes a collaborative approach has the potential to benefit communities by empowering them to find their own solutions to challenges such as diabetes” (826). In this way, Indigenous people not only take control over the way research is conducted, but also they contribute to knowledge production that is neither oppressive nor racist. Having influence over the way different states of illness are defined and treated is the most pronounced example of tribal empowerment and an expression of health sovereignty.

Developing Indigenous models of diabetes  105

Healing, storytelling, and community-​based prevention and treatment programs Published in 1995, Arthur Frank’s seminal work The Wounded Storyteller offers a framework that interprets patients’ responses to illness in relation to how they narrate their altered experiences of embodiment and the need to redefine themselves in a family and friends network (27–​52). It is in the stories told by patients that both Kleinman and Frank see the possibility of offering a more comprehensive approach to healing which respects patients and their social and cultural background. Unfortunately, Western medicine tends to pay little attention to these narratives, concentrating instead on returning the body to its biochemical balance with little attention paid to psychological aspects of the loss of health (Kleinman 13–​30). Both Kleinman and Frank expand the notion of medicine’s scope of intervention and more importantly, draw attention to culturally sensitive approaches to patients from distinct ethnic backgrounds. A recent explosion in interest in medical humanities further emphasizes culture as an important aspect of healing practices.16 In their collaborative anthropological project, Eva Garroutte (Cherokee) and Kathleen Delores Westcott (Anishinaabe and Cree), drawing from Frank’s insights about the curative potential of narrating illness, emphasize the complex functions of storytelling in Native cultures. Indeed, Indigenous people’s observations on the healing power of stories predate similar arguments propagated in the field of medical humanities. The act of claiming a voice to narrate stories of trauma, illness, and healing is indeed a powerful act as demonstrated for instance by Larissa Petrillo and Melda Trejo (Lakota) in their discussion of sundancing and storytelling as parts of vibrant Lakota culture revitalization efforts (91–​ 5); Denise Nadeau and Alannah Earl Young (Anishnabe/​ Creek)’s “Still Movement:  Restoring Sacred Vitality” program addressed to Native women of Vancouver (119–​22); and stories of incarcerated Indigenous women collected by Sharon Leslie Acoose (Sakimay First Nation) and John E. Charlton to demonstrate how reclamation of one’s stories facilitates psychological recovery from trauma of colonization (174–​5). Similarly, but in the Canadian context, the Indigenous community of Eeyou Istchee, based in the territory of the James Bay Cree of Northern Québec, compiled stories of contemporary life in the north and how it is affected by diabetes. The stories were narrated during a Talking Circle, a cultural event, organized to hear and tell stories as well as to heal. The final product of this culturally oriented intervention in the diabetic epidemic, The Sweet Bloods of Eeyou Istchee: Stories of Diabetes and the James Bay Cree, was published in 2017 and received several prestigious awards.17 The same practice to incorporate stories into medicine-​based treatment and prevention programs brings interesting and promising results. The Native American Diabetes Project was a program designed to help modify lifestyle habits and was offered to eight Native communities in New Mexico. In

106 Diabetes developing the program, Janette Carter, Georgia E. Perez (Nambe Pueblo), and Susan S.  Gilliland relied heavily on community meetings to collaboratively establish the program’s goals and the framework of addressing health problems faced by the communities. To facilitate communication among health providers and the community members, Perez composed a story entitled “Through the Eyes of the Eagle,” which was read at the beginning of the meetings. As the authors of the program observe, there was “a difference in the quality and quantity of participant interactions and in participants’ willingness to more openly discuss diabetes” (185). Moreover, participants saw the story as an important tool of relating diabetes to their values and beliefs and expressed hope about their future lives with this condition (185–​6). Following the success of the program, in 2002 the Native Diabetes Wellness Program (formerly the National Diabetes Prevention Center) and the Centers for Disease Control and Prevention forged a partnership with the New Mexico State Diabetes Prevention and Control Program and the Office of Native American Diabetes Program at the University of New Mexico to publish a series of children’s books dedicated to obesity and diabetes prevention authored by Native writers and illustrators (Perez, Tricky iii). Following the cartoons framework, the stories in the series are set on an unnamed reservation and feature a Native boy named Rain That Dances along with his friends who learn about healthy lifestyles and diets. Animal figures, Eagle, Coyote, and Rabbit, who often appear in Indigenous stories as important teachers, spiritual guides, or tricksters, convey practical knowledge about diabetes prevention. Healing is seen as a goal to be achieved by an entire community and an individual’s good health, or well-being, is a communal responsibility. While at times overtly didactic in tone, the stories exert significant cultural impact as they promote balanced diets and physical exercise as a return to traditional lifestyles rather than solely as a means of avoiding obesity and diabetes. It is the method of adapting knowledge about diabetes to a cultural setting rather than patronizing and proselytizing that guarantees success of the series and other diabetes prevention programs in Native communities. For example, Smith-​Morris observes that for the Pima People, “The concept of exercise for exercise’s sake is foreign or impractical for some community members” and thus useless for prevention purposes (39). Drawing from her long-​ term engagement with Indigenous communities, she posits that “The most successful examples of diabetic health programs are ones with a community-​ based focus” which use “cultural stories and metaphors for learning, [often] offered in native languages” and “are in other ways tailored to the local native population” (39). Moreover, in her recommendations for diabetes program developers Morris-​Smith adds that to “Manage community participation in ways that are savvy about, if not deferential to, local knowledge and power structures, and ensure that community members’ investments in the process will be valued and employed appropriately” (40). Such indigenization of diabetes treatment and prevention practices expands the understanding of tribal sovereignty. While the importance of self-​governing in a political

Developing Indigenous models of diabetes  107 and economic sense is indeed unquestionable, the right to decide about the shape and quality of medical treatment available to Indigenous tribes as well as its culturally sensitive framework are equally significant. The following chapter will demonstrate how Native American literature similarly articulates limitations of the biomedical model of diabetes and expands the space of the discussion about diabetes to include historical and cultural elements.

Notes 1 In 1974, Kelly M. West (1925–​80), often referred to as the “father of diabetes epidemiology,” published an article entitled “Diabetes in American Indians and Other Native Populations of the New World,” in which he claimed that prior to 1940, diabetes was extremely rare among Oklahoma tribes in the USA. Interestingly, the article and its thesis quickly became a classic, repeatedly quoted in research on diabetes in Native American communities. In “Diabetes in Indian Territory,” Devon Mihesuah attempts to refute this claim demonstrating that various historical records “reveal that many Southeastern tribespeople moved away from their traditional foods prior to their 1830s removals to Indian Territory, or began to add nontraditional items such as sugar and flour to their diets and began to feel the repercussions of diet changes before the Civil War, probably including pre-​ diabetes or Type 2 diabetes” (2). 2 Yin Paradies et  al. provide a thorough analysis of the thrifty gene hypothesis, discussing in detail its history and growing popularity. See Yin Paradies, M.  J. Montoya, and Stephanie M.  Fullerton, “Racialized Genetics and the Study of Complex Diseases: The Thrifty Genotype Revisited,” Perspectives in Biology and Medicine, vol. 50, no. 2, Spring 2007, pp. 203–​27. 3 The name of the tribe is not revealed in the article to protect the privacy of the community. 4 In Chapter 5 of The River Is In Us, Hoover presents research results which directly identify a positive association between diabetes and elevated serum levels of PCBs, dichlorodiphenyldichloroethylene, and hexachlorobenzene (232). 5 The community members also draw attention to the fact that plants with hazardous materials are often located near reservation lands, which serves as a yet another example of contemporary settler colonialist practices. 6 See Devon Mihesuah, Recovering Our Ancestors’ Gardens: Indigenous Recipes and Guide to Diet and Fitness (Lincoln: University of Nebraska Press, 2005). 7 In “Decolonizing Our Diets by Recovering Our Ancestors’ Gardens,” Devon Mihesuah provides particular examples of how Native foodways were altered due to enforced cultural changes and assimilationist policies. Devon Mihesuah, “Decolonizing Our Diets by Recovering Our Ancestors’ Gardens,” The American Indian Quarterly, vol. 27, no. 3&4, Summer/​Fall 2003, pp. 807–​39. 8 The topic of boarding schools for Indian children is further explored in Chapter 1. 9 In Indian Country, government-​provided food is often referred to as “commodity food” or “commods.” 10 For more, see the recent publication Devon A. Mihesuah and Elizabeth Hoover, editors, Indigenous Food Sovereignty in the United States:  Restoring Cultural Knowledge, Protecting Environments, and Regaining Health (Norman: Oklahoma University Press, 2019).

108 Diabetes 11 An interesting case in point is the example of the Anishinaabeg people from White Earth Reservation in Minnesota, who defend their right to harvest wild rice (manoomin) grown in Minnestora lakes. See Chapter 5 in Amy Trauger, We Want Land to Live:  Making Political Space for Food Sovereignty (Athens:  University of Georgia Press, 2017); David Treuer, Rez Life:  An Indian’s Journey through Reservation Life (New York: Atlantic Monthly Press, 2012). 12 For more examples of Native American food sovereignty, see for example, Joni Adamson, “The Ancient Future:  Diasporic Residency and Food-​ based Knowledges in the Work of American Indigenous and Pacific Austronesian Writers,” Canadian Review of Comparative Literature /​Revue Canadienne de Littérature Comparée, vol. 42, no.  1, March 2015, pp.  5–​17; Devon Mihesuah, “Indigenous Health Initiatives, Frybread, and the Marketing of Nontraditional ‘Traditional’ American Indian Foods,” Native American and Indigenous Studies, vol. 3, no.  3, 2016, pp.  45–​69; Patty Talahongva, “No More ‘Die Bread’:  How Boarding Schools Impacted Native Diet and the Resurgence of Indigenous Food Sovereignty,” Journal of American Indian Education, vol. 57, no.  1, 2018, pp. 145–​53. 13 See https://​gardenwarriorsgoodseeds.com/​. 14 See Cathy Caruth, Unclaimed Experience:  Trauma, Narrative, and History (Baltimore: Johns Hopkins University Press, 2016); Dominick LaCapra, History and Memory after Auschwitz (Ithaca: Cornell University Press, 1998); Representing the Holocaust: History, Theory, Trauma (Ithaca: Cornell University Press, 1994); and Writing History, Writing Trauma (Baltimore:  Johns Hopkins University Press, 2014). 15 For more on CBPR in health, see Community-​ Based Participatory Research for Health:  From Process to Outcomes, edited by Meredith Minkler and Nina Wallerstein (San Francisco:  Josey-​ Bass, 2008); Handbook of Community-​ Based Participatory Research, edited by Steven S.  Coughlin et  al. (Oxford: Oxford University Press, 2017); Community-​ Based Participatory Research for Health: Advancing Social and Health Equity, edited by Nina Wallerstein et al. (San Francisco: Josey-​Bass,  2018). 16 See Bonnie Blair O’Connor, Healing Traditions:  Alternative Medicine and the Health Professions (Philadelphia: University of Pennsylvania Press, 1995); Erika Brady, Healing Logics:  Culture and Medicine in Modern Health Belief Systems (Logan:  Utah State University Press, 2002); Mary-​Jo DelVecchio Good, Sarah S.  Willen, Seth Donal Hannah et  al. Shattering Culture:  American Medicine Responds to Cultural Diversity (New York: Russell Sage Foundation, 2011); Geri-​ Ann Galanti, Caring for Patients from Different Cultures (Philadelphia: University of Pennsylvania Press, 2014); Robert Henry, Amanda LaVallee, Nancy Van Styvendale, and Robert Alexander Innes, Global Indigenous Health: Reconciling the Past, Engaging the Present, Animating the Future (Tucson:  University of Arizona Press, 2018). 17 More on the project, see “The Sweet Bloods of Eeyou Istchee: Stories of Diabetes and the James Bay Cree,” www.sweetbloods.org/​.

4  Beyond the biomedical model of diabetes Settler colonialism, traditional foodways, and historical trauma in Sherman Alexie’s selected works and LeAnne Howe’s Miko Kings: An Indian Baseball Story In the introduction to their in-​depth and innovative study, Indigenous Peoples and Diabetes, Mariana Leal Ferreira and Gretchen Chesley Lang encourage us to “consider diabetes as a reaction of the organism to adverse life conditions, rather than a morbid or pathological phenomenon superimposed on the organism” (16; emphasis in original). The rise of biomedicalization as a discourse authorized to make viable claims about human bodies only further draws attention to how diseases are conceptualized in terms of biochemical analyses and biotechnologies that produce them. In such a context, it is indeed a challenging task to reconfigure the paradigm of diabetes as more than a strictly medical condition. In this chapter, I intend to analyze Sherman Alexie’s selected short stories and poems and LeAnne Howe’s novel Miko Kings: An Indian Baseball Story to demonstrate that such changes in perceiving diabetes are inherently part of how Native people understand the consequences of settler colonialism on their bodies and cultures. Alexie and Howe generously contribute to the debate about a need for a new, more inclusive methodological paradigm for approaching diabetes in Native American communities. While the analyzed texts do not concentrate exclusively on diabetes, they nevertheless show that the pervasiveness of diabetes is one of the most salient aspects of American Indian reality. Both Alexie and Howe trace its connection with traumatic history, which allows us to observe the diabetic epidemic in a historical and cultural context. However, I posit that it is specifically Howe’s Miko Kings which creates a productive space of empowerment by theorizing diabetes with an emphasis on tribally specific histories rather than a biomedical model, thus illustrating the relevance of theories of intergenerational trauma and unresolved historical grief. Alexie discusses the topic of diabetes through the prism of the conspicuousness of junk food in Native diets and the loss of traditional lifeways as a result of settler colonialism. However, it seems that his treatment of diabetes preempts possibilities for empowerment and decolonization by underscoring how his characters cannot escape the disease. Thus it replicates, to some extent, the logic of

110 Diabetes genetic determinism. Nevertheless, the treatment of diabetes in Alexie’s short stories and poems and Howe’s novel recognize the historical factors in the creation of the diabetes epidemic. They also deal with the revival of traditional lifestyles, exemplified by the food sovereignty movement, and the return to traditional healing ceremonies, used to complement allopathic medicine. These literary texts also consider diabetes in the context of ethical questions about the quality of health care offered to minority patients and raise the issue of the provision of care as seen from the perspective of Indigenous philosophies.

Dreaming diabetic dreams In his portrayals of twentieth-​century Indians, Sherman Alexie frequently presents diabetes as a well-​established element of the reservation landscape.1 In “One Good Man,” a short story from The Toughest Indian in the World collection, the powerful image of wheelchair ramps attached to reservation houses reminds the reader of the ineffectiveness of biomedical approaches to diabetes treatment and prevention programs; the ramp announces the arrival of a yet another disfigured Indian body ravaged by the disease and sentenced to death. As the story opens, a ramp is being built in the narrator’s house as his father has just had his feet amputated due to diabetes complications. The father’s disfigured body heralds further complications that cannot be cured and which, according to doctors, leave him with only six months to live. The language spoken by diabetes is one of decay, degeneration, and decomposition. It is also the language of symptoms taken from a biomedical model that successfully reduces individuals to definitions of disorders and their manifestations. When Atticus, the narrator, helps his father into a wheelchair he cannot remain blind to how much weight he has lost (“forty pounds in the last few months”), which he immediately juxtaposes with an image of his father from the past: He was a man who used to teach ballroom dancing, back when he was young and strong and financing his communications education at the University of Washington (he’d always meant to start his own radio station on the reservation). (215) As Atticus shows his father round his redecorated house, altered to meet the demands of a disabled person, images of disintegration abound. The older man is unable to see all the improvements since “his vision was impaired by the blood that flowed from the broken veins in his eyes” (216). His hands are trembling, “his skin [which] had once been dark and taut … had grown pale and loose,” (230) and he looks exhausted all the time. For dinner, Atticus serves his father a homemade tomato soup, but the father’s digestive organs are unable to process more complex foods and his “kidneys and liver [are]

Beyond the biomedical model of diabetes  111 beginning to shut down. Shut down” (229; emphasis in original). Alexie’s tracing of the signs of diabetes is a pervasive narrative of physical, emotional, and, on some level, cultural dissolution. Reverberating in this image is the fact that the demise of Indigenous bodies will only be followed by the demise of social structures and cultural continuity. Similarly, “War Dances” from the 2009 collection of the same title repeats the logic of the inescapability of diabetes. The Indian urbanite narrator is violently confronted by the decay and disintegration of his father’s diabetic body: “[H]‌is feet and toes had been black with rot and disease. … [N]ow they were gone, sliced off ” (32). Repeating Atticus’s gesture, the narrator juxtaposes the image of the father’s body in the past and the one in the hospital bed: He looked so small and pale lying in that hospital bed. How had that change happened? For the first sixty-​seven years of his life, my father had been a large and dark man. And now, he was just another pale and sick drone in a hallway of pale and sick drones. (34) These scenes are filled with a sense of the inescapability of a diabetic fate. The conspicuousness of wheelchair ramps and bodies affected by diabetes signifies a rupture in the integrity of the community. The pervasiveness of diabetes in Indian Country is also signaled by Alexie’s depiction of the disease as a colonizing agent. By identifying diabetes with the postcontact Native American reality, Alexie’s strategy bears striking resemblance to Madonna Swan’s narrative, discussed in Chapter 2, which also sees illness, tuberculosis in this case, as a trope for colonization:  in both cases, the bodies are inscribed with the language of symptoms and decay. Diabetes invades the bodies and the characters’ personalities and self-​perceptions. In “Witnesses, Secret and Not,” a short story from the 1993 collection The Lone Ranger and Tonto Fistfight in Heaven, the teenage narrator creates a personified image of diabetes, a constant companion with whom he has an intimate but complex relationship: “Diabetes is just like a lover, hurting you from the inside. I was closer to my diabetes than to any of my family or friends. Even when I  was all alone, quiet, thinking, wanting no company at all, my diabetes was there” (221–​2; emphasis added). In “One Good Man,” Atticus’s father becomes obsessed with his amputated feet, repeatedly inquiring what the medical personnel might have done with them. Atticus begins to see his father through the prism of his condition, sadly musing that his father is alone “in his bedroom where he dreamed his diabetic dreams” (222). What appears particularly problematic in this merging of diabetic characters with their disease is the suggestion that their fate is indeed inescapable, written into genetic material. Alexie’s language is saturated with imagery of genetic fatalism. Not only does Alexie portray diabetes as an inevitable element in Indian life but he also approaches other social problems such as

112 Diabetes alcoholism in a similar way. In fact, critics Gloria Bird and Elizabeth Cook-​ Lynn have famously criticized Alexie for reinforcing the stereotype of the drunken Indian.2 However, as Stephen F. Evans has observed, Alexie’s extensive use of satire and irony in his portrayal of reservation life complicates such claims and illuminates the validity of social problems in discussions about the importance of tribal unity (58–​9). For instance, in “War Dances,” the narrator admits that his father’s diabetes has been aggravated by alcoholism, the two being “natural causes for an Indian” (37). It seems as if the narrator is simultaneously aware of the ironic potential implied in the pervasiveness of the stereotype and emotionally devastated by his father’s condition being caused by alcoholism. In “Witnesses,” the young narrator and his father stop for lunch in a fast-​food restaurant and explain their food choices thus: “We ordered what we always ordered: a Whammy burger, large fries, and a Big Buy Diet Pepsi. We order Diet since my father and I are both diabetic. Genetics, you know?” (217). What complicates the genetic explanation is the fact that the narrator never openly mentions his family’s economic status which, to a large extent, dictates his dietary choices.3 Later in the story, the boy refuses a candy from a detective due to his condition (an ironic gesture in the light of what he ordered for lunch). Immediately, the detective reduces the narrator to a stereotype of a diabetic Indian doomed to premature death: “ ‘Oh, sorry,’ the detective said and looked at us with sad eyes. Especially at me. Juvenile diabetes. A tough life” (221). While indeed, there is space to explore the subversive potential of Alexie’s engagement of stereotypes, it is genetic and social determinism that dominate in his portrayal of Native communities. If diabetes is consistently represented as a pathology, a combination of genetics and poor lifestyle choices that inevitably leads to rotting limbs, the question arises: is there any space for a less oppressive and reductionist discourse to emerge? One which would instead help theorize the diabetic epidemic in terms of a larger number of cultural and historical perspectives and take into account more diverse factors such as historical trauma, for example. As suggested in the fast-​food restaurant scene from “Witnesses,” this potential is signaled in the treatment of the motif of food.

Diabetes, food sovereignty, and the problem with frybread power Food features prominently in Alexie’s fiction and is frequently a reminder of economic conditions on Indian reservations. In Reservation Blues, the members of the Indian music band, having run out of commodity food, chew on “wish sandwiches”:  “Two slices of bread with only wishes in between” (187). Food often signals characters’ social status and Alexie is determined to emphasize that lifestyle choices are less about making conscious decisions and more about being constrained by the realities of a capitalist economy. Thus, his image of diabetes suggests it is connected with social contexts. In “Witnesses,” the diabetic narrator observes that, “Sometimes it does feel like we are all defined by the food we eat, though.

Beyond the biomedical model of diabetes  113 My father and I  would be potted meat product, corned beef hash, fry bread, and hot chili. We would be potato chips, hot dogs, and fried bologna” (217). The fact that all these foods are highly processed, low in nutrients, and often provided in governmental food programs succinctly illustrates the scope of the settler colonial invasion of Indigenous lands and bodies. A similar sentiment is present in the poem “Diabetes” from the 1996 collection The Summer of Black Widows: Having learned sugar kills me piece by piece, I have to eat with more sense than taste. So I travel alone in this limited feast, choosing the right place and plate (44) While unhappy with dietary choices dictated by diabetes and, therefore, forced to enjoy a “limited feast,” the speaker seems nevertheless to understand the reality of this new situation. The need to choose “the right plate” transforms the act of eating into a solitary, lonely event, deprived of the spontaneity of communal food sharing. “Totem Sonnets” from the same collection offers a list of food items; however, this time, it is structured by a different logic than demonstrating the pervasiveness of fast food: Steamed Rice Whole Wheat Bagel Egg White Baked Chicken Tomato Soup Broccoli Cheddar Cheese Garlic Clove Grape-​Nuts and Non-​Fat Milk Almonds Apple Ice Water Insulin Hypodermic (33) Clearly, the foods listed here have been more carefully selected in terms of their glycemic index,4 richness in protein, and calorie content. There are grains, fruit and vegetables, and water. The last two lines signal that

114 Diabetes a person suffering from diabetes has made these dietary choices. The speaker is aware that insulin administered through hypodermic needles is needed to control diabetes, yet she nevertheless remains bitter about this fact, which she expresses by stating that insulin is “served” last as an ironic “dessert.” Again, food is not associated with pleasure or a balanced lifestyle and becomes instead a mirthless act of life-preservation. Nancy Peterson observes that “Totem Sonnets” begins as a mock sonnet (a list of food items as an atypical theme), but the final couplet “ultimately develops serious tribal implications: … [it] bears witness to the epidemic of diabetes among Native people and perhaps is a personal acknowledgement of Alexie’s father diabetic illness” (142). Indeed, the pessimistic list of food items leaves little room for regenerative or healing potential. Moreover, the speaker might have found out if some of the items on the list did not belong to traditional diets and thus transformed the burdensome diet into an act with decolonization potential. The most dramatic list of fast-​food products that adequately demonstrates how colonialism has altered or destroyed traditional foodways is found in “One Good Man.” Before his father returns home from the hospital, Atticus thoroughly searches the house for sweets and other unhealthy items, which, considering his father’s condition, could easily hasten his death: Among the most dangerous or near-​dangerous:  two boxes of donuts buried beneath Pendleton blankets on the top shelf of his closet; a quart of chocolate milk lying flat in the refrigerator’s vegetable’s drawer; a six-​ pack of soda pop submerged in the lukewarm water of the toilet tank; hard candy stuffed deeply into the pockets of every coat he owned; and then more hard candy stuffed into the pockets of my late mother’s coats, my siblings’ long-​abandoned coats, and the coats I  wore when I  was a child. … Together, these items represented my father’s first line of defense. He knew they would be found easily. Decoys. Camouflage. … My father was smart to distract me from the large caches. In the garage, I poured out ten pounds of Hershey’s chocolate kisses one by one from an aluminum gas can. In the attic, I wore gloves and long sleeves when I pulled seven Payday peanut bars from between layers of fiberglass insulation. … Inside the doghouse, a Tupperware container filled with Oreo cookies was duct-​ taped to the ceiling. … Carefully hidden beneath a layer of frost, popsicles were frozen to the freezer door. How could my father accomplish such a thing? (213–​14) The considerable effort required to destroy unhealthy products signaled by the presence of military metaphors demonstrates the father’s dependence on addictive and unhealthy foods and the extent to which they have dominated and transformed his diet, a disturbing fact considering the spiritual and ceremonial dimension of food in many Indigenous cultures. These

Beyond the biomedical model of diabetes  115 changes, however, are not examples of one individual’s irresponsible choices but rather, like rising diabetes levels, high suicide rates, and alcoholism, are all manifestations of historical trauma. The homemade tomato soup that Atticus serves his father functions as an attempt to break this circle of oppression and use food as a medicine and a demonstration of affection. It is not only the opposition of homemade vs. canned food but also the emphasis on the fact that Atticus prepares the food from scratch, which introduces an association with traditional food preparation techniques. The conspicuousness of fast food in Alexie’s work illustrates how its introduction to Native American communities is a result of the eradication of traditional foodways. Alexie repeatedly writes about traditional diets to demonstrate how their loss and the impossibility of returning to precontact diets affect Indigenous people today. He frequently returns to the theme that salmon is critical for Spokane people and their cultural survival. As Stephen F. Evans writes, Alexie repeatedly emphasizes that fact that the Spokane are a salmon people, very different from the Plains Indians whose image is most often abused in the production of Native American stereotypes (194).These sentiments are present in Smoke Signals, a 1998 film by Chris Eyre (Cheyenne and Arapaho) based on Alexie’s short story “This is What it Means to Say Phoenix, Arizona,” the short story “The Toughest Indian in the World,” the early poems “The Powwow at the End of the World” and “The Place Where the Ghosts of Salmon Jump” from the 1996 The Summer of Black Widows, and “At the Diabetic River” from The Man Who Loves Salmon (1998). What the characters in these texts angrily emphasize is that the annihilation of the salmon population exacerbated the cultural and social disintegration of Indigenous people living in the Pacific Northwest. As Chad Wriglesworth notes, the interior tribes of this area “felt the deepest economic and cultural repercussions from the salmon loss caused by the Grand Coulee Dam” (143). However, as well as lamenting the situation, Alexie also envisages acts of decolonization intended to reverse environmental manipulation on the Spokane River and to restore the salmon population. In “The Powwow at the End of the World,” the speaker envisages a moment when “that salmon leaps into the night air above the water, throws /​a lightning bolt at the brush near my feet, and starts the fire /​which will lead all of the lost Indians home” (139–​40). Repeating the logic with which Alexie presents the Ghost Dance5 as a radical act of Indigenous revival, the speaker in the poem topples the Grand Coulee Dam and the nuclear reactors at Hanford, thus facilitating the return of salmon and traditional lifestyles. On the other hand, Alexie also explores the empowering potential of the motif of food, especially when ritualized as a communal event. In Indian Killer, food, even junk food, can also be an instrument of pan-​ Indian alliances and mobilization. Mary Polatkin, an uncompromising student who ridicules her wanna-​be white professor of Native American literature, is well aware of how food, or rather lack of it, intersects with racial and economic contexts. She becomes “the Sandwich Lady” when she starts distributing free

116 Diabetes sandwiches among urban homeless Indians in Seattle, thus “oppos[ing] the dispersion and marginalization of Indian people in the city” (Bańka 151). Giving food to those who need it most –​the racially excluded and economically dispossessed –​becomes an expression of communitism and simultaneously, establishes the urban context as a space of possible alliances and pan-​tribal cooperation. The motif of food and food sharing as an empowering and decolonial ceremony is most visible in Alexie’s continued emphasis on frybread. Sherman Alexie has repeatedly used frybread as a symbol of Indigenous survival, turning it into a leitmotif of his work. In Reservation Blues, the Spokane tribe holds a frybread cooking contest every year and claims to possess a secret recipe which makes their frybread not only the best but also the most Indian (Alexie 47). Smoke Signals can be seen as a tribute to frybread. One of the Native characters, in an assertion of his Indianness, puts on a T-​shirt with the “Frybread Power” slogan. In another scene, mocking the biblical story of Jesus’s miraculous sharing of food,6 Arlene, the main character’s mother, divides 50 pieces of her “magic frybread” among one hundred Indians, thus quelling “a fry bread riot” (Alexie, Smoke Signals 74–​6). It must be admitted that on some level such renditions of frybread exhibit an empowering potential by, for instance, strengthening pan-​Indian solidarity and emphasizing the spirit of survivance. As Joanne Hearne observes, in Smoke Signals, frybread symbolizes the ability to create something out of nothing and employ white resources for the purpose of Indigenous survival. The presentation of these features with frybread, itself a product of cultural syncretism, “underscore[s]‌their physical importance for Native resilience … [and] answers the ‘independence’ of ‘vanishing Indians’ with the substantiation of familial and community ties in the form of food” (Hearne 122). Indeed, in an interview for SAIL, Alexie identifies combining frybread and other non-​Native food in contemporary Native American diets as a sign of survivance. As a writer, he relies on “the traditional imagery and fried bread and fried bologna … which is a mix of traditionalism and contemporary culture” (Purdy 15). While undoubtedly effective, the glorification of frybread seems problematic in the context of the diabetic epidemic and the need to create tribally oriented prevention and treatment programs. Made of salt, flour, and fried in oil, frybread has become a cultural signifier offered at powwows and county fairs.7 As one online commenter on the frybread article published in Smithsonian Magazine put it, “Your not a real Native if u don’t no (sic) how to make or eat frybread” (qtd. in Mihesuah, “Indigenous” 55). The problem with frybread, as Devon Mihesuah continuously emphasizes, is that it is neither traditional nor healthy, and, considering rising diabetes rates in Indian Country, should not be promoted as such. The frybread legend that portrayed it as survival food emerged around 1866 when the Navajo, originally inhabiting modern-​ day Arizona and western New

Beyond the biomedical model of diabetes  117 Mexico, were forcefully relocated to the Bosque Redondo reservation. There, cut-​off from their traditional food resources, over 8,500 Navajo and 500 Mescalero Apaches were often given food such as salt, cornmeal, mutton, beef, pork, offal, wheat flour, and coffee beans to complement their agricultural produce. Army records confirm the introduction of heat flout to the Navajo at Bosque Redondo; however, all these reports “are bleak, conjuring reminders of sickness and death –​not of survival” (“Indigenous” 48). Not only was the distributed flour of poor quality, but the Navajo did not know how to prepare it properly and suffered from serious intestinal distress. Moreover, in her research into frybread in Native American history, Mihesuah reports that while wheat flour was indeed among the products distributed to Native Americans at the beginning of the twentieth century, there are only a few documents which mention “frybread” or “fry bread” as consumed in Native communities, thereby challenging the status of frybread as a traditional food (“Indigenous” 50–​4). Moreover, Patty Talahongva identifies frybread as a remnant of boarding schools and unhealthy diets introduced to students. “Today I call fry bread ‘Die Bread’ ” (147), writes Talahongva and insists that this strong vocabulary is needed to change dietary patterns in Native communities and eradicate romanticized stories of frybread. That this is by no means an easy task is illustrated in Devon Mihesuah’s attempts to change dietary patterns in Indian Country. In 2003, she wrote for an academic journal in which she presented an argument against the overconsumption of frybread. Her opinion on the subject is also expressed on her bumper sticker and T-​shirts which feature the word frybread with a red line through it. “As a result,” she writes, “I was assailed by frybread fans as ‘anti-​Indian’ and ‘not really Indian’ ” (“Indigenous” 45). Alexie’s use of frybread as a signifier for survivance echoes earlier commentaries on cultural syncretism found in, for instance, the works of Simon Ortiz and Leslie Marmon Silko8 and demonstrates the efficacy of such artistic choices. However, it seems that Alexie tends to introduce dichotomous logic in his discussion of food in Native American communities: it is either fast food and the health threats it poses or traditional food which is no longer available. In-​between these two motifs, there is the idealization of frybread as a traditional and empowering food, which as many scholars demonstrate, contradicts historical sources and is ethically problematic. What I argue is that with such significant investment in the theme of food in Native American communities, Alexie’s failure (or a decision not) to situate food and a restoration of traditional foodways in a constructive context of cultural renewal and decolonization practice is truly problematic and preempts the empowering potential signaled in the emphasis on the food theme. In effect, the very presentation of how dietary choices have been distorted by forced cultural changes is not enough to offer a rupture in the stereotype of an alcoholic, diabetic Indian with which Alexie so abundantly fills his fiction.9

118 Diabetes

Diabetes and historical trauma: boarding school experience In a passage quoted in the previous chapter, Ms. Rudd, a Yurok fisherwoman, establishes a direct relationship between her traumatic experience of attending an off-​reservation boarding school and diabetes. Having learnt that her son is to be sent away to Chemawa school,10 Ms. Rudd is terrified at the prospect of her child going through the same ordeal. Similarly, LeAnne Howe’s Miko Kings draws attention to the importance of historical factors in understanding the scale of diabetic epidemics in Indian Country through the character of Hope Little Leader, the Miko Kings’ talented pitcher, who also suffers from the trauma of the boarding school experience. The novel narrates the history of the all-​Indian baseball team, revealing multiple connections between Indigenous ball games and the all-​American game. With the story of Hope, Howe demonstrates the complex functions performed by traditional ball games in Native communities in the precontact era and how playing ball became a way of cultural survival shortly after the Dawes Allotment Act and the creation of Oklahoma in 1907. Over 60 years later, in 1969, Hope is a patient at the Elms Nursing Home in Ada and dying from diabetes-​related complications. By presenting Hope’s life and disease in the wider context –​his boarding school experience and forced separation from his younger siblings as well as the loss of the Choctaw land and the ensuing creation of the state of Oklahoma –​Howe’s novel participates in a discussion emphasizing the cultural and historical sources of the diabetic epidemic in Indian communities. At the Elms Nursing Home in Ada, Oklahoma, John Lennon, a nurse, not the ​singer, administers morphine to Hope Little Leader, a Choctaw patient suffering from diabetes and its multiple complications. Hope is known to the staff of the nursing home as “No-​Hands,” a nickname that directly relates to his disability. Hope does not remember the circumstances that rendered his body incomplete. To John Lennon, the answer seems to be an obvious one. Having seen so many Indigenous diabetic patients with amputated limbs, he assumes that it must have been diabetes that deprived Hope of his hands. Ironically, readers of the novel discover that in Hope’s case, it is not the disease that is responsible for Hope’s disability. What is significant, however, is that John Lennon immediately associates amputated hands with diabetes, which is indicative of the disease’s prevalence in Native communities as well as the lack of a systemic plan for diabetes prevention. Lennon’s automatic association makes one think of houses with built-in wheelchair ramps or medical facilities and hospitals administered by the Indian Health Service, such as the Phoenix Indian Medical Center in Arizona, which specializes in diabetes-related amputations. Bedridden and semiconscious from his morphine shots, Hope inhabits an alternative reality of his baseball days where his magic hands knew how to play the game. At the same time, John does his best to administer medicines, convince his patient to eat, and inspire him not

Beyond the biomedical model of diabetes  119 to succumb to the illness: “We’re fighting diabetes and John Wayne movies, right?” (Howe 59; emphasis in original). The Elms Nursing Home scenes are interspersed with Hope’s memories from Hampton Institute, the boarding school he was sent to after the death of his mother. Founded in 1868 during the Reconstruction by General Samuel Chapman Armstrong, the school provided industrial education for blacks. When in 1877, Lieutenant (later Capitan) Richard Henry Pratt was looking for a place where a smaller group of 72 Indian prisoners (Cheyenne, Arapaho, Kiowa, Comanche, and Caddo) from Fort Marion, Florida,11 could be placed to continue education and acculturation, it seemed logical, considering General Armstrong’s previous attempts at “domesticating Indians,”12 to put them in Hampton (Adams 36–​51). Upon arrival at Hampton, Hope Little Leader and his younger sisters, Lucinda and Helema, are separated and the girls are sent away to Good Land, an orphanage for Indians in Indian Territory, where they soon die. The scene of separation speaks volumes about the government’s assimilationist policies designed for maximum effectiveness and deprived of any sensitivities for family and kin relations: Helema, his baby sister, stretched her arms toward him and tried to jump from the wagon, but Mrs. Spencer held her back. His eight-​year-​old sister Lucinda yelled “Hopai-​a-​a-​a,” releasing the a as she ran out of her breath. He ran as fast as he could across the schoolyard. The school’s janitor, Gorge Lincoln, a full-​grown black man, tackled him before he could reach the wagon. He held Hope on the ground until his screaming sisters were out of sight. (65) The violence of the scene is based on separation on all possible levels: physical (the girls are literally removed from Hope’s embrace), aural (their voices and Choctaw words recede in the distance), and visual (they can no longer be seen). The drama of separation is justified by the mission of acculturation achieved through a separation from cultural and family contexts. In the parlance of assimilationism and its distorted logic, such affective resistance testified to Native people’s subhuman status. In a Hampton promotional publication from 1885, the writers comment thus on Indian parents’ frequent refusal to give up their children: “The love of Indian parents for their children is the strongest –​it seems to me the best –​trait in their character. Call it animal instinct if you will” (Armstrong 20). Apart from the pain caused by the loss of his sisters, Hope is continuously exposed to the racist ideology of forced assimilation and eradication of Native cultures. After one of his runaway attempts (there will be more than 12), Hope is placed in a solitary cell underground, since, the school principal, Reverend Clark, informs him, he cannot “run down the streets of Hampton like some wild animal sprung from a trap” (Howe 61). While

120 Diabetes generally extreme forms of punishment of students was discouraged by the US government, in practice corporal punishment was often applied, as was forced separation from other students (Adams 121–​2). As Donal Lindsey reveals, at Hampton, an underground guard house was established as a form of separation, exclusively for Indian students. Helen Ludlow, a teacher at Hampton, explained that, With the colored student, the strongest possible influence that can be brought to bear is suspension or expulsion from the advantages for which his chances are so few and so highly prized. A refractory Indian, on the other hand, cannot be sent a thousand miles home to his woods since most often this is precisely what the Indian student desires. (D. Lindsey 160) Reminiscent of General Armstrong’s “fatherly talks” given to his students (D. Lindsay 126), Reverend Clark thus justifies Hope’s confinement: “It is here where Indians like you must come and learn the habits of good industry. … You see, he added, by cultivating you wild Indians … we tame the land” (63). As David Adams observes in his study of the era of the Indian educational system, “The boarding school, whether on or off the reservation was the institutional manifestation of the government’s determination to completely restructure the Indians’ minds and personalities” (97). White man’s clothes, cutting-​off boys’ long hair, and a “no Indian” language rule are just a few manifestations of the technologies of forced acculturation. Separation from cultural roots inevitably leads to a sense of alienation from one’s network of kinship and a loss of place in the community. In Miko Kings, Howe recreates this sense of alienation. Hope feels trapped in the institution, not only physically, but also emotionally and spiritually: The teachers discourage personal beliefs, rituals and traditions. His head swims with different names, and he can no longer distinguish the different faces. Everyone is strange, not like his Choctaw relatives at home. The Indians students are trapped here. Like chameleons in the basket, the trick is to become invisible, blend in, and stay out of trouble. He understands now why blending in is important. A  few weeks ago, when he took his plate outside and offered corn to Hashtali, the eye of the sun, the one who watches over all Choctaws, a teacher scolded him for wasting food. … “These ideas of yours are the work of the devil, young man. Please put the food back on your plate,” she said in hushed tones. (62) The scene starkly illustrates the belief that “the twin engines of Christianization and education would produce a people more palatable to European sensibilities” (Carroll 21). To achieve this goal, eradicating every aspect of Indian students’ original cultures was a necessary first step.

Beyond the biomedical model of diabetes  121 Ironically, what saves Hope from complete desperation is playing baseball, and boarding schools offered opportunities to join baseball teams. Different forms of ball games, such as stickball or lacrosse, were a part of Indigenous cultures long before the arrival of Europeans, and as Craig Womack asserts, Ball games were more than just athletic events  –​they were/​are tied to important religious notions and served as a substitute for war, as well as a symbolic embodiment of the delicate balance between the need for war and the need for peace and stable governing. (32) The beginnings of Indian forays into American baseball date back to the Civil War and the subsequent movement of men. “Unlike football, which has its clearest roots later in the century,” writes Philip Deloria (Dakota Sioux), “baseball was, at least in part, a child of the midcentury military, and, in the wake of the Civil War, it spread quickly to posts across the west, most of which were strategically positioned to supervise and control Indian people” (116). Moreover, as it does not involve close physical contact in the way football does, baseball was, in tandem with racial theories of the times, the perfect sport for soldiers and Indians to play together (Deloria 116). Thus, the game spread quickly from tribe to tribe. At the end of the nineteenth century, missionaries, traders, and neighboring baseball clubs further contributed to the spread of the sport on reservations (Powers-​Beck 6). It was the establishment of the boarding school system in 1878, however, that initiated intensive recruitment of talented Indian players and supported the creation of Indian baseball teams. At Carlisle Indian Industrial School, the baseball program, initiated in 1886, was seen as an important part of its founder Richard Henry Pratt’s assimilationist philosophy, aimed at “killing the Indian, and saving the man,” translated into military discipline and the extirpation of all Indian cultural elements (Powers-​Beck 7). Following Pratt’s logic, introducing Indians to baseball and other athletic sports had numerous ideological advantages. As Lawrence Baldassaro observes in The American Game: Baseball and Ethnicity, [E]‌arly in the twentieth century, baseball, already well established as the national pastime, was being hailed as a metaphor of the American melting pot, welcoming, in turn, a succession of ethnic groups … Journalists pointed out the beneficial role of baseball as a means of acculturating the children of immigrants by instilling the American ideals of democracy and fair play. (3) Considering a long tradition of discriminating against different ethnic groups in sports, the claim indeed sounds ironic. On the other hand, for many Indians, playing baseball was seen as a gesture of cultural resistance, as Deloria puts it, “a refigured warrior tradition” which offered an unparalleled opportunity

122 Diabetes to beat whites at their own game.13 Moreover, for many, it opened a gate to American society, an opportunity to obtain education and, not least, “an occasion for fun and sociability” (116). After the return to Indian Territory, Hope pursues his dream of becoming a baseball player and his career as a pitcher unfolds against the background of the loss of Choctaw lands as a result of the Dawes Allotment Act, which the Choctaws attempt to resist. The General Allotment Act of 1887, also known as the Dawes Act, named after the Massachusetts senator, who introduced it, divided reservation lands into individual 160-​, 80-​, and 40-​acre parcels, called allotments. These were to be distributed among Native individuals with the hope of encouraging Natives to adopt American values such as individuality and self-​reliance and consequentially to turn Indians into “better subjects for a capitalist economy” (TallBear, “Native” 56). However, before land was distributed, lists of eligible tribe members, called base rolls, needed to be drawn up. In order to do so, the government introduced the concept of blood quantum,14 which was devised as an effective technique to break up collectively held Indian lands and, in the long-​run, preempt federal obligations toward Native tribes as defined in over 370 treaties ratified between the USA and Indian nations (Jaimes 124). Those who wanted to receive their allotments were required to prove one-​half or more Indian blood; all others were disfranchised. The remaining unallotted land was pronounced “surplus” and opened to non-​Native settlement. Consequently, between 1887 and 1934, the Indian land base in the USA was reduced from about 138 million acres to about 48 million acres (Jaimes 126). Making “surplus” land available to non-​ Native settlers significantly reduced the amount of land in Indian hands. The implications of the act and its grave consequences are clear for the characters in Miko Kings. As one of the characters bitterly explains, in 1904, 75,000 white people in Indian territory applied to the U.S. Dawes Commission for a place on the rolls of the Choctaw and the Chickasaw Nations. … The Dawes Commission admitted them all, but the Cherokees and Choctaws contested the inflated numbers and appealed to the government for a review. It’s still pending. (29) As Clara Sue Kidwell eloquently demonstrates, the Choctaw knew very well what was at stake and desperately resisted allotment. They saw it as a threat for two basic reasons: For one thing, it contradicted the deeply held cultural value of communal land-​holding. … The second reason was that treaties guaranteed land to the Nations as a self-​governing entity. Allotment would break up the national land base and destroy the integrity of the national government. (139)

Beyond the biomedical model of diabetes  123 Therefore, Hope rightly recognizes the Dawes Act as a threat to cultural integrity and hence a continuation of boarding schools’ assimilationist policies.

Healing as an ethics of relatedness In their study on the embodied dimension of historical trauma, Karina L. Walters and colleagues assert that traumatic events targeting Indigenous communities become literally manifested on bodies. Based on epidemiological and ecosocial theories, the authors draw attention to an embodied illustration of the link between historical trauma and social and health inequalities (183–​ 4). From this perspective, Hope’s diabetic body literally becomes a text telling a history of the myriad types of violence he encountered in his life. Indeed, affected by the soul wound caused by the boarding school experience and the loss of tribal lands, over 60 years later, Hope is dying from diabetes-​related complications. While there is little that conventional medicine can offer to stop the progression of the illness, a spirit of healing is produced in the relationship among Hope and his Indian nurses, John Lennon (Comanche) and Kerwin Johnston (Choctaw). Howe’s indirect juxtaposition of allopathic medicine that offers a release from pain and a measure of control over the body through insulin shots, and traditional healing practices that offer release from spiritual anxiety and an immersion in tribal traditions, serves to privilege the latter or emphasize its importance for Native patients. While neither system can effectively cure diabetes in a biomedical sense, the Choctaw understanding of healing is preconditioned on seeing the affected person in a complex network of relationships with animate and inanimate beings. Thus, Hope is redefined: once a terminal patient, “the scrawny corpse-​of-​an-​Indian” (198) as one white nurse describes him, now he is an elder offering invaluable guidance in Choctaw traditions and teaching Kerwin about different manifestations of cultural survival. It is through Kerwin’s attachment to Hope, his act of caring for the patient, and exceptional empathy that Hope’s subjectivity and integrity are recreated in the biomedical context of the nursing home that reduces individuals to their medical conditions and class status: He [Kerwin] is concentrating on gentle movements. He slides both arms beneath his patient and turns him on his side. Kerwin pushes two pillows against No Hands’ back to stabilize him while he investigates a wound the day nurse had noted on the chart. What Kerwin finds is a lesion the size of a dinner plate growing across his patient’s buttocks. There is a moment of silence so profound that Kerwin can barely contain his grief. The bedsore has become infected all the way down to the bone. Once it’s reached this stage it’s unlikely to heal. In fact, for a man in No Hands’ condition, the infection will soon become systemic and most likely cause heart failure. Kerwin blames himself. The pitiful old man wouldn’t be in this shape if he’d been on the job caring for him. Kerwin knows

124 Diabetes that the day nurses don’t give a shit about elderly Indians. He’s overheard them say they take care of paying residents first, Indians on welfare last. (83; emphasis added) What is striking in the passage is the immensity of Kerwin’s empathy, his act of physical and emotional caring, and his insistence on the importance of Hope’s personalized experience of diabetes, the two factors that make Hope a subject of treatment rather than an object. In her study on the care crisis in the USA, Evelyn Nakano Glenn defines caring as “the relationships and activities involved in maintaining people on a daily basis and intergenerationally” (5). Historically, caring, perceived in terms of a moral obligation rather than work offered on a capitalist market, was allocated to the private sphere and consequently associated with women. “In the United States,” writes Glenn, “the social organization of care has been characterized by reliance on the private household, feminization and racialization of care, devaluation of care work and care workers, and abnegation of community and state responsibility for caring” (6).15 The Elms Nursing Home, with an even greater emphasis on the class and racial status of both caregivers and patients, serves as a clear example of this socioeconomic dynamics. Kerwin’s compassionate attitude is juxtaposed with the unnamed nurses’ reluctance to engage in (low-​paid) care for a destitute Indian patient unable to pay for high quality specialized care. That Howe is interested in centralizing Indigenous knowledges about healing practices, especially Native privileging of relatedness, becomes obvious early in the novel, when Lena, a contemporary Choctaw woman, is visited by a ghost of her relative, Ezol Day. Ezol mastered the skill of traveling in time and space by a thorough study of the Choctaw language: The laws of physics do not distinguish between past and present. Neither does the Choctaw language. … Some Choctaw words are tools, in the same way that numbers are tools. We have evidence in our language that our people experienced other dimensions through our use of particles and verbs which attend to specific movements in and out of spacetime. (37, 39)16 The power of Choctaw knowledge is also at work in the actions of an Alikichi, a Choctaw healer, whom young Lena and her grandmother witness dissolving tornado clouds by “pitching his axe into the ground until the earth opened up a large crater … [and] walk[ing] counter-​clockwise around and around [it]” (42). Despite the vividness of the memory, Lena remains skeptical about the healer’s power to affect the weather, and to which Ezol emotionally responds: Choctaw language doesn’t distinguish “science” from “the sacred.”… Embedded in these rituals and games are mathematical codes that harness

Beyond the biomedical model of diabetes  125 cosmic forces. … Indians in North and South America built cosmic observatories in the form of mounds and pyramids, very complicated structures that require geometry. A stomp dance and a baseball game mimic natural phenomena, such as tornado wind, that are counter-​clockwise. Why can’t you believe that the Alikichi knew how to interact with the chaos? (43) The power of an Alikichi is again invoked in the relationship between Kerwin and Hope, a motif through which Howe insists that healing is a reciprocal process. If Kerwin is an Alikichi, who takes care of his Indian patient, so is Hope, who provides the young caregiver with traditional Choctaw knowledge situates him in a kinship network. In one of the conversations, Kerwin admits that he comes from the Okla Hannali people, from the Six Towns district in Mississippi (Halbert 146),17 and that he also occasionally plays baseball. Hope questions Kerwin about his mother’s name18 and concludes that they “are related back there” (97), alluding to complex kin networks in the Choctaw communities as well as a sense of connection shared by all players of baseball, a “game without limitations” (90). Moreover, as an elder, Hope explains to Kerwin the traditional concept of Ohoyo Holba, “like a woman, but not” (Howe 66), thus helping the young man better understand the complex Choctaw views on gender representations. Hope’s message is informative and, even more importantly, affirmative in its insistence on the healing powers of Ohoyo Holba: Ohoyo Holba was a respected person. They were givers who had multiple kinds of power inside them. That’s why a man would put on a woman’s dress. By wearing the dress, he was showing the world that he was in a state of grace, so to speak, a man without limitations. (89) Indeed, in one interview, Howe insists that the Choctaw understanding of gender and sexual identities explodes Western binaries of male/​female, heterosexual/​homosexual, and instead reflects the ethics of relatedness and seeks power from the very act of transgression: I don’t think gays and lesbians are the analogue for Ohoyo Holba. I’m trying to say that Ohoyo Holba was not necessarily homosexual, but many things, including homosexual. Often they weren’t just involved with other men but had many levels of relationships. They were also involved with our community in very special ways. They could be healers. They’re people that protected our children because they embodied more than one thing. And what is part of Choctawan aesthetics is that we revere things that are unusual. Different. So when you look at the spirit that’s connected in Ohoyo Holba, and when they put on that dress in olden

126 Diabetes times, they are saying “the embodiment of many.” That is very different from any discussion of homosexuality mainstream Americans have. (Squint 223) By providing Kerwin with grounding in the traditional knowledge, Hope assumes the role of Alikichi and an elder. Moreover, he is also compared to Ohoyo Holba as his famous pitch, described as an “up-​down” (Howe 196) in one of the newspapers, is also a manifestation of his power to manipulate time, space, and natural phenomena: “When Hope looked up into the sky he disappeared completely on the mound. For a split second the sky cracked open and a blinding light flashed on the ball field” (160). His talents are wasted, however, the moment Hope decides to throw the final game in the Twin Territory Series against the Seventh Cavalrymen. His outraged playmates decide to chop off his hands, and thus deprive Hope of his power to “work in collaboration with the earth’s mathematical systems” (44). Hope’s last healing ceremony and a chance to make up for his cowardly deed from the past takes place at the moment of his death when Kerwin is devotedly attending to his body. Hope is visited by an ancient toli player who calls him by his proper Choctaw name to wake him up and again participate in the final game against the Seven Cavalrymen. In her description of baseball, Ezol asserts that, “A pitcher was the embodiment of the center pole that could access the Middle, Upper, and Lower Worlds” (39). In “Embodied Tribalography,” Howe explains that the center pole, referred to as iti fabassa, marks a sacred space where upper and lower worlds are engaged, creating a sense of three-​dimensionality (“Embodied” 77, 84). Thus, the pitcher, occupying the sacred center, performs an important ceremonial function. In his dream, Hope once again becomes the Miko Kings pitcher but this time, he leads his team to victory: Hope winds up, looking straight up into the Sun as is in prayer to Hashtali, the Choctaw’s source of power. He disappears inside it. When he pulls out of the light he throws everything he’s got at the Cavalry. … And the roar of the Indians can be heard all the way back to Fort Sill, where, after twenty-​two years, Geronimo, honored leader of the Apaches, is still a prisoner of war. (218) The victory is the last game of the Twin Territories series that evidently involves more than a spirit of competition. When in 1907, the Choctaw lost their lands for the second time, first to allotment and now to Oklahoma statehood, defeating the Seventh Calvary, so infamous in their engagement in the Indian Wars, constitutes an act of healing and reconciliation with the past. As Hope reenacts the last game in his final moments, Lena, with the help of Ezol, is completing the story of the Miko Kings, thus, as Emily Lederman observes, creating a “decolonial archive” (64). In this framework,

Beyond the biomedical model of diabetes  127 healing is an act of emotional and spiritual engagement that ultimately leads to empowerment. If Hope’s disfigured and diabetic body is a text testifying to historical trauma, his relationship with Kerwin, reenactment of the last game and baseball as an Indigenous game become acts of spiritual recovery from the “soul wound.” As Howe claims in her documentary, Indian Country Diaries: Spiral of Fire, too many Native stories pass on “historic grief ” and she wonders aloud, “how are we going to heal ourselves? For healing we must forgive. Together we can reconcile our past for peace, for the future” (qtd. in Romero 24).

Beyond the biomedical model The grim statistics which opened the previous chapter demonstrate the seriousness of the diabetes epidemic globally and in particular in Indigenous communities. What is missing, however, in the language of figures, percentages, and medical jargon is the complexity of the disease with its etiology entangled in historical, social, and cultural processes. Undoubtedly, the biomedical model provides important biochemical explanations and tools to control the condition, but only to some extent. However, the way it insists on the genetic origins of the disease creates a sense of genetic fatalism that effectively reduces the patient’s agency to that of a carrier of a faulty gene. Moreover, as many scholars have demonstrated, the biomedical model is a useful explanation as it glosses over the realities of historical trauma caused by settler colonialism. Lastly, it remains oblivious to Native patients’ needs to include cultural understanding and methods of healing. The literary works of Sherman Alexie and LeAnne Howe testify to these ambivalences about biomedical models of diabetes and situate the condition in a place where multiple contexts and influences converge:  collective past experiences, cultural understanding of illness and healing, as well as different forms of resistance to settler colonialism. What is notable in their diverse treatments of diabetes is how they insist on the role of colonialism in the creation of contemporary epidemics. Alexie’s extensive discussion of food, while indeed often intertwined with discourses of genetic determinism, establishes a connection between settler colonialism and the destruction of traditional Indigenous foodways. Similarly, Howe’s ambitious story, by connecting the history of the Dawes Allotment Act, boarding schools, and Indigenous ball games, creates a space for empowering a redefinition of the Choctaws as agents of history rather than victims. Thus, Hope’s body indeed becomes a text that resists erasure and he, as healer and teacher, remains in control of the narrative and engages in the act of embodied resistance.

Notes 1 Alexie has often been criticized for his pessimistic portrayal of a reservation life and an excessive emphasis on social problems such as poverty, alcoholism, and

128 Diabetes unemployment. See Gloria Bird, “The Exaggeration of Despair in Sherman Alexie’s Reservation Blues,” Wicazo Sa Review, vol. 11, no.  2, 1995, pp.  47–​52; Stephen F.  Evans, “ ‘Open Containers’:  Sherman Alexie’s Drunken Indians,” American Indian Quarterly, vol. 25, no. 1, Winter 2001, pp. 46–​72. 2 See Gloria Bird, “The Exaggeration of Despair in Sherman Alexie’s Reservation Blues,” Wicazo Sa Review, vol. 11, no.  2, 1995, pp.  47–​52, and Elizabeth, Cook-​ Lynn, “American Indian Intellectualism and the New Indian Story,” Natives and Academics:  Researching and Writing about American Indians, edited by Devon A. Mihesuah (Lincoln: University of Nebraska Press, 1998), pp. 111–​38. 3 On class in Alexie’s fiction, see Jeff Berglund and Jan Roush, editors, Sherman Alexie: A Collection of Critical Essays (Salt Lake City: The University of Utah Press, 2010); Laura M. Furlan, Indigenous Cities: Urban Indian Fiction and the Histories of Relocation (Lincoln: University of Nebraska Press, 2017); Daniel Grassian, editor, Understanding Sherman Alexie (Columbia:  University of South Carolina Press, 2005); and Leon Lewis, editor, Sherman Alexie (Pasadena, CA: Salem Press, 2012). 4 The glycemic index (GI) is defined as “an index for ranking foods according to their effect on blood glucose concentrations and is defined as the area under the 2-​h blood glucose response curve (AUC), following intake of 50 grams carbohydrate from a particular food” (Aune et  al. 522). As Michael Milburn explains, “Diets characterized by a low glycemic load (the glycemic load is the product of the glycemic index of a food and its carbohydrate content) are associated with better blood sugar control in diabetics, higher blood levels of HDL (‘good’) cholesterol, and lower risks of developing diabetes and cardiovascular disease” (425). 5 The Ghost Dance of 1890 was a social and religious movement which emerged as a response to severe demographic losses and cultural collapse. It originated in western Nevada near the Walker River Indian Reservation and grew to cover a larger area, including a central portion of the western USA. It involved a large number of Indian tribes. The key figure was a Paviosto man, Wovoka, “The Cutter,” also known as Jack Wilson. In 1886 or 1887, Wovoka experienced a vision in which he was told to instruct people how to perform a special kind of dance that would bring back their dead ancestors. The underlying principle of the Ghost Dance doctrine heralded the unification of all Indian tribes, living and extinct, the regeneration of earth and a harmonious coexistence of all people. The Ghost Dance lasted merely a few years, being gradually suppressed by the authorities. In the case of the Sioux Ghost Dance, the movement was brutally quelled on December 29, 1890 at Wounded Knee, where over 300 Sioux were killed. See James Mooney, The Ghost-​Dance Religion and the Sioux Outbreak of 1890 (Lincoln: University of Nebraska Press, 1991) and Russell Thornton, We Shall Live Again:  The 1870 and 1890 Ghost Dance Movements as Demographic Revitalization (Cambridge: Cambridge University Press, 1986). 6 See Matthew 15:32–​9 and Mark 8:1–​9. 7 Dana Vantrease analyzes how frybread and other government-​ provided food have acquired a cultural significance for Native Americans, usually considered as “essence” of Indianness. She does not, however, mention the fact that, considering the rise of diabetes in Indigenous communities, the continuing popularization of frybread is problematic. Dana Vantrease, “Commod Bods and Frybread Power: Government Food Aid in American Indian Culture,” Journal of American Folklore, vol. 126, no. 499, Winter 2013, pp. 55–​69.

Beyond the biomedical model of diabetes  129 8 Leslie Marmon Silko, Ceremony (London:  Penguin Books, 1986)  and Simon J.  Ortiz, “Towards a National Indian Literature:  Cultural Authenticity in Nationalism,” MELUS vol. 8, no. 2, Summer 1981, pp. 7–​12. 9 Think of the motif of gathering seasonal foods and making preserves for winter in Frances Washburn’s The Sacred White Turkey. 10 Chemawa is a boarding school in southern Oregon where most Yuroks, Tolowas and Wiyots were sent. The school is still in operation. 11 Following the Southern Plains Indian wars in Oklahoma and in Texas in 1875, the most highly sought Indian chiefs were captured and imprisoned at Fort Sill, Oklahoma. The President’s Attorney General stated that it was illegal to try them under a military commission, as the state could not declare war on its own wards. Therefore, the prisoners were sent to Fort Marion, Florida, for permanent imprisonment. There, Captain Pratt began his “experiment” in educating and civilizing “his” prisoners, who were later released by the War Department and sent to Hampton Institute (D. Lindsey 27–​33). Pratt established his own Indian program at Carlie Industrial School. For the Fort Marion experience from an Indigenous perspective, see Diane Glancy, Fort Marion Prisoners and the Trauma of Native Education (Lincoln: University of Nebraska Press, 2014). 12 Armstrong tried, unsuccessfully, to include Nez Perce children in his program before admitting Fort Marion prisoners (D. Lindsey 20–​1). 13 Indeed, this is how Wild Buck, an Indian baseball coach, inspires his team to play with the Seventh Cavalrymen: “On June 25, 1876, George Armstrong Custer and the 265 men under his command lost their lives in the Battle of Little Big Horn. No one thought the Indians could take on the Seventh Cavalry and beat them flat. But they did. In 1805, Pushmataha led 350 Choctaw warriors in a battle against the mighty Osage Nation. No one thought a bunch of Choctaw corn growers could whip a mighty Plains tribe –​buffalo hunters at that … This is the battle at Little Big Horn. This is Pushmataha’s finest hour” (Howe, Miko Kings 93; emphasis in original). 14 The concept of blood quantum is discussed in more detail in Chapter 5. 15 In Chapter 2, Glenn writes about how educational programs in Indian boarding schools concentrated on domesticating Indian girls by instructing them in various forms of care work. Evelyn Nakano Glenn, Forced to Care: Coercion and Caregiving in America (Cambridge: Harvard University Press, 2010). 16 For more on Ezol’s theory of time and space, see Patrice Hollrah, “ ‘The Lord and the Center of the Farthest’: Ezol’s Journal as Tribalography in LeAnne Howe’s” Miko Kings: An Indian Baseball Story, Studies in American Indian Literatures, vol. 26, no. 2, Summer 2014, pp. 40–​54; Emily Lederman, “Archival Sovereignty in LeAnne Howe’s Miko Kings: An Indian Baseball Story,” Studies in American Indian Literatures, vol. 29, no. 3, Fall 2017, pp. 64–​88; Carter Meland, “Talking Tribalography:  LeAnne Howe Models Emerging Worldliness in ‘The Story of America’ and Miko Kings,” Studies in American Indian Literatures, vol. 26, no.  2, Summer 2014, pp.  26–​39; Channette Romero, “Expanding Tribal Identities and Sovereignty through LeAnne Howe’s ‘Tribalography,’ ” Studies in American Indian Literatures, vol. 26, no. 2, Summer 2014, pp. 13–​25. 17 The Six Towns included Tala, Chinakbi, Bishkun, Inkillis Tamaha, Nashwaya, and Oka Talaia. 18 The Choctaw were traditionally matrilineal societies.

Part III

Blood and genes

5  From blood memory to genetic memory, and the emergence of Native American DNA A story of biocolonialism at the turn of the millennium In October 2018, Elizabeth Warren, then Democratic presidential candidate, in response to President Donald Trump’s racist mocking of her with the nickname “Pocahontas,” released her DNA test results confirming her Native ancestry. In a rollout video produced for the occasion, we saw Carlos Bustamante, a professor of genetics at Stanford and adviser to Ancestry and 23andMe, studying the results and dramatically proclaiming “The facts suggest that you absolutely have a Native American ancestor in your pedigree” (Cillizza). In the press releases that followed, Warren admitted to not being an enrolled member of any federally recognized tribe in the USA, but nevertheless emphasized the fact that “her family history is her family history,” now confirmed by the test. In response to Warren’s test, Cherokee Nation Secretary of State Chuck Hoskin Jr. released a statement saying: Using a DNA test to lay claim to any connection to the Cherokee Nation or any tribal nation, even vaguely, is inappropriate and wrong. It makes a mockery out of DNA tests and its legitimate uses while also dishonoring legitimate tribal governments and their citizens, whose ancestors are well documented and whose heritage is proven. (Khalid) Faced with severe criticism from Native communities, in February 2019, in an interview for the Washington Post, Elizabeth Warren admitted that she had apologized to the Cherokee Nation for her claims of Native heritage, which was later confirmed by tribal spokeswoman Julie Hubbard. In the same interview, clearly with a better understanding of DNA testing implications, Senator Warren said:  “I can’t go back. But I  am sorry for furthering confusion on tribal sovereignty and tribal citizenship and harm that resulted” (qtd. in Linskey and Gardner). When Warren was just beginning her fight for the Democratic Party’s presidential nomination, many observers wondered whether the DNA test controversy would be used again to discredit her. In March 2020, having received poor results in the crucial Super Tuesday

134  Blood and genes contests, Warren resigned from the presidential race. While Warren’s problematic claims to Native heritage did not contribute directly to her resignation, the debate it inspired about biosciences’ claims to neutrality and their multiple relations to power is indeed revealing. Warren’s use of direct-​ to-​ consumer DNA tests (sold on Amazon, for example) to authenticate her Indigenous heritage illustrates the phenomenon described by Kim TallBear in her insightful Native American DNA. In it, TallBear traces the coproduction of Native American DNA as an object of study vis-​à-​vis the pervasiveness of the category of race in scientific discourses which now promote it as research on populations (rather than races). The aim of such practices is to disassociate science from eugenics and scientific racism of the nineteenth century. The proliferation of DNA discourses is also detectable in nonscientific contexts describing how Indigenous people refer to their cultural heritage. Kim TallBear notes that the concept of blood memory (first articulated by N. Scott Momaday) is gradually substituted by DNA imagery, which reflects scientific discourses’ penetration of everyday language. To illuminate how these bioscientific, biopolitical as well as lay concepts intersect with the literary imagination, in this chapter, I  explain the origins of Momaday’s blood memory and how it opens a dialogue with the federally introduced politics of blood quantum. I provide a brief explanation of why blood quantum is a problematic concept in relation to how tribes define their citizenship requirements. Next, I demonstrate how blood memory gradually gives way to the concept of genetic memory. This shift reflects a proliferation of studies contingent on the extraction of DNA samples from Indigenous, unadmixed populations. This intensified interest in DNA samples received from Indigenous groups is theorized by TallBear as the emergence of Native American DNA, which leads to the objectification of Native bodies in genomic research and, potentially, to legal redefinitions of tribal sovereignties. To illustrate the point, I offer a brief discussion of two widely publicized cases which best illustrate how the emergence of Native American DNA poses a threat to tribal sovereignties. Finally, I refer to TallBear’s call to extend the scope of Native American and Indigenous Studies to Science and Technology Studies (STS), an important act in the meaningful and relevant discussion about the shapes of and dilemmas faced by Native sovereignties in the twenty-​ first century. That Native American literature already engages in this discussion will become clear in the remaining chapters of this book.

N. Scott Momaday’s blood memory The idea of tribal memory as contained in and transmitted through blood was first famously used by N. Scott Momaday in his 1968 Pulitzer Prize winning novel, House Made of Dawn, and further developed in his later works.1 In the novel, Tosamah, the Priest of the Sun, delivers a sermon in which he claims that the original homeland of the Kiowa people “lay like memory in

From blood memory to genetic memory  135 [his grandmother’s] blood. She could tell of the Crows, whom she had never seen, and of the Black Hills, where she had never been” (119).2 While she had never been physically present in the Black Hills and had never seen the Crows, the grandmother remembers these geographical locations and people as this memory is transmitted to her, and younger generations, in the blood. In his later works and interviews, Momaday expands on his idea of “blood memory.” In Ancestral Voice, a series of conversations between Momaday and Charles L. Woodward, then professor of English at South Dakota State University, the crossing of the Bering land bridge is discussed as an event that is remembered rather than imagined: There are times, Chuck, when I think about people walking on ice with dogs pulling travois, and I  don’t know whether it’s something that I’m imagining or something that I remember. But it comes down to the same thing. … I think that each of us bears in his genes or in his blood or wherever a recollection of the past. Even the very distant past. I  just think that’s the way it is. … In the case of the Kiowa, it’s a remembering of the migration. A remembering of coming out of the log. A remembering of crossing the Bering land bridge. (qtd. in Strong and Van Winkle 561) Blood memory, contained and activated in the blood, facilitates cultural continuity by creating a genealogy of stories which, through combined processes of remembering and imagination, are accessed by subsequent generations of Native Americans. In his later writings, the idea of blood memory undergoes a significant conceptual shift. In a brief autobiographical essay published in The American Indian and the Problem of History, a 1987 collection edited by Calvin Martin, Momaday writes about differences in the ways Native and non-​Native people perceive the surrounding environment. He assumes the “existence of intrinsic variables in man’s perception of his universe, variables that are determined to some real extent on the basis of his genetic constitution” (156). As Chadwick Allen rightly observes, with the introduction of genetic thinking, Momaday (and later Linda Hogan) creatively conflate discourses of narrative, autobiography, and science to produce “an argument over who in contemporary America may assume the authority to speak ‘truthfully’ and ‘authentically’ about American Indian perception and identity” (“Blood” 95) as well as how such claims to “authenticity” run the risk of creating essentialist and racist categories. Indeed, Momaday’s reference to memory stored in the blood and genes proved both productive and controversial. On the one hand, the trope inspired many Native American writers to emulate on the idea of a cultural content contained in Native bodies.3 On the other hand, however, it also elicited various critical comments on the meaning and limits of blood imagery in Indian cultures, pointing to the problematic use of the blood quantum as

136  Blood and genes the defining factor of Native identity. The probably best-​ known critical response came from Arnold Krupat in his much acclaimed 1989 volume of literary criticism, The Voice in the Margin. In the space of a footnote, the critic dismisses Momaday’s concept as “absurdly racist” (14n7) and confidently asserts that, “there is no gene for perception, no such thing as memory in the blood” (13). Krupat insists that the concept creates a “mystification” and has an essentializing effect on the way Indians are perceived in popular culture, thus “plac[ing] unnecessary obstacles in the way of a fuller understanding and appreciation of Native American literature” (13). Conversely, enthusiastic responses interpreted blood memory as an empowering gesture of locating Native American identity in distinct cultural experience, history, and geography. Simon Ortiz, for example, sees House Made of Dawn as first of all an example of cultural survival and resistance to the forces of colonization (“Towards” 10–​11). In The Heirs of Columbus, Gerald Vizenor creates a trickster discourse to demonstrate how situating Momaday’s and Krupat’s positions as exclusionary precludes any creative dialogue about complexities of Native identity.4 Pauline Turner Strong and Barrik Van Winkle persuasively demonstrate how Krupat’s brief analysis completely ignores the importance of landscape and movement in the transmission of blood memory. They argue that what lies at the core of the trope is a refiguration of racist discourses on “Indian blood” into a “a vehicle of connection and integration –​literally, a re-​membering … of Kiowa movement across the landscape” (562). Moreover, they observe that while indeed “blood memory” may be seen as an essentialist idea, it is by no means racist: “Nowhere does Momaday express the superiority of those possessing what he figures as ‘blood memories,’ nor does he advocate political, economic, or social distinctions on the basis of the possession of such memories” (562). Rather, what is emphasized is a cultural and geographical continuity. The consistency with which blood memory is linked to the relationship with the land is similarly emphasized by Sean Kicummah Teuton (Cherokee) in Red Land, Red Power. Teuton introduces a philosophically grounded approach of geoidentity, which, using Indigenous ontologies, theorizes how a sense of place and a movement within it is imbricated with other important conceptions such as creation of selfhood, religious practices, and cultural continuity. By emphasizing the dynamics of land and identity in the shaping of contemporary Native American experiences, Teuton asserts that House Made of Dawn “declares a beginning for the political awakening and cultural revival that was to characterize the era of Red Power” (45). The most vocal defense of the blood memory trope comes from Chadwick Allen’s Blood Narrative:  Indigenous Identity in American Indian and Maori Literary and Activist Texts. According to Allen, rather than static and essentializing in its treatment of Native identity, blood memory gradually evolves to become a successful and subversive trope of challenging and deconstructing the discourse of the US government designed to “systematize

From blood memory to genetic memory  137 and regulate Indian identities” (178). In Momaday’s works, the blood quantum discourse is reappropriated to collapse the government’s reductive and racist categories delineating the boundaries of authentic Indian identity to instead construct a discourse deeply rooted in Indigenous epistemologies and individual experiences. “These include,” Allen writes, the assertion of an unmediated relationship to indigenous land bases (whether or not those lands remain under indigenous control), the continuation of oral traditions (whether or not those traditions continue in Native languages), and the power of the Indigenous writer’s imagination to establish communion with ancestors. (178) For Momaday, blood memory is comprised of Native spirituality, narrative, and geography, and it subsequently effectuates the collapse of spatial and temporal differences. In his texts, Momaday physically revisits geographically important locations, and, more importantly, he also imaginatively situates himself “in this landscape, remembers the stories, and in the remembering imagines himself as playing a part in them” (181). The most succinct example of blood memory at work is found in autobiographical The Names, which, apart from numerous stories tracing Momaday’s kinship with the Kiowa people, includes a reprint of his birth certificate confirming, according to the blood quantum logic, his Kiowa identity: To whom it may concern: This is to certify that the records of this office show that Novarro Scott Mammedaty was born February 27, 1934 at Lawton, Oklahoma, and is of 7/​8 degree, as shown on the Kiowa Indian Census roll opposite Number 2035. … By Act of June 2, 1925 (42 Stat. 253), all Indians born within the territorial limits of the United States were declared to be citizens of the United States. (Momaday, The Names 42) It quickly becomes clear, however, that it is not the government-​issued document that constitutes and describes Momaday’s Indian identity. On the contrary, it is the acts of storytelling which situate the speaker in the sacred geography of his ancestors and, thus, collapse the temporal distance between the speaker and his kinship from precontact times. Momaday’s narrative “strongly suggests that he considers blood memory a marker of his Kiowa identity that is superior to blood quantum” (Allen, Blood 186–​7). Similarly, another idea that downplays the authenticity of race conceived in biomedical terms is the concept of the “imagined identity,” famously presented in “The Man Made of Words.” “We are what we imagine,” writes Momaday. “Our very existence consists in our imagination of ourselves. Our best destiny is to imagine, at least, completely, who and what, and that we are. The

138  Blood and genes greatest tragedy that can befall us is to go unimagined” (“Man” 55). The skill of imagination allows him to write himself “out of the room” and “out of the time” and situate himself in the Kiowa realities which, as a twentieth-​century Native writer, he had not and could never have visited. It is again the Kiowa past that he remembers thanks to blood memory rather than blood quantum that authenticates Momaday’s belonging to his clan.

Blood and blood quantum in Native America The potential controversy over the blood memory trope stems from multiple cultural and historical meanings that blood conveys in Native American cultures. The tendency to invest blood with profound significance is a feature of many societies, ancient as well as contemporary, all over the world. As Melissa Meyer notes, “beliefs concerning blood are probably among the oldest surviving ideas from the earliest days of humankind [and t]hey are widely distributed among the peoples of the world in much the same form” (“American Indian” 235). Blood signifies a reproductive cycle of life, fertility, and regenerative power often illustrated in bloodletting ceremonies. On the other hand, the redness of blood, especially gushing from a wound, is an apt reminder of death and the fragility of the human body. In many cultural practices and beliefs, blood functions as both a metaphor and a literal reference to the life-​giving red substance. This is well illustrated with an example of the Bimin-​Kuskusmin people of Papua New Guinea who buried bamboo tubes filled with menstrual blood for fertilization purposes (Meyer, Thicker 5). As this example illustrates, not only is the meaning of blood invested with the power of altering reality, but also it is produced in highly gendered contexts. Similarly, blood figures as an important element in Native cultures in North America. Before Indigenous people had contact with Europeans, they developed distinct beliefs and practices involving blood, often connected with determining family and group affiliations. As Circe Sturm observes in her study of the meaning of blood in the Cherokee Nation of Oklahoma, in the first half of the eighteenth century, “Cherokees distinguished themselves from Europeans, Africans and other Native Americans not by skin color, race, or even language, but by membership in a Cherokee clan, which was theirs by right of birth or adoption.” Clan members believed that “they literally shared a common blood, a blood they were morally obligated to protect and defend” (Blood Politics 29, 33), a belief which finds its manifestation in the “law of blood,” compelling clan members to avenge the death of a kinsman killed by a representative of another clan. Similarly, the Anishinaabeg, with their long history of migrations, intermarriage, relationships with other tribal nations, and participation in fur trade, defined their identity in terms of nindoodemag, namely kinship networks. Clan identities, inherited from fathers, dictated legal and moral obligations as well as access to community resources (Ellinghaus 1, 3). These concepts of investing blood with the power to structure social

From blood memory to genetic memory  139 relations were soon to be challenged by the dissemination of European racial categorizations. With the intensification of contacts with European settlers in the eighteenth century, the understanding of blood changed dramatically and became conflated with the European theories on race. The Cherokee case again serves as an apt example. To more effectively confront US expansionism, Cherokee villages began to abandon clan organization for a more centralized form of governance which provided better protection against the encroachment of white settlers. These processes unraveled simultaneously with an incorporation of racial categories introduced by Europeans that identified collective national identities with a category of race, a concept supported by the colonial scientific thought. As a result, a matrilineal structure of social organization was abandoned and the importance of clan mothers in making political decisions gradually deteriorated. Moreover, an emerging Cherokee state adopted racist ideologies of the USA to create coherent social structures and exert control over an idea of Cherokee identity. The presence of such racialist discourses that is codified in the law is found as early as the beginning of the nineteenth century. For instance, even before the removal of 1838, in the Southeast, the Cherokee Nation, clearly following US racial ideologies, “passed a series of antimiscegenation laws to discourage intermarriage between Cherokees and their African-​American slaves” (Sturm, Blood Politics 54).5 However, the most dramatic intervention into how Cherokees and other Native tribes defined their communal and political identities came with the Dawes Allotment Act, the introduction of assimilationist policies, and the introduction of “blood quantum.” The emergence of blood quantum as a factor authenticating Native ancestry can be traced down to the Dawes Allotment Act of 1887.6 As many scholars observe, blood quantum was devised as an effective technique to break up collectively held Indian lands and, in the long-​run, preempt federal obligations toward Native tribes as defined in over 370 treaties ratified between the USA and Indian nations (Jaimes 124). The Dawes Act divided reservation lands into individual parcels, called allotments. These were to be distributed among Native individuals. However, before land was distributed, lists of eligible tribe members, called base rolls, needed to be drawn up. Those who wanted to receive their allotments were required to prove one-​half or more Indian blood; all others were disfranchised. The remaining unallotted land was pronounced “surplus” and opened to non-​Native settlement. As a result, the size of land in Indian hands was significantly reduced. As Donald Parman writes, “in 1881 the Indian estate amounted for 155,632,312 acres. By 1890 it had fallen to 104,314,349 acres and by 1900 to 77,865,373 acres” (9). An important element in the process of distributing allotments involved the creation of categories of “full-​blood” and “mixed-​blood” individuals. Indians deemed to be “half-​blood” or less were given full title to the land and US citizenship; whereas, those with more than one-​half of Indian blood received their allotments in trust for 25  years (TallBear, Native 56). What

140  Blood and genes is discernable in this logic is the nineteenth-​century belief that people from diverse races demonstrated different intellectual and moral propensities. As Katherine Ellinghaus explains, drawing on the long-​standing European view that racial mixing led to an increase in vigor, white Americans assumed, with easy arrogance, that the addition of white blood made Indians smarter, more business-​like, and au fait with Christianity, the English language, and mainstream ways of life. Indians of full descent were assumed to be lower on the evolutionary scale and thus less intelligent and civilized. They were also portrayed as helpless victims deserving of the government’s aid. By contrast, people of mixed Indian and white descent were depicted as cunning, exploitative, and undeserving of the benefits and rights that came with Indian ancestry. (xii–​xiii) Creating categories of full-​ bloods and mixed-​ bloods represents a firm belief in biology as a definitive factor with no consideration given to culture in constructing definitions of Indianness. Thus defined criteria, tied to meticulously calculated blood quantum,7 successfully worked to dispossess Indians from their land, already shrunk by the US expansionist policies. More significantly, however, they transferred the authority of defining who is “authentically” Indian into the hands of white people and their ideas about racial (im)purity. According to Chadwick Allen, with the introduction of the blood quantum policy, “Indian identity became subject to a genetic burden of proof. Indians who did not ‘look’ Indian enough were –​and are today  –​particularly suspected of falsifying indigenous identity” (“Blood” 97). Not only were categories of Indianness significantly distorted by the prevailing racialist beliefs, but the very process of compiling the rolls was also marred by incompetence of federal commissioners. Some rolls, including the Dawes Rolls (1899–​906), used today by the Oklahoma Cherokees, were compiled over such a long period of time that some applicants died before the paperwork could be completed. The descendants of such individuals, as Eva Marie Garroutte (Cherokee) explains, “would be forever barred from tribal citizenship” (21) even though they were recognized by the community as Indians. Frauds were common too; people with no Indigenous ancestry claimed to be related to Native individuals so that they could receive land.8 Finally, there were Native communities that actively resisted being enrolled. For instance, among Oklahoma Creeks, Cherokees, Chickasaws, and Choctaws, conservative groups known as “irreconcilables” resisted registration with the Dawes Commission to protest the US policy toward Native tribes (Garroutte 21–​2). Therefore, the complexity of the process of calculating blood quantum and creating rolls, both on an ideological and logistical level, proved to be a highly imperfect and contestable method of identifying Indianness.

From blood memory to genetic memory  141 Ironically, despite its application of racial logic, blood quantum, next to descendancy and residency factors, remains the most often used requirement for tribal citizenship in the USA. As Eva Marie Garroutte notes, “[A]‌bout two-​thirds of all federally recognized tribes of the coterminous United States specify a minimum blood quantum in their legal citizenship criteria, with one-​ quarter blood degree being the most frequent minimum requirement” (15). For example, members of the White Mountain Apache Tribe must be half-​ bloods9 while members of Iowa Tribe of Oklahoma just 1/​16.10 The Cherokee Nation of Oklahoma, on the other hand, does not use blood quantum at all and instead requires prospective tribal members to prove a connection to an enrolled ancestor who is on the Dawes Rolls.11 Considering the historical context, one may wonder why tribes persist in utilizing a mechanism that is, in the words of M. Annette Jaimes (Juaneño/​Yaqui), “not especially different in its conception from the eugenics code once adopted by nazi (sic!) Germany” (124). Regardless of where one discovers the answer to this puzzling question, the topic is considered to be one of the most controversial and widely discussed in Indian Country. While many scholars see the persistence of blood quantum as an act of submission to colonialist practices and acceptance of romanticized definitions of Indianness produced by the (white) mainstream,12 the survival of this criterium is tied to a complex sociopolitical context. Eric Beckenhauer identifies economic and cultural rationales behind the survival of blood quantum in the criteria for tribal membership. The criterion of blood quantum is preserved “to conserve historic sources of federal resources, to prevent dilution of new sources of tribal wealth such as Indian gaming, and to maintain tribal character and identity” (168). Federally recognized tribes receive federal assistance and restrictive requirements better control the size of population eligible for funds, and free health care from the Indian Health Service. On the other hand, less restrictive requirements increase the number of enrolled members thereby allowing more persons to receive funding. The economic rationale behind blood quota becomes most clear with the advent of Indian gaming. With the introduction of the Indian Gaming Regulatory Act of 1988, many tribes have considerably improved their economic situation13 and, not coincidently, faced an increase in applications for tribal citizenship. Some tribes react to this intensified interest in tribal enrollment as a possibility to revitalize reservation communities with an addition of new members, which in turn translates into more influence on local and national policies. Others, on the contrary, to protect their economic resources and cultural integrity, increase blood quantum requirements and thus make application for tribal citizenship even more difficult (Beckenhauer 168–​9). Apart from economic reasons justifying the continued use of blood quantum in determining eligibility for tribal citizenship, there exists a set of complex sociocultural incentives whose main function is the protection of tribal identities. Such a use of blood quantum defines Native (or any ethnic) identity as biologically based and is used to protect tribal blood from dilution

142  Blood and genes by non-​Indians or Indians from other tribes. What becomes immediately apparent in such understanding of blood quantum is a belief in the conflation of blood and culture with blood serving as a factor authenticating cultural belonging. As one citizen of the Cherokee Nation of Oklahoma states, If we continue to mix ourselves, then the blood heritage runs out. The blood of a Cherokee is not just a biological thing, but a lot of heritage. There are a lot of real Cherokee people running through our veins. There’s a cultural heritage in there. (qtd. in Sturm, Blood Politics 98) Clearly, in this instance, blood functions as a carrier of Cherokeeness, or Indianness in general, and is necessary for determining who is eligible for political as well as cultural affiliations. This logic and the controversies it produces are best illustrated by the symbolic value attributed to Certificate of Degree of Indian Blood (CDIB) cards issued by the US Department of the Interior’s Bureau of Indian Affairs. To determine who can be issued a CDIB card, the Bureau of Indian Affairs uses a blood quantum definition, usually one-​fourth Native American blood, to identify an individual as a Native American (Thornton, “Tribal” 36). Those who manage to fulfill these legal criteria, “card-​carrying Indians,” often enjoy the status of real Indians, especially in non-​Native contexts. However, individuals with mixed-​ blood heritage find it more difficult to lay claim to their Native identity. Such divisions frequently lead to factionalism within communities, alienate mixed-​blood individuals,14 and create static definitions of Indian identity. As Elizabeth Archuleta observes, “Blood quantum identity ignores [the] history of interrelations, oftentimes forcing one to choose a single identity and history rather than claim multiple ancestries and histories” (8). On the other hand, in a decolonizing gesture of downplaying the importance of blood quantum standards, many tribes emphasize cultural and community connections as necessary to apply for tribal citizenship. Indeed, as Kirsty Gover demonstrates in her study of tribal membership governance, Tribes increasingly use tribe-​specific measures of blood quantum, in contrast to the pan-​tribal concept of Indian blood quantum used in federal policy. … [T]‌hese changes suggest that tribes are becoming more ‘genealogical’ in their approach to membership governance, favoring tribe-​specific descent rules over pan-​tribal or racial measures. (247) For instance, in 2007 the White Earth Nation embarked on a project of constitutional reform that, in 2013, led to the adoption of a new constitution privileging lineal descent rather than a blood quantum requirement. As Jill Doerfler (Anishinaabe) writes, “White Earth citizens decided that citizenship would once again be based on Anishinaabe values, which are rooted in

From blood memory to genetic memory  143 relationships and family” (xxii). Secondly, another tendency is the recognition that blood does not guarantee cultural affiliation and involvement in tribal life. This in turn leads to the introduction of the criteria which are a combination of blood-​related and cultural participation factors. For instance, the Oglala Lakota on the Pine Ridge Reservation in South Dakota and the Haida in Alaska have moved away from prioritizing blood quantum and instead underscore factors such as residency on the reservation, affinity to traditional knowledge systems, and community service (Jaimes 134). Such combined approaches situate agency with determining tribal affiliation in the hands of Native communities and ascribe value to cultural practices including speaking Native languages, recognizing the importance of sacred places, participating in traditional religious rituals, and engaging in a communal life. Indianness is not delineated only by blood (which nevertheless often remains important) but rather manifests itself in a network of social relations. Circe Sturm, in her study of race shifters, white people who chose to identify as Cherokee,15 repeatedly emphasizes how members of the Cherokee Nation object to claims to Cherokeeness based solely on distant blood connections. What constitutes Cherokee identity is, as many tribal members claim, fluency in cultural practices and active participation in the tribal life (Sturm, Becoming Indian 25). Cherokeeness (and any tribal identity) is then not about who one claims to be but whether one is claimed and recognized by the tribe. Expanding definitions of eligibility for tribal citizenship carries other important implications. As Eric Beckenhauer writes, the main reason why blood quantum is harmful to the survival of Native Americans is the fact that “Due to intermarriage and admixture among cultures, subsequent Indian generations face great difficulty in meeting even loose blood quantum membership criteria, since the average blood quantum of their population is inevitably diluted” (170). Indeed, social and political changes in the twentieth century, especially the Indian Relocation Act of 1956 and mass migration of Indigenous people to urban areas, significantly transformed Native American demographic content. Russell Thornton identifies urbanization as the main factor contributing to an increase in the rate of exogamy marriages. It is estimated that almost 60 percent of all American Indians are married to non-​ Indians (“Tribal” 39). Moreover, as a result of the same mechanism, due to the inability to meet the blood quota requirements, individuals born in Native communities and who are culturally fluent will be denied the right to profit from benefits associated with membership in a federally recognized tribe. In this context, Patricia Nelson Limerick’s bitter comment about the logic behind the introduction of blood quantum seems like a gloomy yet realistic prognosis: Set the blood quantum at one-​quarter, hold to it as a rigid definition of Indians, let the intermarriage proceed as it had for centuries, and eventually Indians will be defined out of existence. When that happens, the federal government will be freed of its persistent “Indian problem.” (qtd. in Jaimes 132)

144  Blood and genes

From blood to genes to Native American DNA When Momaday speaks of carrying a recollection of the past in his genes, he signals an important conceptual shift in the way Native American identity is discussed. With the discovery of the double helix by Francis Crick and James Watson in 1953,16 the discourse of genes and genetics has entered popular imagination and successfully replaced the trope of blood as a vehicle of heredity.17 As Kim TallBear observes in her Native American DNA, the gene imagery has also made its entry into the language of American Indians. “Like many Americans,” writes TallBear, we are transitioning in Indian Country away from blood talk to speaking in terms of what “is coded in our DNA” or our “genetic memory.” … I regularly encounter tribal folks old and young, university-​educated and not, and of different class backgrounds who refer to certain characteristics being “in our blood” or increasingly “part of our DNA” or our “genetic memory.” (Native 4, 8) It is however important to understand the rationale behind the use of such imagery. TallBear explains that: Genetic memory refers to a sense of ancestral memory. That is, one might know a place or have knowledge of a place and the nonhumans found there that was not gained actively or personally. Rather, one somehow carries or embodies such knowledge or has a sense of having been in a place before because of ancestors’ historical experiences of that place. One often hears such accounts in relation to the idea that descendants continue to retain knowledge or a sense of deep familiarity with place in spite of their ancestors’ dispossession from the land and from tribal languages. Or descendants might have inherited “in our DNA” historical trauma from ancestors that continues to hamper individuals in their daily lives decades later. (Native 8) Twenty years ago, this sense of inexplicable inheritance or connection would not have been described with the language of genes but, instead, would have been rendered as residing in the blood. However, TallBear warns us that it is important to keep these two concepts separate when taking into consideration their complex historical and ideological meanings. Using examples from the writings of Native scholars such as Ward Churchill, Jill Doerfler, and David Treuer, TallBear demonstrates that the conflation of blood with genes simplifies the complexity of the blood concept in historical, legal, and cultural contexts (e.g., in introduction of Western theories about race, blood quantum policies, contemporary meanings, and applications of blood quantum), and attempts to coproduce genetics as a discourse of authentication of racial

From blood memory to genetic memory  145 belonging. Commenting on her long interest in the topic, TallBear observes that she “has learned that we need to keep clear the difference between biogenetic properties and blood quantum as a semiotic and bureaucratic object constituted through other forms of science, namely the social and policy sciences” (“The Idiom” 54–​5; emphasis in original). In her incisive analysis, TallBear identifies a new and potentially alarming phenomenon of the emergence of Native American DNA as a “research object and tool for categorizing molecules and humans” (7). To theorize this phenomenon, TallBear applies a concept of “coproduction” derived from STS. According to Sheila Jasanoff, co-​production relies on the idea that [k]‌ nowledge and its material embodiments are at once products of social work and constitutive of forms of social life… [Scientific] knowledge both embeds and is embedded in social practices, identities, norms, conventions, discourses, instruments and institutions –​in short, in all the building blocks of what we term the social. (“The Idiom” 2–3; emphasis in original) Such a framework is highly productive as it calls attention to the social and cultural contexts that are inseparable from the processes of knowledge production. Moreover, as Jenny Reardon observes, this framework is particularly useful in the study of emergent phenomena since It is at the point of emergence when actors are deciding how to recognize, name, investigate, and interpret new objects, that one can most easily view the ways in which scientific ideas and practices and societal arrangements come into being together. (7) These considerations are particularly important in the analysis of Native American DNA entailing the recognition of cultural, historical, as well as moral and ethical contexts of its production. What is Native American DNA and what are the meanings it assumes in scientific and social discourses? The beginnings of the concept can be traced down to the 1960s when new biochemical techniques were applied to address questions, traditionally approached by anthropology, about ancient human migration patterns. The new subfield, molecular anthropology, also called anthropological genetics, studies a set of markers or nucleotides in mitochondrial DNA (mtDNA; inherited from genetic females) and Y-​chromosomal units of DNA (inherited from genetic males and only male individuals have the Y chromosome).18 These nucleotides, it was discovered, appeared at different frequencies among different populations, thus providing a tool to “trace” the genes of “founder populations” (TallBear, Native 2–​3). The examples of projects made possible by these discoveries are the Human Genome Diversity Project and the Genographic Project.19 Both projects concentrate on collecting

146  Blood and genes samples of remote “unadmixed” populations, often represented as existing on a brink of extinction, to produce a map of human genome as well as a more detailed human migratory history, which, as is claimed, will be beneficial to all of humankind. What these projects demonstrate is how cutting-​edge genetic technologies are in fact employed to promote old understandings of biological race concealed under the new label of “population.” Voicing concerns about potential abusive applications of genetic studies, scholars and activists use terms such as “biocolonialism” and “bioprospecting” to illuminate “links between exploitative capitalist practices and the emergence of biological (in particular, genetic) diversity as a site of informational and commercial value” (Reardon 15). Discussed from the point of view of Native American sovereignty, however, Native American DNA and technologies of its production create far more pressing problems than solely the reproduction of colonialist discourses in a new biotechnological setting. The main problem arising from this growing interest in DNA collected from Indigenous people to study ancient global human migrations is that knowledge produced by genomic scientists is fundamentally incompatible with Indigenous understandings of indigeneity. The evolution of the terms “indigenous” and “indigeneity” in the late twentieth century draws attention to commonalities of histories of the oppressed people and a shared project of decolonization. As Taiaiake Alfred and Jeff Corntassel write: Indigenousness is an identity constructed, shaped and lived in the politicized context of contemporary colonialism. … It is this oppositional, place-​based existence, along with the consciousness of being in struggle against the dispossessing and demeaning fact of colonization by foreign peoples, that fundamentally distinguishes Indigenous peoples from other peoples of the world. (597) Indigenous Studies calls for a need to recognize and pay respect to non-​ Western ontologies and epistemologies which remain of foundational importance to Indigenous people who have been forced to function in the context of continuing colonialist practices. Bearing in mind the cultural diversity of Indigenous people around the world, it is still possible to say that Indigenous cultures often operate on the place-​oriented values and rules of relatedness. What is of critical importance is how people are related to their place of emergence/​creation and nonhumans that share this space. This stands in sharp contrast to questions asked by genomic scientists who want to establish who was first in the given place and from which direction they arrived. As Kim TallBear explains, “Indigenous notions of peoplehood as emerging in relation with particular lands and waters and their nonhuman actors differ from the concept of genetic population, defined as moving upon or through landscape” (“Genomic” 514–​ 15; emphasis in original). Thus conceived indigeneity, derived from relatedness with the place and nonhuman beings,

From blood memory to genetic memory  147 resists colonialist conceptions that locate “authentic” indigeneity in time “before” contact, and thereby predicate Indigenous identities on the presence of non-​Indigenous, white agents of change. It is precisely the refusal to account for contemporary manifestations and vibrancies of Indigenous identities that characterizes genomic definitions of authentic, sought-​for indigeneity. Instead, they are focused on biological descent and relations between different groups and their progression across time and space. Thus, Indigenous groups are transformed into population-​ based categories and their blood is sampled to obtain information about ancient migratory patterns. This approach is predicated on the concept of what TallBear calls “disappearing indigene” which anticipates a complete disappearance of Indigenous peoples and, therefore, gives urgency to the project of collecting their blood samples. The second ideologically motivated narrative utilized in population genetics and related fields is the theory of the common origins of all humans in Africa. Alluding to the theory of the so-​called “Mitochondrial Eve,” which postulates the presence of the single genetic mother of the entire humanity, TallBear demonstrates how this seemingly positive narrative of inclusion ignores the highly politicized and racialized colonial histories of Europe, America, and Africa. The way how black and Indigenous bodies were represented as primordial and on a lower pier of civilizational reveals the inconsistencies of the “we-​are-​all-​related” narrative (TallBear, “Genomic” 513–​20). More importantly, TallBear draws attention to how discourses of genomic indigeneity may be potentially used to challenge Indigenous peoples’ claims to self-​determination. The way in which genetic indigeneity comes to dominate thinking about Native identities in political and legal contexts provides telling examples of the dangers TallBear articulates. To demonstrate how Native American DNA is coproduced to order and categorize populations, TallBear analyzes several direct-​to-​consumer (DTC) DNA tests that are marketed as particularly useful (or even instrumental) to authenticate Native American identity and aid tribal enrollment decisions.20 These include mtDNA (DNA located in mitochondria) and Y-​chromosome tests that look for markers signaling a connection with “the founder population,” an autosomal test which looks for markers inherited from both parents and “the DNA profile” test, used in criminal cases and paternity disputes. More importantly, such tests rarely provide conclusive answers to the question whether an individual is indeed a descendent of a Native American population. As TallBear observes, “The shortcomings of these tests are that they examine a very few lineages that comprise a very small percentage of one’s total ancestry, less than 1  percent of total DNA” (43). It is thus possible that a person’s North American Indigenous ancestry may not show on the test, or the person may be informed to be of East Asian or other descent (Bardill 158). Moreover, contrary to what genetic companies promise their consumers (TallBear, Native 82–​3), there are neither tests nor markers to identify tribal ancestry, so the applicability of genetic testing in tribal enrollment

148  Blood and genes cases is indeed doubtful. Finally, apart from scientific limitations, there are legal and ethical questions about how DTC DNA tests are marketed as capable of authenticating ethnic identities that often happen to be simulated and imagined.21 It is indeed the questions about legal and cultural definitions of Native American identities that become problematized in the era of genetic testing. DNA tests inevitably simplify these definitions and create “gene fetishism,” which, as has been shown in Chapter 3, leads to a belief that genes provide a definite answer to identity and ancestry questions. Michelle Jacob (Yakama) emphasizes cultural foundations of Native American identities and explains how genetic testing is irrelevant in the historically and culturally specific tribal contexts: … [Native] identity is based on cultural knowledge and practice. This indigenous conception of identity stands in seemingly stark contrast with a genetics-​based identity. The indigenous conception of identity is rooted in cultural knowledge and participation, which necessitates a group-​ based identity and a sense of belonging to one’s homeland. In contrast, a genetics-​based explanation simply necessitates a DNA test and scientific interpretation to “prove” individual identity; there is no social or cultural relevance in such a definition of identity. (280–​1) The danger lies in the fact that genetic ancestry tests significantly distort complex and nuanced cultural, social, and personal interconnections that establish the boundaries of belonging. Furthermore, since they are presented as capable of proving something that cannot be traced in any genetic tests, their constituting power is nevertheless established by the proliferation of such discourses. The widely discussed cases of Kennewick Man and the Havasupai tribe powerfully illustrate this point.

The story of the Kennewick Man The case of the Kennewick Man (also known as the Ancient One) is a telling example of how genetic authentication falls short of fulfilling cultural criteria of tribal belonging and, more importantly, poses a threat to tribal sovereignty. In 1996, researchers unearthed a set of human remains near the Columbia River in Washington. Initially, the remains, later referred to as the Kennewick Man, were presumed to belong to an early Euro-​American settler; however, carbon-​dating analysis revealed that they were over 9000 years old. As the Kennewick Man was found within the land historically belonging to the Confederated Tribes of the Umatilla Indian Reservation, the Colville Confederated Tribes, the Wanapum Band, the Yakama Nation, and the Nez Perce Tribe, these tribes opposed further research and demanded the remains be returned for reburial under the Native American Graves Protection and

From blood memory to genetic memory  149 Repatriation Act (NAGPRA) (TallBear “DNA” 86).22 However, a group of prominent anthropologists led by forensic anthropologist James Chatters, who first studied the remains, filed a lawsuit in a federal court, alleging that the tribes interfered with their constitutional right to study the remains (Beckenhauer 189). The rationale used employed the well-​known argument that genetic research into evolution was ideologically neutral and beneficial to all of humankind. To validate their claims, the scientists attempted to prove that the Kennewick Man could not be traced directly to contemporary Native Americans. NAGPRA requires tribes to document cultural affiliation of the remains and while it is relatively easy to do with the remains from the nineteenth or early twentieth century (the presence of ritual objects, for example), it was not possible with ancient remains. Thus, it was believed that lineal descent tests might prove a genetic connection to contemporary tribes.23. The long and mundane legal dispute lasted for over 20 years. Eventually, the Ninth Circuit Court of Appeals ruled in 2004 that the scientists had the right to study the remains. Then, in 2015, a group of scientists from the University of Copenhagen, Denmark, published an article in Nature stating that the Kennewick Man was in fact related to contemporary Native Americans, including the Confederated Tribes of the Colville Reservation (Rasmussen et al. 458). Finally, on February 18, 2017 the remains were buried in an undisclosed place in the presence of the members of five Columbia Basin tribes. The Kennewick Man controversy clearly demonstrated how genetic definitions of identity stand in contradiction with Native American epistemologies and ontologies and how there exists a possible threat of DNA testing becoming a legal mechanism for interfering in and rewriting these definitions, thus challenging Native American sovereignty. While indeed the remains were finally returned to the tribes, it was only after a more advanced technology was discovered to prove a genetic connection with contemporary Native Americans. The case sets a very disturbing precedence for the future, since as Michelle Jacob rightly observes, it “has helped solidify the privileging of DNA testing as the ‘gold standard’ in producing historical ‘fact’ ” (285). Identifying genetics as a discourse of authentication dismisses historical, cultural, and social complexities of Native American identities and defines them as stable and fixed. It is a manifestation of a belief in infallibility of genetic testing which Ellen Samuels calls “fantasies of identification,” an attempt to “definitively identify bodies, to place them in categories delineated by race, gender, or ability status, and then to validate that placement through a verifiable, biological mark of identity” (2). More importantly, however, it questions Native American tribes’ sovereignty to define who they are and how these identities are manifested.

The story of the Havasupai tribe A highly publicized case of the Havasupai tribe serves as an excellent example of how genetic testing threatens Native American sovereignty

150  Blood and genes and simultaneously poses a set of pressing question about ethics in genetic research.24 In the 1990s, geneticists at Arizona State University (ASU) obtained blood samples from individuals from the Havasupai tribe who inhabit the Grand Canyon area in Arizona. The goal of the project, repeatedly emphasized as significantly different than the ambition of the infamous Human Genome Diversity Project, was to provide answers to questions about the tribe’s devasting rate of diabetes. Samples were collected with the help of the social anthropologist John Martin, who had built a strong relationship with the tribe during a long-​term cooperation (Dalton 500). However, as the tribe soon learnt, the blood samples were used without their consent in projects including studies of population inbreeding, schizophrenia, and human migration patterns, all taboo topics in Havasupai culture (Kurahashi 117). Moreover, the blood samples were shared with other researchers nationwide without obtaining the consent of individuals participating in the project. Consequently, both the tribe and 52 individual members decided to sue ASU for misuse of the samples. After a long legal battle, on April 10, 2010, the Arizona Board of Regents settled the case out of court by rewarding $700,000 to the Havasupai tribal members, a fraction of the sum demanded by the tribe. The settlement also provided instructions for further cooperation with scholars and the tribe and provided for the repatriation of blood samples (Reardon and TallBear S241). There are several fundamental problems illustrated in the Havasupai case. First of all, it draws attention to the logic employed in every genetic research involving Indigenous communities, namely the neutrality of knowledge produced from such projects. The argument is believed to be so strong that it justifies breaching ethical norms and transforming Indigenous bodies into property of Western science. As Reardon and TallBear demonstrate, when the project’s leaders were confronted about their dubious practices, they still adamantly defended their right to use the blood samples in the name of knowledge that is beneficial to all.25 In perhaps the most shocking example, one researcher, noted population geneticist from Stanford, Dr. Peter Parham, when asked to produce documents concerning his work on the samples, simply responded by saying “Obtaining this information would consume a lot of my time. Could you please provide an explanation of why I should expend this time and effort?” (qtd. in Reardon and TallBear S239). The example demonstrates the extent to which a belief in the neutrality of genomic research circumvents ethical issues. However, more importantly, it demonstrates that if genomic knowledge of human evolution is represented as an objective neutral good to be acquired at all costs, then Indigenous people lose “the right to control their own genomic resources and identity” (S240). This leads to the second important problem, namely the question of informed consent26 and the right to refuse participation in a project that does not carry any benefits for an Indigenous community. The Havasupai, and many other Native tribes, are not interested in participating in studies of ancient migration patterns as these often stand in conflict with knowledges derived from tribes’ origin

From blood memory to genetic memory  151 stories that already provide an explanation of their historical processes. The research conducted on their samples suggests that they had migrated from Asia across the Bering Strait,27 a claim that entirely dismisses the Havasupai’s beliefs (Santos 323). As Beckenhauer observes, the assumption that Indian ancestry needs to be discovered is simply offensive to Indigenous people (189). Secondly, perhaps the most important aspect of the case, as TallBear rightly points out, the Havasupai case illustrates the process through which Native American DNA … has emerged as a new natural resource that, like Native American land in the nineteenth century, can be appropriated by the modern subject –​the self-​identified European, both the scientist and the genealogical researcher –​to develop knowledge for the good of the greater society. Through the biotechnosciences, Native American biologies become part of the property inheritance of whites, including the right to use DNA to control the meaning of group identity, or race. (Native 136)28 Such attempts to construct strict definitions of Native American identities with the use of genetics are seen here as similar usurpations over tribal lands, resources, even artifacts, and cultures. Old racial concepts, seemingly erased from social discourses after World War II, return in the language of genetics, marketed as scientifically proven and thus ideologically neutral. If genetics is given prominence in delineating legal and cultural boundaries of Indianness, then tribal sovereignty and access to economic and natural resources are indeed threatened.

What’s next? Native American and Indigenous studies meets science and technology studies In a chapter included in Aileen Moreton-​ Robinson’s collection Critical Indigenous Studies: Engagements in First World Locations, Kim TallBear offers a critique of Native American and Indigenous Studies in a form of a story about a romantic relationship which unfortunately goes awry. Describing first her extensive background as an environmental planner and activist, TallBear admits she had never thought that she would “hook up” with IZ, as she calls the discipline. In a witty and sarcastic style, TallBear describes herself as an idealist, who, having completed a PhD program, at first reluctantly but soon enthusiastically, joined a Native American department at “a university in one of the hearts of Indian Country” (72). As she quickly discovers, the “honeymoon did not last long” (73) and soon TallBear finds herself in a somewhat clumsy and impassionate embrace of her new lover, Mr. Techno-​ science. TallBear’s humorous and yet insightful story draws attention to the way Native American and Indigenous Studies, in her opinion, fails to engage science and technology which are by no means divorced from or incompatible with Native epistemologies and realities.

152  Blood and genes Indeed, what TallBear cannot forgive is IZ’s reluctance to engage STS as relevant for Indigenous sovereignty. “I viewed Native American and Indigenous Studies in the United States,” writes TallBear, “as disproportionately populated by contemporary Native literature scholars and historians, who often focus on the nineteenth century, a pivotal time in U.S.-​Indian relations, to be sure” (72).29 Clearly, such optics, while understandable in the context of indigenizing historical representations, is incomplete to account for all aspects of Native lives. Moreover, this reluctance to engage contemporary sciences and technologies perpetuates the long-​standing stereotype that “Native people have culture and others do science, that Native people are simply objects of intervention and research subjects” (71). The prevalence of this stereotype was repeatedly challenged by Vine Deloria Jr., who often engaged in discussions related to science and the Western production of knowledge. Deloria was indeed one of the first Native American intellectuals who revealed how “the hard sciences could be front and center in undermining indigenous cultures and sovereignty” (qtd. in TallBear 72). Undeniably, his Red Earth, White Lies: Native Americans and the Myth of Scientific Fact extensively documents such practices. Contrary to stereotypes, his thorough engagement in the topic and extensive knowledge about it reveal that Deloria was curious about hard sciences. What he could not tolerate, however, was Western science’s claim to infallibility and its intolerance for other ontologies and ways of knowledge production. Thus, not only does the interrelationship between science and Native sovereignty exist but it has always been addressed by Native scholars. To remain oblivious to STS in Native American contexts means to “ignore the role of techno-​science in indigenous sovereignty” (TallBear, “Dear” 76). Moreover, it implies a failure to understand the mechanisms of how “nation-​ states govern and generate resources in the twentieth-​first century” (77), an “inaction” with far-​reaching consequences for Indigenous nations in terms of how research is conducted and who profits from it. The emergence of Native American DNA, which TallBear analyzes in her book, is a good case in point. What is, thus, needed is an inclusion of technosciences in Native American and Indigenous Studies as well as widening the scope of inquiry: a study of nonhumans, emphasis on local and regional sovereignties, and welcoming gestures toward interdisciplinarity (80–​2). To initiate change, TallBear has accepted the position of the principal investigator for the Indigenous Science, Technology, and Society (Indigenous STS) project, which defines itself as as an international research and teaching hub, housed at the University of Alberta, for the bourgeoning sub-​field of Indigenous STS. Our mission is two-​fold: 1) To build Indigenous scientific literacy by training graduate students, postdoctoral, and community fellows to grapple expertly with techno-​scientific projects and topics that affect their territories, peoples, economies, and institutions; and 2) To produce research and public intellectual outputs with the goal to inform national, global, and Indigenous

From blood memory to genetic memory  153 thought and policymaking related to science and technology. Indigenous STS is committed to building and supporting techno-​scientific projects and ways of thinking that promote Indigenous self-​determination. (“Our”)30 With such diversely identified interests, TallBear does initiate the change in the way hard sciences, their methodologies and potential political impact are approached by Native American and Indigenous Studies. The two remaining chapters will demonstrate how American Indian literary discourses have already engaged these discussions.

Notes 1 For a thorough analysis of the development of the blood memory concept in Momaday’s oeuvre, see Chadwick Allen, “Blood (and) Memory,” American Literature, vol. 71, no. 1, March 1999, pp. 93–​116. 2 Sarah Eden Schiff draws attention to the complex publication history of the passage including Tosamah’s sermon. The text is taken from Momaday’s The Journey of Tai-​Me, a hand-​printed memoir of limited edition, which was later adapted into The Way to Rainy Mountain, a collection of essays for larger audiences. It is only in House Made of Dawn that the text is presented as the words of a fictional character (101–​2). 3 Some of the examples include Paula Gunn Allen’s The Sacred Hoop:  Recovering the Feminine in American Indian Traditions (Boston:  Beacon, 1992); Joy Harjo’s She Had Some Horses (New York: Thunder’s Mouth Press, 1983); Leslie Marmon Silko’s Ceremony (New  York:  Viking, 1977); James Welch’s Winter in the Blood (New  York:  Viking, 1974); and Gerald Vizenor’s Dead Voices:  Natural Agonies in the New World (Norman, University of Oklahoma Press, 1992). Non-​Native writers use the concept too: Imamu Amiri Baraka (LeRoi Jones)’s “Black Woman” in Reflections:  An Anthology of African American Philosophy, edited by Amiri Baraka, James A. Montmarquet, and William H. Hardy (Belmont, CA: Wadsworth Thompson Learning, 2000, 192–​5); and Frank Chin’s Donald Duk (Minneapolis: Coffee House Press, 1991). 4 For a discussion of The Heirs of Columbus as Vizenor’s response to Krupat see Chadwick Allen, “Blood (and) Memory,” American Literature, vol. 71, no. 1, March 1999, pp. 93–​116. 5 In Blood Politics, Circe Sturm devotes an entire chapter to the processes through which African-​American freedmen are denied a claim to Cherokee identity and citizenship (168–​200). 6 The General Allotment Act is discussed in more detail in Chapter 4. 7 See a chart used by the Bureau of Indian Affairs used to calculate blood quanta. Eva Marie Garroutte, Real Indians:  Identity and the Survival of Native America (Berkeley: University of California Press, 2003) 44–​5. 8 The most famous example, known as the White Earth Tragedy, is the case of the Anishinaabeg of Minnesota, who lost huge areas of land as a result of multiple frauds with constructing rolls. See Katherine Ellinghaus, Blood Will Tell:  Native Americans and Assimilation Policy (Lincoln:  University of Nebraska Press, 2017) pp. 1–​22.

154  Blood and genes 9 White Mountain Apache Enrollment Code. http://​thorpe.ou.edu/​archives/​apache/​ enrollment.html#c22. Accessed Nov 19, 2018. 10 Bah Kho-​je (People of the Grey Snow). Enrollment. www.bahkhoje.com/​government/​enrollment/​. Accessed Nov 19, 2018. 11 Cherokee Nation. Tribal Citizenship. Basic Information. http://​webtest2.cherokee. org/​Services/​Tribal-​Citizenship. Accessed Nov 19, 2018. 12 See M.  Annette Jaimes, “Federal Indian Identification Policy:  A Usurpation of Indigenous Sovereignty in North America,” The State of Native America: Genocide, Colonization, and Resistance, edited by M.  Annette Jaimes (Boston:  South End Press, 1992), pp.  123–​38; and Michael Yellow Bird, “Decolonizing Tribal Enrollment,” For Indigenous Eyes Only:  A Decolonization Handbook, edited by Wziyatawin Angela Wilson and Michael Yellow Bird (Santa Fe:  School of American Research, 2005), pp. 179–​88. 13 For a popular example of a claim that the law is used by people who have no Native ancestry see Jeff Benedict’s Without Reservation: The Making of America’s Most Powerful Indian Tribe and Foxwoods the World’s Largest Casino (New York: Harper Collins, 2000). 14 That a mixed-​blood individual is alienated from their Native community is a common theme in Native American literature of the 1970s–​80s. The most famous examples include N.  Scott Momaday’s House Made of Dawn (1976) and Leslie Marmon Silko’s Ceremony (1977). 15 Sturm’s study includes people who are eligible for tribal enrollment as well as those whose Indian heritage is imagined rather than based in biological ties to the tribe. 16 Their research to a large extent relied on conclusions drawn from X-​ray crystallographic images of DNA molecules made by the London researcher Rosalind Franklin, a fact that was often ignored in the popular story of this breakthrough discovery. See Sarah Rapoport, “Rosalind Franklin:  The Unsung Hero of the DNA Revolution” The History Teacher, vol. 36, no. 1, 2002, pp. 116–​27; Brenda Maddox, Rosalind Franklin: The Dark Lady of DNA (New York: HarperCollins,  2002). 17 On how gene imagery infiltrates popular imagination and restructures biological metaphors, see Celeste Condit, The Meaning of the Gene:  Public Debates about Human Heredity (Madison: University of Wisconsin Press, 1999); Ruth Hubbard and Elijah Wood, Exploring the Gene Myth: How Genetic Information Is Produced and Manipulated by Scientists, Physicians, Employers, Insurance Companies, Educators, and Law Enforcers (Boston:  Beacon, 1997); Evelyn Fox Keller, The Century of the Gene (Cambridge, MA: Harvard University Press, 2000); Michel Morange, The Misunderstood Gene, translated by Matthew Cobb (Cambridge, MA:  Harvard University Press, 2000); Siddhartha Mukherjee, The Gene:  An Intimate History (New  York:  Scribner, 2016); Dorothy Nelkin and M.  Susan Lindee, The DNA Mystique: The Gene as a Cultural Icon (New York: Freeman, 1995); Judith Roof, The Poetics of DNA (Minneapolis: University of Minnesota Press, 2007). 18 TallBear provides a comprehensive summary of the structure of DNA and the process of identification of nucleotides (39–​45). 19 In her excellent Race to the Finish, Jenny Reardon explains how the Genome Diversity Project failed to address moral and ethical implications involved in the study of Indigenous samples. Jenny Reardon, Race to the Finish:  Identity and Governance in an Age of Genomics (Princeton: Princeton University Press, 2009).

From blood memory to genetic memory  155 Kim TallBear provides an analysis of the Genographic Project in chapter four of Native American DNA (143–​76). 20 An analysis of how genetic ancestry testing function in Australia, see Elizabeth Watt and Emma Kowal, “What’s at Stake? Determining Indigeneity in the Era of DIY DNA,” New Genetics & Society, vol. 38, no. 2, June 2019, pp. 142–​64. 21 On methodological problems with DNA tests see Kim TallBear, Native American DNA, pp.  73–​ 87. On ethical implications of DTC DNA tests see Jennifer K. Wagner, “Interpreting the Implications of DNA Ancestry Tests,” Perspectives in Biology and Medicine, vol. 53, no. 2, Spring 2010, pp. 231–​48. 22 NAGPRA is discussed in more detail in Chapter  2. Chapter  7 discusses Heid E. Erdrich’s use of NAGPRA in her poetry. 23 As TallBear explains, the proof might be provided by “finding a Native American mtDNA or Y haplotype in the genome” of Kennewick Man (“Genomic” 521). However, these attempts failed. 24 The case served as a canvas for a play by Deborah Zoe Laufer, Informed Consent. The play was coproduced by Geva Theater Center in Rochester, New York, and Cleveland Play House, and directed by Sean Daniels. See Yaro Kurahashi, “Stories In and Outside DNA: Deborah Zoe Laufer’s Informed Consent,” Native American and Indigenous Studies, vol. 3, no. 1, 2016, pp. 116–​29. 25 The same argument is used in Madonna Swan and Louise Erdrich’s LaRose discussed in Chapter 2. 26 On the importance on the concept of informed consent in genetic research in marginalized communities see Sara Goering, Suzanne Holland, and Kelly Fryer-​ Edwards, “Transforming Genetic Research Practices with Marginalized Communities:  A Case for Responsive Justice,” Hastings Center Report, March–​ April 2008, pp. 43–​53. 27 See Vine Deloria Jr., Red Earth, White Lies: Native Americans and the Myth of Scientific Fact (New York: Scribner, 1995). 28 TallBear and Reardon elaborate on the concept of whiteness as a property and discuss mechanisms through which Indigenous peoples can control their samples in “ ‘Your DNA Is Our History’: Genomics, Anthropology, and the Construction of Whiteness as a Property,” Current Anthropology, vol. 53, no. S5, The Biological Anthropology of Living Human Populations:  World Histories, National Styles, and International Networks, April 2012, pp. S23345. More on this topic is found in chapter 4 in the discussion of Heid E. Erdrich’s poetry. 29 A lot has changed since TallBear’s essay was published in 2016. Consider for example, Elizabeth Hoover’s book on environmental contamination in Akwesasne community in upstate New York, The River Is In Us: Fighting Toxics in a Mohawk Community. Part of Hoover’s analysis is presented in chapter two. Another notable example is Braiding Sweetgrass: Indigenous Wisdom, Scientific Knowledge, and the Teachings of Plants by Robin Wall Kimmerer, which offers a synthesis between Indigenous and Western understandings of the environment and ecology. 30 For more on this paradigm-​breaking project see http://​indigenoussts.com/​.

6  “We remember our ancestors and their lives deep in our bodily cells” Mapping history in space and genes in Linda Hogan’s autobiographical writing

In a personal essay tracing Indigenous sources of her performance work, “Stories from the Body: Blood Memory and Organic Texts,” Monique Mojica (Kuna/​Rappahannock) writes: I am talking about the stories I carry because they have been passed on through my blood, encoded in my DNA. My fellow Turtle Jani Lauzon uses the phrase, “Our bodies are our books.” I would build on that thought to say that our bodies are our libraries –​fully referenced in memory, an endless resource, a giant database of stories. Some we lived, some were passed on, some dreamt, some forgotten, some we are unaware of, dormant, awaiting the key that will release them. Of course I can’t and won’t attempt to offer any “scientific” proof of this. However, . . I was struck by the way every person’s body tells a story. … Our very breath, how it is held or released, our ability or lack thereof to connect within and be in our bodies, all tell a story. Our bodies house a collection of experiences as clear as tattoos on our skins. (97) It is interesting to see how in Mojica’s text the body, blood, and DNA become entangled in a process of remembering and passing on a large reservoir of stories which recreates a connection with ancestors and establishes a collective past. Hence, she draws attention to the embodied nature of Indigenous experiences. If the body is a book in which past and present Indigenous experience is inscribed, blood and DNA become mechanisms of this inscription. While Mojica is not interested in exploring a scientific explanation of this phenomenon, she nevertheless insists on its tangibility and relevance. This is a powerful act since it establishes alternative, nonscientific, body-​oriented, and instinctual discourses as viable modes of explaining the world, thus conceiving the space where multiple epistemologies coexist side by side, rather than compete for the status of infallibility. Mojica’s essay serves as an apt introduction to an analysis of Linda Hogan’s engagement of both blood and gene discourses in her treatment

“We remember our ancestors”  157 of Native American identity as significantly shaped by historical experience. In this chapter, I trace this semantic and conceptual shift from blood memory to DNA in Hogan’s autobiographical works, Dwellings and The Woman Who Watches Over the World. Hogan’s investment in blood and genes metaphors constitutes an example of the conflation of these two discourses, which as Kim TallBear elucidates, carries important historical and political implications. Blood and DNA do not function in the same way on a biochemical level of hereditary transmission and as metaphors, engage complex historical and social histories. Thus, to conflate these two concepts runs the risk of undermining their ideological meanings. While indeed Hogan often uses the two concepts interchangeably, I argue that the product of this conflation is nevertheless empowering: she constructs Native American identity as contingent on Native history that is inherently tied to land and organically alive, transmitted through blood and cells. Hogan’s understanding of embodied history and geography enters a productive dialogue with Vine Deloria’s concept of sacred geography which likewise undermines the connections between the spatial and temporal. Such formulations of history and identity account for the fundamental importance of factors such as connection to and reverence for the land, a shared experience of trauma as well as biological relatedness.

From blood memory to genes and DNA That Hogan respects and pays tribute to Native people’s connection to the land is expressed in the title of and Preface to her 1995 collection of personal essays, Dwellings. Hogan writes: “People, animals, land –​the alive and conscious world  –​populate Dwellings in this exploration of the human place within this world. I  write out of respect for the natural world, recognizing that humankind is not separate from nature” (12). Hogan is attentive to how the land signifies the beginning of life and figures prominently in Indigenous creation stories. The stories of people’s origins create a sense of peoplehood and a community tied to the place and sharing the same history. For Hogan, the rootedness of Native identity is a physical, corporeal experience recreated every time a child is born. “When my granddaughter, Vivian, entered her life in the world of air,” writes Hogan, “I was at her emergence to greet her and to cut her cord, the sustaining link between her and her mother, her origins” (17). The word choice describing Vivian’s birth is not accidental here; the child “emerges” into this world, repeating the act of the first people emerging from the place of origins. According to the Chickasaw creation stories, theirs and other tribes’ shared point of emergence is located in Nanih Waiya (a mound near Philadelphia, Mississippi). The first to emerge from the earth were the Muscogee (Creek) who moved east. Then the Cherokee came out and headed north. The Chickasaw were the third to emerge from Nanih Waiya. They followed the Cherokees and “when they got to where the Cherokees had settled and made a people, they settled and made a people close to the Cherokees” (Lankford 111–​12). The Choctaws were the last to emerge. Thus,

158  Blood and genes for Hogan, her granddaughter’s birth is an illustration of life’s continuity and a repetition of the ancient process reminding people of their ties to the land. As Hogan repeatedly emphasizes in the collection, “We come from the land, sky, from love and the body” (Dwellings 95). The state of being inseparable from land and other beings as well as the continuity of this condition manifest themselves on Native bodies biologically recreating this logic of interconnectedness. In the title essay, Hogan describes a hill intersected by a small creek located close to her home. A  hike up the hill reveals a spot where bees reside. Reflecting on its strategic location, exposed to sun and hidden from rain, the bees’ home was built according to the same rules of sustainable land use that Native people used in the precontact time. This architecture is an ancient one, “learned by whatever memory [that] lives in the blood” (Dwellings 118). Momadayan concept of blood memory is used to convey the transfer of knowledge that cannot be accounted for by conventional mechanisms of remembering. Instead, Hogan creates a sense of instinctual memory contained and transferred in the blood. Moreover, as Hogan observes the movement of turtles in the water and ponders on the components of their reptilian blood, she concludes that, as ancient creatures inhabiting this world longer than human beings, they too are subject to this mechanism of “the call of land in deep memory” (84). Bodies of human and nonhuman beings thus become microcosms of life, illustrating ancient and continuous processes of survival. Not only does memory in the blood allow us to understand and corporeally experience the connection with land, but it then also functions as a vehicle of historical transmission, a motif that will be further explored by Hogan in The Woman Who Watches Over the World. In “Old Men at War, Old Women,” a poem included in an autobiographical essay “The Two Lives,” Hogan invokes blood imagery to convey a sense of connection with her white and Chickasaw ancestors whose life stories, marked with poverty and racism, survive in family stories and in the memory of the body: Be silent

Old men who live inside me, dark grandfather that was silent though I was in his blood and wore his black eyes. He’s living in my breath When it’s quiet, All his people are walking Through my veins without speech. (235)1 The stories of her family members are transmitted in a powerful language of embodiment, independent from words and reliant on the regenerative ability of blood as a marker of life. Reflecting metaphorical changes observed by

“We remember our ancestors”  159 TallBear, Hogan’s language gradually gravitates toward molecular metaphors to express the intimacy of the connection between herself and her ancestors. Describing her trip to Mexico, inspired by an uncontrollable urge to connect to the space there, Hogan writes: … we remember our ancestors and their lives deep in our bodily cells. In part, this deep, unspoken remembering is why I have come to the Yucatán, searching out my own beginnings, the thread of connection between old Maya cultures and my own Chickasaw heritage. (“New Trees” 83–​4)2 In another instance, Hogan substitutes cells with hereditary material they contain, namely the double helix of DNA. She observes that the land tells stories though the sounds made by the wind and “These voices of the world infuse our every act, as much as does our own ancestral DNA” (52–​3). It seems that indeed bodies, blood, cells, and DNA perform the function of intergeneration linking, combining in themselves cultural and historical meanings. Thus, the body, as Tewa scholar Gregory Cajete reminds us, is “the source of thinking, sensing, acting, and being, and … the basis of relationship,” constructed of and containing molecules, becomes the most efficient illustration of people’s connection to the world. If Dwellings firmly establishes the concept of ancestral history as remembered in the blood and further expands this image by including cells and DNA in the processes of remembering, then The Woman Who Watches Over the World considerably expands these metaphors to construct an embodied and historically shaped Native identity. Clearly, Hogan puts to test both blood and DNA metaphors to explore how productive they are in conveying the relationship between contemporary Indigenous bodies and their ancestors. To recapitulate TallBear’s argument, such conflation of blood and gene discourses is potentially misleading and may erase important historical contexts of blood politics in Indian Country. However, Hogan’s interchangeable use of blood and genes emphasizes rather than discounts the importance of Native American identity. Moreover, what reverberates in Hogan’s use of corporeal and molecular metaphors is her investment in geographical imagery. Not only does Hogan present how cells and genes create a cultural continuity, but also, she traces the outlines of historical maps inscribed on Indigenous bodies and contained in cells.

Native American history in bodies and maps The Woman Who Watches Over the World celebrates the importance of Native American history in defining Indian identities in the twenty-​first century. History, in Hogan’s terms, is a corporeal experience, evoked in geography, memory, the body, blood, and genes. The title of Hogan’s native memoir is traced back to a female clay figure that the author saw at a museum gift shop

160  Blood and genes in San Martin, Mexico. The figure appealed to Hogan’s imagination as it offered an apt illustration of a powerful female healer who protected the world with her own body and at the same time, being made of clay, represented the connection between all first peoples and the earth. Hogan had the clay woman shipped to her home but, unfortunately, it arrived broken. Despite numerous efforts to fix the figure, it remained fragmented: “Her legs were broken off, the gray interior clay exposed beneath the paint. I glued them back on. Then she began to fall apart in other ways. Her nose broke. Soon one of the hands fell off ” (18). However, Hogan’s initial sense of disappointment was soon replaced by the growing realization that the broken figure in fact best communicated the truth about the state of the world: “Yes, the woman who watches over us is as broken as the land, as hurt as the flesh people. She is a true representation of the world she flies above” (18). The broken body of the clay woman announces Hogan’s investment in embodiment as a powerful way of communicating personal and historical pain. It is the idiom Hogan understands well, having survived a horse-​riding accident that made her acutely aware of the unreliability of words to communicate pain and her body’s newly-​discovered limitations. The multiple injuries she suffered and the long and difficult process of recuperation draw attention to how the body is invested in meaning-​making practices; how this meaning changes under the condition of illness; and how the pain, here of the body but also, as Hogan later realizes, of history, preempts linguistic representation and induces new modes of expression located in the body. First, Hogan conceives of her post-​traumatic body as a representation of the broken world that has lost its integrity and balance. Enumerating her multiple injuries, she employs the imagery of rupture and literally becomes the broken clay woman who flies over the shattered world: I didn’t even know that a brain was injured from a hard impact, hitting the ground hard enough to knock loose the bones in my ears. One of my lungs collapsed from the fall, keeping even more oxygen from reaching the brain. I broke my pelvis in several places, and suffered a broken tailbone, elbow, ankle, sprained neck, and numerous other injuries. (166–​7) Second, the pain accompanying the injuries destroys Hogan’s language that is potentially, through self-​narrative and storytelling, the source of healing. Elaine Scarry, in a now classic study, The Body in Pain, consistently links pain with the destruction of language. “As the content of one’s world disintegrates,” writes Scarry, “so the content of one’s language disintegrates; as the self disintegrates, so that which would express and project the self is robbed of its source and its subject. World, self and voice are lost” (35). Echoing Scarry’s views, Hogan admits that when pain renders her “reduced, as if shrunk,” “meaning escapes language and description” (The Woman 169, 166). When language fails, however, it is the body that has recourse to multiple forms of expression. “I grew up with girls who cut or hit or burned themselves,

“We remember our ancestors”  161 as if it was a way to kill the self or to trade the pain of what resided within for external pain,” Hogan writes. “There was never a language to say it, to form a geography or map or history of what had happened… .[O]‌ur own bodies became our language” (56). Hogan establishes the status of the body as a text in an important project of historical reconstruction that helps in understanding her and other Native people’s situation as a result of historical conditioning. While the broken body of the clay woman relates to Hogan’s discovery of multiple meanings of embodiment, it also illustrates a “new order of disease” (20) afflicting the world. The signs of this disintegration are observed everywhere. Not only are they detected metaphorically in the fragmented structure of Hogan’s text, but also literally in the destruction of ecosystems, uncontrolled technological advancement at the expense of the natural environment, the emergence of new disease patterns reflecting contemporary lifestyles, and the dehumanization of interpersonal interactions. Although observable everywhere, Hogan concentrates on the symptoms of the world’s loss of integrity in Native communities, which are struggling with the immediate consequences of centuries-​long colonization, and faced with the problem of rebuilding their Native identities and communal networks in the contemporary context. Providing examples from the life of her own family and the Chickasaw community, Hogan enumerates the symptoms of illness afflicting Native Americans today. Consistently employed vocabulary consists of violent fragmentation and it inevitably evokes images of the injured body. More importantly, however, it is the body that serves as a text on which this history is inscribed. In the chapter entitled “Falling,” Hogan describes her struggle with alcoholism, which at the time seemed to be the best cure for the “inward pain” and “a broken heart” (54). In another, she reveals the story of her adopted daughters, Jeanette and Marie, the Lakota girls who, after several unfortunate episodes with different foster parents, were finally placed in Hogan’s family. The conspicuous signs of malnutrition and child neglect are a manifestation of a more serious problem. The girls’ experiences compose, in Hogan’s words, “the fragmented stories of the broken children” (The Woman 72). Jeanette “… was a five-​year-​old girl with a stubborn streak,” Hogan writes. She was a wisp of a child with thick long black hair falling down her back, as if all her bodily energy had grown into hair instead of bone and flesh. … Her teeth had all decayed and were capped with aluminum. Under her eyes were dark circles. … [S]‌he was already broken and wounded beyond what could be repaired. (68–​9) Marie, whose story follows the same pattern of violence, “was a girl violated and tortured. … She had been abused, even as an infant, burned by cigarettes and hot wires, and raped. … [S]‌he is the result of a shattered world” (76–​7). Placing Marie’s story in a wider historical context, Hogan writes:

162  Blood and genes She was a remnant of American history, and the fires of a brutal history [that] had come to bear on her. As a Lakota girl, with her large eyes that looked not at anything, she was the result of Custer’s dream, containing the American violences, the people from another continent, that entered this land without compassion. (77) Thus, the daughters’ bodies become texts onto which different histories are inscribed: personal (the girls’ suffering; Hogan’s inability to help them), tribal (social problems in Lakota communities today), and American (the situation of all Indigenous peoples in the context of mainstream American society). As Hogan claims, “The story of my daughters began a hundred years ago” (78). The evocation of the invasion of “the people from another continent” (The Woman 77)  clearly demonstrates that Hogan locates the origins of the world’s illness in the moment of the “discovery” of the New World and the settler colonialist projects that ensued. “History,” in Hogan’s use of the word, encapsulates Spanish, British, and US colonialism, and the consequent policy regulating the Native presence on the American continent that gradually and consistently led to the dispossession of the Indigenous population:  the allotment, the Trail of Tears, the Wounded Knee massacre, the policy of forcefully sending Indian children to boarding schools, forced sterilization of Indian women, and the relocation programs, to name but a few examples. “History is our illness,” Hogan thus concludes (The Woman 59). By constructing settler colonialist history as an ongoing process, a repetition of abuse, whose consequences or symptoms are observable today, Hogan insists on seeing it as instrumental in defining Native identity in the contemporary context. Writing about the Sand Creek Massacre, Hogan observes that “There was no way to send it [pain] away from the self, soul, or mind. There would always be that memory of terror. … We are never not Indians. We have never forgotten this history” (59). For Hogan, being Indian equals immersion in historical memory as it provides a building stone, a tissue, or a foundation for what it means to be Indian today. “To other Americans,” writes Hogan, “this history, if thought of at all, belongs to a far past, but in truth these events are recent and remembered. We have not forgotten the past so quickly and easily” (79).

Mapping sacred geography In his influential God Is Red, Vine Deloria provides a systematized introduction to Native American thinking vis-​à-​vis Western philosophies. In a constructive dialog between the two perspectives, Deloria elucidates the most important differences between the two modes of understanding of time, space, history, and spirituality,3 to name a few examples. One of the most engaging analyses is Deloria’s explanation of the conceptualization of space and land as fundamental for Native American people and their spirituality as intertwined

“We remember our ancestors”  163 with everyday practices. Contrary to Western (and Christian) understanding of land as “an object for exploitation and nothing more” (51), Native people construct a complex relationship with the land and space from which they emerged, or where they were created. This is a relationship of interaction, mutual care, and interdependence. Spirituality and Indian religions are thus place-​based and reflective of the relatedness among human and nonhuman beings. More importantly, spirituality is not divorced from everyday mundane practices nor is it in any way spatially restricted: We live in time and space and receive most of our signals about proper behavior from each other and the environment around us. Under these circumstances, the individual and the group must both have some kind of sanctity if we are to have a social order at all. By recognizing the various aspects of the sacredness of lands … we place ourselves in a realistic context in which the individual and the group can cultivate and enhance the sacred experience. Recognizing the sacredness of lands on which previous generations have lived and died is the foundation of all other sentiment. … Sacred sites that higher spiritual powers have chosen for manifestation enable us to focus our concerns on the specific form of our lives. These places remind us of our unique relationship with the spiritual forces that govern the universe and call us to fulfill our religious vocations. (282) It is precisely that relationship to the land that shapes Native forms of spirituality and defines tribal ontologies. It also informs material practices as the specificity of the environment determines everyday choices and actions: kinds of food and adobes, food gathering, and hunting methods. Revelations which occurred at sacred places are not one-​time events but rather are experienced as a process of gradual understanding of one’s place in the world. As Deloria explains, Thousands of years of occupancy on their lands taught tribal peoples the sacred landscapes for which they were responsible and gradually the structure of ceremonial reality became clear. It was not what people believed to be true that was important but what they experienced as true. Hence revelation was seen as a continuous process of adjustment to the natural surroundings and not as a specific message valid for all times and places. (66) This ongoing relationship with the land, experienced and acknowledged by each successive generation, creates a connection of responsibility and respect. As the relationship to the land is central in Native epistemologies and ontologies, it also affects the way people preserve their stories of the past. Contrary to Western method of recording the past as a linear progression, in

164  Blood and genes Native cultures events are situated in the context of their spatial situatedness rather than chronology. Every important event is tied to a place where it occurred rather than a point in time. This interconnection of time, space, experience, and moral responsibility gives rise to what Deloria calls “sacred geography”: Indian tribes combine history and geography so that they have a “sacred geography,” that is to say, every location within their original homeland has a multitude of stories that recount the migrations, revelations, and particular historical incidents that cumulatively produced the tribe in its current condition. (121) It is important to note how Deloria emphasizes the land’s participation in the “production” and shaping of the tribe, thus establishing place-​based component as fundamental for Native identity. The durability of this connection is best illustrated in the fact that it continued after many tribes had been forcefully removed from their original place of origins. It is well visible in Hogan’s writing when she cherishes both, pre-​and post-​removal spaces: the Mississippi River area as well as present-​day Oklahoma. Similarly, Deloria observes that Cherokees today can still tell stories about the sacred places in Georgia and North Carolina that illuminate the tribal history. The Sioux, Cheyenne, Kiowa, and Arapaho all have traditions that describe Bear Butte in South Dakota and the Devil’s Tower in Wyoming. (121) Recalling claims about Native cultures’ resistance to compartmentalizing their knowledge systems into fields such as philosophy, religion, science etc., Deloria’s “sacred geography” aptly illustrates how material practices become manifestations of spiritual experiences and life ethics. While Hogan does not allude directly to Deloria’s concept, her methodological framework of conceptualizing embodied history and geography clearly engages with such a multifaceted understanding of space and history. The history of Native Americans is contained in the body, blood, and genes, and is always inevitably connected to physical geography. As an Indigenous woman, Hogan understands her place and role in a physical geography, an understanding that differentiates her from non-​Native people and provides a connection with her ancestors. This investment in the trope of memory contained in the body and geography clearly resonates with Momaday’s concept of blood memory and his insistence on how memory is tied to geography. In an introductory part entitled “Geography:  An Introduction,” Hogan states:  “As an Indian woman, I have always wondered why others want to enter our lives, to know the

“We remember our ancestors”  165 private landscape inside a human spirit, the map existing inside tribal thoughts and traditional knowledge” (The Woman 14; emphasis added). Hogan introduces geographical terminology applied in the context of the mental and spiritual phenomena and used to emphasize the land-​based nature of tribal knowledges. In this way, Hogan implies, and will later further explain, that maps are not merely physical objects referring to actual geographical locations, but they are to be understood in a wider context. Maps are memories, stories, and Indigenous bodies with blood and cells inside them leading to places, real or imagined, and on another level to traditions and systems of knowledge that constitute Indigenous identities. Moreover, Hogan draws the boundary between “us” and the other Indigenous and non-​Indigenous bodies, and it is clearly the latter group that is lost and needs the map in possession by Native peoples. The employment of the map metaphor is consistently present in Hogan’s work. In her earlier writings, Hogan has demonstrated an interest in a critique of Western cartography as a discourse of ordering and subjugating space4 and critically “engage[d]‌[this] myth of scientific accuracy and [its] destructive history in the Americas” (Johnson 105). As Gregory Cajete repeatedly emphasizes, what characterizes the Western practice of map-​making is anonymity, separateness, and inherent violence: In the Western scientific perspective, maps of places are drawn to symbolically represent a place based on previously agreed upon criteria that are logical and measurable with regard to the discipline of cartography. But a map is always just a kind of symbol for a place, it is not the place it is meant to describe. Indeed, to know any kind of physical landscape you have to experience it directly; that is, to truly know any place you have to live in it and be a part of its life process. Maps also imply a history, and the political and cultural background of its makers. (181) In Hogan’s Solar Storms (1997), Western maps are useless tools as they are unable to contain Native American knowledge about physical geography and its inhabitants. “What I liked,” one character observes, “was that land refused to be shaped by the makers of maps. Land had its own will. The cartographers thought if they mapped it, everything would remain the same, but it didn’t, and I respected it for that” (123). What Western cartographers always failed to represent on paper (and understand) was how land is made and transformed. “Beavers,” one character says, None of them ever considered how beavers changed the land. … Beavers were the true makers of the land. It was through their dams that the geographies had been laid, meadows created, through their creation that young trees grew, that deer came and moose. (181)

166  Blood and genes Indeed, not only did Western cartography misrepresent complex interrelations between space and its inhabitant, but also it altogether ignored Indigenous map-​making projects. In a Hawai’ian context, Renee Pualani Louis and Moana Kahele (both Kanaka Hawaiʻi) document how cartographic practices of Native people were altogether dismissed as they operated according a logic of inclusion and interconnectedness: Kanaka Hawai’i cartographic practices are a compilation of intimate, interactive, and integrative processes that express Kanaka Hawai’i spatial realities through distinct perspectives, protocols, and performances. Many Kanaka Hawai’i still perceive themselves as an extension of nature and treat all natural and metaphysical elements as part of a sacred genealogical relationship. Precontact Kanaka Maoli incorporated vital spatial knowledge about the places where they live, work, and pray into various cultural practices, including ka ho’okele, Hawai’i navigation; ka haku ‘ana, Hawai’i verbal arts composition; and ka hula, Hawai’i dance. (1) Such maps were renditions of more than space; they provided insight into Native knowledge systems, as well as into spiritual and everyday practices. In The Woman, discarding rules of Western cartography, maps locate geographical and mental spaces, and provide instructions how to read land as a network of connections among animate and nonanimate beings. For Hogan, tribal history is never an ideologically oriented discursive strategy or a theme of the past, but rather a phenomenon located in the physical space and experienced in/​on the body in the time-​transcending process of reconnection. It is also a site that gives rise to a special kind of self-​expression that is at the same time a way of remembering and a strategy of survival.

Transmitting history in blood and DNA While, as Hogan repeatedly demonstrates, history is a source of pain, it is also a source of empowerment and self-​pride. When Hogan refers to the Chickasaw past from pre-​removal era, she constructs an overwhelmingly positive image of beauty and harmony. Her idyllic descriptions are of beautiful people inhabiting fertile lands of what later became “parts of southwestern Kentucky, western Tennessee, northern Mississippi and northwestern Alabama” (“Homeland”): in those eyewitness accounts, it was said how beautiful we Chickasaw were. The men wore turbans and rode about on the famed, now mysteriously disappeared, almost mythic Chickasaw ponies. … The women, reportedly, were beautiful and serene and erect on their horses. (The Woman 54–​5)

“We remember our ancestors”  167 In these accounts, the Chickasaw people relied on the land for their sustenance, wisely using its resources, as it is described in James Atkinson’s Splendid Land, Splendid People (2–​3). The Chickasaw past, still unmarred by colonization, provides Hogan with a sense of identification and belonging, which allows her to situate herself in a long line of Chickasaw clans. Recalling the pain of the Removal, Hogan uses the pronoun “we” rather than “they,” thus fully blending her identity with those of her ancestors. In a text entirely devoted to the Removal, Hogan explains that We use the words “we” and not “they,” and speak of our histories in the present and I have come to think that for us these times are still alive and still taking place. History is present. Time is a variable. While the Indian past seems long ago to other Americans, it is a constant in the daily minds of our own people. (“New Trees” 125) The connection with her ancestors is palpable, experienced mentally and physically:  “We were broken, almost forever, by grief and betrayal” (“Remembering” 56), transmitted in the blood and cells: The line where my grandmother ends and I begin is no line at all. I am a child who once lived inside her, who was carried inside the builders of the mounds, the cells of mourners along the Trail of Tears. From them I  still remember to honor life, mystery, and this incomparable ongoing creation. (“Remembering” 59) The Chickasaw were the last of the Five Civilized Tribes (the Cherokee, Chickasaw, Choctaw, Creek, and Seminole) to begin their Removal to Indian Territory (which in 1907 would become Oklahoma). Beginning in 1830, Chickasaw chiefs were repeatedly summoned to Washington and instructed to begin their exit. As the tribe had a long history of conducting trade relations with Americans, the Chickasaw managed to delay it until 1837 when The Treaty of Doaksville was finally signed. It practically disbanded the Chickasaw Nation and stated that the people would be removed to the western parts of the Choctaw Nation in Indian Territory (Gorman 5–​6). Thus, the Chickasaw “Trail of Tears” began and the tribe was forced to pay for it with the proceeds from the sale of their lands. As Hogan repeatedly emphasizes in many texts, contrary to how it is presented by some historians, it was a painful and traumatic experience.5 Their new home was about four million acres acquired from the Choctaw Nation in the southern part of what is today Oklahoma. Without their own land and with their tribal government eliminated, it took the Chickasaw people over 20 years to reorganize into the Chickasaw Nation, an event that was formalized in Goodsprings, Oklahoma, in 1856.6

168  Blood and genes While Oklahoma is not the Chickasaw place of origin, it is nevertheless cherished as home. As Wendy St. Jean observes, “Removal did not mean defeat or cultural annihilation” (“Trading” 771). The Chickasaws’ beliefs, customs, and stories rooted in the Mississippi Valley and their reverence for the land were transferred to their new home (Schoolcraft qtd. in St. Jean, “Trading” 771–​2). The same sentiment is present in The Woman. Oklahoma, for Hogan, is a place of carefree childhood, where she is immersed in the Chickasaw tradition. “For me,” Hogan writes, as a young person in Oklahoma with my grandparents, the nights with fireflies, the sound of the horses greeting each other, their heavy foot on earth, was the best of life. Our grandma, who’d never cut her hair in all her life, cooked Chickasaw pashofa, a food something like hominy, in a large black kettle on the woodstove. (Dwellings  20–​1) Oklahoma also becomes a signifier that best communicates the connection with the land and ancestors. A trip there that Hogan makes with her father is of tremendous historical and emotional significance. While today Hogan does not live in Oklahoma, it is a place she declares as “her interior” (The Woman 116). “It was not my birthplace,” she writes, but it was my home, the place of my heart, my inner world, the place where I lived before I was born. Oklahoma was the place that shaped me with its loving people, beauty, and heat. It was where, always, I encountered kindness. (116) Oklahoma is more than a physical location. The moment Hogan’s feet touch the red earth of the Indian Territory, Hogan becomes one with the environment and experiences a collapse of spatial and temporal differences. She is once again with her Chickasaw ancestors and enters a communion with her tribal past: When we arrived, I was struck, as always, by the silence and stillness of our homeland. I have always felt it; a physical line crossed where suddenly everything is changed, as if I’m an animal recognizing territory. The air is heavier than in other places, containing the sensuous stillness of land, the rich, heavy odor of nut trees, the heat and the way it rises from the fields nearby. There were fireflies, and the rich smell of red earth and leaf mold. It is an ancient place, with plant fossils along the ground, and mountains so old they are underground, covered by what came later, depression sand storms, washes of clay. (The Woman 116–​17)

“We remember our ancestors”  169 Not only does Hogan become one with the surroundings, but also she immediately identifies with the ancestral “we,” the mound builders who once occupied the territory. Despite the fact that the land she is looking at is no longer in the possession of the Chickasaw Nation, and now houses the Ardmore airpark, Hogan is able to visualize what it must have felt like to be one with the place: My father told me what the old land had looked like, and from within myself, standing there with him in the heat and the smell of black walnut trees, I could see beneath the airport. I could, with my mind’s world, my open eyes, see what had been beautiful. Creek. Pasture. Pond. Valley. (The Woman 125–6) Despite changes, the passing of time, and irreversible destruction of original ecosystems, she manages to return to an unspecified past moment, a mythical space of belonging. Moreover, by returning to Oklahoma, Hogan activates the memory of the Chickasaw Removal stored in “ancestral DNA” (Dwellings 53)  through countless stories retold by strangers, family members, and Hogan herself in her writing. Returning to her earlier claim that Indians do not forget the past “quickly and easily,” Hogan insists that history is anchored in geography, it is inherited, and passed on in genes and blood. “History lives cell-​deep within us” (The Woman 20), declares Hogan and further elaborates that … history, like geography, lives in the body and it is marrow-​deep. … It is recorded there, laid down along the tracks and pathways and synapses. I  was only one of the fallen in a lineage of fallen worlds and people. Those of us who walked out of genocide by some cast of fortune still struggle with the brokenness of our bodies and hearts. Terror, even now, for many of us, is remembered inside us, history present in our cells that came from our ancestor’s cells, from bodies hated, removed, and killed. (The Woman 59) Clearly, Hogan sees history as a genetic code reactivating and replicating itself in the bodies of the next generations and becoming an integral part of them. Tribal removal, the loss of land and cultural annihilation are real and material events that are, first of all, inextricably connected with geographical locations, and secondly detectable in the blood, body, and genes. Hogan’s discourse based on the geographical and the biochemical, communicates that it is “pathways” as much as “synapses” that lead to historical memory and tribal communal identification. Thus, Hogan is in a position to declare: “I am one of the children who lived inside my grandmother, and was carried, cell, gene, and spirit, within the mourners along the Trail of Tears” (The Woman 123; emphasis added). Hogan’s emphasis on the distinct character of her

170  Blood and genes Indigenous blood and body introduces a metaphor which emphasizes Native American experience that derives from historical contexts and cultural ways of life that are biologically transmitted over time. Blood, cells, and marrow are not just another criterion in a racist discourse of authenticity and blood quantum, but rather constitute markers of a shared and distinct culture and a unique experience shaped by the ancestral landscape, sacred geography, and a distinct history of colonialism and its far-​reaching consequences. Hogan’s shift from blood to genes, or rather her interchangeable use of the two terms, illustrate the conceptual transformation of thinking about Native American identity in molecular terms observed by TallBear and other scholars. Circe Sturm, when conducting interviews with race shifters from the South,7 often observed the invocation of gene imagery. For example, Luanne Helton, when commenting on a visit to her Cherokee homeland in North Carolina admits to reconnecting with her genetic memory: “I’m just thinking that in my DNA, I know we carry the DNA of our ancestors, literally, and somehow this was impressed in those genes, the sorrow of leaving the homeland” (Becoming 41). Eerily reminiscent of Hogan’s account of her trip to Oklahoma, the interviewee evokes the same process of inheriting history in genes. Jace Weaver, in Other Words:  American Indian Literature, Law, and Culture, describes an analogous mechanism of passing on the memory of trauma through which a distant event is vividly remembered and repeatedly reenacted: “The Cherokee can never forget the Trail of Tears –​not of some genetic determinism but because its importance to heritage and identity are passed down through story from generation to generation” (8). While rejecting genetic determinism, Weaver nevertheless acknowledges the suitability of the blood metaphor. However, rather than genes, he emphasizes the importance of widely defined cultural practices as carriers of such memories: “Such cultural coding exists finally beyond conscious remembering, so deeply engrained and psychologically embedded as to be capable of being spoken of as ‘in the blood’ ” (8).8 Hogan, on the other hand, insists on the use of blood/​body/​genes trope to evoke the importance of precisely the same kind of heritage in the construction of her Chickasaw identity. The body carrying blood, genes, and memories “voices a common tribal understanding of the ancestral landscapes and the universe as well, of the access to a distinct culture, and of a particular colonial experience incomprehensible to non-​Natives” (Huang 188).

Experiencing the past in the body, blood, and DNA In an essay offering an imaginary take on the Removal, Hogan constructs a voice of her ancestors who are about to leave their beloved lands and embark on a journey to the unknown. The Chickasaw are subjected to a long walk, are hungry and cold, and forced to witness how their possessions are stolen by the soldiers ordered, ironically, to protect them. An emotional enumeration of things and animals packed for the trip  –​dishes, clothes, cats, puppies, and horses  –​powerfully illustrates the trauma of being uprooted.

“We remember our ancestors”  171 What makes the Removal particularly painful is the forced abandonment of lands to which the Chickasaw are organically connected:  “We passed away from the mounds of earth made by the old ones still inside our blood” (“New Trees” 126). Chickasaw bodies recreate sacred geographies of their ancestral landscapes whose maps are transmitted in the blood, and the blood flowing in the veins signifies the life’s continuity. In another part of the essay, Hogan again acknowledges her deep investment in blood memory as a method of knowing/​experiencing her Chickasaw heritage: So when we speak of it [the Removal] in the present tense, it is truly a fully felt experience. Someone, some lives from the past, still live in our blood and the body and the spirit remember this event. Although it is my research that tells me about our foods and medicines in the southeast, another part has lived it. (“New Trees” 125) Hence, while historical trauma is never forgotten and transmitted in the blood, and as Hogan sometimes phrases it, in genes and DNA, the very act of biological and cultural transmission also exhibits an empowering quality. In Dwellings, Hogan writes: “We are the embodiment of paradox; we are the wounders and we are the healers” (151). This embodied knowledge, beyond empirical testing, instinctual and affective, constitutes a powerful method of cultural identification, resistant to the blood quantum logic and the authentication logic of racialized thinking. Hogan’s simultaneous use of blood and DNA imagery illustrates the proliferation of gene discourses in popular thinking that in turn expresses the scope of biomedicalization of everyday practices. Hogan succinctly demonstrates that Native American identity does not need to be discovered with the use of biomedical technologies nor authenticated with DNA tests. Unlike, Heid E. Erdrich, whose work will be analyzed in the next chapter, Hogan is not interested in biomedical mechanisms of hereditary transmission to talk about her ancestral connections. Instead, her deep investment in blood and genes metaphors is dedicated to a construction of multifaceted Native American identity contingent on relationship to the land, ancestors, and memory. It is an embodied identity that is transmitted through blood and cells, written and reread on Indigenous bodies. Hogan’s conflation of blood and genes constitutes an empowering and politically significant act of tying Native identities to ancestral lands.

Notes 1 In The Woman Who Watches Over the World, Hogan traces her lineage to the Colbert family, who vehemently opposed the Removal in the nineteenth century (117). 2 Later in the passage, Hogan alludes to some oral traditions which presumably establish a connection between the Chickasaw and the Mayan people. I have not encountered such claims in the works devoted to Chickasaw history and oral tradition. Elsewhere,

172  Blood and genes Hogan identifies the area of the Mississippi as the ancestral home: “We descended from the mound-​building, architecturally brilliant Mississippians, who built the city of Cahokia and numerous other structures, including animal effigy mounds, such as the great Serpent Mound. Some smaller mounds remained near Holly Springs on what is now private property” (“New Trees” 124). 3 On the problematics of using the terms “spiritual” and “spirituality,” see David Delgado Shorter, “Spirituality,” The Oxford Handbook of American Indian History, edited by Frederick E. Hoxie (Oxford: Oxford University Press, 2016, pp. 433–​52). 4 A critique of Western mapmaking is also found in Louise Erdrich’s Tracks (New York: HarperPerennial, 1998); Joy Harjo’s “A Map to the Next World” from A Map to the Next World: Poems and Tales (New York: Norton, 2000); Deborah A.  Miranda, Indian Cartography (New  York:  Greenfield Review Press, 1999); and Leslie Marmon Silko’s Almanac of the Dead (Simon and Schuster, 1991). On Silko’s “The Five Hundred Year Map” in Almanac of the Dead, probably the most widely discussed Native American map, see Eric Gary Anderson, American Indian Literature and the Southwest (Austin:  University of Texas Press, 1999); Virginia E.  Bell, “Counter-​ Chronicling and Alternative Mapping in Memoria del fuego and Almanac of the Dead” MELUS, vol. 25, no.  3–​4, 2000, pp.  5–​30; Rebecca Tillett, Otherwise, Revolution! Leslie Marmon Silko’s Almanac of the Dead (London: Bloomsbury Academic, 2018); Joanna Ziarkowska, Retold Stories, Untold Histories: Maxine Hong Kingston and Leslie Marmon Silko on the Politics of Imagining the Past (Newcastle upon Tyne: Cambridge Scholars Publishing, 2012). 5 For example, Joshua Gorman writes that it “was not as brutal as that of the Cherokee and Creek” and prizes the US Army with experience in conducting such operations (6). Due to the fact that in terms of demographics, the Chickasaw Nation was a smaller tribe and the last to begin the Removal, the Chickasaw Removal received less scholarly attention. A notable exception is Amanda L. Paige, Fuller L. Bumpers, and Daniel F.  Littlefield, Jr.’s Chickasaw Removal (Ada, Oklahoma:  Chickasaw Press, 2010). 6 Part of the problem with a new definition of the Chickasaw identity in Indian Territory was located in the tradition of hereditary chiefs. US agents insisted that the tribe adopt republican, electoral system (St. Jean, Remaining 2). 7 See Circe Sturm, Becoming Indian:  The Struggle Over Cherokee Identity in the Twenty-​First Century (Santa Fe: School for Advanced Research Press, 2010). 8 In the same paragraph, Weaver adds: “I will always recall the unconveyable disdain and contempt in the voice of my grandmother, expressing a sentiment inherited from my grandfather, when she mentioned the name of Andrew Jackson” (8).

Part IV

Indigenizing biomedicalization

7  The traffic of cells and ideas Heid E. Erdrich’s biotechnological poetry

In the “Notes” to her 2012 collection, Cell Traffic, Heid Erdrich tells how her sister, Angie Erdrich, a pediatrician, sent her an article about the traffic of cells between mother and child during pregnancy. Erdrich became fascinated with the phenomenon, attracted to how, on a molecular level, it explained connections experienced emotionally and instinctively: … the more I learned, the more I felt that knowledge of how our cells act answered basic spiritual questions and upheld my own intuitions about my connections to my children. It seems a hopeful field of study, too, as the role of fetal cells in protecting the mother is becoming understood, or at least written about, in ways that strike me as feminist and positive. (199–​200) Indeed, Cell Traffic is informed by Erdrich’s forays into genetic-​and genomic-​ related technologies and considerations about how these discoveries affect ideas about indigeneity. Erdrich, as a curious and inquisitive reader of technosciences, creates poetry which connects scientific and everyday practices in empowering narratives of self-​definition and self-​exploration as embodied beings. In fact, Erdrich’s writing is strongly oriented toward an experience of embodiment, demonstrating a thorough understanding of corporeality’s multiple meanings in social, cultural, and political contexts. Erdrich is an immensely prolific artist who uses a variety of subjects and media, poetry1, prose, video, Ojibwe language, and oral tradition, to create vibrant, witty, and funny commentaries on Native American lives. As Dean Rader writes in a preface to her 2012 poetry collection, Cell Traffic, Erdrich dismantles (and re-​ mantles) literary forms, she merges science and Native histories, she assembles poems from RSS feeds, she plays with complicated interchanges of creation and translation, she takes on the deeply disturbing topics of skeletal remains and Native peoples, and she is one of the few Native poets who repeatedly engages canonical American poetry.2 At the same time, amazingly, her poetry also reflects an Ojibwe worldview. (xi)

176  Indigenizing biomedicalization The power and appeal of her technoscientific engagements is located in her poetic process that is informed by scientific curiosity and humor as well as an understanding of the ethical implications of many scientific projects for Indigenous communities. In her poetry collections, Erdrich often includes a “notes” section which identifies sources of her inspirations: scientific journals and magazines. The phenomenal appeal of this poetry comes from the fact that it is often a response to what Erdrich learns about science from professional and popular publications. She is a poet as well as a layperson interested in scientific theories and discoveries. Her work is, thus, a poetic reaction to matters that receive extensive public attention and, at the same time, a poetic mechanism that shifts the lens of inquiry and provides an Indigenous perspective on scientific inquiries. This chapter will demonstrate how poems from Erdrich’s two collections, Cell Traffic and National Monuments, engage with problems related to genomic research and the appropriation of Indigenous cultures and bodies, and indigenize perspectives offered on many recent discoveries, such as microchimerism. Thus, Erdrich directly participates in discussions initiated by Kim TallBear and other scholars about the implications of biotechnoscience for Indigenous people and ways of effectively challenging ideologically driven arguments postulating research conducted in the name of all humankind. Indeed, Erdrich’s poetry discusses many controversial issues such as DNA ancestry testing and the emergence of Native American DNA as an object of study, as well as the challenges posed by genomic technologies to tribal sovereignties. More importantly, however, Erdrich explores the potentialities of locating a point of convergence of Western science and Indigenous systems of knowledge. She thus undermines the reductive binary argument that Indigenous knowledge is incompatible with or in opposition to hard sciences and instead demonstrates its validity as an alternative and complementary discourse of understanding the world and its phenomena.

Native science and Indigenous wisdom While Erdrich’s reliance on Native epistemologies to understand biochemical processes is often interpreted as a daring challenge to the hegemony of Western science, she is not the first Native intellectual to emphasize the existence of elaborate knowledge systems that Indigenous people used for centuries. Gregory Cajete’s Native Science: Natural Laws of Interdependence is a good case in point. Like Vine Deloria before him, Cajete demonstrates how Western science tends to exclude alternative ways of inquiry and Indigenous epistemologies, which are deemed as either unscientific or anti-​scientific. Cajete’s complex exposition of the Native science paradigm does not attempt to support this dichotomy but rather, while elucidating differences, foregrounds the productivity of adopting multiple perspectives. “The perspective of Native science,” writes Cajete,

Traffic of cells and ideas  177 goes beyond objective measurement, honoring the primacy of direct experience, interconnectedness, relationship, holism, quality, and value. … Concerned with the processes and energies within the universe, it continually deals in systems of relationships and their application to the life of the community. (66) This emphasis on interconnectedness and relationality allows Cajete to draw attention to how, in fact, Western and Native models of science converge. From a methodological perspective, Native science and phenomenology share investment in human experience and its implications for understanding human–​nature interactions. Moreover, the two epistemologies share an orientation toward previously acquired knowledge and methodological tools such as observation, empirical experiment, and causality. Thus, Cajete’s project resists dichotomizing Western and Native scientific approaches and instead creates a space where a dialogue is possible and appreciated. He concludes that, “Western science needs Native science to examine its prevailing worldview and culture” (307). Similarly, Erdrich’s engagement with genetic sciences and Indigenous perspectives evinces the productivity of such blending. More recently, a materialization of ideas contained in Erdrich’s poetry, Braiding Sweetgrass:  Indigenous Wisdom, Scientific Knowledge, and the Teachings of Plants by Robin Wall Kimmerer (Potawatomi) further illustrates this point. As a botanist and Native scholar, Kimmerer tells of the interdependence of plants and other human and nonhuman beings and integrates scientific facts and her own personal history. She is careful to render this interdependence in terms of cooperation and mutual responsibility rather than of a hierarchy in which people occupy the highest position. More importantly, however, Western science and Indigenous wisdom are represented as complementary rather than antithetical systems. Consider the chapter devoted to the Three Sisters, corn, beans, and squash, three of the most important crops in Mesoamerica. Kimmerer demonstrates how the coexistence of the three plants depends on complex biochemical and physical reactions that together form a perfect environment for them to flourish. In the descriptions, corn, beans, and squash are represented as living beings, each with a different personality. “The Three Sisters,” writes Kimmerer, offer us a new metaphor for an emerging relationship between indigenous knowledge and Western science, both of which are rooted in the earth. I think of the corn as traditional ecological knowledge, the physical and spiritual framework that can guide the curious bean of science, which twines like a double helix. The squash creates the ethical habitat for coexistence and mutual flourishing. I  envision a time when the intellectual monoculture of science will be replaced with a polyculture of complementary knowledges. (139)

178  Indigenizing biomedicalization For Erdrich, the perfect metaphor for this emerging relationship is the phenomenon of microchimerism, discussed later in the chapter. She pursues her interest in the discourse of biosciences that proves productive in Indigenous decolonization efforts in the twenty-​first century. However, while Erdrich is undoubtedly enthusiastic about such empowering uses of Western science, she nevertheless draws attention to its ideological underpinnings.

“DNA Tribes”: the emergence of Native American DNA Erdrich’s poetry reveals a deep fascination with a phenomenon, referred to by Kim TallBear as the emergence of Native American DNA,3 which at the end of the twentieth century, following land and cultural artifacts, has become a new resource, actively searched for and extracted. The Human Genome Diversity Project and the subsequent Genographic Project, aimed to produce a history of human migratory patterns, are excellent examples of endeavors whose success is predicated on the collection of blood samples from Indigenous populations. By shifting emphasis (and vocabulary) from race to genetic populations, scientists engaged in such projects claim that “their efforts will undermine biological conceptions of race and thus counteract racism” (Reardon and TallBear S234). However, as TallBear observes, the discourse of genetic population presupposes the hierarchy of which populations are worthy of being sampled and which, due to their high levels of admixture, are beyond the interest of scientists4 (Native 6). According to this logic, the growing interbreeding among Indigenous populations produces a situation of urgency in which blood samples of some populations must be immediately collected and analyzed. Otherwise, important information will be irretrievably lost, a serious blow to the entire humankind. What is missing in such a scientific discourse is the wide range of cultural and ethical implications for Indigenous communities. Questions about how coproduced knowledge interacts and often challenges Indigenous epistemologies, who owns blood samples, how they can be used, and how scientific and economic benefits will be distributed are usually glossed over or considered irrelevant, whereas Native people’s reactions against such research are deemed “hysterical” or “hypersensitive” (Harry 151). Erdrich’s poetry can thus be seen as an interesting intervention into the practice of continually silencing Indigenous objections to how knowledge is produced and distributed. “Human Map,” from an earlier collection Fishing for Myth (1997), reprinted in Cell Traffic, serves as a comprehensive summary of such controversies and an apt illustration of ethical dilemmas described by TallBear in her Native American DNA. Moreover, it offers a commentary on genome-​related projects from an Indigenous perspective and, by incorporating into its body the lines from Boyce Rensberger’s Washington Post article, “By Analyzing DNA Samples from 400 Ethnic Groups, Scientists Could Reconstruct Human History” (H. Erdrich, Fishing 24), it illustrates how two parallel voices, scientific and Indigenous, explain such research. This juxtaposition reveals how

Traffic of cells and ideas  179 these incompatible epistemologies function in a context of unequal power relations, illustrated by Western science’s claims to truth-​production and a dismissal of alternative perspectives as manifestations of culture or religious beliefs rather than scientific methodologies. Indeed, the language of Rensberger’s article, with its simplicity and clinical detachment, promises to offer an objective description of the project motivated by a universal respect for a pursuit of truth. Since “Hidden within/​ the DNA of each human being is a record of that person’s ethnic history” (180), scientists recognize their duty to uncover evolutionary patterns with a special emphasis placed on a “we-​are-​all-​related” narrative, which displaces Native Americans as the original inhabitants of the continent. To quell any potential doubts, scientists reassure Native people that there is nothing controversial nor racist about the project, since “ ‘the concept of race long ago lost its scientific/​validity’ ” (181). However, as TallBear and earlier Jenny Reardon, and Donna Haraway repeatedly demonstrated, such tactics of substituting “race” with “populations” is only seemingly neutral and in fact it replicates race hierarchies it claims to eradicate (“Genomic” 519; Modest 232). Controversies resolved, Indigenous people are hurried to donate blood samples as their genetic purity is being comprised by admixture as we speak, which may endanger the success of an entire project. However, from the very first lines of “Human Map,” the speaker questions projected objectivity of such science, its methodologies, and politics. It is precisely an unequal distribution of power between researchers and the researched that is at the forefront of the text:  “You will be happy to know someone has asked our cells to tell,/​in their own bloody language, whether or not all Indian tribes/​descend from a single group migrated from Asia” (180). By drawing attention to the fact that it is the cells, not people, that are of interest, the speaker angrily comments on the continuous objectification of Indigenous people in scientific contexts, a practice which effectively prevents them from being seen as contributors to processes of knowledge production. It is an asymmetrical relation that dates back to the beginning of settler colonialism when resources such as land were simply taken. Now, this “Vampire Project” (180) directs its interest toward blood: You say you won’t go to the blood drive? But the needle’s nothing new. Whether we help them or not is no matter. Our blood will out. Our bodies’ code will crack. They will have their map. (180, 181) The needle used to draw blood is placed on par with other weapons which shed blood since “Bloodshed always determines who inherits a patch of earth” (180). Not only does Erdrich allude to white laws of inheritance contingent on blood connections (and therefore dismissing other forms of relatedness), but also, shows how blood is intertwined with the violence of settler colonial practices, the theft of land symbolically contained in the practice of Western

180  Indigenizing biomedicalization cartography, and now again, it is used to disfranchise Native people as even scientists admit that “their findings might be used to support/​‘increasingly incendiary claims of land tenure in ethnic disputes’ ” (180). The use of needles, not conventional weapons, announces the use of new tactics in the old enterprise. The extraction, of bodies, not land this time, is facilitated through the discourse of “civic duty” and manipulation of information to produce Western-​oriented knowledge, and “knowledge,” as Sheila Jasanoff reminds us, “has become the primary wealth of nations, displacing natural resources, and knowledgeable individuals constitute possibly the most important form of capital” (Designs 4). To obtain this new resource, Native people are either induced into or misinformed about participation: “Rumor has it/​donations need no consent and any clinic might be in on it  –​so/​go ahead –​Give Blood! It’s your civic duty” (Cell 180). Here, Erdrich skillfully alludes to the manipulation of an informed consent requirement and situations in which research subjects are either misinformed about research goals or indirectly coerced into participation. With the imagery emphasizing parasitic extraction, the meaning of the word “donation” becomes distorted and instead directed toward coercion. Thus, scientific research, while discursively constructed as objective and politically neutral, is revealed to be connected with a number of ideological agendas. It is not only the presumed objectivity of science that is questioned but also its methodologies, which easily and nonchalantly dismiss any other epistemologies. Of this process, the speaker ironically says: All the way back to “humanity’s dim evolutionary past,” without the flashlight, scientists can trace “the ancient migrations and ancestral intermixings That have shaped every tribe and culture on Earth.” Still, it’s too late to test Sky Woman, whose breath of life exists in all creatures, or Thought Woman, who imagines us even now, or any of the First Beings who survived by tricks. Too late, so they will have to settle for your blood. (180) Introducing important characters from Haudenosaunee and Acoma Pueblo creation stories is a powerful way to draw attention to the conspicuous absence of non-​Western methodologies, which have already generated knowledge about “humanity’s dim evolutionary past.” Moreover, from an Indigenous perspective, the stories of Sky Woman and Thought Woman are not narrative artifacts of a bygone culture, but complex concepts which explain not only the creation of all human and nonhuman beings but also the sources of their relatedness. Vanessa Watts (Mohawk/​Anishinabee) asserts that the narrated events “took place. They were not imagined or fantasized. This is not lore, myth or legend. These histories are not longer versions of ‘and the moral

Traffic of cells and ideas  181 of the story is… .’. This is what happened” (21). Numerous Native scholars emphasize that Indigenous epistemologies resist compartmentalization into distinct categories such as philosophy, religion, science, etc., and instead contain all of these functions. Moreover, they are shaped locally and integrate knowledge and ethics. They demonstrate how “ ‘science’ depends upon the cultural worldview of the definer” (Tsosie, “Indigenous” 1140), which in a sense is a conscious recognition of how knowledge is place-​based, a claim Western scientists fiercely object. Therefore, the speaker emphasizes how creation stories already serve as scientific theories related to disciplines as diverse as evolutionary genetics and quantum physics: Sky Woman’s “breath of life exists in all creatures” and Thought Woman “imagines us even now.” However, since neither Sky Woman nor Thought Woman can be interrogated (nor can their blood be tested), it is Indigenous people’s blood, analyzed with the help of Western methodologies and technologies, that will provide the answer. Claims about the validity of Indigenous epistemologies are followed by Erdrich’s vocal objections to representing Native people as “vanishing.” “Human Map” directly tackles the idiom of the “vanishing Indian,” or as TallBear rephrases it “vanishing indigene,” to include global contexts, which successfully renders population genetics research urgent and threatened by admixture. Ironically alluding to acronyms used to refer to consecutive genomic projects, the speaker in “Human Map” references a long history of scientific interest in Native people and research conducted in the name of either saving Native cultures from oblivion or contributing to the welfare of  all humankind: Anthropologists, our friends, support this “needy and urgent cause.” And who knows? You may be one of the “HIP people” (Historically Interesting Population) who, they note, are vanishing at an alarming rate. (180) Reduced to scientific objects and remnants of the past, their survival into the modern era considered miraculous and interesting only from a scientific/​ anthropological perspective, Indigenous people are again deprived of agency and subjectivity in the Western process of knowledge production. The speaker actively resists such sentiments, by saying: “Vanishing? They make it sound so passive, as if whole peoples/​simply fade away” (180). In “Human Map,” not only are Native people alive and well, but they also critically (and humorously) challenge the discourse which portrays them as being on the brink of extinction and at the mercy of scientists who will save their blood samples but not their bodies. Census data and various manifestations of Indigenous activism speak the language of regeneration and resistance, not death. As TallBear writes,

182  Indigenizing biomedicalization Genetic-​based assertions about the impending doom of the indigene contradict key indigenous claims. A pivot-​point of indigenous organizing is that while peoples acknowledge assaults on them and their lands, they view themselves as working toward survival as peoples, toward greater autonomy. Not surprisingly, they resist terms that objectify them as historical or biological curiosities or vestiges. (“Genomic” 518)

Indigenous blood, bones, body parts, and American property rights In Erdrich’s poetry, investigations into the implications of genomic research bring to light questions about property rights and the need for their redefinition in the context of biotechnological research. Indeed, the concept of what constitutes property and on what (whose) grounds pervades many of Erdrich’s poems. National Monuments thoroughly explores the theme of settler colonial projects contingent on the appropriation of Native cultures and bodies.5 Many poems explore NAGPRA and its implications as well as gray areas not covered by the act which help prolong the practice of reducing Indigenous human remains to the status of objects of study or archeological collections.6 It is, however, the biomedical context that gives rise to the most pressing epistemological and legal concerns. The cases of the Kennewick Man and the Havasupai Tribe, discussed in Chapter 5, illustrate this point. Erdrich repeatedly returns to the colonial violence of drawing blood for research, the type of research conducted with these samples, the sharing out of potential profits, and legal regulations that seem neutral but in fact serve the interest of Western science. In her poetic analyses of particular cases, Erdrich again interweaves stories of bodily appropriations (blood and bones) in the rubric of settler colonial practices. Cheryl Harris’s groundbreaking essay “Whiteness as Property,” published in 1993, eloquently draws attention to how whiteness and property were so intimately linked in the colonial era that whiteness in fact became theorized as property in American law. Historically, only whites could construct and possess property. Hence, whiteness itself became property, protected by the racialization of nonwhite groups excluded from property privileges (1713). These multiple convergences of law, whiteness and racialization of the “other,” are further complicated in the era of biotechnological research which challenges traditional definitions of bodily integrity and completely excludes non-​Western epistemologies. In her exploration of the concept of cultural harm, Rebecca Tsosie provides numerous examples of how Native concepts of property and ownership drastically depart from American legal definitions. The quintessential difference relies on how Indigenous communities perceive individuals as a part of linked and interconnected kin structures rather than as isolated from organized society, as is the case in American law. This and other factors influence the construction of the American property rights system, which is governed by three crucial criteria:  universality, exclusivity,

Traffic of cells and ideas  183 and transferability (398, 397).7 As Tsosie rightly points out, “A key question for consideration is whether this supposedly ‘universalist’ conception of property rights can apply across cultures and across time periods” (“Cultural” 397). Moreover, these concerns are even further complicated in the context of biotechnologies because “contemporary courts distinguish between the property rights held by persons while the body is intact versus the rights held when blood and tissue are removed” (396). In other words, individuals whose blood has been extracted lose the right to profit from technologies produced with the use of their blood samples.8 In cases related to bodily integrity, property rights are complemented or sometimes replaced by privacy laws, which consist of two components: the right to personal privacy and the right to relational privacy. The first is understood as a right to bodily integrity, whereas the second “provides the freedom to create and maintain intimate associations apart from the state, but it does not shield commercial transactions between strangers” (Rao 389). Radhika Rao’s exhaustive analysis of property and privacy laws reveals how the two fail to adequately address contexts related to genetic research and the use of human tissues due to the conflicting functions that they serve.9 In the context of Indigenous epistemologies and sovereignties, genetic research is even more problematic. In many Native cultures, violating the integrity of the body is one of the most important taboos which “reflects a pervasive belief that bodily substances continue to retain the essence of the individual, even after the removal from the body” (Tsosie, “Cultural” 405). Secondly, as the Havasupai case demonstrates,10 tribes are concerned about the unauthorized use of their body samples in research that is in conflict with their traditional beliefs and may in the future be used to challenge tribal sovereignty and land claims. Finally, tribes fear scientific and economic exploitation when their samples are used to produce commercial products from which they do not directly benefit. These concerns are even more strongly articulated in the context of Western science’s claims that Indigenous blood samples are indispensable in the production of knowledge discursively represented as “beneficial” to all humankind. In their insightful article with the telling title, “Your DNA Is Our History,” Jenny Reardon and Kim TallBear trace the evolution of the discourse in which scientists claim Indigenous DNA is a resource that needs to be studied to reconstruct European migratory history. Analyzing the language deployed in the promotion of the Genographic Project, Reardon and TallBear demonstrate how “Native American DNA has emerged as a new natural resource that Native people possess but that the modern subject –​the self-​identified European  –​has the desire and ability to develop into knowledge that is of value and use to all humans” (S235). Drawing from Yael Ben-​zvi’s excellent essay on Lewis Henry Morgan, “Your DNA Is Our History” reveals how property rights (and the logic of whiteness as property) became intertwined with anthropological concepts of human evolution to produce the idea that Indigenous DNA is an inheritance of whites. Morgan, one of the most influential anthropologists at the beginning of the twentieth century,11 created a

184  Indigenizing biomedicalization theory of cultural progress with three main periods: savagery, barbarism, and civilization. Clearly, Americans represented the last, advanced stage of evolution. However, Native Americans were important objects of study because they illustrated an earlier stage of development of all mankind. In other words, they were what whites once had been, before their evolutionary progress. According to Reardon and TallBear, genetic evolutionism has somehow incorporated this logic into its discourse:  “If indigenous people represent modern humans at an earlier point in evolution, then indigenous DNA is part of modern humans’ inheritance and, thus, property” (S238).12 This mode of thinking is well illustrated in the responses to accusations of unethical conduct leveled at the scientists involved in the Havasupai case. They all believed that “genetic knowledge of human evolution is an objective neutral good that benefits all” (S240).13 In response to criticism, Therese Markow, one of the principal investigators in the project, simply asserted: “I was doing good science” (qtd. in Reardon and TallBear S240). In her poetry, Erdrich boldly confronts these ethical issues and elucidates the psychological and social impact of processes that objectify human bodies and tissues. “Vial” (Cell 134) refers to an incident from 1996 when Karitiana Indians, an Indigenous group from the Brazilian Amazon, agreed to donate blood samples in exchange for medical drugs.14 However, the promised medications never arrived. Moreover, with the arrival of the Internet, the Karitiana community incidentally discovered that their blood samples that had been collected earlier, in the 1970s, were kept and are still being sold by an American company to scientists around the world for $85 a sample. As Larry Rother explains, Francis Black, the first researcher who took samples in the community, had died, which made an investigation into the matter difficult. However, the officials of the National Indian Foundation (FUNAI), a Brazilian agency that supervises Indigenous groups in Brazil, claimed that his presence on the reservation was not authorized and violated existing regulations. Similarly, in 1996 scientists did not have permission to conduct genetic research (“In the Amazon”).15 “Vial” begins with a compelling and defamiliarizing description of a vial of blood: Tube of red like a lipstick passion’s paint, paid for, yet unpaid for, filched like a drugstore compact pinched (65) The first stanza draws attention to the aesthetic quality of blood, its thick substance, and passionate color, and immediately establishes an association with

Traffic of cells and ideas  185 beauty products such as lipstick and pressed powder. These, with their aesthetically appealing packaging, are used for beauty enhancement and, more importantly, are products that can be purchased, “paid for,” or “filched.” The distressing effect of the introductory stanza is achieved through this violent juxtaposition: Unlike lipstick, blood is not or should not be a product subject to the rules of financial transactions. And yet it is. In the second stanza, blood is not viewed as a product to be sold but carries spiritual importance. By comparing a “slender vial of DNA” to a “glass finger,” Erdrich demonstrates that contrary to the logic of property laws, in some cultures, blood even when removed from the body is still perceived as its integral element. While for scientists, research centers, and pharmaceutical companies, blood can be decoded, transformed into blood products, commodified, sold, and purchased, for the Karitiana people, it remains an integral part of their bodies and essential for the community’s health and integrity. Specifically, Erdrich draws attention to how blood is instrumental in the passage to the afterlife and cannot be replaced: “Rich and red/​blood of hunger/​bled in fear of the next world wanting/​the body whole,/​each drop accounted for …” (65–​6). Therefore, it is justified to assume that the decision to donate blood was not easy and was only taken with a view to receiving medical help. This transforms the scientists’ unethical conduct into an instance of cultural harm,16 showing a complete disregard for culture-​related beliefs and practices:  “Promised medicine/​ Karitiana, Amazonian/​ indigenous, offered/​ blood and got/​nothing” (65; emphasis in original). Cheating the Karitiana people out of medicine is represented not as an isolated event, but as a scientifically sanctioned practice of biocolonialism, or biopiracy. In an alliterative enumeration tracing of what happened to the blood samples once they were collected  –​“For Sale/​to non-​profits/​yet non-​bought/​non-​paid for” (65) –​Erdrich ridicules the rationale used in the scientific world to justify such practices. As Rother explains, Coriell Cell Repositories, a nonprofit group located in Camden, New Jersey, stores human genetic material, the Karitiana people’s included, and offers it for research. In a telephone conversation with Rother, Joseph Mintzer, the then president of the center, denied profiting from the distribution of the samples (“In the Amazon”). However, the samples did become products distributed and sold online, the profits from which never reached the community. Hence, Erdrich’s piercing juxtaposition of blood samples being “nonbought” (since voluntarily donated) and yet “not-​paid for” (not in money but in medications that the community was promised, or in an act of exchange), emphasizes the perfidy of such behavior which clearly takes advantage of the unequal power structures inherent in the dealings of scientists with Indigenous tribes, especially those in remote areas of the world with limited access to information and legal counsel. When agreeing to the donation, the Karitiana people believed they were bartering. Instead, they became victims of extraction and exploitation that dates back to beginnings of settler colonialism and continues in biotechnological form: “When they sell it all,/​they’ll come back/​for more” (66).

186  Indigenizing biomedicalization What reverberates most strongly in the National Monuments collection is the bodily violence of the mistreatment and objectification of Native bodies. In “Author’s Notes,” Erdrich writes: “Because the body has become a location, a site and a text to scholars, what would seem violation of a sacred space (say a temple or shrine) becomes a legitimized and urgent need of study” (94).17 The transformation of Indigenous bodies into research objects is accompanied by a similarly violent commodification that transforms them into products, as “Vial” succinctly demonstrates. In “eBay Bones,” Erdrich references an actual auction in which Native Hawaiian bones were offered for sale. A brief explanation in “Author’s Notes” that “Such an auction took place” (96) and is not a product of poetic imagination demonstrates how flagrantly outrageous this act is; among thousands of products usually bought and sold on eBay every day, there are human bones on offer. “Her skull goes to the highest bidder./​How much would you give for a warrior head?” asks Erdrich, thus emphasizing the brutality of the body’s fragmentation and commodification. To counter such violence, Erdrich erases the anonymity and vulnerability of the female human remains by endowing them with a potential story of the woman’s interment and establishing a personal relationship: “She was not much older than me./​Woman of volcanic earth so rich she probably/​eased into loam like her shawl,/​wrapped up warm for her final sleep” (54). The speaker laments the fact that the woman’s body was ever found and subjected to desecration: “They should have buried her more deeply./​Should have thought of science’s creepy needs./​Should have known the web one day/​ hold our dead in its sacred sites” (54). Erdrich’s subversive employment of the homograph “sites” poignantly describes the scale of disrespect for Indigenous people and their epistemologies. Like Louise Erdrich’s LaRose, the poem addresses the long history of mistreating Native human remains. When in 1868, the Surgeon General of the USA issued an order to troops to help commence a craniological collection, the practice of desecrating Native graves received state-​sanctioned recognition. Difficulties enforcing NAGPRA and the appalling example of the bones for sale on eBay only demonstrate the longevity of the idea that Native bodies are indeed either research objects or commodities to be purchased or displayed in museum collections. Heid Erdrich makes abundantly clear the existence of double standards in the rules pertaining to the treatment of the dead: “The grave may be a fine and secret place,/​but kept a fine secret only for some” (54; emphasis added). Indeed, the graves of white people are much more rarely desecrated in a similar fashion and such incidents are severely punished.18 What “eBay Bones” thus demonstrates is the exclusion of Native beliefs and traditions as nonscientific and irrelevant and, more importantly, the fact that elevating scientific inquiry to the rank of universal priority absolves such practices from legal and moral responsibilities. The last stanza begins with a bitter realization of this legal and epistemological injustice:

Traffic of cells and ideas  187 Someone will pay for this. Someone did. Her ivory grin worth less than human curiosity, less than the rest of all humanity, all humanity at rest beneath us all. (54) The first line alludes to two kinds of remuneration: monetary, for purchased products, and moral or ethical, which invokes an idea of justice. While a prospective bidder will pay for the object, no one will be held responsible for the violence of commodifying and objectifying Native human remains. In this sense, the logic of scientific and historical inquiry renders the Native woman’s remains (and life) worthless: Consider the enjambment in the third and fourth lines. As Karen Poremski observes, “In these lines, science and history are demoted to being ‘human curiosity;’ they are not noble fields of study that wish to advance humankind, but mere curiosity, a desire to see and poke and pry” (24). By appealing to “all humanity,” Erdrich asks when –​or if –​non-​Natives will recognize and respect the humanity of Native people. If arguments based on Native epistemologies fail to discontinue commodification, the appeal to empathy constitutes a test for humanity.

What tribe are you? or the false promise of genetic testing As a poetic counterpart and predecessor of Native American DNA by Kim TallBear, Cell Traffic addresses the complex problem of attributing to DNA testing the power to determine and authenticate tribal belonging. Chapter five presents Kim TallBear’s analysis of the coproduction of genetic ancestry tests, from which she concludes that they provide easy biological answers to complex social, legal, and cultural questions. Despite the presence of such claims in many genetic companies’ marketing materials, there is no marker for a tribe that would unequivocally prove an individual’s biological connection to the tribe and, thus, facilitate the enrollment process. Ancestry markers, most commonly used in such tests, are not restricted to single populations. Rather, they are found at higher frequencies in some populations and at lower frequencies in others. Moreover, genetic tests entirely ignore the fact that the tribe is not a genetic population but a dynamic social, legal, and cultural organism which does not rely solely on biological connections. In “DNA Tribes” (Cell 9), Erdrich draws attention to Native American DNA discourses whose omnipresence announces the proliferation of technosciences in everyday life. While the world of nature, represented in the poem by the red-​eyed vireo, is governed by elegant simplicity, the world of emails and computers is somehow erratic and artificial:

188  Indigenizing biomedicalization The red-​eyed vireo calls: Here I am. Where are you? Like some bizarre bio-​mimic, Web ads pop up while I email Asking: Native American DNA –​ What Tribe Are You? (9) Beginning with the image of a vireo, a line from a nursery rhyme, and continuing with biomimetics and allusions to Konrad Lorenz’s book on the human-​like behavior of graylag geese,19 Erdrich juxtaposes the world of nature and the world of technology, the latter in caricature form. The vireo performs a dance of deception to hide the true location of its nest: “The red-​eyed vireo calls,/​misleading us to relocate,/​following its flight/​away from nestlings tight in twigs,/​to get us lost in a bog” (9). The bird only appears to be lost, “asking all along if we even/​know our own locale:/​Here I am. Where are you?” (9). Its seemingly chaotic movement is only a ruse to keep away potential intruders. DNA testing ads, mimicking a similar dance (popping up), pose an analogous question about belonging: “What Tribe Are You?” The answer, it is promised, is contained in a ridiculously simple act: “All’s I’d need to do is swab/​and mail away/​cells my ancestors took/​millennia to perfect” (9). However, the use of the conditional form reveals that the speaker is not so easily deceived. In the last stanzas of the poem, the speaker dismisses the false promises of genetic testing: belonging is not solely in the genes; rather, it is a culturally defined and land-​based concept: As if that could fool us, Make us forget the nesting grounds, The red eye cast backward To the place always known as home. (9) By establishing Native identity as contingent on land (as home), with its distinct histories, geographies, and networks of interdependencies between human and nonhuman beings, Erdrich resists the alluring and yet reductive discourses of genetic ancestry tests. While described as relevant in tribal belonging disputes, genetic tests are unable to account for complex concepts of kinship and relatedness. The danger of embracing genetic testing as a legal means of authenticating ethnic belonging is illustrated by the Kennewick Man case (“The Ancient One”), discussed in Chapter 5. The complex story of the repatriation of the remains reveals how genetic testing, or Western science in general, usurps the power to delineate the limits of “authentic Indianness” and simultaneously rejects Native methodologies, such as a reliance on oral tradition, for being nonscientific and spiritual in nature. In National Monuments, Erdrich includes

Traffic of cells and ideas  189 poems that directly address the controversy surrounding the contested repatriation and seriously disrupt narratives representing the Kennewick Man as a passive, dehumanized specimen. Karen Poremski reveals that in a personal communication, Erdrich identified Suzanne Crawford’s article from Repatriation Reader as an important inspiration (26). What Crawford demonstrates in her text is how Western science and popular press produce the Native body as a text that is meant to be read and interpreted with the help of scientific methodologies. This process of interpretation, or genetic decoding, produces a historical narrative of human origins on the American continent which is appropriately tailored to meet ideological demands of justifying settler colonial practices and, at the same time, retains the control over the definition of what constitutes “authentic” Indianness. The success of this interpretative project is predicated upon the dismissal of Native methodologies, a strategy which performs two main functions: it deprives Native people of subjectivity expressed in the right to self-​definition and successfully denies them a position of partners/​equals in the ongoing debate. As Crawford writes: The ability to name oneself, to assume a position of subjectivity, is an indicator of power and agency, a reversal in hierarchical systems of exploitation, and Kennewick Man is a revealing illustration of this process. The power to name, describe, and construct narratives around the body has come to be seen as an indicator of authority. To allow Native narratives to have equal voice and authenticity is to place Native use of language on an equal plane with that of Western Enlightenment empiricism and rationalism. To accept Native origin stories and historical narratives as being of equal value to those of Western science is thus to grant Native peoples semiotic sovereignty and as such to grant them subjectivity. It is not a question of who is correct or incorrect, but a matter of respecting the different embodied world views with which people approach their history. (233; emphasis in original) This clearly demonstrates how scientific, legal, cultural, and popular discourses coproduce the racialized body rather than simply engage in an innocent act of its reading/​decoding. While sadly the Kennewick Man case still testifies to the unequal distribution of power in the processes of knowledge production, it also serves as an opportunity for Native people to interrogate an institution of Western science with questions originating in Indigenous epistemologies. It is such subversive, disrupting potential that informs Erdrich’s contribution to the debate. “Kennewick Man Tells All” begins with an epigraph from a New Yorker article in which James Chatters, the forensic anthropologist who first studied the remains, says: “We didn’t go digging for this man. He fell out –​he was actually a volunteer. I think it would be wrong to stick him back in the ground without

190  Indigenizing biomedicalization waiting to hear the story he has to tell” (59). Indeed, as Crawford extensively documents, the arguments against reburial repeatedly evoked the concept of Kennewick Man as a storyteller who desperately wanted to tell his story (215). If so, Kennewick Man emerges as a perfect “Native informant” since He can be read through empirical processes to provide scientifically verifiable data. He cannot speak for himself but must be spoken for. And even better, he cannot mislead researchers through misinformation or poor translations, as living Native “informants” are wont to do. (220) Erdrich’s strategy to counter such objectifying discourse attempts to achieve two things. First of all, she endows Kennewick Man with voice and agency and, secondly, she draws attention to science’s unstable claim to be able to “explain all”: Ladies and Gentleman of the press –​ Kennewick Man will now make a brief statement after which he will answer questions as time permits. I am 9,200 years old I am bone. I am alone. (59) Evoking a press conference setting, Erdrich acknowledges extensive coverage of the case in the press as well as the immense importance ascribed to genetic and radiocarbon testing. However, the climax never arrives as Kennewick Man reveals little, or rather he chooses to reveal more personal ruminations than hard scientific data. By admitting that he is alone, he rejects the passive identity of a research object and instead assumes agency and a personality. Moreover, his brief performance is about emotions rather than scientific facts. He is transformed from a specimen into an individual, separated from his culture and land and therefore suffering. He is alone and yet no longer alone, since Erdrich established a personal and intimate connection by acknowledging his humanity. By thus reframing what Kennewick Man communicates, Erdrich lampoons the idea that investment in Western sciences is the only narrative capable of ordering and explaining worldly phenomena. “Kennewick Man Attempts Cyber-​ date” continues the process of transforming the remains into a living individual, here confronted with technologically oriented problems of the twenty-​first century. Responding to his newly emerged needs, he attempts to arrange a date on the Internet. He needs to confront the dilemma of self-​representation and the careful balancing of reality and fantasy: “So when Cyber-​date asks me what I look like,/​ I am no liar./​Not like I expect to match a hottie./​Not looking for ‘Barbie and Kennewick Man’ ” (62). The concentration on Kennewick Man’s physical appearance is not accidental here: Again, the poem is preceded by a quotation

Traffic of cells and ideas  191 from James Chatters. This time, referring to artist Thomas McClelland’s reconstruction of Kennewick Man’s face from a plaster cast of his skull, Chatters says:  “And then, one evening, I  turned on the TV and there was Patrick Stewart –​Captain Picard of Star Trek, and I said, ‘My God, there he is! Kennewick Man!’ ” (62). As Crawford skillfully demonstrates, there is indeed nothing innocent about Chatters’s association of Kennewick Man with a white and British actor. Chatters’s comment contains two separate ideas governing evolutionary history as created by genetic scientists. First of all, what appealed to the popular press was Kennewick Man’s “Caucasoid” characteristics as they were often described. Clearly, representing Kennewick Man as a representative of Caucasoid people who originally inhabited Europe allows people to challenge the status of Native Americans as the first inhabitants of the continent and, in the long run, dismiss their claims to tribal lands and sovereignties. It is the same logic present in the “we-​are-​all-​related” narratives, spread by genetic science, which incessantly emphasize the theory of the common origins of humanity. Secondly, Kennewick Man is claimed to be of European origin because he does not look Native according to the existing stereotypes. Crawford asserts that “Authentic Indians” as projected by whites  –​“[the] one[s]‌with the land, [who] wear buckskin and feathers, live in tipis, dance with wolves, and hunt buffalo while riding bareback” (222) –​are difficult to find today. “Through Kennewick Man,” writes Crawford, “white popular culture can appropriate the role of the ‘Authentic Indian’ that Native Americans have not adequately embodied” (223). Consequently, similarly to the rationale behind blood quantum policy,20 the perpetuation of the “Authentic Indian” stereotype secures white culture’s grip on the definition of Indianness. Is Kennewick Man ever aware of the complex issues enveloping his existence? While the cyber format of dating clearly does not appeal to his sensibilities, he does want to “smell a woman’s neck again!” (62). Thus, in the last stanza, he needs to complete the application: Or just fill all required fields. To simply state: My age My race My God. (64) Erdrich humorously points out how, in the case of the Kennewick Man, these seemingly simple questions cannot be answered, even with the help of science. Moreover, the identification of race becomes even more complicated considering the long history of white people’s insistence on the right to delineate racial boundaries, with blood quantum in the case of Native Americans and the “one-​drop” rule for African Americans. Thus, not only does science fail to “tell all,” as Kennewick Man’s decoded body is expected to, but it also

192  Indigenizing biomedicalization remains oblivious to a rich body of Indigenous epistemologies which already contain theories of human origins and migrations. If “My God” is Kennewick Man’s exclamation rather than a question about religion, science’s pretense to infallibility confounds him enormously. In her analysis of Erdrich’s investment in the NAGPRA discourse, Poremski asserts that by humanizing Kennewick Man, Erdrich “voices the bones” and thus achieves the effects for which NAGPRA was created: respect paid to the dead as well an emphasis on “relationships based on familial and human ties rather than material value” (27). It is in a reconstruction of Kennewick Man’s personality and body that Erdrich locates the most effective strategy of resistance to the objectification of Native people’s bodies in Western sciences.

“Cells shift purpose on purpose”: microchimerism, migration, and embodiment In “Notes to Cell Traffic,” Erdrich writes: The title of this collection … suggests movement, small units passing back and forth, busy telecommunications, internet chatter and terrorist groups, the sale or traffic in DNA or body parts or bones, indigenousness and ancestral inheritance, migration through procreation, and other biological processes. (199) With this daring combination of biomedical, technological, and Ojibwe concepts, Erdrich permits us a glimpse of her project in the collection:  A dialogue between genetic theories and Ojibwe ontologies which does not privilege either of the perspectives, instead celebrating the multiplicity of voices. Moreover, by incorporating theories of cellular microchimerism into Ojibwe ontologies, Erdrich refutes claims that Native people are antiscientific. In her poems, she creates a space where the two discourses, while indeed different and contingent on divergent assumptions, do enter a productive dialogue. Several poems in Cell Traffic are responses to Erdrich’s exposure to research on microchimerism. In the context of bidirectional cell traffic during pregnancy, the term “microchimerism” denotes “the presence of small, though diverse, cell populations or of minute amounts of cell-​free DNA, from a ‘donor’ within the ‘recipient’ ” (Gleicher 341). In the fetal–​maternal scenario, the presence of donor cells may persist for as long as 27 years postpartum, thus, becoming engrafted in the recipient’s tissues, such as bone marrow, spleen, and liver blood (Tan et  al. 1443). Resent research concentrates on the extent to which “this naturally occurring microchimerism may be causally related to the occurrence of autoimmune diseases” (Gleicher 341). Thus, following a possibility of negative connotations contained in the word “traffic” (trafficking of illegal substances and people), microchimerism carries a threat

Traffic of cells and ideas  193 of health complications. Notwithstanding the connotations of the word “traffic,” Erdrich concentrates on the productive potential of microchimerism as a metaphor for relationality, since it redefines the boundaries of selves and bodies and sees them as interconnected. “Blood Chimera” offers a humorous take on the topic of blood and how microchimerism transforms the way it is perceived. The speaker begins with an invocation to blood, a life-​connoting substance, but the pompousness of invocations next to the biochemical components of blood make the address comical: O’ my blood, thrumming in my hands,

my cup of knuckles laced to hold you, if need do. O’ you positive, you plus. Body, O’ Body –​and antibody. Bloody cup drained red from white. (16) Relying on the ambiguity of words determining blood groups –​“positive” and “plus”  –​Erdrich draws attention to how blood produces divergent meanings depending on perspectives. For some, it is indeed the liquid of life, “thrumming” in the body. For others, it is analyzed in the context of identifying antigens, the Rh antigen included, on the surface of red blood cells. The interaction of “body” (referring to the blood’s container) and “antibody” (a biochemical component of blood) announces what will become evident with the discovery of microchimerism:  A challenge to the inside/​outside binary which clearly delineates the boundaries of personhood. Regardless of which language is used, personal or scientific, blood evokes a sense of vitality and movement. This view of blood as a carrier of life is further complicated and enriched by microchimerism which, governed by multidirectional movement, redefines the idea of where one body ends and another begins: Never a divide, only the pulse of ancestry, Red river surge of time. Beyond understanding now: my blood not mine. (16) “The pulse of ancestry” and “surge of time” are indeed powerful metaphors for conveying biological continuity as well as cultural connections which are not contained in blood but often figured as such. Microchimerism complicates the idea of linear blood flow and calls for a redefinition of ideas about embodiment and personal integrity. Furthermore, the poem redefines the idea of being “alone” since with ancestors’ cells circulating in the blood system, one is never literally alone: “Never again solitary, never sole” (16).

194  Indigenizing biomedicalization The use of “solitary” and “sole” is interesting here. Erdrich invokes ideas of simultaneously independence, separation, and singularity to demonstrate how microchimerism shifts an entire embodiment paradigm. Attention is shifted from the individual (and individualistic capitalism) to communal values where “we” dominates over “I” and “my.” With microchimerism, one is never alone. This reorientation toward personal integrity constructed as contingent on participation in the community creates a model of embodiment derived from Ojibwe and other Indigenous cultures. Indeed, the last line of the poem suggests that wholeness and wellbeing is predicated upon community rather than self-​contained individualism:  “Body, blood, antibody. Perfect, unsullied, whole” (16). The alliterative flow of body concepts emphasizes how, redefined through microchimerism and an understanding of DNA as a molecular map of life, body and blood become powerful concepts to connect individuals to their collective past. Moreover, by illustrating cell mixture and traffic as productive phenomena, Erdrich reveals the absurdity of the blood quantum logic with its emphasis on (unattainable, as it turns out) blood purity. “Little Souvenirs from the DNA Trading Post” juxtaposes diverse ideas of traffic and movement and intergenerational transmission. If, historically, trading posts were centers of trade and exchange of goods and information, genetic material participates in a similar traffic of biochemical components and traces of human affect and interactions. Composed of loosely related extracts from postcards and letters as well as ruminations about travel and topography, the poem begins with an epigraph from Dr.  Diana Bianchi’s comments on maternal–​fetal microchimerism. Indeed, ideas of traffic and exchange structure the text, creating an impression of things in a constant flux and people’s bodies imprinted with the movement:  “GREETINGS FROM SUNNY…,” “I AM FINE, WISHING YOU WERE HERE,” “I hear you always, like Eiffel Tower earrings jingling in my ears” (36). The physical movement in space, across continents, is accompanied with the molecular movement of cells: “Touch me here and you touch her” (36), writes Erdrich, thus articulating the embodied dimension of biological and cultural relatedness. The seemingly chaotic movement of things, ideas, concepts, and cells converges on the space of the body. Thus, Erdrich draws attention to the often-​undermined role of embodiment in structuring knowledge and experience of the world. “Microchimerism” combines Erdrich’s investment in microchimerism and embodiment. Here, she addresses the maternal–​fetal cell traffic in order to construct complex models of connection, relatedness, and exchange emerging from at least three sources: the body, genetics, and Ojibwe culture. As in many of her poems, Erdrich juxtaposes personal and scientific discourses to illuminate differences in methodologies and languages. While the two perspectives remain epistemologically divergent, here microchimerism and a personal, intimate understanding of the mother–​child connection coexist side by side, creating a hybrid, chimera-​like narrative.

Traffic of cells and ideas  195 The speaker begins with an image that will be repeated several times in the poem, that of a fetus developing into a human form and inscribed in the mother’s body through microchimerism: Nub of human,

shell pink fingernail, whether you live or all unformed leave your body she will never be without you. (11) The process of transformation from “nub of human” to a body living outside the mother’s nurturing and caring body leaves a permanent mark and creates an unbreakable connection. The same is expressed, or confirmed, with the voice of science in the form of italicized quotations from Dr. Judith G.  Hall’s 2002 presentation, “Fetal Determinants of Adult Health” and a Tufts University profile of geneticist Dr. Diana Bianchi: This, scientists tell us, is literally true: … the cells from her miscarriages, her stillborns, and all of her children … We carry them for a lifetime. But the cells actually go both ways. (11) While Erdrich’s juxtaposition of the personal and the scientific is not intended to privilege either, her humorous use of the adverb “literally” subtly reminds us of science’s hegemonic pretenses. Nevertheless, its language confirms what the speaker experiences on an intimate level of embodiment. If scientists and their language are challenged at all, it is not by suggesting an alternative methodology, but rather, by pointing out that what microchimerism describes has always been known by mothers or felt by their bodies. Erdrich describes this connection as palpable and enduring, defying laws of physics, experienced on the level of the body and affect: Vivid dreams in her bed echoed,

a wall away and you felt her, knew her wakefulness through the quiet she maintained. She knew it too and tried explaining, “It is like she is in me, knows my brain, and wakes me up before she wakes.” Darkness so soft she feels its nap

196  Indigenizing biomedicalization cushion her movements, still she reaches you just as your cries begin, then you two are one again. (11–​12) Knowing the baby is awake or waking up before she wakes up illustrates a primordial, ancient, and powerful connection. Microchimerism theory is not concerned with revealing a new phenomenon. Rather, it expresses on a microcellular level something that had been known all along and whose traces are detectable in everyday actions such as touching, nursing, and responding to the fetus’s and then the newborn’s needs. Food and milk emerge as powerful manifestations of this bond: “her milk for you –​your milk,/​a million messages, recipes, connections” (12). Similarly, during pregnancy, food urges are manifestations of cellular traffic inside two intertwined bodies: “This month you demand/​brain grease, complex fats;/​next month another mix/​produced especially for you” (12). Thus, microchimerism does not belittle or invalidate the embodied experience of motherhood. Rather, it offers a translation into the language of cell traffic. Erdrich is fascinated by the inconspicuous and yet tangible space of productive dialogue between the personal and the scientific. Characteristic of both is the idiom of movement, mobility. By emphasizing such interconnections, Erdrich demonstrates how microchimerism unexpectedly reflects Ojibwe cultural values. Both emphasize the importance of movement in cultural and personal histories. Movement and migration are important elements in Ojibwe tradition. In History of the Ojibway People, perhaps the most important historical text on the subject, William Warren explains that the people’s migration from “the shores of the Atlantic Ocean, about the Gulf of the St. Lawrence River” (76) was a defining moment for the original people and is preserved in oral tradition. The Lemi Lenape people (known today as Delaware), who migrated westward, were probably the ancestors and the Grandfathers of the present-​day Ojibwe and other mid-​western tribes. The epic story of the migration and eventual dispersion of the people is known as the Great Migration, the Wallum Olum, and apart from surviving in the oral tradition, it is recorded on bark tablets and song sticks (Peacock and Wisuri 22–​3).21 According to Scott Richard Lyons (Ojibwe/​Dakota), migration has remained one of the primary cultural values for the Ojibwe. Migration protects against stagnation and produces an idea of home. Peoples on the move were always united and motivated by their destination, which, in prophecies heralding the migration, was a welcoming space. “The Ojibwe envisioned life as a path and death as a journey,” writes Lyons. [E]‌ven Ojibwemowin, the Ojibwe language, is constituted by verbs on the move. [Migration] …produces difference: new communities, new peoples, new ways of living, new sacred foods, new stories, and new ceremonies.

Traffic of cells and ideas  197 The old never dies; it just gets supplemented by the new, and one result is diversity. (4; emphasis in original) Likewise, Leanne Betasamosake Simpson (Michi Saagiig Nishnaabeg) emphasizes how mobility leads to productivity and the forging of unexpected coalitions: “We’ve always moved throughout our territories and through the territories of others with the practice of diplomacy, moving with the consent of other nations” (197). In the poem, Erdrich recreates the same dynamics of movement which a potential for regeneration: “Your cells and hers/​flowed back and forth” (Cell 12). What else is microchimerism if not a constant migration/​traffic of cells which preserves the old and yet creates the new? A dialogue between the Ojibwe culture and scientific discourse is revealed in the metaphor used to convey the novelty of microchimerism as a biomedical discovery. Using the very language of scientists, Erdrich writes/​quotes: The waves of fetal microchimerism Are just beginning to break Along the scientific shore. (12; emphasis in original) The words “waves” and “shore” point to water imagery. Water is a fundamental element in Ojibwe creation stories. After Kitche Manitou (the Great Spirit) created the world, it is destroyed by water, which creates an enormous sea covering the world for generations. In the recreation story, Sky Woman descends from the sky and lands on the back of a turtle. A number of water creatures dive underwater to bring her soil from the waterbed. All fail except for a muskrat who manages to bring in his paws a small morsel of soil. Sky Woman breathes life into the soil and thus is formed the first island (Johnston 12–​15). The flow of water reminds one of the flow of blood which in turn is about the flow of cells. The repeated image of a developing fetus, opening each section of the poem, is compared to “shell pink fingernail.” The reference to shells is not accidental; sacred shells, Midemegis, are important attributes of Ojibwe medicine men and women and are used in the Midewewin ceremony (The Medicine Society).22 As Basil Johnson (Anishnabeg) explains, Set beside the sacred drum was the Midemegis, the sacred shell. Always present in the lodge, the shell symbolized the fact that long life was not sought for its own sake. Instead, long life was a gift that the Anishnabeg had to reclaim after it had been lost by the man who first challenged the Spirit of the Underworld. (Ojibway Ceremonies 107) Thus, the shell signified the fluidity of life, its sometimes-​unstable dimension. Culture, like water, flows, and blood, with its internal biodirectional

198  Indigenizing biomedicalization traffic, only repeats this ancient movement. Thus, by discovering these unexpected correspondences between Ojibwe culture, embodied motherhood, and microchimerism, Erdrich creates a democratic and inclusive space where divergent discourses permeate one another with none dominating the others. Moreover, Erdrich demonstrates how, contrary to accepted beliefs, Indigenous epistemologies and Western science produce similar conclusions but expressed in different discourses, hence refuting claims that their relation to one another is antithetical. Finally, Erdrich employs microchimerism to illuminate the profound scale of biological relatedness which, contingent on the flow of blood and cell traffic, establishes a connection with the first ancestors, possibly the Lemi Lunape: Nub of human, Shell pink fingernail –​ Who left cells in your mother That she gave you? A million unknown others. (13) While the remote ancestors may be unknown, they are still accounted for and cherished in oral tradition.23 With the mechanism of microchimerism, they are literally contained in contemporary Native bodies, trafficked in cells in the flow of blood:  “Now we know:/​masses of genetic material not our own/​inside us, always with us, like the soul” (13). There are no binaries  –​ us/​them, inside/​outside, with/​without  –​ which unnecessarily privilege one element over another. Instead, there is a flow, porousness, permeation. Here, Erdrich’s politics of creating a multiplicity of perspectives rather than hierarchies manifests itself in the most powerful form. Gregory Cajete’s and Robin Wall Kimmerer’s insistence on the inclusion of multiple voices and perspectives in scientific inquiry materializes in her use of microchimerism.

Embodied resistance at a cellular level Erdrich’s scientific curiosity leads to an exploration of how microchimerism becomes an appropriate metaphor for intergenerational relatedness and the embodied dimension of Indianness connected with human beings, nonhuman beings, and nonorganic matter. Moreover, Erdrich’s poetry is an important intervention into scientific protocols that render blood as an object of study, divorced from the individuals from whom it comes. With this gesture, she draws attention to how poetic discourse, by referencing and appropriating scientific language, juxtaposing it with Ojibwe oral tradition, and demonstrating its unexpected ambiguities, produces a rupture in the continuity of settler colonial structures constructed out of metanarratives such as law, science,

Traffic of cells and ideas  199 and ethics. Erdrich’s poems about the Kennewick Man intervene in scientific narratives that represent Western science as objective, apolitical, and entitled to do any kind of research. Similarly, humanizing Kennewick Man and giving a voice to the Karitiana tribe constitute a powerful refusal to agree to the appropriation and commodification of Native bodies and cultures. Perhaps most importantly, Erdrich’s courageous explorations of bioscience and her engagement with ethics and legal studies refute claims that Native people are antiscientific and unable to recognize the significance of technosciences in exercising tribal sovereignties. National Monuments and Cell Traffic challenge assumptions that Native people and cultures are remnants of the past, irrelevant in contemporary social, political, and scientific contexts. If Indigenous people are included in these discussions at all, it is never as agents, individuals, or sovereign nations but as the embodiment of American fantasies or, more recently, objects of research. Both collections disrupt such narratives. Yet, they operate on different levels, thus revealing the scope and scale of Erdrich’s project and its consistency.24 The grandeur of National Monuments is manifested in its deconstruction of homogeneous narratives of American history contained in national monuments such as the Black Hills in South Dakota and Grand Portage near Minnesota, its destruction of monuments of American literature (e.g., Robert Frost and William Carlos William), and its exposure of the ideological underpinnings of legal mechanisms. In Cell Traffic, Erdrich shifts her analysis of subjugation to a cellular level and thus pointedly demonstrates the intensity with which Native bodies continue to be objectified in yet another discursive and conceptual field. However, “microscopic” does not mean “inconsequential.” On the contrary, Erdrich’s embodied resistance to decolonization is indeed powerful as it seems coded in DNA and circulated in a never-​ending traffic of cells.

Notes 1 Erdrich’s video poems can be accessed here http://​heiderdrich.com/​. 2 The most notable examples are Erdrich’s responses to poems by William Carlos Willams (“To Elsie”) and Robert Frost (“The Gift Outright”). 3 TallBear’s observations of an emergence of Native American DNA are discussed in Chapter 5. 4 In “Your DNA Is Our History,” Reardon and TallBear draw attention to how the criterion of “admixture” is constructed in genetic studies of human evolution. The ideal is “to sample individuals with four grandparents from the same population. In Luca Cavalli-​Sforza et al.’s History and Geography of Human Genes, aboriginal populations with ‘25% or more admixture’ are excluded” (S237n13). 5 Wendy Rose (Hopi/​Miwok) was an earlier poet to draw attention to the objectification of Native human remains. See Wendy Rose, Bone Dance: New and Selected Poems, 1965–​1993 (Tucson: University of Arizona Press, 1994). 6 Consider, for example, “Guidelines for the Treatment of Sacred Objects,” “Desecrate,” and “Body Works.”

200  Indigenizing biomedicalization 7 For a more detailed discussion, see Tsosie’s “Cultural Challenges to Biotechnology: Native American Genetic Resources and the Concept of Cultural Harm,” Journal of Law, Medicine & Ethics, vol. 35, no. 3, September 2007, pp. 396–411. 8 See Moore v. Regents of the University of California, 793 P.2d 479 (Cal. 1990), cert. denied, 499 U.S. 936 (1991); Radhika Rao, “Property, Privacy, and the Human Body,” Boston University Law Review, vol. 80, no. 2, April 2000, pp. 359–​460. 9 The coexistence of these two systems creates conflicts that can be summarized in five concepts: fragmentation (how the legal conception of property produces a fragmented relationship between the body and its owner), instrumentalization (the body as property can be approached instrumentally but privacy laws protect against such practices), alienation (separate body parts are alienated from their owner but again privacy laws exclude the idea of the body as subject of transaction), expropriation (property rights can be transferred and reassigned, which is not possible with individual-​specific privacy laws), and inequality (property rights are inherently unequal but all persons possess privacy rights) (Rao 429–​43). 10 The Havasupai People’s case is discussed in Chapter 5. 11 Morgan’s most famous and influential work is Ancient Society; or, Researches in the Lines of Human Progress from Savagery through Barbarism to Civilization (1985. Tucson: University of Arizona Press, 1995). 12 Clayton Dumont demonstrates how museums and scientific community, to defend the need to study Native human remains, use the same logic of “rights and obligations” on behalf of all (white) Americans to protect the heritage of the country. See Clayton W.  Dumont, Jr., “Contesting Scientists’ Narrations of NAGPRA’s Legislative History:  Rule 10.11 and the Recovery of ‘Culturally Unidentifiable’ Ancestors,” Wicazo Sa Review, vol. 26, no. 1, 2011, p. 5–​41. 13 More examples are provided in Chapter 3. 14 In his unpublished manuscript, “Moving Bodies:  Sovereignty, Science, and Indigenous Ontology in the Poetry of Heid Erdrich,” Ryan Joseph Rhadigan also extensively explores the use of scientific discourses in “Vial,” “Blood Chimera,” “Microchimerism,” and “Little Souvenirs from the DNA Trading Post.” However, his analysis concentrates on and critically engages with Gerald Vizenor’s concept of transmotion and powerfully demonstrates Erdrich’s commitment to Ojibwe culture. Moreover, Rhadigan provides a fascinating reading of the ways Erdrich’s poetry engages in discourses of nutritional epigenetics. 15 Not much has been done to identify the individuals responsible for this ethical and legal breach. An article in Cultural Survival claims that in November 2018, the Brazilian government responded positively to the request of Mercio Pereira, the president of FUNAI, for a federal investigation into online sales of genetic material collected from Indigenous people. See “Brazil:  Indians’ Genetic Material Sold on Internet,” www.culturalsurvival.org/​news/​ brazil-​indians-​genetic-​material-​sold-​internet. 16 Rebecca Tsosie extensively demonstrates how the concept of cultural harm is still not recognized in American law. See “Cultural Challenges to Biotechnology: Native American Genetic Resources and the Concept of Cultural Harm,” Journal of Law, Medicine & Ethics, vol. 35, no. 3, September 2007, pp. 396–411. 17 Consider how the destruction of the Notre Dame Cathedral in Paris was lamented as “a terrible tragedy” by the Western world. See Claire Sergent, “Notre Dame fire: Parisians mourn the loss of their beloved cathedral after ‘terrible’ tragedy,” Independent, April 16, 2019.

Traffic of cells and ideas  201 18 In a debate concerning the provisions of NAGPRA, a member of the Klamath Tribe, working with the National Forest Service makes a similar observation: “If I  was to go down to the graveyard in [local neighboring community] and start digging people up, and then say well we’re going to unlock your mysteries for you by digging up your ancestors here, and then I’m gonna build a museum and I’m gonna take all their artifacts and put them in a museum and charge you to see this stuff so that I can protect your heritage for you and preserve it for you, they’d put me in jail” (qtd. in Dumont, “The Politics” 113). 19 See Konrad Lorenz in collaboration with Michael Martys and Angelika Tipler, Here Am I –​Where Are You?  The Behavior of the Greylag Goose, translated by Robert D. Martin, Harcourt Brace Jovanovich, 1991. 20 The concept of blood quantum is discussed in detail in Chapter 5. 21 For more, see Scott Richard Lyons, X-​ Marks:  Native Signatures of Assent (Minneapolis:  University of Minnesota Press, 2010)  and William W.  Warren, History of the Ojibway People, 1885 (St. Paul:  Minnesota Historical Society Press, 1984). 22 Rhadigan also makes this connection (21–​2). 23 This is a perfect example of a connection not recognized by NAGPRA. 24 I am grateful to an anonymous reviewer for making this insightful observation.

8  Biomedical psychiatry, Native American identity, and the politics of visibility in Elissa Washuta’s My Body Is a Book of Rules

In My Body Is a Book of Rules, Elissa Washuta describes her experience of suffering from bipolar disorder: A mixed state is like a foot cramp, one of those urgent, painful ones; not a tempest, which has been said to many times before; maybe jalapeños, the way they hurt my mouth so badly but they taste good; sunburn, while it’s happening, the way the skin feels so hot and it stings but the light is all pleasure. (147) While the metaphorical language manages to capture a wide spectrum of bodily and mental emotions, it somehow fails to authenticate bipolar disorder as a real and disabling condition for those who claim that she is not sick, just “moody.” To validate bipolar disorder as belonging to the realm of psychiatry, Washuta interweaves her metaphors with a medical discourse:  “Depression is a real medical condition, the other name for the dread that pulls you down melting Maryland asphalt on steaming mornings while you drag your buttery bones along, wondering who liquefied your insides” (53). The biomedical model of mental disorder, therefore, provides a legitimate status of a mental health patient, helps better understand the patient’s condition, and ameliorates some of the effects of social stigma. However, does it? In My Body Is a Book of Rules, Washuta puts biomedical psychiatry to test and demonstrates her often ambivalent feelings about the effects of the biomedical discourse on social perceptions of mental disorders as well as patients themselves. Moreover, in her ruminations on her Native/​white identity, Elissa similarly experiments with biomedical metaphors to explore their potential for framing questions about culture, genetics, and identity politics. In this case, biomedical language is gradually revealed as inadequate to express all complexities of reciprocal and relational concepts on which tribal belonging and identity rest. While Washuta does not entirely reject biomedical metaphors to convey emotional and mental states, I argue that her emphasis on historical and social contexts, which influence contemporary concepts of indigeneity in the USA, complicates the seemingly productive use of biomedicine

Biomedical psychiatry  203 exemplified by such clusters as “Indian blood” and “history in DNA.” While Linda Hogan employs biomedicine as a language of empowerment,1 Washuta is more critical of the hidden implications contained in such a language. What she resists is not the epistemology of biomedicine in general: rather, she resists conceptual shortcuts that first subject her body to processes of fragmentation into Indian blood, genes, and DNA, only to be later fetishized as markers of “authentic” Indianness.

Biomedical psychiatry and psychiatric pharmacology The biomedical model of psychiatry2 promotes a biological understanding of brain states and activities. Mental illness is attributed to a deficiency or an excess of neurotransmitters,3 to hormonal imbalances, or to genetic makeup rather than to “problems of the mind.” These biological processes of the brain that lie at the core of mental illness can be detected with the help of other sciences such as neurosciences, molecular biology, and genetics, to name a few (Thachuk 145–​55). While validated with the flourishing scientific advancements in the late twenty and twenty-​first centuries, the idea of biological basis of mental disorders is not new. German psychiatrist Emil Kraepelin (1856–​926) is often considered to be the father of clinical psychiatry, venerated for strengthening the biomedical model, and thus helping to authenticate the field’s status as a science (Engstrom 163). His nosology of mental disorders influenced postpsychoanalytic psychiatry in the USA, where in the 1960s and 70s “neo-​Kraepelinians,” using newly emergent psychopharmacology, demonstrated reliability and utility of his methods (Ghaemi and McHugh 150–​1). This paradigm shift, from psychoanalytical4 to biomedical model, was clearly facilitated with advancements in pharmacotherapies. The discovery of the antimanic effect of lithium in 1949 and antipsychotic properties of chlorpromazine and reserpine in 1952 sparked further research creating a belief that every mental disorder can be traced down to anomalies in neurotransmitter systems and corrected with a proper chemical substance. The psychiatric brain was thus described as any other organ that could be broken down into regions, parts, and functions. Such an approach created a whole new discourse to describe the brain’s activities: brain chemicals, brain functions, experimental model systems used to test drugs’ efficiency, and biomedical investigative techniques. As Nikolas Rose succinctly points out, “The new style of thought in biological psychiatry not only establishes what counts as an explanation, it establishes what there is to explain” (The Politics 192). The rise of biomedical inquiry into the brain was also made possible with the development of brain visualization technologies, which added yet another dimension to processes of how the body is rendered visible and subjected to medical gaze, famously described by Michel Foucault in The Birth of the Clinic. Foucault demonstrated how in the late eighteenth-​and early nineteenth-​ centuries physical examination and dissection of corpses displaced patients’

204  Indigenizing biomedicalization descriptions of symptoms. Medical epistemologies, from then on, were visual rather than narrative and were governed by the clinical, detached gaze. The doctor directed his gaze into the interior of the patient’s body: The gaze plunges into the space that it has given itself the task of traversing. … In the anatomo-​clinical experience, the medical eye must see the illness spread before it … as it penetrates into the body, as it advances into its bulk, as it circumvents or lifts its masses, as it descends into its depths. Disease is no longer a bundle of characters disseminated here and there over the surface of the body and linked together by statistically observable concomitances and successions … it is the body itself that has become ill. (136) Apparently, the gaze of the nineteenth and early-​twentieth centuries failed to penetrate the body thoroughly, even with such revolutionary discoveries as X-​rays. The late-​twentieth century, however, offered a whole range of visualization technologies that not only provided a better illustration of brain structures but also its activities in real time:  Computerized Tomography (CT), Single Photon Emission Computer Tomography (SPECT), Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI), and then Functional Magnetic Resonance Imaging (fMRI). All of these new visual technologies redefined the shift described by Foucault.5 The impressive accuracy of these technologies led to claims that objective distinctions can be made between normal and pathological functioning, which in turn can be managed by appropriate pharmacotherapies (Rose, The Politics 196). Indeed, the transparency of the brain has been achieved and paved the way for increased efficiency of psychiatric treatment, further legitimizing the field as a scientific discipline. As Rita Carter observed as early as in 1998, The biological basis of mental illness is now demonstrable: no one can reasonably watch the frenzied, localized activity in the brain of a person driven by some obsession, or see the dull glow of a depressed brain, and still doubt that these are physical conditions rather than some ineffable sickness of the soul. (qtd. in Rose, The Politics 198) A direct result of biomedicalization of psychiatry and reliance on data provided from sciences is the standardization of psychiatric diagnosis. The first Diagnostic and Statistical Manual for Mental Disorders, published in 1952,6 included minor and major mental disorders and was based on the premise that the key to appropriate treatment is accurate diagnosis (Rose and Abi-​Rached 118). The revised version was published in 1968, to be followed by DSM III in 1980. DSM III, with almost 500 pages and 265 distinct diagnoses, was a reaction to the crisis in the legitimacy of psychiatry in the 1970s

Biomedical psychiatry  205 and an attempt to refine the definition of mental illness and establish a set of criteria of observable symptoms that will facilitate an objective diagnosis (Rose and Abi-​Rached 122, 120).7 Announced as “revolutionary” by many commentators, DSM III8 reorganized psychiatric diagnosis by abandoning “vaguely defined and loosely based psychoanalytic descriptions” for “detailed symptom checklists” (B. Lewis 97). Thus, the intended goal was the reliability and uniformity of treatment: a person seeking help from two different psychiatrists should receive the same diagnosis. What was abandoned in the process, though, in the name of reliability and objectivity was the patient’s individual history. Rather than shaped by unique experiences, the patient becomes a part of a diagnostic population with the same illness category (Lakoff 12). Furthermore, advocates of biomedical psychiatry believed that objective diagnostic criteria would liberate the field from accusations of subjective judgement and neutralize psychiatry’s long history of political engagements.9 Transparent diagnostic criteria, derived from biomedical sciences, while inevitably attractive for their apparent objectivity, do pose important problems related to the patient’s agency and psychiatric practice, as does the entire project of biomedical psychiatry. With the shift observed by Foucault, medical epistemology became concentrated on the visual signs, in particular how the diseased body manifests its illness (R. Porter 313). Objective signs were privileged over symptoms that were seen as the patient’s subjective rendition of an uncomfortable experience. In late twentieth-​century psychiatry, as demonstrated with DSM III, such subjectivity and ambiguity were to be eliminated. As Angel Martínez-​Hernáez observes, One of the strategies of biomedicine is to convert symptoms into signs, patients’ accounts into biological phenomena that can only be treated in the somatic dimension. In this way, social processes are reified:  by removing the patient from the sphere of disease, the clinician is free to treat only biology. (1021) One of the direct consequences of such methodologies is a reductionist belief that every mental process, be it cognitive, emotional, volitional, as well as all mental disorders can be defined using solely biological frameworks. This is naturally a problematic statement: it is enough to consider how the diagnosis of mental illness (or the lack thereof) is part and parcel of social, cultural, racial, and economic contexts of the patient. In a biomedical model, not only is mental illness expressed through biomedical discourse solely, but also the patient’s race, gender, and social class become erased. As one proponent of biomedical psychiatry asserts, Whether the diagnosis is … mania, schizophrenia, or obsessional neurosis … course or outcome is more important than whether the individual

206  Indigenizing biomedicalization is male or female, black or white, educated or ignorant, married or divorced, well-​adjusted or not, religious or not, etc. (qtd. in Martínez-​Hernáez 1023) However, a large body of illness narratives, an important, visible, and commercially successful literary genre,10 succinctly demonstrates the importance of factors such as the personal context of the experience, an acceptance of diagnosis as well as reactions to treatments of mental illness. Similarly, the emergence of theories emphasizing the importance of environmental factors, such as the kindling model in bipolar disorder which will be briefly discussed later, seem to corroborate the view about more nuanced etiologies of mental disorders. While biomedicine is appealing in its rigorous methodologies, corporeality, as Rose and Abi-​Rached assert “is in constant transaction with its milieu, and the biological and the social are not distinct but intertwined” (3). The shift to a biomedical model of psychiatry, cemented by the publication of DSM III, involves extended reliance on pharmacology in the treatment of mental illness. While many practitioners still recognize the need for integrated approaches in psychiatry, which “must continually reflect the reciprocal influences of mind, body, and spirit” (Kaut 220), the hegemony of pharmacological solutions is an undisputed fact. The shift is also reflected in the transformation of psychiatric training which, since the 1990s, has been almost exclusively devoted to pharmacotherapies rather than building relationships with patients through the use of psychoanalysis (Lurhmann qtd. in Goldberg 20). However, questions concerning biochemical mechanisms of psychiatric drugs, their psychological impact on patients, and the production of “medicated selves” remain problematic. In tracing multiple interrelations among pharmacotherapies, scientific innovations, and psychiatry’s need for legitimization, Andrew Lakoff claims that the main rationale behind drug intervention in biomedical psychiatry is the normalization of the patient’s functioning (7). This in turn raises old questions about what constitutes “normal” and describes “the practice of psychiatry [as] … inherently value laden and responding to norms, principles, values, and ideals” (Glas 33). Indeed, it is not only the involvement of pharmacological psychiatry in social normalization practices that is problematic, but also the extent to which psychiatric drugs become a profitable business. The success story of Prozac, the emblematic drug to control mood disorders, is a telling example.11 The Food and Drug Administration authorized the introduction of the drug into the market in 1987. By 1993, the number of prescriptions for Prozac had climbed to 7.6 million, and reached 27 million by 2002 when the patent expired (B. Lewis 122). Initially advertised as a substance targeting depression, it was quickly reframed as applicable to such diverse disorders as anorexia, bulimia, obsessive compulsive disorder, panic disorder, to name a few. When Prozac went out of patent, the manufacturer Eli Lilly began marketing the same compound in different packaging as efficient for premenstrual dysphoric disorder (Rose, The Politics 212). The revealing marketing histories, as well as

Biomedical psychiatry  207 early challenges to claims about the efficacy of the drug (B. Lewis 128–​9), problematize Prozac’s relationship with American and global pharmaceutical markets and preempt biomedical psychiatry’s claims to neutrality. A  recent example of ethically dubious marketing strategies used to advertise Purdue Pharma’s OxyContin as nonaddictive, which in consequence produced an opioid epidemic in the USA,12 reveals the extent to which profit incentives take precedence or misinterpret research in the continuously growing market of psychiatric drugs. The enormous profits that psychiatric drugs generate will only exacerbate the problem: in a report published by the Zion Research, it is estimated that the global depression drug market is valued at USD 14.51 billion and is expected to grow reaching USD 16.8 billion by the end of 2020 (Research and Markets). As Jackie Orr asserts, “biopsychiatry has become all but inseparable from the funding and financial structures, research agendas, advertising and marketing campaigns, and globalizing ambitions of the transnational pharmaceutical industry” (353).

Elissa Washuta’s My Body Is a Book of Rules: Native American identity and the bipolar disorder diagnosis One review described Washuta’s book, My Body Is a Book of Rules, as “a modern coming of age memoir that reaches into these tangles of the body and mind through American pop culture” (Updegrave 62). Indeed, in her unconventional memoir, written in a vibrant and witty language and composed of autobiographical essays which defy chronology and unified structure, Washuta explores the painful and frequently violent dimension of embodiment, mental illness, and dilemmas embedded in questions about self-​ definition. How to create a coherent identity narrative is a pervasive theme. Washuta is an enrolled member of the Cowlitz Tribe and her Native ancestors can be traced to the Cascades Indians, whose leaders were hanged and shot by the US Army in 1856 (3). However, as she admits, “I am Native, but I am also very, very white” (88). The “very, very white” part applies to Washuta’s family’s middle-​class background and lifestyle as well as the fact that to many people she looks white. The impossibility to aspire to expectations about authentic Indianness, often ridiculous and always based on stereotypes, complicates Washuta’s relationship to her heritage. When she is diagnosed with bipolar disorder and undergoes pharmacotherapy, her sense of alienation from her true self is further deepened. At first, the diagnosis seems to put an end to constant questions about identity: “I felt relieved to have finally arrived at an answer” (155) and provide her with a new sense of direction: I quit my part-​ time tribal relations job at USDA soon after I  was diagnosed, partly because I thought I had a lot of shit to work out, … and partly because I didn’t need to work so hard at being Native now that I had something else to work on. (155)

208  Indigenizing biomedicalization However, as it is soon revealed, being bipolar is not something that can be easily “worked on.” Moreover, while during her first year in college, Washuta is date raped, which again affects her mental state as well as her relationship to her body, sexuality, and subjectivity. My Body Is a Book of Rules, thus demonstrates the difficulties of navigating cultural expectations concerning mental illness, ethnic and gender identities, reconciling mind/​body dichotomy, and finally (re)constructing self-​narratives out of alienated and alienating discourses of pop culture, biomedicine, psychology, and politics.

296.62: problems with the biomedical model and questioning what it means to be bipolar DSM-​5 differentiates two kinds of bipolar disorder:  bipolar I  disorder refers to a condition often referred to as manic-​ depressive disorder or affective psychosis and must include one manic or a mixed-​state episode, and bipolar II disorder whose diagnosis requires a lifetime experience of at least one episode of major depression and at least one hypomanic episode (American Psychiatric Association [APA] 123). The definition of mania, which constitutes an important part of the diagnostic criterion includes four components with symptoms as diverse as “A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-​directed activity or energy, lasting at least 1 week,” inflated self-​esteem or grandiosity, decreased need for sleep, being more talkative than usual or experiencing the pressure to keep talking, “distractibility, psychomotor agitation, and excessive involvement in activities that have a high potential for painful consequences.” The mood disturbance must be so severe “to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features” and the episode is not caused by any chemical substances such as drugs or medications. To receive the diagnosis, “At least one lifetime manic episode is required for the diagnosis of bipolar I disorder” (124–​5).13 The DSM-​5 definition of bipolar disorder, delivered in clear and univocal language, reveals the politics of biomedical psychiatry that insists on transparency of diagnosis expressed in a list of signs to be checked. However, Washuta continuously feels betrayed by the clarity of the description as to what she experiences is far from the unemotional, detached, and unambiguous. Symptoms are not so easily translated into signs. It seems that the language of diagnostic symptoms utterly fails to describe the experience of being bipolar. What is elegantly phrased as “excessive involvement in activities that have a high potential for painful consequences” is in fact “overspending, overeating, promiscuity, … a causal fuck or an ice cream cone here and there … [that] sometimes accumulate, leading to bingeing” (51), all examples of behavior which, when divorced from medical settings, invite moral judgment. In sum, Washuta shares that there is no adequate idiom, no metaphor for what mood disorder entails:

Biomedical psychiatry  209 Call it dysphoric mania, agitated depression, or a mixed state:  nobody will understand anyway. Mania and depression at once mean the will to die and the motivation to make it happen. This is why mixed states are the most dangerous periods of mood disorders. Tearfulness and racing thoughts happen. So do agitation and guilt, fatigue and morbidity and dread. Walking late at night, trying to get murdered, happens. Trying to explain a bipolar mixed state is like trying to explain the Holy Trinity, three persons in one God: you just have to take it on faith when I tell you that the poles bend, cross, never snapping. (139) Equally disappointing is the translation into the universal language of digits that DSM creates to code particular conditions:  “296.62. My brain  –​my swirls of dusty glitter, my gray matter wrung like a sponge –​are summed up in a five-​digit number” (140). Like in the case of blood quantum discourse, the conciseness of the code emerges as equally ridiculous since a sum of digits somehow fails to communicate the incommensurability of the experience. For instance, the fifth digit provides information about the severity of the condition, with “1 for Mild severity, 2 for Moderate severity, 3 for Severe Without Psychotic Features, 4 for Severe With Psychotic Features, 5 for in Partial Remission, 6 in Full Remission, and 0 if Unspecified” (140). Elissa’s fifth digit is 2, implying “moderate severity,” but to what extent can this classification account for her spectrum of experiences? Similarly disappointing is the anonymity of psychiatric treatment which, when concentrated on pharmacotherapy, fails or is not expected to build relationships between the patient and the psychiatrist. “Note,” an edited letter issued by Elissa’s Maryland psychiatrist to a prospective mental health counselor in Seattle, where she moves for her graduate studies, is a vivid parody of this presumed emotional indifference. To achieve clinical detachment, the psychiatrist never refers to Elissa with her first name, which creates an awkward style of endless repetition:  the patient, the patient, the patient. Elissa instinctively rejects this discourse and instead produces descriptions of her symptom, thereby defying the rules of diagnostic codes:  “The patient said that her internal organs felt as if they were being constantly unraveled and knitted into something too tight. The patient said that her brain was uncoiling and re-​clenching, as her fist does during a blood draw” (13). These emotional descriptions of symptoms are important because they are hers and, therefore, Elissa wants to reject the clinical gaze reducing her experience to a diagnostic criterion. Elsewhere, she rebels against the repeated mantra of comforting phrases: “You are not the first person to go through this. But I’m the first person ever to be Elissa” (141; emphasis in original). Moreover, the language used by the psychiatrist deliberately blurs the demarcation lines between agency and submission in the treatment, creating a false sense of empowerment. “We prescribed Lexapro,” the doctor writes, but it is acutely apparent that the role of the patient in these decision-​making processes is limited. Finally,

210  Indigenizing biomedicalization editing the original note proceeds in the direction of an emotional connection between the psychiatrist and the patient: Although the patient’s current course of Abilify has stabilized her mood, she does meet the criteria for bipolar disorder, mixed, rapid cycling, and will need to receive lifelong drug treatment. If anyone tells her otherwise and tells her to shrug it off and cheer up, I have promised her I will personally kick his or her teeth in. I wish Miss Washuta the best. (13) Thus, “Note” pointedly illustrates how biomedicine finds the concepts of neutrality, sought for by the psychiatrist and in biomedicine in general, and that of empathy, expected by the patient, as incompatible. Indeed, throughout the text, Washuta is addressing her ambivalent feelings toward biomedical framing of her disorder. While biomedical explanation provides a logical explanation for her abrupt mood swings and irresponsible behavior, as well as it erases the context that would otherwise invite moral judgement, Elissa finds the reduction of her mental processes to chemical imbalance problematic, especially in view of her agency and creative potential. On the one hand, she is a model patient with total medical compliance, knowledgeable about her state and administered therapy, and clearly fascinated with ostensible simplicity of biomedical explanation. In this framework, it is the brain, “a mass of tissue, another part of the body that can escape me, no different from a busted ankle or nonfunctioning gallbladder” (50), which is responsible for “breed[ing] diseased actions, sick thoughts, a desperate need to just fucking fix this one thing and then everything will be a whole lot better” (188). What this explanation offers, is, as also emphasized in Angela Thachuk’s research (147), a gesture of relieving the patient from responsibility for morally and socially unacceptable behavior. However, as attractive as the biomedical model is, Elissa feels there is more to the brain and body than tissues and chemical substances. At one point, she comments that classical philosophers identified the heart as the origin of reason and emotions but heart is also just “an organ that pumps blood all over the body, all muscle and no smarts” (188). If the brain is just an organ too, then what about the mind? Where is it and how does it do what it does? According to the biomedical model, “Mind is simply what the brain does. And mental pathology is simply the behavioral consequence of an identifiable, and potentially correctable, error or anomaly in some of those elements now identified as aspects of that organic brain” (Rose, The Politics 192). However, a feeling that not everything can be reduced to tissue and chemicals often overwhelms Elissa. “My body keeps secrets all the time,” she admits and muses: I can go to the doctor, check WebMD, check my symptoms in the symptoms checker, scour the forums, see who’s falling apart in the exact way I’m falling apart, let the woman in the lab coat steal vials of my

Biomedical psychiatry  211 blood, let the other woman swab me up my nose or swab my cervix where it tickles or take a cup of my piss, but my diagnosis is just a guess. (187) While biomedical frameworks claim to speak in the seemingly objective language of lab test results, the mind and the body resist such representations, drawing attention to the complexity of affect and corporeality. Immersed in biomedical thinking, Elissa nevertheless admits that, “I try to remember that my body is not really the sum of what’s visible,” either on a CT scan or in lab results (187). In an attempt to accommodate more factors into the biomedical model, Elissa searches for complimentary explanations of what happens and why it occurs in a bipolar brain. When, at one point, in an effort to establish a genetic link, her psychiatrist asks about a history of bipolar disorder in her family, she becomes acutely aware of the constructed nature of the condition. To be bipolar, one needs to be first diagnosed as such and, according to DSM-​5, the condition is more common in high-​ income countries, which speaks volumes about how it is socially and culturally coproduced. Andrew Lakoff draws attention to this social context of bipolar diagnosis by pointing out that in Argentina, the condition is virtually unknown due to the prevalence of psychoanalytical model in psychiatry. Thus, even though nobody in Elissa’s family had been diagnosed as bipolar, it does not mean that nobody would have met diagnostic criteria. What about her Cascade ancestor, Tumalth? Having witnessed the disintegration of his culture and the theft of tribal lands, would his anxiety about the future be classified as a proof of chemical imbalance or, considering the context, a very realistic reaction? Or, as Elissa muses, “I have found no exact place in the DSM-​IV for the woman, expecting the birth of my grandma, who takes a pair of scissors to bed with her every night, wanting no white woman to mess with her” (179). Moreover, if DSM-​5 admits that other factors such as culture and gender may play a role, what about the patient’s individual context and experiences? Even Bipolar Disorder for Dummies, a “more than a repair manual for the bipolar brain” (1) states that “Pinpointing the location of bipolar disorder in your brain is almost as difficult as finding affordable health insurance” (35) and lists a number of external factors that might contribute to the condition. One such theory, apart from including genetic and neurobiological elements, is the kindling model, which emphasizes the role of stress as a trigger of the initial episode (Bender and Alloy 384). For Elissa, if the kindling model does not account for the entire complexity of her condition, it successfully convinces her about the necessity of treatment: If a bipolar person goes untreated, she risks a worsening of a disorder. Episodes can increase in frequency and severity. Known as the kindling effect, this phenomenon was first observed in rats’ brains that researchers stimulated using a low-​dose electric jolt. … Scientists apply the term

212  Indigenizing biomedicalization “kindling” because the process is much like a log fire: by itself, the log is unsuitable for starting a fire, but the addition of smaller pieces of wood makes the fire easier to start. Allowing small episodes to smolder invites the brain to later burn. (50) To prevent the self-​destruction of the brain is of paramount importance and, therefore, Elissa “exhibit[s]‌a complete willingness to improve her mental state through drug treatment” (10). This, however, is more challenging than fixing a sprained ankle.

Help yourself to the “bipolar buffet” The most compelling description of bipolar disorder and ambivalences regarding biomedical models concerns pharmacotherapy, which Elissa undergoes to control her swinging moods. The chapter titled “Prescribing Information” provides a history of Elissa’s long and exasperating pharmacological journey to finally identify drugs that stabilize her moods and allow her to function. Written in the form of diary entries, the chapter documents each prescribed drug, the dosage, and Elissa’s reactions to it. Imitating the language of pharmaceutical package leaflets, with lists of possible side effects that would turn everyone into a hypochondriac, “Prescribing Information” simultaneously offers a gripping rendition of the bipolar experience and demonstrates the alienation of the psychiatric patient, now forced to face both the mental disorder and the drugs’ side effects. The blending of pharmaceutical jargon and Washuta’s performed ironic detachment create a humorous effect, thereby intensifying the drama of the experience:  the search for the “cocktail” that finally works. Finding the right combination of drugs is a long journey into a wide spectrum of side effects. Ativan, administered in the dosage of 0.5 mg, does bring some balance but the price, literally, of stability is high: Careful: welcome this drug into your life and be prepared to wake up to see Ebay emails congratulating you on your purchases of such treasures as fake vintage Blondie posters and a genuine overpriced Farrah Fawcett poster –​yes, the one with the nipple. (54) When Elissa’s diagnosis is switched from depression to bipolar disorder, she is prescribed Lamictal, which stabilizes her mood but unfortunately produces a very rare and dangerous reaction called Stevens-​Johnson syndrome,14 and unfortunately, must be discontinued. “Naked I came out of my mother’s womb, and naked shall I  return thither” writes Elissa, “the LAMICTAL gave, and the LAMICTAL hath taken away; blessed be the name of the LAMICTAL,” despairs Elissa (56; emphasis in the original). Next, she is prescribed lithium,

Biomedical psychiatry  213 which is still “the gold standard, treating the range of bipolar symptoms” (Fink and Kraynak 117), and at the same time she is enveloped in cultural associations with “crazy.”15 This is an important moment in Elissa’s therapy as she fully realizes that her treatment, while needed to stabilize her moods, is potentially harmful to the body. Lithium can reach toxic levels in the body and produce adverse effects; therefore, patients are required to have monthly blood tests (Newcomer et al. 370–​3). Toxic lithium flowing in her bloodstream is, however, less scary than her almost inevitable weight gain and the resultant problems with comforting to female body images circulated by popular culture.16 “Welcome to the world of fat,” ironically comments Elissa. In Elissa’s diary, pharmacotherapy is far from easy and efficient. While the language of biomedicine creates an illusion that every chemical imbalance can be fixed with an appropriate chemical substance, the reality is a story of balancing one side effect over another. The language of information leaflets becomes disconnected from what it is meant to signify; a “feeling of restlessness” is much closer to a feeling that “your own body is attacking the idea of the rest of the world, its limits, and its stillness so hard that you are, pretty much, the one in the choke collar, the one on the leash” (57). Insomnia has nothing to do with the inability of falling asleep but is about the dread of “the leak that drips all night without sound” (57). At some point, even Elissa’s psychiatrist admits “he just doesn’t know what to do this time” (56). In sum, the alluring efficiency of biomedical explanations of mental illness seems to give way to the incomprehensibility of the real experience. Identifying the right cocktail of medication apart from finally facilitating normal functioning and providing a relief from mood swings endows Elissa with an understanding of her condition’s permanent character. Abandoning the therapy would entail slipping into chaos and dread again. It seems that at that point, despite ambivalences, she embraces the biomedical definition of her condition and its implications. “You’ll always be bipolar” (58), Elissa writes. More importantly, with pharmacotherapy comes the realization that her bipolar disorder is a part of her identity, an element that cannot be eliminated but must be controlled: No drug is going to make you stop being the person you are. … [Y]‌ou have your cocktail settled. You will not go crazy. Taking your Seroquel, Lexapro and lithium as prescribed each day will let you drive with a clean windshield. … Every morning and night, you are given a choice: you can live in this world, your brain doused in more chemicals than the fruits on the produce pesticide watch list in your wallet, or you can go organic and wild, as you were created. This is no choice between the blue pill and the red, blissful ignorance or a chance to live real. … Every day, you will recommit yourself to the capsule and the tablet, the pink pill and the white, the yellow, because you will want to live among the people of this world. (58)

214  Indigenizing biomedicalization In describing pharmacotherapy, Elissa does not demonize drugs as producing “medicated selves,” or individuals normalized and deprived of agency with the help of pharmaceuticals, as many critics fear.17 What medications offer is a possibility of functioning in a social context and safety from the unpredictability of mood swings. Having experienced a wide range of side effects, Elissa admits that the worst ones are not the ones that are pharmacologically produced, but rather those arising out of the public’s lack of knowledge about her condition: You will experience the unpleasant side effect known as the acquaintance’s innocent question: “Don’t you ever think about not taking those nasty chemicals?” And you will feel your slick tongue in your mouth, anchored to bone, writhing like a sea anemone. The muscles will pulse and want to tell the things that aren’t said in polite company, the truth about how to keep a bipolar person from turning feral, or worse. But your tired, billowy lungs just sigh out an answer: “You know, I’ve never thought about that.” (58) Thus, navigating bipolar disorder entails the management of shifting moods, medications’ side effects, and stereotypes concerning “normal” behavior and mental illness.

Bipolar disorder and the stigma of mental illness In her study on the stigma associated with mental illness, Angela Thachuk demonstrates how the biomedical model of mental disorders, by drawing simplistic analogies between mental and physical illnesses, significantly contributes to the stigmatization process. In her analysis, the three most commonly discussed drawbacks of the biomedical explanations include: (1) [the] reinforcement of notions that persons with mental illnesses are of a fundamentally “different kind,” (2)  [the] entrenchment of misperceptions that persons with mental illness are inherently more violent, and (3)  [the] promotion of psychiatric labeling and pharmaceutical treatments, which some argue further stigmatizes and disempowers mental-​health service users. (151) My Body Is a Book of Rules offers an engaging discussion concerning the last disadvantage, namely the impact of acquiring a label of a mentally ill person. Washuta offers illuminating comments about how society responds to mental illness, how these responses are shaped by stereotypes, and a lack of public awareness in general regarding mental illness. While the biomedical model of psychiatry offers objective diagnostic criteria and thus claims that abnormalities may be easily identified and

Biomedical psychiatry  215 demarcated, mental illness is still a phenomenon that cannot be seen or objectively represented unlike, for instance, low white cell counts (as seen in laboratory tests) or a broken bone (viewed through X-​rays or USG) (Washuta 179). Hence, many people do not believe in bipolar disorder (Washuta 147). As a consequence, the problem is not reduced to raising awareness only, but rather it concerns the challenge posed to the very ontological status of mental illness. It is precisely the politics of visibility that functions as a legitimizing criterion, deciding about one’s participation in a community of similarly affected individuals and possibly, the right to enjoy special legal status due to the diagnosis. This emphasis on the visibility of a disorder is extensively challenged in responses to disability studies that define disability mainly through visible features. For instance, Lennard Davis asserts that “Disability … is a disruption of the visual, auditory, or perceptual field as it relates to the power of the gaze” (53). Similarly, Rosemarie Garland-​Thomson’s influential definition insists that disability is a process that emerges through “a complex relation between seer and seen” (136). Even the title of her seminal study, Extraordinary Bodies, draws attention to how disability relies on visibility.18 While such definitions are instrumental in theorizing mechanisms of discrimination, they eliminate conditions such as mental illness and other concealed impairments, both invisible and impossible to prove with a laboratory test. For Elissa, the immediate consequence of the politics of visibility is either dismissal of her condition as nonexistent or a proliferation of well-​intended but useless and frustrating advice: If the condition is invisible and thus ontologically questionable, everyone may claim expertise on how to approach it. Hence, Elissa repeatedly receives instructions on how to embrace well-being as a lifestyle and a cure: You have to heal your body if you want to heal your brain. … Optimize Your Nutrition; Balance Your Hormones; … Enhance Detoxification. Boost Your Energy Metabolism; Calm Your Mind. Do this and you’re straight. … Açai. Kombucha. Certain teas. Do not make dairy a part of your life. Fitness bands, Swiss balls, medicine balls, kettle bells, barbells, elliptical trainers, treadmill, rower, lift, pull, tone, tuck, pant, breathe, build muscle, improve metabolism, stamina, overall well-​being. Let me once again stress the importance of overall well-​being. You need to manage the stressors in your life. Just improve your life. Make an effort. After all, the problem is nothing more than bad thoughts. (147) Embedded in these instructions (masterfully ridiculing well-being discourses), is the good old idea of self-​reliance and a belief in complete control over one’s life. As long as Elissa’s condition is invisible to the eye, the treatment does not need to be medical but, instead, requires moral adjustments: self-​discipline, good diet, exercise, and self-​discipline again.

216  Indigenizing biomedicalization As famously demonstrated by Michel Foucault and other scholars,19 mental illness, with its long genealogy, is inevitably implicated in the fluid processes of defining the normal and the pathological. In a chapter entitled “Many Famous People Suffer from Bipolar Disorder,” Washuta assesses the relevance of this claim and furthermore demonstrates that social interpretations of mental illness are contingent on class, race, and gender. In an effort to find her bipolar role model, Elissa juxtaposes two life stories: Kurt Cobain’s and Britney Spears’s, both famous musicians whose careers were the topics of extensive press coverage. Cobain, an iconic figure and front man of the American rock band Nirvana, committed suicide in 1994, after a long history of severe depression, heroin addiction, and possibly undiagnosed bipolar disorder. Britney Spears, also an American singer and songwriter, released two highly successful albums in 1999 and 2000, quickly becoming a worldwide star. Soon, the image of a well-​behaved yet sexually alluring schoolgirl that became a characteristic feature of her brand was marred by erratic and unpredictable behavior, extensively photographed and exposed to public scrutiny in popular media. Today, her career has stalled and a court-​appointed conservator supervises all her professional and personal decisions because she has been deemed unfit to make decisions on these fronts (Spanos). Kurt’s and Britney’s respective stories tell volumes about how the public feeds on and responds to stories of mental instabilities. It is also important to note, as Elissa does, that the two narratives are gendered and thus assume disparate trajectories. Cobain’s story is one of a fall of a talented yet overly sensitive artist mastering an art of self-​destruction. To demystify Kurt’s final decision and counter discourses romanticizing suicide, Elissa applies the kindling model and a biomedical explanation:  “genes, circuity, abnormal anatomy, and then the kindling effect, when every episode added to the burning down of the house in his head” (131). While this framework construes Cobain’s condition as medical rather than resulting from his artistic potential, it has one significant drawback: Cobain is in a sense relieved from responsibility for the life he led, often destructive to his closest family and other Nirvana members. As a cultural icon and a suicide victim, he nevertheless continues to inspire. Elissa is not resistant to this appeal either: “I loved Kurt so much that from age fourteen to seventeen, I retreated into an online message board dedicated to the band. Thousands of us were not about to forget him” (133). Indeed, he is remembered not as a victim of a mental illness but a tortured and eccentric artist. Britney’s experience, however, is a different story. “Kurt’s depression was syrupy, wearing the soft gray flannel of the early nineties. Britney ushered in oversaturated MTV hues, gleaming vinyl, and sparkly skin” (135), writes Elissa. Catapulted to the status of the star, she soon started to exhibit erratic behavior: getting married to her childhood friend and annulling the marriage after 55 hours, shaving her hair in front of cameras, driving a car with her son on the lap, and attacking a paparazzo’s car, to name a few examples.

Biomedical psychiatry  217 As a result, Spears was hospitalized several times and finally placed under permanent conservatorship. Reading tabloid stories and watching the documentary Britney:  For the Record, Elissa admires her perseverance and the determination to fight back:  “Even though she must feel as though every human on earth has seen her melt down, and even though her ex-​husband and father control everything that has ever been hers, she sweats to regain it all” (137). The public’s perception is, however, different. Britney’s madness is not venerated as Kurt’s: she is judged and assessed according to the prevailing standards of womanhood and motherhood, propriety, and moral conduct. Clearly, she is held responsible for her actions. When Kurt is irresistible, Britney is simply crazy. As one caller to Seattle’s KISS FM claims, “She’s gross. She’s mentally insane. Why would you wanna have sex with her?” (Washuta 130). The dynamics that Elissa depicts, in fact, has a long history. In their study on depression memoirs, Ginger Hoffman and Jennifer Hansen reveal how the genre reveals cultural assumptions about gender and an experience of mental disorder. One of the characteristic patterns in the texts they analyze is the tendency to represent male mental illness as a sign of genius and a gateway for creativity. Women’s depression, however, is compared to hysteria or a state of irritating “neediness.” “This pattern,” Hoffman and Hansen write, “of men as melancholic (and thus genius) and women as ‘merely depressed’ can be traced throughout the history of Western medicine” (293). Not only is the trope of mental genius gendered, but it is also racialized. As Meri Nana-​Ama Danquah observes in her memoir Willow Weep for Me, Stereotypes and clichés about mental illness are as pervasive as those about race. I have noticed that the mental illness that affects white men is often characterized, if not glamorized, as a sign of genius, a burden of cerebral superiority, artistic eccentricity –​as if their depression is somehow heroic. White women who suffer from mental illness are depicted as idle, spoiled, or just plain hysterical. Black men are demonized and pathologized. Black women with psychological problems are certainly not seen as geniuses; we are generally not labeled “hysterical” or “eccentric” or even “pathological.” When a black woman suffers from a mental disorder, the overwhelming opinion is that she is weak. And weakness in black women is intolerable. (20) In her search for a bipolar role model, Elissa encounters the same logic of double standards that render diagnosed women responsible for not complying with social norms. In this framework, mental illness is defined in cultural rather than medical terms. Therefore, when she constructs her bipolar story, Elissa shifts importance from the cultural to the medical, making the most of the biomedical model:

218  Indigenizing biomedicalization Bipolar disorder is incurable, and for some of us, for Kurt, it’s so active and malignant that it becomes terminal, a disease that will end the life of the sufferer. Britney and I will just hope that it won’t come to suicide for us, and accept that we’ll be gulping down pills until we die. (152) Aware of gendered and social constructedness of mental illness, Washuta insists on the biomedical model to demonstrate the seriousness of bipolar disorder and authenticate it as a condition that might be terminal and, therefore, requiring professional medical intervention and treatment. Britney’s story is indeed a good illustration of the stigmatizing effect of mental illness. Since Britney undergoes constant scrutiny, Elissa is well aware that the art of being accepted relies on constant self-​control: “Watch your moods. Don’t let people see you fluctuate. Don’t let yourself run your mouth. Never ever cry, even alone, because your cat or your kettle might tell. Always smile, but don’t laugh loudly” (138). This again draws attention to the constructed nature of social norms as well as diagnostic criteria. Elsewhere, Elissa indirectly admits that part of the treatment concerns production of socially acceptable behavior:  “Medications aim to allow the mentally ill to fit into society as much as they soothe the brain’s distress. … Fitting into society is like being directed down a pink-​highlighted route” (186). According to Nikolas Rose, that is precisely the function of contemporary psychiatric medications: “restor[ing] and maintain[ing the patients’] … capacity to enter the circuits of everyday life” (The Politics 210). Elissa’s metaphor and her insistence on “fitting in” as an integral part of the treatment process pointedly demonstrate the scope and mechanism of stigmatization. Returning to Erving Goffman’s concept of social stigma, introduced in Chapter 2, it is important to remember that stigma should be explored in “a language of relationships, not attributes” (12). The process of stigmatization emerges through actions rather than solely a presence of disability or difference. “The attitudes we normals have,” writes Goffman, towards a person with a stigma, and the actions we take in regard to him, are well known, since these responses are what benevolent social action is designed to soften and ameliorate. By definition, of course, we believe the person with a stigma is not quite human. On this assumption we exercise varieties of discrimination, through which we effectively, if often un-​ thinkingly, reduce his life chances. (14) The biomedical model of mental illness, while undoubtedly implicated in psychiatry’s legitimizing politics, emerges as at least a partially efficient strategy to challenge the discriminatory processes that are part of stigmatization. “In the past two years, I  have met other bipolars,” Elissa writes. “Friends, friends of friends. A  girl who lost it halfway through senior year

Biomedical psychiatry  219 of college, a guy with scars on his arms, my hospitalized ex-​boyfriend, others who tell no stories” (185). What a biomedical model offers is a claim to visibility as sufferers from a mental disorder, which in the long-​term, may facilitate a redefinition of social relationships.

Being Native and the politics of visibility revisited Elissa’s story of bipolar disorder is punctuated by another important narrative. Episodic and only seemingly random passages that are numbered and united with a title “A Cascade Autobiography,” trace Washuta’s Cowlitz and Cascade heritage and her evolving relationship to what is means to be Native. It is also a frustrating account of what it means to be Native when one looks white, or rather when one does not comply with cultural fantasies about Indianness. The fragmented structure of “A Cascade Autobiography” is not accidental. It pointedly illustrates how Elissa’s claim to Indianness is constantly challenged and posited as in need of authentication, and, as a result, perpetually negotiated and redefined. Therefore, before Elissa arrives at an understanding of multiple meanings of her heritage, her Indianness is first experienced as an ongoing process of mediations, negotiations, and authentication practices. It is an experience of constant frustration and discomfort which takes place vis-​ à-​vis Elissa’s other struggles: the burden of Catholic education and its impact on body imagery and sexuality, bipolar disorder, trauma of rape, and a return to her professional and artistic projects. Moreover, I argue that mechanisms of social perception subject Elissa’s Indianness to the same politics of visibility that challenges the ontology of a bipolar state: There is no test for bipolar disorder. I offer no proof, no card with my name and a rainbow brain scan image. … I am bipolar in a way that real Indians are really Indian: at thirteen, I knew I was bipolar without being told, before anyone else caught on. (179) Even though ironically, Elissa can produce “proof ” of her Native heritage, her CDIB card,20 her Indianness is still not imprinted on her body and thus subject to refutation. From her early years, whenever Elissa evokes her Native heritage, she is confronted with three kinds of reactions. On the one hand, when her Indianness is “discovered,” she is immediately reduced to a pan-​ Indian stereotype; her anthropology professor becomes excited about her enrollment and tells her “he admire[s]‌our ways” (43). In her Catholic school, when the nuns learn that Elissa is Cowlitz Indian, they offer her “Blessed Kateri Tekakwitha, the Lily of the Mohawks, as a spiritual guide. … She was Indian and I was Indian” (22). On the other hand, there are openly hostile reactions arising from a belief in Native Americans’ unearned economic or legal privilege, for example, people’s reactions to her scholarship: “That

220  Indigenizing biomedicalization money never went to white kids” (4)  and “… haven’t the Indians already mooched off this country enough with their casino-​building and slipping loose from tax-​paying?” (59). It is interesting to see how these reactions erase the context of settler colonial domination, the theft of Indigenous lands, and the resultant economic dispossession, and situate the white majority as an object of economic, legal, and academic discrimination.21 Finally, the third group of responses challenges Elissa’s Indianness as invisible and thus fabricated. The politics of visibility, as in the case of bipolar disorder, is at work again. At the core of the mechanisms questioning Elissa’s heritage is the simple fact that she does not comply with the concept of Indianness based on cultural fantasies and desires. As Elissa admits many times, she does not look Indian, or to reverse the logic, she looks too white and is thus considered a fraud. In such a context, noninvasive body and appearance modifications such as growing her hair long or a visit to a tanning salon often bring satisfactory effects: “From Seattle white girl, I become Indian princess” (146). The last comment pointedly demonstrates that Elissa fully comprehends the implications of the politics of visibility; the point is to visibly fulfill the fantasy of what real Indians really look like: Pocahontas or “Sonseeahray from the 1950 Broken Arrow, Debra Paget in brownface” (141). To find the best framework to encapsulate the complexity of her white and Native heritage, Elissa turns to the biomedical discourse and its metaphors. While in the case of bipolar disorder, such an approach has its advantages, it fails utterly in the context of narrating complexities of being Indian. Elissa tests and experiments with several biomedical metaphors only to be confronted with their unsuitability on the one hand, and the faulty logic of federally approved techniques of calculating blood quantum, on the other.

Why biomedical metaphors do not work Elissa’s relationship to her Cowlitz and Cascade heritage is a complex one, shaped by an absence of contacts with her Indian family members and geographical separation from the land of her ancestors. Thus, she needs to forge ancestral networks and rejuvenate kinship relationships herself. Surrounded by biomedical imagery penetrating everyday language, as shown by Kim TallBear and Linda Hogan, Elissa experiments with its potential to provide meaningful narratives of what Indianness might mean. With the emergence of Native American DNA as an object of study, DNA’s “substantial power to adjudicate questions about anything associated with relatedness” (Bolnick 13)  has only been reaffirmed. Similarly, Elissa imagines her DNA as carrying attributes of her heritage, still invisible but capable of providing a sense of continuity with past ancestors. In the opening chapter, she traces her mother’s family to one of the Cascade Indians leaders,

Biomedical psychiatry  221 Tumalth, who was charged with attacking white settlers and executed in 1856: “Tumalth begat Mary who begat Abbie who begat Kathleen who begat Leslie who begat Elissa” (1). Elissa’s insights from science lessons convince her that this linear relationship, reproduced in the DNA helix, has the power to produce a space of indigeneity that she would inhabit: “… genetic material is passed down through mitochondrial DNA, which live in women’s eggs. … I reasoned that something in me, holding court in every cell, was truly indigenous” (71). Sometimes, this Indigenous DNA does emerge to the body level and produces visible signs of Indianness: My mother said that when she went to college … she saw other people with shapes like hers and knew they had to be Indian. I would look at the old photo in our hallway of the stunning and sturdy Abbie and Mary and know I had come out of them. (115) Moreover, like Linda Hogan in her writing, Elissa transcends the biomedical definition of what is passed on, and apart from biological substance, talks about historical pain and trauma that become “wrapped around … DNA double-​helixes”  (93). However, the employment of DNA imagery is inevitably entangled with blood metaphors, which, as Kim TallBear had demonstrated and I discuss in Chapter 6, is problematic. Considering the federally introduced institution of blood quantum, the historical context of its introduction and the resultant legal implications, it is unsettling to see how genes, DNA, blood, and culture became confused and unified into one metaphor for inheritance. Indeed, it seems that Washuta becomes aware of the problematics and she gradually, if not abandons, then surely complicates the use of biomedical imagery. Take the example of blood. At first, Elissa is responsive to the beauty and simplicity of the imagery: “I would almost get my blood boiling enough to reduce it down to a steaming, potent syrup that would contain some legitimate Indian essence” (156). Yet, monthly blood tests to check her lithium levels teach her that blood is simply blood, a red substance that is only endowed with powerful symbolism: “[My psychiatrist] pulled out my blood and showed me what was really in it, glanced at each trace mineral in the lab results, each lurking marker” (156). Once biochemically deconstructed, blood seizes to signify Indigenous heritage. Moreover, as Elissa comprehends on what erroneous and ideologically driven grounds the concept of blood quantum is constructed, a cultural deconstruction follows and the allure of “indigeneity in the blood” disappears: … blood quantum has nothing to do with blood –​there is no such thing as Indian albumin, Irish hemoglobin, Ukrainian leukocytes, or French platelets. The veins and arteries do not split in those who are mixed,

222  Indigenizing biomedicalization and the blood does not contain the oily and watery liquids of disparate ethnicities. ‘Blood’ is just a metaphor, and it’s not much of one. (59) Yet, blood quantum penetrates all meanings surrounding Native identity and culturally constructed notion of authenticity. Since Elissa does not look Indian, she repeatedly receives questions about blood quantum: “When I tell people I’m Native, they often ask, ‘How much?’ It seems to be a reflex, the way, when I’m asked how I’m doing, I always fib that I’m ‘fine’ ” (15). Few people, however, are aware of the origins of the concept or how “the tendency to divide Indian ancestry into numerical parts … has been written into American law since the colonial period” (59). Elissa draws attention to how blood quantum, apart from it being an assault on Indigenous people’s right to self-​definition, produces split, fragmented identities, a process she compares to literally “tear[ing] a person limb from limb” (59). In a powerful gesture, Washuta visually performs this painful act of splitting, demonstrating how meaningless it is as far as questions about her complicated ethnic identity are concerned: My breakdown: 3/​16  Irish 5/​32 Scottish 1/​8  Polish 1/​8 Ukrainian 1/​8  German 1/​8  Dutch 1/​16 Cascade 1/​32 Cowlitz 1/​32  Welsh 1/​32 French. (157) The meaninglessness of this language of fractions speaks volumes about ideological agendas contained in blood quantum discourse and makes it an easy subject of ridicule. Jokes about the danger of having a nosebleed and hence losing an entire Indian blood component in one’s blood quantum are well known in Indian Country. Elissa herself indulges in such humor, commenting on the need to find a full-​blood husband to “get the quantum up” (116) in her bloodline. Relinquishing the blood metaphor makes it possible to look critically at biomedical imagery in general. At college, Elissa undergoes a gallbladder removal surgery. Gallbladder disease, by Elissa’s Native friends described as “the Indian curse,” is believed to be more common among Native Americans. However, scientists do not univocally support this view.22 Since the experience of the malfunctioning organ might be used as proof of Elissa’s Indianness,

Biomedical psychiatry  223 she does not reveal that, “[her] white dad had his gallbladder out too” (153). The discourse of racial susceptibility, discussed at length in Chapter 1 in relation to tuberculosis, is here humorously dismissed and demonstrated as a strategic rather than medical apparatus. Interestingly, the connection with genetic relatives is established not through DNA testing but in a more conventional way, through building relationships. “Every summer,” writes Elissa, Chief Tumalth’s descendants get together at beacon Rock in Southern Washington’s Columbia Gorge. … We gather in an outdoor pavilion and eat all different kinds of potato salad. Still, years after moving to Washington, I meet unfamiliar relatives there. At first, few truly felt like family. … But after attending every year, I learned names and relations, and a family feeling begun to percolate. I got the hand of it and started to see that there’s something special about being invited to belong. (154–​5) Elissa’s process of slowly “growing into” her inheritance pointedly illustrates how tribal belonging does not proceed from biochemical markers derived from DNA tests or legal definitions evolved from blood quantum, but is a communal and reciprocal gesture of being claimed and responding to this invitation. In the course of the story, Elissa is exposed to different paradigms of what Native identity means in different social and cultural contexts: racial phenotype, economic disadvantage, unearned privilege (as seen by white college students), genetic population, political activism, and participation in a community. Out of these diverse and sometimes conflicted voices, Elissa creates a format that is meaningful for her and encompassing for her other experiences and identities. Finally, what deserves consideration is how these diverse discourses of biomedical psychiatry, subjective experiences of bipolar disorder, mixed-​blood identity, tribal belonging as well as colonial violence, and exploitation converge on Elissa’s body. In questioning the assumed adequacy of biomedical models to discuss her bipolar disorder and revealing ideological underpinnings of blood and DNA metaphors to convey Indian identity, Elissa assumes control over these narratives on a discursive and bodily levels. Her body becomes a counter text to the titular “book of rules,” inspired by Catholic education with a distorted vision of human sexuality and social expectations framing desired models of femininity. After the rape, Elissa feels that her body must be reclaimed in the same way her definitions of Indianness must displace racialized ones. In framing her traumatic experience, Elissa discovers how it is contingent on the other questions that preoccupy her. She never reports the incident, since she believes her mental disorder compromises her credibility and the fact that it was her boyfriend who raped her challenges social definition of sexual assault. Moreover, the similarity and coexistence of sexual and colonial violence are not lost on Elissa. However, fitting her experience

224  Indigenizing biomedicalization into an “academic” framework of “a history of violent oppression and subjugation, something about inherited ancestral consciousness” (178) does not work; Elissa somehow feels that a story of how “That boy colonized my brown body” (178; emphasis in original) is not hers. Most importantly, however, Elissa emphasizes survival of her body and the Cascade Indians, contained in bodies, genes, and DNA of the next generation: “… the rape wasn’t really anything like what happened one hundred and fifty years ago at the Cascades of the Columbia River, because unlike Tumalth’s broken-​up generation, I got much better” (178–​9).

Beyond biomedical metaphors In an Introduction to The Beginning and End of Rape, Sarah Deer draws attention to how an unprecedented rate of violence toward Indigenous women is rendered in the biomedical language and compared to epidemics. “I think we’ve been using the wrong word,” observes Deer and demonstrates how the biological connotation misrepresents the origins of the problem and absolves society of any blame. The word epidemic suggests “a short-​term, isolated problem” that “originated independent of long-​standing oppression” (ix). This is not the case, however, with violence toward Native women, which is “a fundamental result of colonialism, a history of violence reaching back centuries.” “An epidemic is a contagious disease; rape is a crime against humanity” (x), Deer concludes. This example succinctly demonstrates the problem Elissa Washuta explores in My Body Is a Book of Rules. While biomedical language is attention grabbing, in some contexts it fails to represent the full implications of the problem and instead leads to reductive conclusions, blurring the actual impact of existing power relations. Washuta applies biomedical models to two distinct projects: coping with her bipolar disorder and her Native identity, which is often challenged in social contexts. While in the first case such framing has many advantages –​it legitimizes mental illness as a medical condition, offers a transparent discourse for discussing the condition, and ameliorates some effects of stigmatization –​it simultaneously creates other problems, the most significant being a loss of agency and subjectivity in diagnostic and treatment processes. In the second, identity-​related context, Washuta discovers that biomedical models often fail to describe full complexity of the problem. Moreover, blood and DNA metaphors are inextricably linked to historical processes of controlling definitions of Indianness by settler-​colonial states, and thus, their ideological underpinnings turn them into a problematic tool. With the identification of these problems, Washuta voices concerns articulated by Kim TallBear in her analysis of Native American DNA. History and pain imprinted in DNA, while so fitting for Linda Hogan’s exploration of Indigenous identity, are received with growing skepticism by Washuta, who values relationships, family networks, and relationality over genetic markers. If resistance and decolonization are seen as inscribed on the body, it is the macrolevel that fulfills this

Biomedical psychiatry  225 potential: Indigenous bodies in the act of rebuilding kinship structures and revitalizing communities and cultures.

Notes 1 Linda Hogan’s use of biomedical metaphors is discussed in Chapter 6. 2 There are numerous dialogues between evidence-​based medicine and biological psychiatry. See for example, Robyn Bluhm’s “Evidence-​Based Medicine, Biological Psychiatry, and the Role of Science in Medicine,” Extraordinary Science and Psychiatry: Responses to the Crisis in Mental Health Research, edited by Jeffrey Poland, Serife Tekin (The MIT Press, 2017, pp. 37–58) and Philip Thomas et al.’s “The Limits of Evidence-​Based Medicine in Psychiatry,” Philosophy, Psychiatry, & Psychology, vol. 19 no. 4, 2012, pp. 295–308. 3 Neurotransmitters are endogenous chemicals that transmit signals across a chemical synapse from one neuron to another. These include the monoamines dopamine, norepinephrine, epinephrine, acetylcholine, and serotonin. This new understanding of neurotransmission gave rise to extensive research on psychiatric drugs (Rose, The Politics 199). 4 On the popularity of psychoanalysis in the USA and its cultural meanings, see e.g., Nathan G.  Hale, Jr., The Rise and Crisis of Psychoanalysis in the United States: Freud and the Americans, 1917–​1985 (New York: Oxford University Press, 1995)  and Lawrence R.  Samuel, Shrink:  A Cultural History of Psychoanalysis in America (Lincoln: University of Nebraska Press, 2013). 5 It is important to remember, however, that these new technologies of visualization are digital representations, mapped in pixels. In this sense, they are not “more true” or closer to reality than photography and are subject to similar processes of meaning-​ making. For more, see Lisa Cartwright, Screening the Body:  Tracing Medicine’s Visual Culture (Minneapolis: University of Minnesota Press, 1995); José van Dijck, The Transparent Body: a Cultural Analysis of Medical Imaging (Seattle: University of Washington Press, 2005); Joseph Dumit, Picturing Personhood: Brain Scans and Biomedical Identity (Princeton:  Princeton University Press, 2005); Nikolas Rose and Joelle M. Abi-​Rached, Neuro: The New Brain Sciences and the Management of the Mind (Princeton: Princeton University Press, 2013). 6 It is interesting to consider that the idea of classifying types of mental disorders began in the USA much earlier and not as a medical project but statistical. In the 1840 census, the category of “idiocy/​insanity” was recorded. In 1880, there were already eight categories of what 40 years earlier was put into one category (Rose, The Politics 198). 7 DSM III also marked an important moment in the development of American psychiatry. The 1980 manual and its subsequent revisions, DSM IV (2000) and DSM 5 (2013), were approved by the National Institute of Mental Health (NIMH) and diagnoses based on DSM III classifications became required elements in research protocols, in the academia (psychiatric journals), clinical trials, and reimbursement criteria for health organizations (Rose and Abi-​Rached 121–​2). Indeed, the development of DSM III and the creation of subsequent revisions as well as controversies surrounding these processes offer a fascinating story about psychiatry’s multiple investments in cultural, political, and economic projects. The theme extends beyond the scope of the chapter and to explore it further, see for example, Bradley Lewis, Moving Beyond Prozac, DSM, and the New Psychiatry: the Birth of Postpsychiatry

226  Indigenizing biomedicalization (Ann Arbor: The University of Michigan Press, 2006) and Nikolas Rose and Joelle M. Abi-​Rached, Neuro: The New Brain Sciences and the Management of the Mind (Princeton: Princeton University Press, 2013). 8 A comprehensive discussion of DSM, its diagnostic, social, and political implications and the controversies surrounding its implementation extend beyond the scope of the chapter. For a broader view, see for example, Steeves Demazeux and Patrick Singy, editors, The DSM-​5 in Perspective:  Philosophical Reflections on the Psychiatric Babel (New  York:  Springer, 2015)  and Joel Paris and James Phillips, editors, Making the DSM-​ 5:  Concepts and Controversies (New York: Springer, 2013). 9 For a summary of views on political dimension of psychiatry, see Nikolas Rose, On Psychiatric Future: The Politics of Mental Health (Cambridge: Polity, 2019). Obviously, here exists an impressive body of works on psychiatry’s involvement in political agendas. For more recent works, see for example, Grégory Dufaud and Lara Rzesnitzek, “Soviet Psychiatry through the Prism of Circulation: The Case of Outpatient Psychiatry in the Interwar Period,” Kritika: Explorations in Russian and Eurasian History, vol. 17, no. 4, 2016, pp. 781–​803; Ericka Dyck, Psychedelic Psychiatry:  LSD from Clinic to Campus (Baltimore:  Johns Hopkins University Press, 2008); Jennifer L.  Lambe, Madhouse:  Psychiatry and Politics in Cuban History (Chapel Hill: The University of North Carolina Press, 2017); Paul Lerner, Hysterical Men:  War, Psychiatry, and the Politics of Trauma in Germany, 1890–​ 1930 (Ithaca, NY: Cornell University Press, 2003); Marco A. Ramos, “Psychiatry, Authoritarianism, and Revolution: The Politics of Mental Illness during Military Dictatorships in Argentina, 1966–​1983,” Bulletin of the History of Medicine, vol. 87 no. 2, 2013, pp. 250–​78; Rebecca Reich, State of Madness: Psychiatry, Literature, and Dissent After Stalin (DeKalb: Northern Illinois University Press, 2018) and, in the Native American context, Carla Joinson, Vanished in Hiawatha:  The Story of the Canton Asylum for Insane Indians (Lincoln: University of Nebraska Press, 2016). 10 For an insightful theory of illness narratives, see Arthur W. Frank, The Wounded Storyteller:  Body, Illness, and Ethics (Chicago:  The University of Chicago Press, 2013). See also Einat Avrahami, The Invading Body:  Reading Illness Autobiographies (Virginia:  University of Virginia Press, 2007); Thomas Couser, Recovering Bodies:  Illness, Disability, and Life Writing (Madison:  University of Wisconsin Press, 1997); Lisa Diedrich, Treatments:  Language, Politics, and the Culture of Illness (Minneapolis: University of Minnesota Press, 2007); and Ann Jurecic, Illness as Narrative (Pittsburgh: University of Pittsburgh Press, 2012). 11 The phenomenon of Prozac has been extensively analyzed. For the most well-​ known publications, see for example, Peter D.  Kramer, Listening to Prozac (New  York:  Viking, 1993); Bradley Lewis, Moving Beyond Prozac, DSM, and the New Psychiatry:  the Birth of Postpsychiatry (Ann Arbor:  The University of Michigan Press, 2006); and Elizabeth Wurtzel, Prozac Nation:  Young and Depressed in America (New York: Riverhead Books, 1995). 12 On an opioid epidemic in the USA, see for example, Beth Macy, Dopesick: Dealers, Doctors, and the Drug Company That Addicted America (Boston:  Little, Brown and Company, 2018); Chris McGreal, American Overdose:  The Opioid Tragedy in Three Acts (New York: Public Affairs, 2018); and Barry Meier, Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic (New York: Random House, 2018).

Biomedical psychiatry  227 13 See Gordon Parker et al. “Revising Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Criteria for the Bipolar Disorders:  Phase I  of the AREDOC Project,” Australian & New Zealand Journal of Psychiatry, vol. 52, no. 12, December 2018, pp. 1173–​82. EBSCOhost, doi:10.1177/​0004867418808382. 14 Stevens-​Johnson syndrome is a serious disorder of skin and mucous membranes, usually caused by medication or an infection. Its initial symptoms are flu-​like, followed by a painful red or purplish rash that spreads and blisters. The condition carries the potential for severe, long-​term adverse effects, including death (“Stevens-​Johnson Syndrome”). See also Jordan A. Woolum et al. “A Review of the Management of Stevens-​Johnson Syndrome and Toxic Epidermal Necrolysis,” Advanced Emergency Nursing Journal, vol. 41, no. 1, Jan. 2019, pp. 56–​64. 15 In her study on bipolar disorder in American culture, Emily Martin describes the most common associations connected with lithium. Analyzing patients’ responses to lithium, she writes: “Lithium is surrounded by ambivalence. For all that some people appreciate how it can lift depression and dampen mania, others resist it more ferociously than any other drug that psychiatrists prescribe. … Partly this is because lithium’s side effects –​on the liver and thyroid –​are well known. But partly it is because people are loath to have the pleasures of a rising mood taken away from them” (163). 16 Washuta explores different shades of eating disorders in Starvation Mode:  A Memoir of Food, Consumption, and Control (Instant Future  –​Future Tense Books, 2015). 17 The most extreme is probably Peter R. Breggin’s Toxic Psychiatry: Why Therapy, Empathy, and Love Must Replace the Drugs, Electroshock, and Biomedical Theories of the “New Psychiatry,” (New  York:  St. Martin’s Press, 1991)  which in a sense suggests psychotherapy and psychosocial programs for conditions such as bipolar disorder and schizophrenia. 18 See also Rosemarie Garland-​Thomson, Staring: How We Look (Oxford: Oxford University Press, 2009). 19 See, for example, Michel Foucault, Madness and Civilization; a History of Insanity in the Age of Reason, translated by Richard Howard (New York: New American Library, 1967); Andrew Scull, Madness in Civilization:  A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine (Princeton:  Princeton University Press, 2015); and Allen Thiher, Revels in Madness: Insanity in Medicine and Literature (Ann Arbor: University of Michigan Press, 1999). 20 On the importance of CDIB cards in Indian Country, see James Hamill, “Show Me Your CDIB:  Blood Quantum and Indian Identity among Indian People of Oklahoma,” American Behavioral Scientist, vol. 47, no. 3, 2003, pp. 267–​82. 21 It is interesting to see how economic impoverishment is a precondition for “authentic” indigeneity. As Jessica Cattelino observes in relation to tribes successfully running their casino operations, tribal nations “require economic resources to exercise sovereignty, and their revenues often derive from their governmental rights; however, once they exercise economic power, the legitimacy of tribal sovereignty and citizenship is challenged in law, public culture, and everyday interactions within settler society” (235–​6). 22 See for example, Marsha M. Cohen et al., “Ethnic Variation in Cholecystectomy Rates and Outcomes, Manitoba, Canada, 1972–​84,” American Journal of Public Health, vol. 79, no. 6, June 1989, pp. 751–​5.

Coda

Frances Washburn’s Elsie’s Business: healing beyond biomedicalization Frances Washburn’s Elsie’s Business opens when an African-American man, George Washington, arrives in Jackson, South Dakota, to unravel the mystery of Elsie Roberts, a Lakota woman, who was murdered in mysterious circumstances. As we soon learn, George is Elsie’s father. He comes to Jackson to retrieve his daughter’s remains and take them home to Mississippi. Washburn’s novel offers a powerful depiction of the young woman’s physical and spiritual suffering and effectively demonstrates that healing assumes multiple meanings and occurs in more than merely a biomedical context. More importantly, Washburn insists that healing is a process that situates an individual as an element in a network of relationships: with one’s family, community, and culture.1 When Elsie is a victim of a brutal assault, medical intervention is necessary but it is by no means enough to heal her physical and mental wounds. As anthropologist Larissa Petrillo observes about Lakota Sundancing, healing is inextricably a relational concept and occurs through acts that strengthen community ties (103). Thus, while Washburn’s novel engages in the critique of medicine as an oppressive institution implicated in discriminatory practices and draws attention to existing tensions between Western medicine and Indigenous healing practices, it nevertheless underscores the creative potential of mutual exchanges and cooperation between the two models. As Adele Clarke and colleagues insist, biomedicalization is characterized by instabilities and contradictions that, however, do not necessarily produce solely negative phenomena. Indeed, biomedicalization’s influences include constructive changes: new sites of power negotiations, new manifestations of patients’ agency, and the visibility of previously subjugated knowledges. Yet, from patients’ perspectives, the most common biomedical practices seem to undervalue and ignore the significance of social contexts such as the trauma of diagnosis, an experience of illness as well as the choice of treatment and its physical and mental demands. In his seminal work The Illness Narrative, Arthur Kleinman claims, “We manage as medical problems the symptoms resulting from the social sources of distress and disease. We blame the victim in

Coda  229 the ideology of personal life-​style change” (21). Equally important is the network of relationships into which an experience of illness is inscribed: patients with doctors and patients and their families, friends, coworkers, and other witnesses of illness. Finally, biomedicine’s claims to infallibility and consistent rejection of other systems of knowledge preempt a possibility of expanding the range of biomedical methodologies. Susan Wendell, scholar of Disability Studies, accurately summarizes this predicament: Collectively, doctors and medical researchers exhibit very little modesty about their knowledge, rarely admitting to patients or the public the vast remaining gaps in scientific medicine’s understanding of the human body or their inability to repair or heal most physical conditions that cause suffering, limitation, and death. Scientific medicine participates in and fosters the myth of control by focusing overwhelmingly on cures and lifesaving medical interventions, and by tending to neglect chronic illnesses, rehabilitation, pain management, and the quality of patients’ experiences, including their experiences of dying. (94) Contrary to such reductivism and fetishization of biotechnologies, healing in Native American cultures is conceived as a process contingent on relationality:  relationships with people, nonhuman agents, the environment, and culture. Similarly, healing practices are not restricted to the body but involve the patient’s spiritual beliefs and, furthermore, are designed to bring harmony to the entire community. In her study of contemporary health programs developed by the Salish people in South Puget Sound, Suzanne J. Crawford O’Brien writes: The Intertribal Intergenerational Women and Girls’ Gathering and its approach to healing embodies the cultural creativity and adaptability of the region, as well as, importantly, its emphasis on wellness and healing as essentially relational activities. Illness (frequently if not always) emerges from a breach in relationships –​whether human, ecological, or spiritual, and healing more often than not centers on negotiating and restoring these relationships. (“Healing” 152) What is profoundly important in Crawford O’Brien’s observations is her emphasis on creativity and adaptability, which draws attention to the effects of settler colonialism on healing systems, in particular, from the nineteenth century onwards, outlawing Native American religious and cultural practices. Thus, contemporary forms of healing approaches are viewed as part of a larger decolonization agenda in which choices about one’s treatment and the right to simultaneously rely on Western as well as Indigenous methods coalesce in the concept of cultural sovereignty.

230 Coda

Healing in Frances Washburn’s Elsie’s Business On a dark evening, when Elsie is walking to the hospital to visit her ailing mother, she is assaulted by a group of white college boys. They have a long history of abusing Indian girls at school and this time is no different. Elsie is brutally beaten, kicked, and almost run over by the boys’ car. Afterwards, she is abandoned on the roadside. The scene of the assault is long and constructed in great detail as Washburn’s intention is to situate the reader in Elsie’s position, to hear the insults, and to corporeally experience the physical pain: “God DAMN dirty bitch!” … Paul kicks again at Elsie’s crumpled body, the blow catching her in mid-​throat with a mushy crunch, and she is gone off into herself. … She is breathing heavily, her nose, an overripe plum swelling squashy on her face. Blood bubbles come from the corner of her mouth with each breath. (12) The emphasis on Elsie’s body is not coincidental here, neither are the identities of the oppressors  –​white teenage boys from upper middle-​class families, two sons of a prominent local politician among them. The arrogance of their behavior and apparent sense of impunity illustrate the power imbalance between Indigenous people and white settlers. The function of their violence, also sexual, is to reduce Elsie to a subhuman level, thus absolving them from the despicable crime. Analyzing Amnesty International report, Maze of Injustice: The Failure to Protect Indigenous Women from Sexual Violence in the USA,2 Dian Million asserts that Rape and sexual violence have always been normative to the subjugation of colonized peoples. Colonization … is a gendered heterosexual colonization profoundly insinuated into the most intimate of relations… Even a cursory reading of literatures on colonization in Africa or Australia (or even if we reduce this reading to Canada and the United States) reveals that rape, murder, and sexualization of Indigenous women has been constitutive to the founding of western nation-​states. (38) In the novel, sexual violence is indeed inscribed in a wider context of male dominance and misogyny of which all women, not only Indigenous, fall victim: Mr. Packwood, an owner of The Steak House inn, consistently sexually abuses his female workers, taking advantage of their underprivileged status. In Mohawk Interruptus:  Political Life Across the Borders of Settler States, Kahnawake Mohawk anthropologist Audra Simpson explores the roots of violence toward Indigenous women:

Coda  231 Indian women “disappear” because they have been deemed killable, able to be raped without repercussion, expendable. Their bodies have historically been rendered less valuable because of what they are taken to represent:  land, reproduction, Indigenous kinship and governance, an alternative to heteronormative and Victorian rules of descent. Theirs are bodies that carry a symbolic load because they have been conflated with land and are thus contaminating to a white, settler social order. So it is that they must be eradicated. (156; emphasis in original) In the hospital scenes, when Elsie wakes up from an anesthesia-​induced sleep, Washburn continues the strategy of representing Elsie’s body as a text that communicates the violence of colonialism and its social and political injustice. “Her body screams with pain,” Washburn powerfully writes and demonstrates how the pain penetrates the body and consciousness: She in encased in concrete, pinning her flat, and she can’t breathe, except through her mouth, but every breath that goes down pokes red hot pins in her throat, punishes the so-​slight movement of her chest. She cannot lift her arms. … She turns her head just an inch or so toward [her mother’s] hand, and her throat screams in pain, but she cannot make a sound. (25) This corporeal discourse, filtered through Elsie’s perspective, is juxtaposed with a doctor’s description of her injuries. While the doctor is sincerely sympathetic, the medical jargon of pure diagnosis operates on a different level than that of emotional shock. Its impact arises from the accumulation of injuries the patient sustains, but its precision and clinical detachment fail to represent Elsie as an individual in need of personalized, culturally centered help: You’ve got a simple fracture of the left tibia, three broken bones in your left hand, broken left ulna, dislocated left shoulder, broken ribs –​you’re lucky none of them punctured a lung –​broken nose, severe concussion, crushed larynx. And that’s just the big stuff. I’ve also put more stiches into you than I can count and cleaned off the places where you have no skin left. You’re going to live. You’re going to walk again, but you’ll probably have a hitch in your get-​along for the rest of your life. I don’t think you’re going to talk again, but you’ll be able to make some sound. (26) The violence done to the body is enormous and it is, without doubt, in Audra Simpson’s words, perpetrated with an intent to eradicate. Moreover, Elsie’s injured larynx and the consequent muteness are equally significant: not only is an Indigenous body expendable, it is also rendered silent to silence the

232 Coda narrative of injustice. The mute brutalized Indigenous female body is thus molded to serve and silently endure the suffering. If the unnamed doctor symbolizes the medical approach to healing, his empathy and dedication do not overcome larger systemic problems of healthcare disparities. He is genuinely shocked by the brutality of the fact but, at the same time, cannot see beyond common misconceptions and stereotypes about his Indian neighbors. Commenting on the assault and influenced by common stereotypes, the doctor assumes that Elsie is just another case of domestic or alcohol-​induced violence: “I also want to know when you goddamned Indians are going to quit trying to kill each other” (27). When the nurse objects to his language, the doctor vents his frustration at having to work in a small rural town with a high nonwhite population: “Why the hell I can’t get a transfer out of this hellhole, I don’t know” (27). There is no space (nor funding) for more culturally sensitive approach that would take into consideration Elsie’s emotional and cultural background. Moreover, the fact that her mother dies shortly after Elsie regains consciousness is never taken into consideration. Elsie is forced to mourn her mother alone, without the support of the Lakota community. Once Elsie recovers from her wounds, she is employed as a housekeeper for Father Horst at Our Lady of the Sacred Heart Catholic Church in Jackson. And yet, in the novel, Elsie remains an elusive character, contained in her own world. Clearly, what facilitates the process of recovery is Elsie’s return to Lakota cultural practices. Elsie takes up tanning hides and beading. Believed to have seen the Deer Woman, who rewards women with the ability to make beautiful things, she produces moccasins with intricate patterns that she sells to local people. Elsie’s peacefulness creates an illusory sense of closure and healing. However, as Raymond A. Bucko and Stella Iron Cloud observe about healing in the Lakota context, recovery “extends beyond physical maladies to repairing social disruption and indeed to the welfare of the entire universe. … Rituals of healing are generally conducted communally, and family prayer and support are vital in the healing process” (596–​7). These are never properly enacted when Elsie is still alive. Healing occurs much later, when Elsie’s sudden death shakes Native and white communities in Jackson and forces them to react to the trauma. Thus, in describing healing, Washburn insists on its relational character and its potential to build bridges between estranged groups. The setting of the novel is located in South Dakota, a territory previously occupied by the Lakota people, in two off-​reservation towns, Mobridge and Jackson. Numerous poignant comments about human interactions in the towns draw a picture of the two communities, Indian and white, marred by power-​struggle, corruption, and jealousy, as well as indifference and egoism in interpersonal interactions. For instance, in the respectable part of Jackson, it is common knowledge that Mr. Packwood repeatedly sexually harasses women who work as cleaners at his house. Father Horst, Elsie’s employer,

Coda  233 while he thinks highly of his religiosity, is unable and unwilling to respect Elsie’s cultural and religious difference. The inhabitants of Jackson tolerate John Caulfield, a local drunk, but never offer him substantial help to fight his addiction. The Lakota community is similarly marred by internal quarrels and misunderstandings. When Elsie settles down in Jackson, no one from the Indian community reaches out to her to help her integrate into the new environment: “It wasn’t that they were unkind to Elsie, but that they were a little afraid of her, being as she was, the embodiment of past transgressions, living proof of what happens when people upset the social order of things” (68). But the most serious ailment that characterizes the two communities is a complete and paralyzing indifference towards each other, which reduces any cross-​ cultural interactions to a minimum: The Indians and the whites in Jackson occupied congruent spaces, but lived separate lives. While the Indians knew all about the white world, had to know for their own survival, events in the Indian community –​gossip –​ seldom crossed from the Indian world to the white world. (41) It is as if an invisible wall divided the two groups, hindering any gestures of kindness and communication. Elsie’s tragic death aggravates the situation as a sense of guilt penetrates both communities. For the white people of Jackson, Elsie is a reminder of their passivity in the face of violence, violence toward an Indigenous woman and, clearly, historical violence towards Indigenous people written into the American past. The Lakotas, on the other hand, fear the spirit of Elsie, who is strikingly similar to the Deer Woman or the Double-​ Faced Woman, characters from traditional stories that revolve around the theme of social transgressions. The arrival of George Washington and his uncomfortable questions initiates a healing process which rests on storytelling and its ability to promote a sense of integrity and spiritual rebirth. It is the very act of retelling Elsie’s story that actively engages both communities to examine their shortcomings, improve neighborly relations, and find a sense of closure on emotional and spiritual levels. Alternate chapters in the novel retell Elsie’s life and engage different narrative genres, for example, Elsie’s memories, other people’s comments and those relating the process of George’s uncovering of the life and death of his daughter. How the stories transform the environment and its inhabitants is best demonstrated in the transition that George Washington experiences. Initially, a stranger in town who invites curious and hostile stares, George is invited by Oscar, a Lakota elder, to stay at his place and save money he will later need to pay for the transport of Elsie’s remains. It is Oscar who well understands that Elsie’s story is not to be found in police records:  “If you want to know more about Elsie’s story … you have to ask one of the grandfathers, because they know all the stories as well as the new ones, the

234 Coda latest gossip, and sometimes it’s all the same stories happening over and over” (1). While the police’s passivity is implied here too, Oscar in fact emphasizes how Elsie is a part of an ongoing process of cultural survival. To pay respect to Elsie and initiate a healing process of the entire community, the Lakota people organize the Wiping of the Tears ceremony in which George is invited to participate. As Oscar explains: It’s been just a little over a year since she died, so it’s time to put away mourning now and let her go from us. We should have done it back in December, but you know, people kind of wanted to forget about Elsie. Until you showed up. You need to go. Kind of put her to rest for you. (195) Generous contributions to a giveaway ceremony and large attendance illustrate the rebirth of communal ties. The Wiping of Tears ceremony, conducted by wicasa wakan, is not described, it is simply announced as commencing and then as having finished. During its course, George thinks about his life as an African American caretaker in a school in the South. He thinks about the hard work, hardships, and humiliations, and the small savings he managed to accumulate, which are now going to be spent on Elsie’s funeral. In the meantime, the ceremony is complete, and people share gifts and donate money for the cause. The amount collected is still less than the sum quoted by the undertaker. However, it is the collective act of helping George to pay for the funeral, an effort shared the members of the community which is of critical importance here. The very act of telling Elsie’s story emerges as transformative for the entire community. Elsie is finally properly grieved and both communities realize the extent to which they failed her. Healing also means forgiving:  Nancy Marks, who helped Elsie integrate into the community of Jackson, attends the exhumation of Elsie’s body despite the fact that she was probably romantically involved with her husband; and Jack Mason, the father of the rapists from Mobridge, in search of closure, approaches George to tell him that he is not responsible for Elsie’s death. The name of the killer will never be known, but it seems plausible to say that the real point is that Elsie’s story is known and passed on, and thus not forgotten. As Elsie’s body is put into the hearse, George leaves behind a transformed community. As he sits in the front seat, George too emerges a changed man: “You turn around and glance back at Elsie’s coffin in the back, remembering that word that Oscar said to Irene. Cunksi. Cunksi. We’re going home, daughter” (212). While he does not speak Lakota, George’s use of the word demonstrates the effects of Oscar’s lessons and his understanding of how certain concepts, like the one of kinship, cannot be easily translated into English. Hence, he realizes that to know Elsie he needs to situate her life in the Lakota context, and, thanks to Oscar’s stories, he is now more competent in this respect. Considering the importance and complexity of kinship in Lakota culture, George’s internalization of the word

Coda  235 cunksi demonstrates his symbolic identification with Elsie and her Lakota culture. As Oscar explains early in the novel, “Elsie was everybody’s niece. … You know, it’s the old kinship way of thinking about people. We are all related in that way, so Elsie was my niece in that Indian way …” (4). Thus, George’s use of the Lakota term illustrates the workings of the healing process that expands beyond Elsie’s hospital room and the necessity of medical procedures. Elsie’s Business is a fine example of a literary text which demonstrates how the tensions between Western and Indigenous concepts of healing produce conclusions that locate the points where each could profit from the other. When the two methodologies are combined, as is often the case in Native American communities (Crawford O’Brian, Religion), Indigenous approaches centered around connections and well-being of an entire community complement biomedicine with individualized perspectives on patients and offer a framework for a complex understanding of illness etiology that takes into consideration social, historical, and cultural factors.

Notes 1 I discuss the motif of healing in Washburn’s writing in “ ‘Bringing Things Together’:  Tribalography, Lakota Language, and Communal Healing in Frances Washburn’s Elsie’s Business and The Sacred White Turkey,” Review of International American Studies RIAS, vol. 12, no. 1, Spring/​Summer 2019, pp. 45–​64. 2 The report is available online: www.amnestyusa.org/​pdfs/​mazeofinjustice.pdf.

Bibliography

Abel, Emily K., and Nancy Reifel. “Interactions Between Public Health Nurses and Clients on American Indian Reservations During the 1930s.” Social History of Medicine, vol. 9, no. 1, April 1996, pp. 89–​108. Abrams, Jeanne E. “ ‘Spitting Is Dangerous, Indecent, and Against the Law!’: Legislating Health Behavior During the American Tuberculosis Crusade.” Journal of the History of Medicine and Allied Sciences, vol. 68, no. 3, July 2013, pp. 416–​50. Project MUSE, muse.jhu.edu/​article/​511870. Acoose, Sharon Leslie, and John E. Charlton. “They Stole My Thunder:  Indian Women and Post-​Incarceration Health.” Global Indigenous Health:  Reconciling the Past, Engaging the Present, Animating the Future, edited by Robert Henry, Amanda LaVallee, Nancy Van Styvendale, et al., University of Arizona Press, 2018, pp. 174–​92. Adair, John, Kurt W. Deuschle, and Clifford R. Barnett. The People’s Health: Medicine and Anthropology in a Navajo Community. University of New Mexico Press, 1988. Adams, David Wallace. “Beyond Bleakness:  The Brighter Side of Indian Boarding Schools, 1870–​1940.” Boarding School Blues: Revisiting American Indian Educational Experiences, edited by Clifford E. Trafzer, et  al., University of Nebraska Press, 2006, pp. 35–​64. ——. Education for Extinction: American Indians and the Boarding School Experience, 1875–​1928. University Press of Kansas, 1995. Adams, Lisa V. “Loud Emergencies II: Tuberculosis.” Diseases of Poverty: Epidemiology, Infectious Diseases, and Modern Plagues, edited by Lisa V. Adams and John R. Butterly, Dartmouth College Press, 2015, pp. 122–​42. Adams, Lisa V., and John R. Butterly, editors. Diseases of Poverty:  Epidemiology, Infectious Diseases, and Modern Plagues. Dartmouth College Press, 2015. Adamson, Joni. “The Ancient Future:  Diasporic Residency and Food-​ Based Knowledges in the Work of American Indigenous and Pacific Austronesian Writers.” Canadian Review of Comparative Literature/​ Revue Canadienne de Littérature Comparée, vol. 42, no. 1, Mars 2015, pp. 5–​ 17. Project MUSE, doi:10.1353/​ crc.2015.0002. Agamben, Giorgio. Homo Sacer: Sovereign Power and Bare Life, translated by Daniel Heller-​Roazen. Stanford University Press, 1998. Alexander, John. “Some Advances in the Technic of Thoracoplasty.” Annals of Surgery, vol. 104, no. 4, 1936, pp. 545–​51. doi:10.1097/​00000658-​193610440-​00006. Alexie, Sherman. Indian Killer. 1996. Grove Press, 2008. ——. Reservation Blues. 1995. Warner Books, 1996

 237

Bibliography 237 ——. Smoke Signals. A Screenplay. Hyperion, 1998. ——. The Lone Ranger and Tonto Fistfight in Heaven. Grove Press, 1993. ——. The Summer of Black Widows. Hanging Loose Press, 1996. ——. The Toughest Indian in the World. Grove Press, 2000. ——. War Dances. Grove Press, 2009. Alfred, Taiaiake. Peace, Power, Righteousness:  An Indigenous Manifesto. Oxford University Press, 1999. Alfred, Taiaiake, and Jeff Corntassel. “Being Indigenous:  Resurgences Against Contemporary Colonialism.” Government and Opposition, vol. 40, no. 4, 2005, pp. 597–​614. Alkon, Alison Hope, and Julian Agyeman, editors. Cultivating Food Justice:  Race, Class, and Sustainability. The MIT Press, 2011. Allen, Paula Gunn. Skins and Bones. Poems 1979–​87. West End Press, 1988. Allen, Chadwick. “Blood (and) Memory.” American Literature, vol. 71, no. 1, March 1999, pp. 93–​116. JSTOR, www.jstor.org/​stable/​2902590. ——. Blood Narrative: Indigenous Identity in American Indian and Maori Literary and Activist Texts. Duke University Press, 2002. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, DSM-​5. American Psychiatric Publishing, 2013. Amnesty International. Maze of Injustice: The Failure to Protect Indigenous Women from Sexual Violence in the USA. New  York:  Amnesty International USA, 2007. www.amnestyusa.org/​pdfs/​mazeofinjustice.pdf. Anderson, Eric Gary. American Indian Literature and the Southwest. University of Texas Press, 1999. Andrews, Colleen M., Kevin Wyne, and James E. Svenson. “The Use of Traditional and Complementary Medicine for Diabetes in Rural Guatemala.” Journal of Health Care for the Poor and Undeserved, vol. 29, no. 4, November 2018, pp. 1188–​208. Archibald, Jo-​ ann, Jenny Bol Jun Lee-​ Morgan, and Jason De Santolo, editors. Decolonizing Research:  Indigenous Storywork as Methodology. ZED Books Ltd, 2019. Archuleta, Elizabeth. “Refiguring Indian Blood Through Poetry, Photography, and Performance Art.” Studies in American Indian Literatures, vol. 17, no. 4, Winter 2005, pp. 1–​26. JSTOR, www.jstor.org/​stable/​20737303. Archuleta, Margaret L., Brenda J. Child, and Tsianina Lomawaima, editors. Away From Home: American Indian Boarding School Experiences, 1879–​2000. The Heard Museum, 2000. Armstrong, Mary Frances, editor. Hampton Institute. 1868 to 1885. Its Work for Two Races. Normal School Press, 1885. Aronson, Naomi E., et al. “Long-​Term Efficacy of BCG Vaccine in American Indians and Alaska Natives: A 60-​Year Follow-​up Study.” JAMA, vol. 291, no. 17, May 5, 2004, pp. 2086–​91. Atkinson, James R. Splendid Land, Splendid People:  The Chickasaw Indians to Removal. University of Alabama Press, 2003. Aune, D., D. S. M. Chan, and R. Lau et al. “Carbohydrates, Glycemic Index, Glycemic Load, and Colorectal Cancer Risk:  A Systematic Review and Meta-​Analysis of Cohort Studies.” Cancer Causes & Control, vol. 23, no. 4, April 2012, pp. 521–​35. Avrahami, Einat. The Invading Body: Reading Illness Autobiographies. University of Virginia Press, 2007.

238

238 Bibliography Ayer, Edward Everett (1841–​1927). 1912–​1922. U.S. Board of Indian Commissioners files [manuscript]: 1912–​1922 [Box 5, Folders 34 to 35]. Available through: Adam Matthew, Marlborough, American Indian Histories and Cultures. Accessed April 12, 2019. Baldassaro, Lawrence. “Introduction.” The American Game: Baseball and Ethnicity, edited by Lawrence Baldassaro and Richard A. Johnson, Southern Illinois University Press, 2002, pp. 1–​5. Baldassaro, Lawrence, and Richard A. Johnson, editors. The American Game: Baseball and Ethnicity. Southern Illinois University Press, 2002. Ball, Tom and Theresa D. O’Nell. “Square Pegs and Round Holes:  Understanding Historical Trauma in Two Native American Communities.” Culture and PTSD: Trauma in Global and Historical Perspective, edited by Devon E. Hinton and Byron J. Good, University of Pennsylvania Press, 2015, pp. 334–​58. Bańka, Ewelina. View from the Concrete Shore: Visions of Indian Country in the Works of Silko, Vizenor, and Alexie. Wydawnictwo KUL, 2018. Bardill, Jessica. “Native American DNA:  Ethical, Legal, and Social Implications of an Evolving Concept.” The Annual Review of Anthropology, vol. 43, 2014, pp. 155–​66. Barker, Joanne. Native Acts:  Law, Recognition, and Cultural Authenticity. Duke University Press, 2011. Barker, Joanne, editor. Sovereignty Matters: Locations of Contestation and Possibility in Indigenous Struggles for Self-​Determination. University of Oklahoma Press, 2005. Barnes, David S. The Making of a Social Disease: Tuberculosis in Nineteenth-​Century France. University of California Press, 1995. Bates, Barbara. Bargaining for Life:  A Social History of Tuberculosis, 1876–​1938. University of Pennsylvania Press, 2015. Beard, Laura J. “Teaching Native Autobiographies as Acts of Narrative Resistance.” Pedagogy, vol. 11 no. 1, 2011, pp. 109–​34. Project MUSE, muse.jhu.edu/​article/​ 409323. Beckenhauer, Eric. “Redefining Race: Can Genetic Testing Provide Biological Proof of Indian Ethnicity?” Stanford Law Review, vol. 56, no. 1, October 2003, pp. 161–​90. JSTOR, www.jstor.org/​stable/​1229684. Begay, Manley A., Jr. “The Native American Graves Protection and Repatriation Act after Twenty Years: A View from Indigenous Country.” Arizona State Law Journal, vol. 625, 2012, pp. 625–​38. Bell, Virginia E. “Counter-​Chronicling and Alternative Mapping in Memoria del fuego and Almanac of the Dead,” MELUS, vol. 25, no. 3–​4, 2000, pp. 5–​30. Bender, Jacob and Lydia Maunz-​Breese. “Louise Erdrich’s The Round House, the Wiindigoo, and Star Trek: The Next Generation.” The American Indian Quarterly, vol. 42 no. 2, 2018, pp. 141–​61. Project MUSE, muse.jhu.edu/​article/​693375. Bender, Rachel E., and Lauren B. Alloy. “Life Stress and Kindling in Bipolar Disorder: Review of the Evidence and Integration with Emerging Biopsychosocial Theories.” Clinical Psychology Review, vol. 31, no. 3, Apr. 2011, pp. 383–​ 98. EBSCOhost, doi: 10.1016/​j.cpr.2011.01.004. Benedict, Jeff. Without Reservation: The Making of America’s Most Powerful Indian Tribe and Foxwoods the World’s Largest Casino. Harper Collins, 2000. Benson, Todd. “Blinded with Science: American Indians, the Office of Indian Affairs, and the Federal Campaign against Trachoma, 1924–​1927.” American Indian Culture and Research Journal, vol. 23, no. 3, 1999, pp. 119–​42.

 239

Bibliography 239 Berglund, Jeff, and Jan Roush, editors. Sherman Alexie:  A Collection of Critical Essays. University of Utah Press, 2010. Bird, Gloria. “The Exaggeration of Despair in Sherman Alexie’s Reservation Blues.” Wicazo Sa Review, vol. 11, no. 2, 1995, pp. 47–​52. JSTOR, www.jstor.org/​stable/​ 1409096. doi: 10.2307/​1409096. Bissonette, Bertha. “An Essay on Tuberculosis.” The Oglala Light:  The Monthly Magazine Printed by Indians, December 1913. Pine Ridge, South Dakota:  The Oglala Indian Training School. Available through: Adam Matthew, Marlborough, American Indian Histories and Cultures, http://​www.aihc.amdigital.co.uk/​ Documents/​Details/​Ayer_​1_​O35 [Accessed April 18, 2019]. Blair, Bonnie O’Connor. Healing Traditions:  Alternative Medicine and the Health Professions. University of Pennsylvania Press, 1995. Bloodworth, William. “Varieties of American Indian Autobiography.” MELUS, vol. 5, no. 3, 1978, pp. 67–​81. JSTOR, www.jstor.org/​stable/​467341. doi:10.2307/​ 467341. Bloom, Barry R. editor. Tuberculosis: Pathogenesis, Protection, and Control. American Society for Microbiology, 1994. Bloss, Emily, Timothy H. Holtz, John Jereb et al. “Tuberculosis in Indigenous Peoples in the U.S., 2003–​2008.” Public Health Reports, vol. 126, no. 5, September/​October, 2011, pp. 677–​89. JSTOR, www.jstor.org/​stable/​41639419. Bluhm, Robyn. “Evidence-​Based Medicine, Biological Psychiatry, and the Role of Science in Medicine.” Extraordinary Science and Psychiatry: Responses to the Crisis in Mental Health Research, edited by Jeffrey Poland, Serife Tekin, The MIT Press, 2017, pp. 37–​58. Bolnick, Deborah. “The Risks and Benefits of Inferring Relatedness, Identity, and Cultural Affiliation from Ancient DNA.” DNA and Indigeneity: The Changing Role of Genetics in Indigenous Rights, Tribal Belonging, and Repatriation. Symposium Proceedings. British Columbia Canada, October 22, 2015, pp. 13–​8. Brady, Erika. Healing Logics: Culture and Medicine in Modern Health Belief Systems. Utah State University Press, 2002. Breggin, Peter R. Toxic Psychiatry: Why Therapy, Empathy, and Love Must Replace the Drugs, Electroshock, and Biomedical Theories of the “New Psychiatry.” St. Martin’s Press, 1991. Brooks, Lisa. “Digging at the Roots: Locating an Ethical, Native Criticism.” Reasoning Together: The Native Critics Collective, edited by Craig S. Womack. Daniel Heath Justice, and Christopher B. Teuton, University of Oklahoma Press, 2008, pp. 234–​64. Browdy de Hernandez, J. “Writing (for) Survival:  Continuity and Change in Four Contemporary Native American Women’s Autobiographies.” Wicazo Sa Review, vol. 10, no. 2, 1994, pp. 40–​62. JSTOR, www.jstor.org/​stable/​1409132. doi:10.2307/​ 1409132. Bruchac, Margaret M, et  al. Savage Kin:  Indigenous Informants and American Anthropologists. University of Arizona Press, 2018. Brumble III, H. David. American Indian Autobiography. University of California Press, 1988. Bucko, Raymond A., and Stella Iron Cloud. “Lakota Health and Healing.” Southern Medical Journal, vol. 101, no. 6, 2008, pp. 596–​98. Burke, Heather, Claire Smith, et  al., editors. Kennewick Man:  Perspectives on the Ancient One. Left Coast Press, 2008.

240

240 Bibliography Burke, Stacie. Building Resistance: Children, Tuberculosis, and the Toronto Sanatorium. McGill-​Queen’s University Press, 2018. Busatta, Flavia. “Obesity, Diabetes and the Thrifty Gene:  The Case of the Pima,” Antrocom Online Journal of Anthropology, vol. 7, no. 11, 2011, pp. 117–​33. Bynum, Helen. Spitting Blood:  The History of Tuberculosis. Oxford University Press, 2012. Cajete, Gregory. Native Science:  Natural Laws of Interdependence. Clear Light Publishers, 2000. Carden, Mary Paniccia. “ ‘The Unkillable Mother’:  Sovereignty and Survivance in Louise Erdrich’s The Round House.” Studies in American Indian Literatures, vol. 30 no. 1, 2018, pp. 94–​116. Project MUSE, muse.jhu.edu/​article/​692230. Carlson, Amanda E., Benjamin D. Aronson, et  al. “Apathy and Type-​2 Diabetes Among American Indians: Exploring the Protective Effects of Traditional Cultural Involvement.” Journal of Health Care for the Poor and Undeserved, vol. 28, no. 2, May 2017, pp. 770–​83. Carroll, James T. “The Smell of the White Man Is Killing Us”:  Education and Assimilation Among Indigenous People.” U.S. Catholic Historian, vol. 27, no. 1, Winter 2009, pp. 21–​48. JSTOR, www.jstor.org/​stable/​27671173. Carter, Janette S., Georgia E. Perez, and Susan S. Gilliland. “Communicating Through Stories: Experience of Native American Diabetes Project.” The Diabetes Educator, vol. 25, no. 2, March/​April 1999, pp. 179–​88. Cartwright, Lisa. Screening the Body: Tracing Medicine’s Visual Culture. University of Minnesota Press, 1995. Caruth, Cathy. Unclaimed Experience: Trauma, Narrative, and History. Johns Hopkins University Press, 2016. Cattelino, Jessica R. “The Double Bind of American Indian Need-​Based Sovereignty.” Cultural Anthropology, vol. 25, no. 2, 2010, pp. 235–​62. EBSCOhost, doi:10.1111/​ j.1548-​1360.2010.01058.x. Chari, Sangita, and Jaime N. Lavallee, editors. Accomplishing NAGPRA: Perspectives on the Intent, Impact, and Future of the Native American Graves Protection and Repatriation Act. Oregon State University Press, 2013. Cherokee Nation v. Georgia, 30 U.S. 1 (1831). Child, Brenda J. Boarding School Seasons:  American Indian Families, 1900–​1940. University of Nebraska Press, 1998. ——. My Grandfather’s Knocking Sticks:  Ojibwe Family Life and Labor on the Reservation, 1900–​1940. University of Minnesota Press, 2014. ——. “The Boarding School as Metaphor.” Journal of American Indian Education, vol. 57, no. 1, Spring 2018, pp. 37–​57. doi:10.5749/​jamerindieduc.57.1.0037. Chilisa, Bagele. Indigenous Research Methodologies. SAGE Publications, 2012. Cillizza, Chris. “Elizabeth Warren’s Native-​American Heritage Reveal Was Just As Bad As You Thought It Was.” CNN Politics. December 7, 2018. Accessed May 4, 2019. Clark, James, Sir, 1788–​1870. A Treatise On Pulmonary Consumption: Comprehending an Inquiry Into the Causes, Nature, Prevention, and Treatment of Tuberculosis and Scrofulous Diseases In General. Carey, Lea, and Blanchard, 1835. Clarke, Adele E., et  al. “Biomedicalization:  Technoscientific Transformations of Health, Illness, and U.S. Biomedicine.” American Sociological Review, vol. 68, no. 2, 2003, pp. 161–​94. JSTOR, www.jstor.org/​stable/​1519765.

 241

Bibliography 241 Clarke, Adele E., et  al. “Biomedicalization:  A Theoretical and Substantive Introduction.” Biomedicalization:  Technoscience, Health, and Illness in the U.S., edited by Adele E. Clarke. Duke University Press, 2010, pp. 1–​44. Clarke, Adele E., et al, editors. Biomedicalization: Technoscience, Health, and Illness in the U.S. Duke University Press, 2010. Cohen, Marsha M., et al. “Ethnic Variation in Cholecystectomy Rates and Outcomes, Manitoba, Canada, 1972–​84.” American Journal of Public Health, vol. 79, no. 6, June 1989, pp. 751–​5. EBSCOhost, doi:10.2105/​AJPH.79.6.751. Coker, Richard. From Chaos to Coercion: Detention and the Control of Tuberculosis. St. Martin’s Press, 2000. Collins, David R., and Kristen Bergren. Ishi:  The Last of His People. Morgan Reynolds, 2000. Condrau, Flurin. “Beyond the Total Institution:  Towards a Reinterpretation of the Tuberculosis Sanatorium.” Tuberculosis Then and Now: Current Issues in the History of an Infectious Disease, edited by Flurin Condrau and Michael Worboys, McGill-​ Queen’s University Press, 2010, pp. 72–​99. ——. “ ‘Who Is the Captain of All These Men of Death?’:  The Social Structure of a Tuberculosis Sanatorium in Postwar Germany.” Journal of Interdisciplinary History, vol. 32 no. 2, 2001, pp. 243–​62. Project MUSE muse.jhu.edu/​article/​16228. Condrau, Flurin, and Michael Worboys, editors. Tuberculosis Then and Now: Current Issues in the History of an Infectious Disease. McGill-​ Queen’s University Press, 2010. Cook, William A. “Thoracoplasty for Tuberculosis.” Adult Chest Surgery, edited by David J. Sugarbaker, et al. 2nd ed., McGrow Hill, 2015, pp 876–​0. Cook-​Lynn, Elizabeth. “American Indian Intellectualism and the New Indian Story.” Natives and Academics: Researching and Writing about American Indians, edited by Devon A. Mihesuah, University of Nebraska Press, 1998, pp. 111–​38. ——. New Indians, Old Wars. University of Illinois Press, 2007. ——. Why I Can’t Read Wallace Stegner and Other Essays. University of Wisconsin Press, 1996. Coker, Richard. From Chaos to Coercion: Detention and the Control of Tuberculosis. St. Martin’s Press, 2000. Condit, Celeste. The Meaning of the Gene:  Public Debates About Human Heredity. University of Wisconsin Press, 1999. Connolly, Cynthia A. Saving Sickly Children:  The Tuberculosis Preventorium in American Life, 1909–​1970. Rutgers University Press, 2008. Conti, Meredith. “ ‘I Am Not Suffering Any More …’:  Tragic Potential in the Nineteenth-​Century Consumptive Myth.” Journal of Dramatic Theory and Criticism, vol. 24, no. 1, Fall 2009, pp. 59–​82. Project MUSE, doi:10.1353/​dtc.2009.0005 Copeland, Samuel. “Thoracoplasty and Tuberculosis.” The Southwest Respiratory and Critical Care Chronicles, vol. 5, no. 19, 2017, pp. 32–​3. Directory of Open Access Journals, doi:10.12746/​swrccc.v5i19.393. Coughlin, Steven S. et  al., editors. Handbook of Community-​ Based Participatory Research. Oxford University Press, 2017. Couser, Thomas. Recovering Bodies: Illness, Disability, and Life Writing. University of Wisconsin Press, 1997. Crawford, Suzanne J. “(Re)Constructing Bodies: Semiotic Sovereignty and the Debate Over Kennewick Man.” Repatriation Reader: Who Owns American Indian Remains?, edited by Devon A. Mihesuah, University of Nebraska Press, 2000, pp. 211–​36.

242

242 Bibliography Crawford O’Brien, Suzanne J. “Healing Generations in the South Puget Sound.” Religion and Healing in Native America: Pathways for Renewal, edited by Suzanne J. Crawford O’Brian, Praeger, 2008, pp. 135–​59. Crawford O’Brien, Suzanne J., editor. Religion and Healing in Native America: Pathways for Renewal. Praeger, 2008. Cummins, S. Lyle, and David Davis. “ ‘Virgin Soil’ –​and After. A Working Conception of Tuberculosis in Children, Adolescents, and Aborigines.” The British Medical Journal, vol. 2, no. 3575, July 13, 1929, pp. 39–​41. JSTOR, www.jstor.org/​stable/​ 25333084. Dalton, Rex. “When Two Tribes Go to War.” Nature, vol. 430, no. 6999, 2004, pp. 500–​2. EBSCOhost, doi:10.1038/​430500a. Daniel, Thomas M. Captain of Death:  The Story of Tuberculosis. University of Rochester Press, 1997. Danieli, Yael, editor. International Handbook of Multigenerational Legacies of Trauma. Plenum Press, 1998. Danquah, Meri Nana-​Ama. Willow Weep for Me. Norton, 1998. Davis, Lennard J. “Nude Venuses, Medusa’s Body, and Phantom Limbs:  Disability and Visuality.” The Body and Physical Difference: Discourses of Disability, edited by David T. Mitchell and Sharon L. Snyder, University of Michigan Press, 1997, pp.  51–​70. Day, Carolyn A. “Consumptive Chic.” History Today, vol. 68, no. 7, July 2018, pp.  68–​77. Deer, Sarah. The Beginning and End of Rape: Confronting Sexual Violence in Native America. University of Minnesota Press, 2015. DeJong, David H. “If You Knew the Conditions”: A Chronicle of the Indian Medical Service and American Indian Health Care, 1908–​1955. Lexington Books, 2008. ——. Plagues, Politics, and Policy:  A Chronicle of the Indian Health Service, 1955–​ 2008. Lexington Books, 2011. ——. “Unless They Are Kept Alive”:  Federal Indian Schools and Student Health, 1878–​1918.” The American Indian Quarterly, vol. 31, no. 2, Spring 2007, pp. 256–​82. Deloria Jr., Vine. Red Earth, White Lies: Native Americans and the Myth of Scientific Fact. Scribner, 1995. ——. The World We Used to Live In: Remembering the Powers of the Medicine Men. Fulcrum Publishing, 2006. DelVecchio Good, Mary-​Jo, Sarah S. Willen, et  al. Shattering Culture:  American Medicine Responds to Cultural Diversity. Russell Sage Foundation, 2011. Demazeux, Steeves and Patrick Singy, editors. The DSM-​5 in Perspective: Philosophical Reflections on the Psychiatric Babel. Springer, 2015. “Diabetes and American Indians/​Alaska Natives.” U.S. Department of Health and Human Services, Office of Minority Health, https://​minorityhealth.hhs.gov/​omh/​ browse.aspx?lvl=4&lvlid=33. “Diabetes. Fact sheet.” World Health Organization. http://​www.who.int/​mediacentre/​ factsheets/​fs312/​en/​. Diedrich, Lisa. Treatments: Language, Politics, and the Culture of Illness. University of Minnesota Press, 2007. Doerfler, Jill. Those Who Belong: Identity, Family, Blood, and Citizenship Among the White Earth Anishinaabeg. Michigan State University Press, 2007. Dormandy, Thomas. The White Death: A History of Tuberculosis. New York University Press, 2000.

 243

Bibliography 243 DuBois, W.E.B, and Elijah Anderson. The Philadelphia Negro:  A Social Study. University of Pennsylvania Press, 1996. Dufaud, Grégory and Lara Rzesnitzek. “Soviet Psychiatry Through the Prism of Circulation:  The Case of Outpatient Psychiatry in the Interwar Period.” Kritika: Explorations in Russian and Eurasian History, vol. 17 no. 4, 2016, pp. 781–​ 803. Project MUSE, doi:10.1353/​kri.2016.0049 Dumit, Joseph. Picturing Personhood: Brain Scans and Biomedical Identity. Princeton University Press, 2005. Dumont, Clayton W., Jr. “Contesting Scientists’ Narrations of NAGPRA’s Legislative History:  Rule 10.11 and the Recovery of ‘Culturally Unidentifiable’ Ancestors.” Wicazo Sa Review, vol. 26, no. 1, 2011, p. 5–​41. ——. “The Politics of Scientific Objections to Repatriation.” Wicazo Sa Review, vol. 18, no. 1, Spring 2003, pp. 109–​28. Muse PROJECT, doi:https://​doi.org.10.13.53/​ wic.2003.0003. Duran, Eduardo. Healing the Soul Wound:  Counseling with American Indians and Other Native People. Teachers College Press, Colombia University, 2006. Duran, Eduardo, and Bonnie Duran. Native American Postcolonial Psychology. State University of New York Press, 1995. Duran, Bonnie, Eduardo Duran, and Maria Yellow Horse Brave Heart. “Native Americans and the Trauma of History.” Studying Native America:  Problems and Perspectives, edited by Russell Thornton, University of Wisconsin Press, 1998, pp.  60–​76. Duran, Eduardo, Bonnie Duran, Maria Yellow Horse Brave Heart, and Susan Yellow Horse-​Davis. “Healing the American Indian Soul Wound.” International Handbook of Multigenerational Legacies of Trauma, edited by Yael Danieli, Plenum Press, 1998, pp. 341–​54. Dyck, Erika. Psychedelic Psychiatry:  LSD from Clinic to Campus. Johns Hopkins University Press, 2008. Eastman, Charles. “The Medicine Man’s Practice.” Pharmaceutical Era, vol. 52, 1919, pp. 281. Ellinghaus, Katherine. Blood Will Tell:  Native Americans and Assimilation Policy. University of Nebraska Press, 2017. Engstrom, Eric J. “Tempering Madness:  Emil Kraepelin’s Research on Affective Disorders.” Osiris, vol. 31, no. 1, 2016, pp. 163–​80. The University of Chicago Press Journals, https://​doi.org/​10.1086/​687834. Erdrich, Heid E. Cell Traffic:  New and Selected Poems. University of Arizona Press, 2012. ——. Fishing for Myth. New Rivers Press, 1997. ——. National Monuments. Michigan State University Press, 2008. Erdrich, Louise. LaRose. HarperCollins, 2016. ——. Love Medicine. HarperCollins, 2009. ——. The Last Report on the Miracles at Little No Horse. HarperCollins, 2001. ——. The Painted Drum. HarperCollins, 2001. ——. The Plague of Doves. HarperCollins, 2008. ——. The Round House. Harper Perennial, 2013. Estes, Nick. Our History Is the Future:  Standing Rock Versus the Dakota Access Pipeline, and the Long Tradition of Indigenous Resistance. Verso, 2019. Estes, Nick, and Jaskiran Dhillon, editors. Standing with Standing Rock: Voices from the #NoDAPL Movement. University of Minnesota Press, 2019.

244

244 Bibliography Evans, Stephen F. “ ‘Open Containers’: Sherman Alexie’s Drunken Indians.” American Indian Quarterly, vol. 25, no. 1, Winter 2001, pp. 46–​72. Faden, Ruth R. “Informed Consent and Clinical Research.” Kennedy Institute of Ethics Journal, vol. 6 no. 4, 1996, pp. 356–​9. Project MUSE, doi:10.1353/​ken.1996.0035. Farmer, Paul E. “The Consumption of the Poor: Tuberculosis in the 21st Century.” Ethnography, vol. 1, no. 2, December 2000, pp. 183–​216. Fausto-​Sterling, Anne. “Refashioning Race: DNA and the Politics of Health Care.” differences:  A Journal of Feminist Cultural Studies, vol. 15 no. 3, 2004, pp. 1–​37. Project MUSE muse.jhu.edu/​article/​174488. Feldberg, Georgina D. Disease and Class:  Tuberculosis and the Shaping of Modern North American Society. Rutgers University Press, 1995. Ferreira, Mariana Leal. “Love in Colonial Light:  History of Yurok Emotions in Northern California.” Indigenous Peoples and Diabetes: Community, Empowerment and Wellness, edited by Mariana Leal Ferreira and Gretchen Chesley Lang, Carolina Academic Press, 2006, pp. 357–​86. ——. “Slipping Through Sky Holes: Yurok Body Imagery in Northern California.” Indigenous Peoples and Diabetes:  Community, Empowerment and Wellness, edited by Mariana Leal Ferreira and Gretchen Chesley Lang, Carolina Academic Press, 2006, pp. 73–​103. Ferreira, Mariana Leal, and Gretchen Chesley Lang, editors. Indigenous Peoples and Diabetes:  Community, Empowerment and Wellness. Carolina Academic Press, 2006. Ferreira, Mariana Leal, and Gretchen Chesley Lang. “Introduction: Deconstructing Diabetes.” Indigenous Peoples and Diabetes:  Community, Empowerment and Wellness, edited by Mariana Leal Ferreira and Gretchen Chesley Lang, Carolina Academic Press, 2006, pp. 3–​32. Ferzacca, Steve. “Diabetes and Culture.” Annual Review of Anthropology, vol. 41, 2012, pp. 411–​26. EBSCOhost, doi:10.1146/​annurev-​anthro-​081309-​145806. Fink, Candida, and Joseph Kraynak. Bipolar Disorder for Dummies. Wiley Publishing Inc., 2005. Flick, Lawrence F. (Lawrence Francis), 1856–​ 1938. Practical Measures for the Prevention of Tuberculosis. Philadelphia: Lea Brothers & Co., [1893?]. Foucault, Michel. Power/​Knowledge:  Selected Interviews and Other Writings 1972–​ 1977, edited by Colin Gordon, translated by Colin Gordon, Leo Marshall, John Mepham, and Kate Soper, Pantheon Books, 1980. ——. “Society Must Be Defended”:  Lectures at the Collège de France, 1975–​1976, edited by Mauro Bertani and Alessandro Fontana, translated by David Macey, Picador, 2003. ——. The Birth of the Clinic: An Archeology of Medical Perception, translated by A. M. Sheridan Smith, Random House, 1973. Francis, Leslie P. “Discrimination in Medical Practice: Justice and the Obligations of Health Care Providers to Disadvantaged Patients.” The Blackwell Guide to Medical Ethics, edited by Rosamond Rhodes et al. Blackwell Publishing, 2007, pp. 162–​79. Frank, Arthur W. The Wounded Storyteller: Body, Illness, and Ethics. 1995. University of Chicago Press, 2013. Galanti, Geri-​Ann. Caring for Patients from Different Cultures. University of Pennsylvania Press, 2014. Gamble, Vanessa Northington. Making a Place for Ourselves:  The Black Hospital Movement, 1920–​1945. Oxford University Press, 1995.

 245

Bibliography 245 Garland-​Thomson, Rosemarie. Extraordinary Bodies: Figuring Physical Disability in American Culture in Literature. Columbia University Press, 1997. ——. Staring: How We Look. Oxford University Press, 2009. Garroutte, Eva Marie. Real Indians:  Identity and the Survival of Native America. University of California Press, 2003. Garroutte, Eva, and Kathleen Delores Westcott. “ ‘The Stories Are Very Powerful’: A Native American Perspective on Health, Illness, and Narrative.” Religion and Healing in Native America: Pathways for Renewal, edited by Suzanne J. Crawford O’Brien, Praeger, 2008, pp. 163–​84. Ghaemi, S. Nassir and Paul R. McHugh. The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness. Johns Hopkins University Press, 2007. Gidley, Mick. Edward S.  Curtis and the North American Indian, Incorporated. Cambridge University Press, 1998. Glancy, Diane. Fort Marion Prisoners and the Trauma of Native Education. University of Nebraska Press, 2014. Glas, Gerrit. “Psychiatry as Normative Practice.” Philosophy, Psychiatry, & Psychology, vol. 26 no. 1, 2019, pp. 33–​48. Project MUSE, doi:10.1353/​ppp.2019.0002. Gleicher, Norbert. “Pregnancy-​ Related Cell Traffic, Microchimerism and Autoimmunity:  The Possibility of Reducing Autoimmune Disease Prevalence.” Expert Review of Obstetrics & Gynecology, vol. 2, no. 3, May 2007, pp. 341–​5. Glenn, Evelyn Nakano. Forced to Care: Coercion and Caregiving in America. Harvard University Press, 2010. Goering, Sara, Suzanne Holland, and Kelly Fryer-​Edwards. “Transforming Genetic Research Practices with Marginalized Communities: A Case for Responsive Justice.” Hastings Center Report, March–​April 2008, pp. 43–​53. Goffman, Erving. Stigma:  Notes on the Management of Spoiled Identity. Penguin, 1963. Gold, S. W. “Observations on the Character, and Predisposing and Exciting Causes of Phthisis Pulmonalis.” Boston Medical & Surgical Journal, vol. 13, no. 11, Oct 1835, pp.  182–​7. Goldberg, Susan G. The Social Construction of Bipolar Disorder: The Interrelationship Between Societal and Individual Meanings. 2007. Fielding Graduate University, PhD dissertation. Gorman, Joshua M. Building a Nation: Chickasaw Museums and the Construction of History and Heritage. University of Alabama Press, 2011. Gover, Kirsty. “Genealogy as Continuity: Explaining the Growing Tribal Preference for Descent Rules in Membership Governance in the United States.” American Indian Law Review, vol. 33, no. 1, 2008/​2009, pp. 243–​309. JSTOR, www.jstor.org/​ stable/​20455382. doi:10.2307/​20455382. Grassian, Daniel. Understanding Sherman Alexie. University of South Carolina Press, 2005. Grayshield, Lisa, Jeremy L. Rutherford, Sibella B. Salazar et al. “Understanding and Healing Historical Trauma: The Perspectives of Native American Elders.” Journal of Mental Health Counseling, vol. 37, no. 4, October 2015, pp. 295–​307. EBSCOhost, doi:10.17744/​mehc.37.4.02. Guadagnolo, B. Ashleigh, et al. “Medical Mistrust and Less Satisfaction with Health Care Among Native Americans Presenting for Cancer Treatment.” Journal of Health Care for the Poor and Underserved, vol. 20 no. 1, 2009, pp. 210–​26. Project MUSE, doi:10.1353/​hpu.0.0108.

246

246 Bibliography Gupta, Prachi. “  ‘Our Vote Matters Very Little’:  Kim TallBear on Elizabeth Warren’s Attempt to Claim Native American Heritage.” Jezebel:  A Supposedly Feminist Website. October 16, 2018. https://​theslot.jezebel.com/​our-​vote-​mattersvery-​little-​kim-​tallbear-​on-​elizabeth-​1829783321. Gurr, Barbara. Reproductive Justice: The Politics of Health Care for Native American Women. Rutgers University Press, 2014. Hadden, Eleanor Louise. “BCG Tuberculosis Vaccine Experiment on Southeast Alaska Natives:  A Medical Experiment Without Informed Consent.” Global Indigenous Health: Reconciling the Past, Engaging the Present, Animating the Future, Robert Henry, Amanda LaVallee, Nancy Van Styvendale, et al., editors, University of Arizona Press, 2018, pp. 61–​75. Halbert, H. L. “Okla Hannali; or the Six Town Districts of the Choctaws.” The American Antiquarian and Oriental Journal, vol. 15, no. 3, May 1893, p. 146. Hale, Lorraine. Native American Education:  A Reference Handbook. ABC CLIO, 2002. Hale, Jr., Nathan G. The Rise and Crisis of Psychoanalysis in the United States: Freud and the Americans, 1917–​1985. Oxford University Press, 1995. Hämäläinen, Pekka. Lakota America:  A New History of Indigenous Power. Yale University Press, 2019. Hamill, James. “Show Me Your CDIB: Blood Quantum and Indian Identity Among Indian People of Oklahoma.” American Behavioral Scientist, vol. 47, no. 3, 2003, pp. 267–​82. Handley, Becca L., et  al. “A Systematic Review of Historical and Contemporary Evidence of Trachoma Endemicity in the Pacific Islands.” PLoS ONE, vol. 13, no. 11, November 15, 2018, pp. 1–​ 19. EBSCOhost, doi:10.1371/​journal. pone.0207393. Harley, J. B. The New Nature of Maps: Essays in the History of Cartography, edited by Paul Laxton, Johns Hopkins University Press, 2002. Haraway, Donna J.  Modest₋Witness@Second₋Millennium.FemaleMan₋Meets₋Onco Mouse: Feminism and Technoscience. Routledge, 1997. Harris, Cheryl I. “Whiteness as Property.” Harvard Law Review, vol. 106, no. 8, 1993, pp. 1707–​91. EBSCOhost, doi:10.2307/​1341787. Harry, Debra. “Indigenous Peoples and Gene Disputes.” Chicago-​Kent Law Review, vol. 84, no. 1, 2009, pp. 147–​96. Hearne, Joanna. Smoke Signals:  Native Cinema Rising. University of Nebraska Press, 2012. Henry, Robert, Amanda LaVallee, Nancy Van Styvendale, et  al. Global Indigenous Health: Reconciling the Past, Engaging the Present, Animating the Future. University of Arizona Press, 2018. Herndl, Diane Price. Invalid Women: Figuring Feminine Illness in American Fiction and Culture, 1840–​1940. University of North Carolina Press, 1993. Hinton, Devon E., and Byron J. Good, editors. Culture and PTSD: Trauma in Global and Historical Perspective. University of Pennsylvania Press, 2015. Hoffman, Ginger A., and Jennifer L. Hansen. “Prozac or Prosaic Diaries? The Gendering of Psychiatric Disability in Depression Memoirs.” Philosophy, Psychiatry, & Psychology, vol. 24, no. 4, December 2017, pp. 285–​98. Project MUSE, doi:10.1353/​ppp.2017.0041. Hogan, Linda. Dwellings:  A Spiritual History of the Living World. Touchstone, 1996.

 247

Bibliography 247 ——. “New Trees, New Medicines, New Wars: The Chickasaw Removal.” Canadian Review of Comparative Literature/​Revue Canadienne de Littérature Comparée, vol. 42, no. 1, Mars 2015, pp. 121–​9. Project MUSE, doi:10.1353/​crc.2015.0007. ——. “Remembering.” Chickasaw: Unconquered and Unconquerable. Essays by Jeannie Barbour, Amanda Cobb, and Linda Hogan. Introduction by Bill Anoatubby, Governor of the Chickasaw Nation, photography by David G.  Fitzgerald, Chickasaw Press, 2006, pp. 58–​9. ——. Solar Storms. Scribner, 1997. ——. “The Two Lives.” I Tell You Now: Autobiographical Essays by Native American Writers, edited by Brian Swann and Arnold Krupat, University of Nebraska Press, 1987, pp. 231–​49. ——. The Woman Who Watches Over the World: A Native Memoir. W. W. Norton & Company, 2001. Hollrah, Patrice. “ ‘The Lord and the Center of the Farthest’:  Ezol’s Journal as Tribalography in LeAnne Howe’s Miko Kings: An Indian Baseball Story,” Studies in American Indian Literatures, vol. 26, no. 2, Summer 2014, pp. 40–​54. Project MUSE, muse.jhu.edu/​article/​548053. “Homeland.” The Chickasaw Nation. www.chickasaw.net/​Our-​Nation/​History/​ Homelands.aspx. Accessed Dec 3, 2018. Hoover, Elizabeth. The River Is in Us:  Fighting Toxics in a Mohawk Community. University of Minnesota Press, 2017. ——. “ ‘You Can’t Say You’re Sovereign if You Can’t Feed Yourself’:  Defining and Enacting Food Sovereignty in American Indian Community Gardening.” American Indian Culture and Research Journal, vol. 41, no. 3, 2017, pp. 31–​70. EBSCOhost, doi:10.17953/​aicrj.41.3.hoover. Hopkins, Richard A., et al. “The Modern Use of Thoracoplasty.” Annals of Thoracic Surgery, vol. 40, no. 2, 1985, pp. 181–​7. Howe, LeAnne. “Embodied Tribalography: Mound Building, Ball Games, and Native Endurance in the Southeast.” Studies in American Indian Literatures, vol. 26, no. 2, Summer 2014, pp. 75–​93. Project MUSE, muse.jhu.edu/​article/​548056. ——. Miko Kings: An Indian Baseball Story. Aunt Lute Books, 2007. Huang, Hsinja. “Blood/​Memory in N.  Scott Momaday’s The Names:  A Memoir and Linda Hogan’s The Woman Who Watches Over the World: A Native Memoir.” Concentric: Literary and Cultural Studies, vol. 32, no. 1, January 2006, pp. 171–​95. Hubbard, Ruth and Elijah Wood. Exploring the Gene Myth: How Genetic Information Is Produced and Manipulated by Scientists, Physicians, Employers, Insurance Companies, Educators, and Law Enforcers. Beacon, 1997. Hudson, J. Blaine. “Stephen Bishop.” The Encyclopedia of Louisville, edited by John E. Kleber et al., University Press of Kentucky, 2001, pp. 94. Huhndorf, Shari M. Mapping the Americas: The Transnational Politics of Contemporary Native Culture. Cornell University Press, 2009. Jacob, Michelle M. “Making Sense of Genetics, Culture, and History. A Case Study of Native Youth Education Program.” Genetics and the Unsettled Past: The Collision of DNA, Race, and History, edited by Keith Wailoo, Alondra Nelson, and Catherine Lee, Rutgers University Press, 2012, pp. 279–​94. Jaimes, M. Annette. “Federal Indian Identification Policy:  A Usurpation of Indigenous Sovereignty in North America.” The State of Native America: Genocide, Colonization, and Resistance, edited by M. Annette Jaimes, South End Press, 1992, pp. 123–​38.

248

248 Bibliography James, Elizabeth. “  ‘Hardly a Family Is Free from the Disease’:  Tuberculosis, Health Care, and Assimilation Policy on the Nez Perce Reservation, 1908–​1942.” Oregon Historical Quarterly, vol. 112, no. 2, Summer 2011, pp. 142–​69. JSTOR, doi:136.152.143.121. Jasanoff, Sheila. Designs on Nature: Science and Democracy in Europe and the United States. Princeton University Press, 2005. ——. “Ordering Knowledge, Ordering Society.” States of Knowledge: The Co-​Production of Science and Social Order, edited by Sheila Jasanoff, Routledge, 2004, pp. 13–​45. ——. “The Idiom of Co-​Production.” States of Knowledge:  The Co-​Production of Science and Social Order, edited by Sheila Jasanoff, Routledge, 2004, pp. 1–​12. Jasanoff, Sheila, editor. States of Knowledge: The Co-​Production of Science and Social Order. Routledge, 2004. Joe, Jennie R., and Robert S. Young, editors. Diabetes as a Disease of Civilization: The Impact of Culture Change on Indigenous Peoples. Mouton de Gruyter, 1994. Johnson, Kelli Lyon. “Writing Deeper Maps:  Mapmaking, Local Indigenous Knowledges, and Literary Nationalism in Native Women’s Writing.” Studies in American Indian Literatures, vol. 19, no. 4, Winter 2007, pp. 103–​20. Johnston, Basil. Ojibway Ceremonies. University of Nebraska Press, 1982. ——. Ojibway Heritage. 1976. University of Nebraska Press, 1990. Joinson, Carla. Vanished in Hiawatha:  The Story of the Canton Asylum for Insane Indians. University of Nebraska Press, 2016. Jones, David S. Rationalizing Epidemics:  Meanings and Uses of American Indian Mortality since 1600. Yale University Press, 2004. ——. “The Health Care Experiments at Many Farms: The Navajo, Tuberculosis, and the Limits of Modern Medicine, 1952–​1962.” Bulletin of the History of Medicine, vol. 76, no. 4, Winter 2002, pp. 749–​90. Jurecic, Ann. Illness as Narrative. University of Pittsburgh Press, 2012. Kapsalis, Terri. Public Privates:  Performing Gynecology from Both Ends of the Speculum. Duke University Press, 1997. Kasper, Siegfried and Robert M.  A. Hirschfeld, editors. Handbook of Bipolar Disorder: Diagnosis and Therapeutic Approaches. Taylor & Francis, 2005. Kaut, Kevin P., and Josephine A. Dickinson. “The Mental Health Practitioner and Psychopharmacology.” Journal of Mental Health Counseling, vol. 29, no. 3, July 2007, pp. 204–​25. EBSCOhost, doi:10.17744/​mehc.29.3.t670636302771120. Keers, R.Y. Pulmonary Tuberculosis:  A Journey Down the Centuries. Baillière Tindall, 1978. Keller, Evelyn Fox. The Century of the Gene. Harvard University Press, 2000. Keller, Jean A. Empty Beds: Indian Student Health at Sherman Institute, 1902–​1922. Michigan State University Press, 2002. ——. “When Native Foods Were Left Behind:  Boarding School Nutrition and the Sherman Institute, 1902–​ 1922.” News from Native California, vol. 15, no. 3, Spring2002, pp. 22–​4. Kelly, L. C. The Assault on Assimilation: John Collier and the Origins of Indian Policy Reform. University of New Mexico Press, 1963. Kelsey, Penelope Myrtle. “Disability and Native North American Boarding School Narratives: Madonna Swan and Sioux Sanatorium.” Journal of Literary & Cultural Disability Studies, vol. 7, no. 2, 2013, pp. 195–​211. Project MUSE, muse.jhu.edu/​ article/​518199.

 249

Bibliography 249 ——. Tribal Theory in Native American Literature: Dakota and Haudenosaunee Writing and Indigenous Worldviews. University of Nebraska Press, 2008. Khalid, Asma. “Warren Apologizes To Cherokee Nation For DNA Test.” NPR. February 1, 2019. Accessed May 4, 2019. Kidwell, Clara Sue. The Choctaws in Oklahoma. From Tribe to Nation, 1855–​1970. University of Oklahoma Press, 2007. Kirch, Claire. “Old-​Fashioned Justice.” Publisher Weekly, vol. 263, no. 16, April 18, 2016, pp. 86–​7. Kirkpatrick, Katherine W. Mysterious Bones: The Story of Kennewick Man. Holiday House, 2011. Kleber, John E. et  al., editors. The Encyclopedia of Louisville. University Press of Kentucky, 2001. Kleinman, Arthur. The Illness Narratives: Suffering, Healing and the Human Condition. Basic Books, 1988. Kluchin, Rebecca M. Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950–​1980. Rutgers University Press, 2009. Kolhatkar, Sheelah. “Can Elizabeth Warren Win It All?” The New Yorker, June 24, 2019, pp. 36–​47. Kovach, Margaret. Indigenous Methodologies:  Characteristics, Conversations and Contexts. University of Toronto Press, 2009. Kozak, David L. “Surrendering to Diabetes: An Embodied Response to Perceptions of Diabetes and Death in the Gila River Indian Community.” OMEGA, vol. 35, no. 4, 1997, pp. 347–​59. Kramer, Peter D. Listening to Prozac. Viking, 1993. Kristeva, Julia. The Powers of Horror: An Essay on Abjection, translated by Leon S. Roudiez, Columbia University Press, 1982. Kroeber, Karl, and Clifton Kroeber, editors. Ishi in Three Centuries. University of Nebraska Press, 2003. Kroeber, Theodora. Ishi in Two Worlds: A Biography of the Last Wild Indian in North America. University of California Press, 2004. Krupat, Arnold. For Those Who Come After:  A Study of Native American Autobiography. California University Press, 1985. ——. “The Indian Autobiography: Origins, Type, and Function.” American Literature, vol. 53, no. 1, 1981, pp. 22–​42. JSTOR, www.jstor.org/​stable/​2926192. ——. The Voice in the Margin: Native American Literature and the Canon. University of California Press, 1989. Kurahashi, Yaro. “Stories In and Outside DNA:  Deborah Zoe Laufer’s Informed Consent.” Native American and Indigenous Studies, vol. 3, no. 1, 2016, pp. 116–​29. Project MUSE, muse.jhu.edu/​article/​635766. Kurup, Seema. “From Revenge to Restorative Justice in Louise Erdrich’s The Plague of Doves, The Round House, and LaRose.” American Revenge Narratives: A Collection of Critical Essays, edited by Kyle Wiggins, Palgrave Macmillan, 2018, pp. 99–​117. Kurup, Seema and Linda Wagner-​Martin, editors. Understanding Louise Erdrich. University of South Carolina Press, 2015. LaCapra, Dominick. History and Memory After Auschwitz. Cornell University Press, 1998. ——. Representing the Holocaust: History, Theory, Trauma. Cornell University Press, 1994. ——. Writing History, Writing Trauma. Johns Hopkins University Press, 2014.

250

250 Bibliography la paperson. A Third University Is Possible. University of Minnesota Press, 2017. Lakoff, Andrew. Pharmaceutical Reason: Knowledge and Value in Global Psychiatry. Cambridge University Press, 2005. Lambe, Jennifer L. Madhouse: Psychiatry and Politics in Cuban History. University of North Carolina Press, 2017. Lankford, George E. Native American Legends of the Southeast:  Tales from the Natchez, Caddo, Biloxi, Chickasaw, and Other Nations. University of Alabama Press, 2011. Lawlor, Clark. Consumption and Literature:  The Making of the Romantic Disease. Palgrave MacMillan, 2006. Lederman, Emily. “Archival Sovereignty in LeAnne Howe’s Miko Kings:  An Indian Baseball Story.” Studies in American Indian Literatures, vol. 29, no. 3, Fall 2017, pp. 64–​88. Project MUSE, muse.jhu.edu/​article/​682447. Lefler, Lisa J., and Roseanna Belt. “Historical Trauma, Stress, and Diabetes: A Modern Model among Eastern Band of Cherokees.” Under the Rattlesnake: Cherokee Health and Resiliency, edited by Lisa J. Lefler, Susan Leading Fox, Heidi M. Altman et al., University of Alabama Press, 2009, pp. 61–​78. Lerner, Paul. Hysterical Men: War, Psychiatry, and the Politics of Trauma in Germany, 1890–​1930. Cornell University Press, 2003. Lewis, Bradley. Moving Beyond Prozac, DSM, and the New Psychiatry: The Birth of Postpsychiatry. University of Michigan Press, 2006. Lewis, Melissa E., and Myhra, Laurelle L. “Integrated Care with Indigenous Populations: Considering the Role of Health Care Systems in Health Disparities.” Journal of Health Care for the Poor and Underserved, vol. 29 no. 3, 2018, pp. 1083–​ 107. Project MUSE, doi:10.1353/​hpu.2018.0081. Lewis, Thomas H. The Medicine Men: Oglala Sioux Ceremony and Healing. University of Nebraska Press, 1990. Lindholdt, Paul, editor. The Spokane River. University of Washington Press, 2018. Lindsay, Brendan C. Murder State: California’s Native American Genocide, 1846–​1873. University of Nebraska Press, 2012. Lindsey, Donal F. Indians at Hampton Institute, 1877–​1923. University of Illinois Press, 1995. Linskey, Annie, and Amy Gardner. “Elizabeth Warren Apologizes for Calling Herself Native American.” The Washington Post, Feb 5, 2019. Accessed March 5, 2019. Lomawaima, K. Tsianina. They Called It Prairie Light: The Story of Chilocco Indian School. University of Nebraska Press, 1994. Lomawaima, K. Tsianina and Teresa L. McCarty. To Remain an Indian:  Lessons in Democracy from a Century of Native American Education. Teachers College Columbia University, 2006. Lomawaima, K. Tsianina, and Jeffrey Ostler. “Reconsidering Richard Henry Pratt: Cultural Genocide and Native Liberation in an Era of Racial Oppression.” Journal of American Indian Education, vol. 57, no. 1, 2018, pp. 79–​100. JSTOR, doi:10.5749/​jamerindieduc.57.1.0079. Lombardo, Paul A., and Gregory M Dorr. “Eugenics, Medical Education, and the Public Health Service: Another Perspective on the Tuskegee Syphilis Experiment.” Bulletin of the History of Medicine, vol. 80, no. 2, 2006, pp. 291–​316. Project MUSE, doi:10.1353/​bhm.2006.0066. Lorenz, Konrad et al. Here Am I –​ Where Are You? The Behavior of the Greylag Goose, translated by Robert D. Martin, Harcourt Brace Jovanovich, 1991.

 251

Bibliography 251 Louis, Renee Pualani, and Moana Kahele. Kanaka Hawai’i Cartography:  Hula, Navigation, and Oratory. Oregon State University Press, 2017. Lovern, Lavonna L., and Carol Locust. Native American Communities on Health and Disability: A Borderland Dialogue. Palgrave Macmillan, 2013. Luczak, Ewa Barbara. Breeding and Eugenics in the American Literary Imagination: Heredity Rules in the Twentieth Century. Palgrave Macmillan, 2015. Lyman, Christopher M. The Vanishing Race and Other Illusions:  Photographs of Indians by Edward S. Curtis. Pantheon Books, 1982. Lyons, Scott Richard. X-​Marks: Native Signatures of Assent. University of Minnesota Press, 2010. Lux, Maureen K. Separate Beds:  A History of Indian Hospitals in Canada, 1920s-​ 1980s. University of Toronto Press, 2016. Macy, Beth. Dopesick:  Dealers, Doctors, and the Drug Company That Addicted America. Little, Brown and Company, 2018. Maddox, Brenda. Rosalind Franklin: The Dark Lady of DNA. HarperCollins, 2002. Madsen, Deborah L. “The Making of (Native) Americans: Suturing and Citizenship in the Scene of Education.” Parallax, vol. 17, no. 3, 2011, pp. 32–​45. Routledge, doi:10.1080/​13534645.2011.584413. Marmot, Michael, and Richard G. Wilkinson. Social Determinants of Health. Oxford University Press, 2005. Martin, Calvin, editor. The American Indian and the Problem of History. Oxford University Press, 1987. Martin, Emily. Bipolar Expeditions:  Mania and Depression in American Culture. Princeton University Press, 2007. Martínez-​Hernáez, Angel. “Biomedical Psychiatry and Its Concealed Metaphors: An Anthropological Perspective.” Collegium Anthropologicum, vol. 37, no. 3, 2013, pp. 1019–​25. Mbembe, Achille. “Necropolitics.” Public Culture, vol. 15, no. 1, 2003, pp. 11–​40. McAllister, Mick. “Native Sources:  American Indian Autobiography.” Western American Literature, vol. 32 no. 1, 1997, pp. 3–​23. Project MUSE, doi:10.1353/​ wal.1997.0032. McGreal, Chris. American Overdose:  The Opioid Tragedy in Three Acts. Public Affairs, 2018. McMillen, Christian W. Discovering Tuberculosis:  A Global History, 1900 to the Present. Yale University Press, 2015. ——. “ ‘The Red Man and the White Plague’:  Rethinking Race, Tuberculosis, and American Indians, ca. 1890–​1950.” Bulletin of the History of Medicine, vol. 82 no. 3, 2008, pp. 608–​45. Project MUSE, doi:10.1353/​bhm.0.0094. Meier, Barry. Pain Killer:  An Empire of Deceit and the Origin of America’s Opioid Epidemic. Random House, 2018. Meland, Carter. “Talking Tribalography: LeAnne Howe Models Emerging Worldliness in ‘The Story of America’ and Miko Kings,” Studies in American Indian Literatures, vol. 26, no. 2, Summer 2014, pp. 26–​39. Melillo, Edward D. “Make No Bones About It:  The Need to Reform the Native American Graves Protection and Repatriation Act.” Quinnipiac Probation Law Journal, vol. 30, no. 2, 2017, pp. 149–​64. Meriam, Lewis, Ray A. Brown, Henry Roe Cloud, et  al., for the Institute for Government Research. The Problem of Indian Administration. Johns Hopkins University Press, 1928.

252

252 Bibliography Meyer, Melissa L. “American Indian Blood Quantum Requirements:  Blood Is Thicker than Family.” Over the Edge:  Remapping the American West, edited by Valerie J. Matsumoto and Blake Allmendinger, University of Berkeley Press, 1999, pp. 231–​49. ——. Thicker Than Water: The Origins of Blood as Symbol and Ritual. Routledge, 2005. Million, Dian. Therapeutic Nations: Healing in an Age of Indigenous Human Rights. University of Arizona Press, 2013. Miranda, Deborah A. Indian Cartography. Greenfield Review Press, 1999. Mihesuah, Devon. “Diabetes in Indian Territory: Revisiting Kelly M. West’s Theory of 1940.” American Indian Culture and Research Journal, vol. 40, no. 4, 2016, pp. 1–​21. EBSCOhost, doi:10.17953/​aicrj.40.4.mihesuah. ——. “Decolonizing Our Diets by Recovering Our Ancestors’ Gardens.” The American Indian Quarterly, vol. 27, no. 3&4, Summer/​Fall 2003, pp. 807–​39. ——. “Indigenous Health Initiatives, Frybread, and the Marketing of Nontraditional ‘Traditional’ American Indian Foods.” Native American and Indigenous Studies, vol. 3, no. 3, 2016, pp. 45–​69. Project MUSE, muse.jhu.edu/​article/​641379. ——. Recovering Our Ancestors’ Gardens: Indigenous Recipes and Guide to Diet and Fitness. University of Nebraska Press, 2005. Mihesuah, Devon A., editor. Natives and Academics: Researching and Writing About American Indians. University of Nebraska Press, 1998. ——. Repatriation Reader:  Who Owns American Indian Remains? University of Nebraska Press, 2000. Mihesuah, Devon A., and Elizabeth Hoover, editors. Indigenous Food Sovereignty in the United States:  Restoring Cultural Knowledge, Protecting Environments, and Regaining Health. Oklahoma University Press, 2019. Milburn, Michael P. “Indigenous Nutrition: Using Traditional Food Knowledge to Solve Contemporary Health Problems.” The American Indian Quarterly, vol. 28, no. 3&4, Summer/​Fall 2004, pp. 411–​34. JSTOR, www.jstor.org/​stable/​ 4138925. Minkler, Meredith, and Nina Wallerstein, editors. Community-​Based Participatory Research for Health: From Process to Outcomes. Josey-​Bass, 2008. Mitchell, David T., and Sharon L. Snyder, editors. The Body and Physical Difference: Discourses of Disability. University of Michigan Press, 1997. Momaday, N. Scott. House Made of Dawn. A Signet Book, 1968. ——. The Names: A Memoir. University of Arizona Press, 1976. ——. “The Man Made of Words.” Indian Voices: The First Convocation of American Indian Scholars. Indian Historian Press, 1970, pp. 49–​84. ——. “Personal Reflections.” The American Indian and the Problem of History, edited by Calvin Martin, Oxford University Press, 1987, pp. 156–​61. Mojica, Monique. “Stories from the Body: Blood Memory and Organic Texts.” Native American Performance and Representation, edited by S. E. Wilmer, University of Arizona Press, 2011, pp. 97–​109. Mooney, James. The Ghost-​Dance Religion and the Sioux Outbreak of 1890. University of Nebraska Press, 1991. Morange, Michel. The Misunderstood Gene, translated by Matthew Cobb, Harvard University Press, 2000. Moreton-​Robinson, Aileen. “Relationality: A Key Presupposition of an Indigenous Social Research Paradigm.” Sources and Methods in Indigenous Studies, edited by Chris O’Brien and Jean M. Andersen, Routledge, 2017, pp. 69–​77.

 253

Bibliography 253 ——. “Toward a New Research Agenda? Foucault, Whiteness, and Indigenous Sovereignty.” Journal of Sociology 42, no. 4, 2006, pp. 383–​95. https://​doi.org/​ 10.1177/​1440783306069995. Moreton-​Robinson, Aileen, editor. Critical Indigenous Studies: Engagements in First World Locations. University of Arizona Press, 2016. Morgensen, Scott Lauria. “The Biopolitics of Settler Colonialism:  Right Here, Right Now.” Settler Colonial Studies, vol. 1, no. 1, 2011, pp. 52–​76. doi:10.1080/​ 2201473X.2011.10648801. Morin, Peter. “This Is What Happens When We Perform the Memory of the Land.” Arts of Engagement: Taking Aesthetic Action In and Beyond the Truth and Reconciliation Commission in Canada, edited by Dylan Robinson and Keavy Martin, Wilfrid Laurier University Press, 2016, pp. 67–​91. Morgan, Lewis Henry. Ancient Society. 1985. University of Arizona Press, 1995. Rpt. of Ancient Society; or, Researches in the Lines of Human Progress from Savagery through Barbarism to Civilization. 1877. Mukherjee, Siddhartha. The Gene: An Intimate History. Scribner, 2016. Murphy, Joseph A. “Health Conditions Among the Indians.” Report of the Twenty-​ Ninth Annual Lake Mohonk Conference of Friends of the Indian and Other Dependent Peoples, October 18th, 19th and 20th, edited by Miss Lillian D.  Powers. Lake Mohonk Conference of Friends of the Indian and Other Dependent Peoples, 1911, pp.  41–​6. ——. “Manual on Tuberculosis: Its Cause, Prevention, and Treatment.” Washington: Government Printing Office, 1910. Murray, John F. “A Century of Tuberculosis.” American Journal of Respiratory and Critical Care Medicine, vol. 169, 2004, pp. 1181–​6. Nadeau, Denise, and Alannah Earl Young. “Restoring Sacred Connection with Native Women in the Inner City.” Religion and Healing in Native America: Pathways for Renewal, edited by Suzanne J. Crawford O’Brien, Praeger, 2008, pp. 115–​34. National Tuberculosis Association. Committee on Tuberculosis among the North American Indians. Tuberculosis Among the North American Indians:  Report of a Committee of the National Tuberculosis Association. 67th Cong., 4th Sess. Washington: Government Printing Office, 1923. Nelkin, Dorothy and M. Susan Lindee. The DNA Mystique: The Gene as a Cultural Icon. Freeman, 1995. Newcomer, John W. et  al. “Expected Side-​Effect Profile of Medications and Their Management.” Handbook of Bipolar Disorder:  Diagnosis and Therapeutic Approaches, edited by Siegfried Kasper and Robert M.  A. Hirschfeld, Taylor & Francis, 2005, pp. 369–​94. Nielsen, Marianne, and Karen Jarratt-​Snider. Crime and Social Justice in Indian Country. University of Arizona Press, 2018. Niezen, Ronald. The Origins of Indigenism: Human Rights and the Politics of Identity. University of California Press, 2003. Noodin, Margaret. Review of LaRose, by Louise Erdrich. Native American and Indigenous Studies, vol. 5 no. 1, 2018, pp. 223–​5. Project MUSE, https://​muse.jhu. edu/​article/​704751. Norgaard, Kari Marie, Ron Reed, and Carolina Van Horn. “A Continuing Legacy:  Institutional Racism, Hunger, and Nutritional Justice on the Klamath.” Cultivating Food Justice:  Race, Class, and Sustainability, edited by Alison Hope Alkon and Julian Agyeman, The MIT Press, 2011, pp. 23–​46.

254

254 Bibliography O’Brien, Chris, and Jean M. Andersen, editors. Sources and Methods in Indigenous Studies. Routledge, 2017. Omura, Emily. “Mino-​ Miijim’s ‘Good Food for the Future’:  Beyond Culturally Appropriate Diabetes Programs.” Indigenous Peoples and Diabetes:  Community, Empowerment and Wellness, edited by Mariana Leal Ferreira and Gretchen Chesley Lang, Carolina Academic Press, 2006, pp. 139–​65. Orr, Jackie. Panic Diaries:  A Genealogy of Panic Disorder. Duke University Press, 2006. Ortiz, Simon J. “Towards a National Indian Literature:  Cultural Authenticity in Nationalism. MELUS vol. 8, no. 2, Summer 1981, pp. 7–​12. JSTOR, www.jstor. org/​stable/​467143. Ott, Katherine. Fevered Lives: Tuberculosis in American Culture since 1870. Harvard University Press, 1996. Owsley, Douglas, and Richard L. Jantz. Kennewick Man: The Scientific Investigation of an Ancient American Skeleton. Texas A&M University Press, 2014. Paige, Amanda L., Fuller L. Bumpers, and Daniel F. Littlefield, Jr. Chickasaw Removal. Chickasaw Press, 2010. Paradies, Yin, M. J. Montoya, and Stephanie M. Fullerton. “Racialized Genetics and the Study of Complex Diseases:  The Thrifty Genotype Revisited.” Perspectives in Biology and Medicine, vol. 50, no. 2, Spring 2007, pp. 203–​27. Project MUSE, doi:10.1353/​pbm.2007.0020. Paris, Joel, and James Phillips, editors. Making the DSM-​5: Concepts and Controversies. Springer, 2013. Parke, Julia C. “John Croghan.” The Encyclopedia of Louisville, edited by John E. Kleber et al., University Press of Kentucky, 2001, pp. 232–​3. Parker, Gordon, et  al. “Revising Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Criteria for the Bipolar Disorders: Phase I of the AREDOC Project.” Australian & New Zealand Journal of Psychiatry, vol. 52, no. 12, December 2018, pp. 1173–​82. EBSCOhost, doi:10.1177/​0004867418808382. Parker, Sarah, and Wilson Kaiser. “Native American Literature and L’Écriture Féminine: The Case of Louise Erdrich.” Tulsa Studies in Women’s Literature, vol. 36 no. 1, 2017, pp. 151–​73. Project MUSE, doi:10.1353/​tsw.2017.0015. Parman, Donald L. Indians and the American West in the Twentieth Century. Indiana University Press, 1994. Peacock, Thomas, and Marlene Wisuri. Ojibwe. Waasa Inaabidaa:  We Look in All Directions. Afton Historical Society Press, 2008. Pensley, D. S. “The Native American Graves Protection and Repatriation Act (1990): Where the Native Voice Is Missing.” Wicazo Sa Review, vol. 20, no. 2, Fall 2005, pp. 37–​65. Project MUSE, doi:10.1353/​wic.2005.0025. Petrillo, Larissa, and Melda Trejo. “Figuring It Out:  Sundacning and Storytelling in the Lakota Tradition.” Religion and Healing in Native America:  Pathways for Renewal, edited by Suzanne J. Crawford O’Brien, Praeger, 2008, pp. 91–​111. Perez, Georgia. Knees Lifted High. Rockville, MD: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, Division of Diabetes Translation, National Diabetes Prevention Center, 2005. ——. Plate Full of Color. Rockville, MD: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, Division of Diabetes Translation, Native Diabetes Wellness Program, 2006.

 255

Bibliography 255 ——. Through the Eyes of the Eagle. Rockville, MD:  U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, Division of Diabetes Translation, National Diabetes Prevention Center, 2004. ——. Tricky Treats. Rockville, MD:  U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, Division of Diabetes Translation, Native Diabetes Wellness Program, 2006. Peterson, Nancy J. “The Poetics of Tribalism in Sherman Alexie’s The Summer of Black Widows.” Sherman Alexie:  A Collection of Critical Essays, edited by Jeff Berglund and Jan Roush, University of Utah Press, 2010, pp. 134–​58. Philip, Kenneth R. John Collier’s Crusade for Indian Reform, 1920–​1954. University of Arizona Press, 1977. Piatote, Beth H. Domestic Subjects: Gender, Citizenship, and Law in Native American Literature. Yale University Press, 2013. ——. “The Indian/​Agent Aporia.” Studies in American Indian Literatures, vol. 25 no. 2, 2013, pp. 45–​62. Project MUSE, muse.jhu.edu/​article/​515531. Pope, Saxton T. 1875–​1926. The Medical History of Ishi. University of California Press, 1920. Poland, Jeffrey, and Serife Tekin, editors. Extraordinary Science and Psychiatry: Responses to the Crisis in Mental Health Research. The MIT Press, 2017. Poremski, Karen M. “Voicing the Bones: Heid Erdrich’s Poetry and the Discourse of NAGPRA.” Studies in American Indian Literatures, vol. 27 no. 1, 2015, pp. 1–​32. Project MUSE, muse.jhu.edu/​article/​584397. Porter, Joy, and Kenneth M. Roemer, editors. The Cambridge Companion to Native American Literature. Cambridge University Press, 2005. Porter, Roy. The Greatest Benefit to Mankind:  A Medical History of Humanity. Norton, 1997. Powers, Marla N. Oglala Women: Myth, Ritual, and Reality. University of Chicago Press, 1986. Powers-​Beck, Jeffrey. The American Indian Integration of Baseball. University of Nebraska Press, 2004. Pratt, Richard Henry. “The Advantages of Mingling Indians with Whites.” Americanizing the American Indians: Writings by the “Friends of the Indian,” 1880–​ 1900, edited by Francis Paul Prucha, Harvard University Press, 1973, pp. 260–​71. Prescott, Heather Munro. “The White Plague Goes to College: Tuberculosis Prevention Programs in Colleges and Universities, 1920–​ 1960.” Bulletin of the History of Medicine, vol. 74, no. 4, Winter 2000, pp. 735–​72. Project MUSE, doi:10.1353/​ bhm.2000.0194. Purdy, John. “A Conversation with Sherman Alexie.” Studies in American Indian Literatures, vol. 9, no. 4, Winter 1997, pp. 1–​18. Rader, Dean. “The Poetry of Participation:  On the Work of Heid Erdrich.” Cell Traffic: New and Selected Poems, by Heid E. Erdrich. University of Arizona Press, 2012, pp. xi–​xvi. Ralston-​ Lewis, Marie. “The Continuing Struggle Against Genocide:  Indigenous Women’s Reproductive Rights.” Wicazo Sa Review, vol. 20, no. 1, Spring 2005, pp. 71–​95. JSTOR, www.jstor.org/​stable/​4140251. Ramenofsky, Ann F., Alicia K. Wilbur, and Anne C. Stone. “Native American Disease History:  Past, Present, and Future Directions.” World Archeology, vol. 35, no. 3, October 2003, pp. 241–​57. JSTOR, www.jstor.org/​stable/​3560225.

256

256 Bibliography Ramos, Marco A. “Psychiatry, Authoritarianism, and Revolution:  The Politics of Mental Illness During Military Dictatorships in Argentina, 1966–​1983.” Bulletin of the History of Medicine, vol. 87 no. 2, 2013, pp. 250–​78. Project MUSE, doi:10.1353/​ bhm.2013.0029 Rao, Radhika. “Property, Privacy, and the Human Body.” Boston University Law Review, vol. 80, no. 2, April 2000, pp. 359–​460. Rapoport, Sarah. “Rosalind Franklin: The Unsung Hero of the DNA Revolution.” The History Teacher, vol.36, no., 1, 2002, pp. 116–​27. JSTOR, www.jstor.org/​stable/​ 23183371. Rasmussen, Morten, et al. “The Ancestry and Affiliations of the Kennewick Man.” Nature, vol. 523, pp. 455–​64. EBSCOhost, doi:10.1038/​nature14625. Reardon, Jenny. Race to the Finish: Identity and Governance in an Age of Genomics. Princeton University Press, 2009. Reardon, Jenny and Kim TallBear. “ ‘Your DNA Is Our History’:  Genomics, Anthropology, and the Construction of Whiteness as a Property.” Current Anthropology, vol.53, no. S5, The Biological Anthropology of Living Human Populations: World Histories, National Styles, and International Networks, April 2012, pp. S233–​S245. Refsum, Erling. Thoracoplasty in the Treatment of Cavernous Tuberculosis of the Lung; a Clinical-​Statistical Study of the Late Results. Acta Tuberculosea Scandinavica. Supplementum: 29. Copenhagen: Munksgaard, 1951. Reich, Rebecca. State of Madness:  Psychiatry, Literature, and Dissent After Stalin. Northern Illinois University Press, 2018. Reilly, Philip. The Surgical Solution: A History of Involuntary Sterilization in the United States. Johns Hopkins University Press, 1991. Research and Markets. “Global Depression Drug Market Report 2014–​2020 Analysis, Technologies & Forecasts  –​Key Vendors:  Forest Labs, AstraZeneca, Naurex  –​ Research and Markets.” Business Wire (English), 2016 Summer 7AD. Reverby, Susan M. Examining Tuskegee: The Infamous Syphilis Study and Its Legacy. University of North Carolina Press, 2013. Reyhner, Jon, and Jeanne Eder. American Indian Education: A History. University of Oklahoma Press, 2017. Rhadigan, Ryan Joseph. “Moving Bodies: Sovereignty, Science, and Indigenous Ontology in the Poetry of Heid Erdrich.” MA Thesis. University of California, Los Angeles, 2013. Rhodes, Rosamond, et al., editors. The Blackwell Guide to Medical Ethics. Blackwell Publishing, 2007. Rifkin, Mark. “Indigenizing Agamben:  Rethinking Sovereignty in Light of the ‘Peculiar’ Status of Native Peoples.” Cultural Critique, no. 73, 2009, pp. 88–​124. Rios, Theodore, and Kathleen Mullen Sands. Telling a Good One: The Process of a Native American Collaborative Biography. University of Nebraska Press, 2000. Robinson, Dylan, and Keavy Martin, editors. Arts of Engagement: Taking Aesthetic Action In and Beyond the Truth and Reconciliation Commission in Canada. Wilfrid Laurier University Press, 2016. Romero, Channette. “Expanding Tribal Identities and Sovereignty Through LeAnne Howe’s ‘Tribalography.’ ” Studies in American Indian Literatures, vol. 26, no. 2, Summer 2014, pp. 13–​25. Project MUSE, muse.jhu.edu/​article/​548051. Rosenkrantz, Barbara Gutmann, editor. From Consumption to Tuberculosis:  A Documentary History. Garland Publishing, 1994.

 257

Bibliography 257 Rother, Larry. “In the Amazon, Giving Blood But Getting Nothing.” New York Times, June 20, 2007. Accessed May 2, 2019. Roof, Judith. The Poetics of DNA. University of Minnesota Press, 2007. Rose, Nikolas. The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-​First Century. Princeton University Press, 2007. Rose Nikolas, and Joelle M. Abi-​Rached. Neuro:  The New Brain Sciences and the Management of the Mind. Princeton University Press, 2013. Rothman, Sheila M. Living in the Shadow of Death:  Tuberculosis and the Social Experience of Illness in American History. Basic Books, 1994. Sahota, Puneet Chawla. “Genetic Histories:  Native Americans’ Accounts of Being at Risk for Diabetes.” Social Studies of Science, vol. 42, no. 6, 2012, pp. 821–​42. JSTOR, www.jstor.org/​stable/​41721362. Salmón, Enrique. Eating the Landscape: American Indian Stories of Food, Identity, and Resilience. University of Arizona Press, 2012. Samuel, Lawrence R. Shrink:  A Cultural History of Psychoanalysis in America. University of Nebraska Press, 2013. Samuels, Ellen. Fantasies of Identification:  Disability, Gender, Race. New  York University Press, 2014. Sands, Kathleen Mullen. “Collaboration or Colonialism: Text and Process in Native American Women’s Autobiographies.” MELUS, vol. 22, no. 4, 1997, pp. 39–​59. JSTOR, www.jstor.org/​stable/​467988. Santos, LorrieAnn. “Genetic Research in Native Communities.” Progress in Community Health Partnerships:  Research, Education, and Action, vol. 2, no. 4, Winter 2004, pp. 321–​7. Project MUSE, doi:10.1353/​cpr.0.0046. Sarris, Greg. Keeping Slug Woman Alive:  A Holistic Approach to American Indian Texts. University of California Press, 1993. Scarry, Elaine. The Body in Pain:  The Making and Unmaking of the World. Oxford University Press, 1987. Schacht, Miriam. “Game of Silence:  Indian Boarding Schools in Louise Erdrich’s Novels.” Studies in American Indian Literatures, vol. 27, no. 2, Summer 2015, pp. 62–​79. Project MUSE, muse.jhu.edu/​article/​587819. Scheder, Jo C. “A Sickly-​Sweet Harvest: Farmworker Diabetes and Social (In)Equality.” Indigenous Peoples and Diabetes: Community, Empowerment and Wellness, edited by Mariana Leal Ferreira and Gretchen Chesley Lang, Carolina Academic Press, 2006, pp. 279–​312. ——. “The Spirit’s Cell: Reflections on Diabetes and Political Meaning.” Indigenous Peoples and Diabetes: Community, Empowerment and Wellness, edited by Mariana Leal Ferreira and Gretchen Chesley Lang, Carolina Academic Press, 2006, pp. 335–​55. Scheper-​Hughes, Nancy. “Ishi’s Brain, Ishi’s Ashes: Reflections on Anthropology and Genocide.” Ishi in Three Centuries, edited by Karl Kroeber and Clifton Kroeber, University of Nebraska Press, 2003, pp. 99–​131. Schiff, Sarah Eden. “Power Literature and the Myth of Racial Memory.” Modern Fiction Studies, vol. 57, no. 1, Spring 2011, pp. 96–​122. Project MUSE, doi:10.1353/​ mfs.2011.0010. Schneider Eileen. “Tuberculosis Among American Indians and Alaska Natives in the United States, 1993–​2002.” American Journal of Public Health, vol. 95, no. 5, May 2005, pp. 873–​80. EBSCOhost, doi:10.2105/​AJPH.2004.052456.

258

258 Bibliography Schoolcraft, Henry. Historical And Statistical Information Respecting The History, Condition, And Prospects Of The Indian Tribes Of The United States. Lippincott, Grambo, 1851–​57. Scull, Andrew. Madness in Civilization:  A Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine. Princeton University Press, 2015. Sergent, Claire. “Notre Dame Fire:  Parisians Mourn the Loss of Their Beloved Cathedral After ‘Terrible’ Tragedy.” Independent, April 16, 2019. Accessed April 30, 2019. Shorter, David Delgado. “Spirituality.” The Oxford Handbook of American Indian History, edited by Frederick E. Hoxie, Oxford University Press, 2016, pp. 433–​52. Silko, Leslie Marmon. Almanac of the Dead. 1991. Penguin Books, 1992. ——. Ceremony. 1977. Penguin Books, 1986. Silliman, Jael, and Anannya Bhattacharjee, editors. Policing the National Body: Race, Gender, and Criminalization. South End Press, 2002. Silva, Cristobal. Miraculous Plagues: An Epidemiology of Early New England Narrative. Oxford University Press, 2011. Simpson, Audra. Mohawk Interruptus:  Political Life across the Borders of Settler States. Duke University Press, 2014. Simpson, Betasamosake Leanne. As We Have Always Done:  Indigenous Freedom Through Radical Resistance. University of Minnesota Press, 2017. Smith, Andrea. “Better Dead than Pregnant:  The Colonization of Native Women’s Reproductive Health.” Policing the National Body: Race, Gender, and Criminalization, edited by Jael Silliman and Anannya Bhattacharjee, South End Press, 2002, pp. 123–​46. ——. “Boarding School Abuses, Human Rights, and Reparations.” Social Justice, vol. 31, no. 4, 2004, pp. 89–​102. JSTOR, www.jstor.org/​stable/​29768278. ——. Conquest: Sexual Violence and American Indian Genocide. South End Press, 2005. Smith, Cynthia J., Elaine M. Manahan, and Sally G. Pablo. “Food Habit and Cultural Changes Among the Pima Indians.” Diabetes as a Disease of Civilization:  The Impact of Culture Change on Indigenous Peoples, edited by Jennie R. Joe and Robert S. Young, Mouton de Gruyter, 1994, pp. 407–​33. Smith, Linda Tuhiwai. Decolonizing Methodologies: Research and Indigenous Peoples. Zed Books Ltd, 1999. Smith-​Morris, Carolyn M. “Reducing Diabetes in Indian Country: Lessons from the Three Domains Influencing Pima Diabetes.” Human Organization, vol. 63, no. 1, 2004, pp. 34–​46. JSTOR, www.jstor.org/​stable/​44126989. Sontag, Susan. Illness as Metaphor. Farrar, Straus, and Giroux, 1978. Spanos, Brittany. “#FreeBritney:  Understanding the Fan-​ led Britney Spears Movement.” Rolling Stone, May 9, 2019. Accessed June 5, 2019. Sprayberry, Sandra L. Review of Madonna Swan: A Lakota Woman’s Story, As Told Through Mark St. Pierre. Studies in American Indian Literatures, vol. 2, no. 5, Spring 1993, pp. 110–​2. JSTOR, doi:136.152.143.67. Squint, Kirstin L. “Choctawan Aesthetics, Spirituality, and Gender Relations:  An Interview with LeAnne Howe.” MELUS, vol. 35, no. 3, Fall 2010, pp. 211–​24. Project MUSE, doi:10.1353/​mel.2010.0009.

 259

Bibliography 259 St. Jean, Wendy. Remaining Chickasaw in Indian Territory, 1830s–​1907. University of Alabama Press, 2011. ——. “Trading Paths:  Mapping Chickasaw History in the Eighteenth Century.” American Indian Quarterly, vol. 27, no. 3&4, Summer & Fall 2003, pp. 758–​80. Project MUSE, doi:10.1353/​aiq.2004.0085. St. Pierre, Mark. Madonna Swan: A Lakota Woman’s Story, As Told Through Mark St. Pierre. University of Oklahoma Press, 1991. Stanford, Ann Folwell. Bodies in a Broken World: Women Novelists of Color and the Politics of Medicine. University of North Carolina Press, 2003. Starn, Orin. Ishi’s Brain: In Search of America’s Last “Wild” Indian. Norton, 2004. “Statistics about Diabetes.” American Diabetes Association. http://​www.diabetes.org/​ diabetes-​basics/​statistics/​. “Stevens-​Johnson Syndrome.” Mayo Clinic. www.mayoclinic.org/​diseases-​conditions/​ stevens-​johnson-​syndrome/​symptoms-​causes/​syc-​20355936. Stirrup, David. Louise Erdrich. Manchester University Press, 2010. Stote, Karen. An Act of Genocide:  Colonialism and the Sterilization of Aboriginal Women. Fernwood Publishing, 2015. Strong, Pauline Turner, and Barrik Van Winkle. “ ‘Indian Blood’:  Reflections on the Reckoning and Refiguring Native North American Identity.” Cultural Anthropology, vol. 11, no. 4, November 1996, pp. 547–​76. JSTOR, www.jstor.org/​ stable/​656667. Sturm, Circe. Becoming Indian:  The Struggle Over Cherokee Identity in the Twenty-​ First Century. School for Advanced Research Press, 2010. ——. Blood Politics: Race, Culture, and Identity in the Cherokee Nation of Oklahoma. University of Berkeley Press, 2002. Sugarbaker, David J., et al., editors. Adult Chest Surgery. 2nd ed., McGrow Hill, 2015. Oliphant v. Suquamish Indian Tribe, 435 U.S. 191 (1978). Szasz, Margaret Connell. Indian Education in the American Colonies, 1607–​1783. University of New Mexico Press, 1988. Talaga, Tanya. All Our Relations:  Finding the Path Forward. House of Anansi Press, 2018. Talahongva, Patty. “No More ‘Die Bread’: How Boarding Schools Impacted Native Diet and the Resurgence of Indigenous Food Sovereignty.” Journal of American Indian Education, vol. 57, no. 1, 2018, pp. 145–​ 53. EBSCOhost, doi:10.5749/​ jamerindieduc.57.1.0145. TallBear, Kim. “Dear Indigenous Studies, It’s Not Me, It’s You” Why I  Left and What Needs to Change.” Critical Indigenous Studies:  Engagements in First World Locations, edited by Aileen Moreton-​Robinson, University of Arizona Press, 2016, pp.  69–​82. ——. “DNA, Blood, and Racializing of the Tribe.” Wicazo Sa Review, vol. 18, no. 1, Spring 2003, pp. 81–​107. Project MUSE, doi:10.1353/​wic.2003.0008. ——. “Genomic Articulations of Indigeneity.” Social Studies of Science, vol. 43, no. 4, 2013, pp. 509–​33. JSTOR, www.jstor.org/​stable/​43284191. ——. Native American DNA:  Tribal Belonging and the False Promise of Genetic Science. University of Minnesota Press, 2013. Tan, Xiao-​Wei, et al. “Fetal Microchimerism in the Maternal Mouse Brain: A Novel Population of Fetal Progenitor or Stem Cells Able to Cross the Blood-​ Brain Barrier?” Stem Cells, vol. 23, no. 10, pp. 1443–​52.

260

260 Bibliography Teller, Michael E. The Tuberculosis Movement:  A Public Health Campaign in the Progressive Era. Greenwood Press, 1988. Teuton, Christopher B. “Theorizing American Indian Literature:  Applying Oral Concepts to Written Tradition.” Reasoning Together: The Native Critics Collective, edited by Craig S. Womack, Daniel Heath Justice, and Christopher B. Teuton, University of Oklahoma Press, 2008, pp. 193–​215. Teuton, Sean Kicummah. Red Land, Red Power: Grounding Knowledge in the American Indian Novel. Duke University Press, 2008. Teves, Stephanie Nohelani, Andrea Smith, and Michelle H. Raheja, editors. Native Studies Keywords. University of Arizona Press, 2015. Thachuk, Angela K. “Stigma and the Politics of Biomedical Models of Mental Illness.” IJFAB: International Journal of Feminist Approaches to Bioethics, vol. 4 no. 1, 2011, pp. 140–​63. Project MUSE, muse.jhu.edu/​article/​426255. Thiher, Allen. Revels in Madness: Insanity in Medicine and Literature. University of Michigan Press, 1999. Thomas, Philip, Pat Bracken, and Sami Timimi. “The Limits of Evidence-​Based Medicine in Psychiatry.” Philosophy, Psychiatry, & Psychology, vol. 19 no. 4, 2012, pp. 295–​308. Project MUSE, muse.jhu.edu/​article/​502310. Thomas, Samuel W., et  al. “A History of Mammoth Cave, Emphasizing Tourist Development and Medical Experimentation Under Dr.  John Croghan.” The Register of the Kentucky Historical Society, vol. 68, no. 4, October 1970, pp. 319–​40. JSTOR, www.jstor.org/​stable/​23377230. Thornton, Russell. “Tribal Membership Requirements and the Demography of ‘Old’ and ‘New’ Native Americans.” Population Research and Policy Review, vol. 16, no. 1/​ 2, Demography of American Indians and Alaska Natives, April 1997, pp. 33–​42. JSTOR, www.jstor.org/​stable/​40230131. ——. We Shall Live Again: The 1870 and 1890 Ghost Dance Movements as Demographic Revitalization. Cambridge University Press, 1986. Thomas, David Hurst. Skull Wars: Kennewick Man, Archaeology, and the Battle for Native American Identity. Basic Books, 2000. Thornton, Russell, editor. Studying Native America:  Problems and Perspectives. University of Wisconsin Press, 1998. Tillett, Rebecca. Otherwise, Revolution! Leslie Marmon Silko’s Almanac of the Dead. Bloomsbury Academic, 2018. Tillett, Rebecca, editor. Howling for Justice:  New Perspectives on Leslie Marmon Silko’s Almanac of the Dead. University of Arizona Press, 2014. Tomes, Nancy. “Epidemic Entertainments:  Disease in Popular Culture in Early-​ Twentieth-​Century America.” American Literary History, vol. 14, no. 4, Winter 2002, pp. 625–​52. ——. The Gospel of Germs: Men, Women, and the Microbe in American Life. Harvard University Press, 1998. Torpy, Sally J. “Native American Women and Coerced Sterilization: On the Trail of Tears in the 1970s.” American Indian Culture and Research Journal, vol. 24, no. 2, 2000, pp. 1–​22. Trafzer, Clifford E., Jean A. Keller, and Lorene Sisquoc. “Introduction:  Origin and Development of the American Indian Boarding School System.” Boarding School Blues: Revisiting American Indian Educational Experiences, edited by Clifford E. Trafzer, Jean A. Keller, and Lorene Sisquoc, University of Nebraska Press, 2006, pp. 1–​33.

 261

Bibliography 261 Trafzer, Clifford E., Jean A. Keller, and Lorene Sisquoc, editors. Boarding School Blues: Revisiting American Indian Educational Experiences. University of Nebraska Press, 2006. Trauger, Amy. “Putting Food Sovereignty in Place.” Food Sovereignty in International Context: Discourse, Politics and Practice of Place, edited by Amy Trauger, Routledge, 2015, pp. 1–​12. ——. We Want Land to Live: Making Political Space for Food Sovereignty. University of Georgia Press, 2017. Trauger, Amy, editor. Food Sovereignty in International Context:  Discourse, Politics and Practice of Place. Routledge, 2015. Trennert, Robert A. “The Federal Government and Indian Health in the Southwest:  Tuberculosis and the Phoenix East Farm Sanatorium, 1909–​1955.” Pacific Historical Review, vol. 65, no. 1, February 1996, pp. 61–​84. JSTOR, www. jstor.org/​stable/​3640827. Treon, Frederick. “Consumption Among the Sioux Indians.” The Cincinnati-​Lancet Clinic, vol. 62, August 10, 1889, 148–​54. Treuer, David. Rez Life:  An Indian’s Journey through Reservation Life. Atlantic Monthly Press, 2012. Trope, Jack F. “The Case for NAGPRA.” Accomplishing NAGPRA: Perspectives on the Intent, Impact, and Future of the Native American Graves Protection and Repatriation Act, edited by Sangita Chari and Jaime N. Lavallee, Oregon State University Press, 2013, pp. 19–​54. Tsosie, Rebecca. “Cultural Challenges to Biotechnology:  Native American Genetic Resources and the Concept of Cultural Harm.” Journal of Law, Medicine & Ethics, vol. 35, no. 3, September 2007, pp. 396–​411. EBSCOhost, doi:10.1111/​ j.1748-​720X.2007.00163.x. ——. “Indigenous Peoples and Epistemic Injustice:  Science, Ethics, and Human Rights.” Washington Law Review, vol. 87, no. 4, 2012, pp. 1133–​2012. ——. “Introduction: Symposium on Cultural Sovereignty.” Arizona State Law Journal, vol. 34, no. 1, Spring 2002, pp. 1–​14. “Tuberculosis.” World Health Organization. www.who.int/​en/​news-​room/​fact-​sheets/​ detail/​tuberculosis. Accessed December 12, 2018. Tuck, Eve. “Breaking Up with Deleuze:  Desire and Valuing the Irreconcilable.” International Journal of Qualitative Studies in Education (QSE), vol. 23, no. 5, Sept. 2010, pp. 635–​50. Tucker, Todd. The Great Starvation Experiment: Ancel Keys and the Men Who Starved for Science. University of Minnesota Press, 2007. Turner, Sarah E. “ ‘Spider Woman’s Granddaughter’:  Autobiographical Writings by Native American Women.” MELUS, vol. 22, no. 4, 1997, pp. 109–​32. JSTOR, www. jstor.org/​stable/​467992. Twomey, Tish Eshelle. “More Than One Way to Tell a Story:  Rethinking the Place of Genre in Native American Autobiography and the Personal Essay.” Studies in American Indian Literatures, vol. 19, no. 2, 2007, pp. 22–​51. Project MUSE, doi:10.1353/​ail.2007.0019. United Nations. United Nations Declaration of the Rights of Indigenous Peoples. New York: United Nations, 2007. www.un.org/​development/​desa/​indigenouspeoples/​ wp-​content/​uploads/​sites/​19/​2018/​11/​UNDRIP_​E_​web.pdf. Accessed January 23, 2019.

262

262 Bibliography Updegrave, Samantha Claire. “My Body Is a Book of Rules.” Bitch Magazine: Feminist Response to Pop Culture, no. 64, Fall 2014, pp. 62–​3. U.S. v. Kagama, 118 U.S. 375 (1886). Valandra, Edward Charles. “The As-​Told-​To Native [Auto]biography:  Whose Voice Is Speaking?” Wicazo Sa Review, vol. 20 no. 2, 2005, pp. 103–​19. Project MUSE, doi:10.1353/​wic.2005.0027. Van Dijck, José. The Transparent Body:  A Cultural Analysis of Medical Imaging. University of Washington Press, 2005. Vantrease, Dana. “Commod Bods and Frybread Power:  Government Food Aid in American Indian Culture.” Journal of American Folklore, vol. 126, no. 499, Winter 2013, pp. 55–​69. JSTOR, www.jstor.org/​stable/​10.5406/​jamerfolk.126.499.0055. Vizenor, Gerald. Crossbloods: Bone Courts, Bingo, and Other Reports. University of Minnesota Press, 1990. ——. “Mister Ishi:  Analogies of Exile, Deliverance, and Liberty.” Ishi in Three Centuries, edited by Karl Kroeber and Clifton Kroeber, University of Nebraska Press, 2003, pp. 363–​72. ——. Manifest Manners: Narratives on Postindian Survivance. University of Nebraska Press, 1994. ——. Native Liberty: Natural Reason and Cultural Survivance. University of Nebraska Press, 2009. Voss, Richard W., Victor Douville, Alex Little Soldier, and Albert White Hat, Sr. “Wo’Lakol Kiciyapi:  Traditional Philosophies of Helping and Healing Among the Lakotas:  Toward a Lakota-​ Centric Practice of Social Work.” Journal of Multicultural Social Work, vol. 7, no. 1–​2, pp. 73–​93. Taylor & Francis Online, doi:10.1300/​J285v07n01_​05. Vrettos, Athena. Somatic Fictions:  Imagining Illness in Victorian Culture. Stanford University Press, 1995. Waggoner, Jess. “ ‘My Most Humiliating Jim Crow Experience’:  Afro-​ Modernist Critiques of Eugenics and Medical Segregation.” Modernism/​modernity, vol. 24, no. 3, September 2017, pp. 507–​25. Project MUSE, doi:10.1353/​mod.2017.0057. Wagner, Jennifer K. “Interpreting the Implications of DNA Ancestry Tests.” Perspectives in Biology and Medicine, vol. 53, no. 2, Spring 2010, pp. 231–​48. Wallerstein, Nina, and Bonnie Duran et al., editors. Community-​Based Participatory Research for Health: Advancing Social and Health Equity. Josey-​Bass, 2018. Walker, James R. Lakota Society, edited by Raymond J. DaMallie, University of Nebraska Press, 1982. Wallace, Cynthia R. “A Cloud of Unknowing:  Agonistic Anticolonial Ethics in Louise Erdrich’s The Last Report on the Miracles at Little No Horse.” Contemporary Literature, vol. 59 no. 4, 2018, pp. 447–​79. Project MUSE, muse.jhu.edu/​article/​ 734809. Wallace, Mark. “Black Hawk’s ‘An Autobiography’:  The Production and Use of an ‘Indian’ Voice.” American Indian Quarterly, vol. 18, no. 4, 1994, pp. 481–​94. EBSCOhost, doi:10.2307/​1185393. Walters, Karina L., et al. “Bodies Don’t Just Tell Stories, They Tell Histories: Embodiment of Historical Trauma Among American Indians and Alaska Natives.” Du Bois Review vol. 8, no. 1, pp. 179–​89. EBSCOhost, doi:10.1017/​S1742058X1100018X. Warne, Donald, and Denise Lajimodiere. “American Indian Health Disparities:  Psychosocial Influences.” Social & Personality Psychology Compass, vol. 9, no. 10, Oct. 2015, pp. 567–​79. EBSCOhost, doi:10.1111/​spc3.12198.

 263

Bibliography 263 Warren, William W. History of the Ojibway People. 1885. Minnesota Historical Society Press, 1984. Warrior, Robert Allen. Tribal Secrets:  Recovering American Indian Intellectual Traditions. University of Minnesota Press, 1995. ——. “Your Skin Is the Map: The Theoretical Challenge of Joy Harjo’s Erotic Poetics.” Reasoning Together. The Native Critics Collective, edited by Craig S. Womack, Daniel Heath Justice, and Christopher B. Teuton, University of Oklahoma Press, 2008, pp. 340–​52. Washington, Harriet A. Medical Apartheid:  The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. Doubleday, 2006. Washburn, Frances. Elsie’s Business. University of Nebraska Press, 2006. ——. The Sacred White Turkey. University of Nebraska Press, 2010. Washuta, Elissa. My Body Is a Book of Rules. Red Hen Press, 2014. ——. Starvation Mode: A Memoir of Food, Consumption, and Control. Instant Future –​ Future Tense Books, 2015. Watt, Elizabeth, and Emma Kowal, “What’s at Stake? Determining Indigeneity in the Era of DIY DNA.” New Genetics & Society, vol. 38, no. 2, June 2019, pp. 142–​64. EBSCOhost, doi:10.1080/​14636778.2018.1559726. Watts, Vanessa. “Indigenous Place-​ Thought & Agency Amongst Humans and Non-​Humans (First Woman and Sky Woman Go on a European World Tour!).” Decolonization: Indigeneity, Education & Society, vol. 2, no. 1, 2013, pp. 20–​34. Weaver, Jace. “Indian Presence with No Indians Present:  NAGPRA and Its Discontents.” Wicazo Sa Review, vol. 12, no. 2, Autumn, 1997, pp. 13–​ 30. JSTORE: www.jstor.org/​stable/​1409204. ——. Other Words:  American Indian Literature, Law, and Culture. University of Oklahoma Press, 2001. ——. That the People Might Live: Native American Literatures and Native American Community. Oxford University Press, 1997. Weaver, Jace, Craig S. Womack, and Robert Warrior. American Indian Literary Nationalism. University of New Mexico Press, 2005. Wendell, Susan. The Rejected Body: Feminist Philosophical Reflections on Disability. Routledge, 1996. Whitbeck, Les B., Gary W. Adams, and Dan R. Hoyt. “Conceptualizing and Measuring Historical Trauma Among American Indian People.” American Journal of Community Psychology, vol. 33, no. 3–​4, 2004, pp. 119–​30. Whitt, Laurelyn. Science, Colonialism, and Indigenous Peoples: The Cultural Politics of Law and Knowledge. Cambridge University Press, 2009. Wiggins, Kyle, editor. American Revenge Narratives: A Collection of Critical Essays. Palgrave Macmillan, 2018. Wilbur, Rachel E., Steven M. Corbett, and Jeanne A. Drisko. “Tuberculosis Morbidity at Haskell Institute Boarding School for Native American Youth, 1910–​ 1940: Impacts of Historical and Existing Social Determinants of Health.” Annals of Anthropological Practice, vol. 40, no. 1, 2016, pp. 106–​14. EBSCOhost, doi:10.1111/​ napa.12092. Wilkins, David E., and Tsianina Lomawaima. Uneven Ground:  American Indian Sovereignty and Federal Law. University of Oklahoma Press, 2001. Wilmer, S. E., editor. Native American Performance and Representation. University of Arizona Press, 2011.

264

264 Bibliography Wilson, Waziyatawin Angela, and Michael Yellow Bird, editors. For Indigenous Eyes Only: A Decolonization Handbook. School of American Research, 2005. Wilson, Shawn. Research Is Ceremony:  Indigenous Research Methods. Fernwood Publishing, 2008. Wisecup, Kelly. Medical Encounters:  Knowledge and Identity in Early American Literatures. University of Massachusetts Press, 2013. Womack, Craig S. Red on Red: Native American Literary Separatism. University of Minnesota Press, 1999. Womack Craig S., Daniel Heath Justice, and Christopher B. Teuton, editors. Reasoning Together: The Native Critics Collective. University of Oklahoma Press, 2008. Wong, Hertha Dawn. “Native American Life Writing.” The Cambridge Companion to Native American Literature, edited by Joy Porter and Kenneth M. Roemer, Cambridge University Press, 2005, pp. 125–​44. ——. Sending My Heart Back Across the Years:  Tradition and Innovation in Native Autobiography. Oxford University Press, 1992. Woody, Elizabeth. “Translation of Blood Quantum.” Chicago Review, vol. 39, no. 3–​4, 1993, pp. 89–​90. Woolford, Andrew. This Benevolent Experiment:  Indigenous Boarding Schools, Genocide, and Redress in Canada and the United States. University of Nebraska Press, 2015. Woolum, Jordan A., et al. “A Review of the Management of Stevens-​Johnson Syndrome and Toxic Epidermal Necrolysis.” Advanced Emergency Nursing Journal, vol. 41, no. 1, Jan. 2019, pp. 56–​64. EBSCOhost, doi:10.1097/​TME.0000000000000225. World Health Organization. Global Report on Diabetes. World Health Organization Press, 2016. https://​apps.who.int/​iris/​bitstream/​handle/​10665/​204871/​97892415 65257_​eng.pdf;jsessionid=9DF3F61F5F0E32945FF1944952A920F2?sequence=1. Accessed December 2, 2018. Wright, Frank Hall. “Saving Indians from Tuberculosis.” Proceedings of the Twenty-​ Fifth Annual Meeting of The Lake Mohonk Conference of Friends of the Indian and Other Dependent Peoples, reported by Miss Lilian D. Powers, The Lake Mohonk Conference, 1907, pp. 38–​40. Wriglesworth, Chad. “Writing on Water:  Sherman Alexie’s Poetry on Salmon and Spokane Falls.” The Spokane River, edited by Paul Lindholdt, University of Washington Press, 2018, pp. 142–​53. Wurtzel, Elizabeth. Prozac Nation:  Young and Depressed in America. Riverhead Books, 1995. Yancey, Diane. Tuberculosis. Twenty-​First Century Medical Library, 2008. Yellow Bird, Michael. “Decolonizing Tribal Enrollment.” For Indigenous Eyes Only: A Decolonization Handbook, edited by Waziyatawin Angela Wilson and Michael Yellow Bird, School of American Research, 2005, pp. 179–​88. Yellow Horse Brave Heart, Maria, and Lemyra M. DeBruyn. “The American Indian Holocaust:  Healing Historical Unresolved Grief.” American Indian and Alaska Native Mental Health Research, vol. 8, no. 2, 1998, pp. 60–​82. Young, T. Kue. The Health of Native Americans: Toward a Biocultural Epidemiology. Oxford University Press, 1994. Zamir, Shamoon. “Native Agency and the Making of The North American Indian: Alexander B. Upshaw and Edward S. Curtis.” The American Indian Quarterly, vol. 31 no. 4, 2007, pp. 613–​53. Project MUSE, doi:10.1353/​aiq.2007.0042.

 265

Bibliography 265 Ziarkowska, Joanna. “ ‘Bringing Things Together’: Tribalography, Lakota Language, and Communal Healing in Frances Washburn’s Elsie’s Business and The Sacred White Turkey.” Review of International American Studies RIAS, vol. 12, no. 1, Spring/​Summer 2019, pp. 45–​64. doi:10.31261/​rias.6989. ——. “Disease, Disability, and Human Debris: The Politics of Medical Discourse in Silko’s Almanac.” Howling for Justice: New Perspectives on Leslie Marmon Silko’s Almanac of the Dead, edited by Rebecca Tillett, University of Arizona Press, 2014, pp.  56–​68.

Index

Agamben, G. 65–​6 Alexander, J. 44 Alexie, S. 110–​17; decolonization and resistance 115, 116; “Diabetes”113; and diabetes as an effect of colonialism; 110–​14; frybread 116–​17; genetic fatalism 111–​12; Indian Killer 115–​16; and the loss of traditional foodways 113–​15; and diabetic bodies 110–​11; “One Good Man” 110, 111, 114–​15; “The Powwow at the End of the World” 115; Reservation Blues 112, 116; and salmon 115; Smoke Signals 115, 116; “Totem Sonnets” 113–​14; “War Dances” 111, 112; “Witnesses, Secret and Not” 111, 112–​13 American Indian Literary Nationalism 9–​12 Anishinaabeg 138, 142–​3 Armstrong, S. C. 119–​20 Aronson, J. 45, 46 Aronson, N. 47 BCG vaccine 29, 44–6; efficacy of 53n47; and ethical concerns 46–​8; response of American doctors to 29, 45–​6; and the Lübeck Tragedy 46; tests in Native American communities 46–​7 biocolonialism 55, 146, 185 biomedicalization 5–​9, 71, 109, 171, 228; and biopolitics 6, 7–​8, 13–​14 biomedical psychiatry see My Body Is a Book of Rules blood: in Karitiana culture 185; the meaning of 138; in precontact Native American cultures 138–​9; post-​ contact understanding of 139; see also

blood memory; blood quantum; Erdrich, H. E. blood memory 134–​9; and Arnold Krupat’s criticism of 136; and Chadwick Allen on 136–​8; in Linda Hogan’s work 158 blood quantum 122, 134–​6, 139–​43, 194; and alternative factors of determining tribal citizenship 142–​3; and Certificate of Degree of Indian Blood (CDIB) 142; impact on Indigenous identity 140–​2, 191; and intermarriages 143; the origins of 139–​40; and tribal citizenship 141; see also tuberculosis boarding schools: and TB 27; the birth of 38; and infectious diseases 38–​40; see also LaRose; Miko Kings Brinton, D. 81 Cajete, G. 159, 165, 176–​7, 198 Cartwright, S. A. 31 Chaplin, J. E. 4 Chatters, J. 149, 189–​90, 191 Cherokee 92, 143; and ancestry testing 133–4; and blood quantum 140–2; and meanings of blood and kinship 138–9, 141–2; and response to the diabetes epidemic 97; and sacred places 164; and the Trail of Tears 170, 172n5 Chickasaw people 157, 167 Choctaw Nation 167 Clark J. 28 Clarke, A. E. 5–​9 communitism 10–​11, 18, 116 community-​based participatory research (CBPR) see diabetes Cummins, S. L. 35

Index  267 Dawes Allotment Act, 122–​3, 139–​40; and compiling the rolls 140; see also Miko Kings Deloria Jr., V. 2, 17, 152, 157, 162–​4; and recording the past 163–​4; and sacred geography 157, 163–​4; and sacredness of land 163–​4 diabetes: biomedical model 91–​2; and boarding schools 97–​8; and community-​based participatory research (CBPR) 104; as a disease of civilization 93; and genetic research 93; and geneticization of Native Americans 94; and global statistics 91, 92; and historical (transgenerational) trauma 101–​3, 115, 123; and history of colonialism 96–​8, 101; and Indigenous approaches to healing 105–6; and Indigenous understanding of 91–2, 104; and loss of traditional foodways 98–​100; in Native American communities before 1940s 107n1; and J. Neel 93; and negative effects of thrifty gene theory 95–​6; and the Pima People 92–​4, 96, 106; rates for American Indians 91, 92–​3; and thrifty gene hypothesis 93, 94–​5 Diagnostic and Statistical Manual (DSM) see My Body Is a Book of Rules DNA: and direct-​to-​consumer (DTC) DNA tests 147–​8, 133, 187; popular discourse on 144; of Indigenous people 146, 147; see also the Havasupai tribe; Hogan, L.; Erdrich, H. E.; sovereignty Du Bois, W. E. B. 31 Duran, E. and B. Duran 16, 97, 101–​2; and the soul wound 102 embodied resistance 14, 57, 69–​71, 77–​9, 82, 101, 127, 156, 159, 163–4, 171, 175, 198–9 embodiment see embodied resistance Erdrich, H. E. 175–​201; and the body as a commodity 185–​7, 189; and blood 179–​81, 193; “Blood Chimera” 193–​4; “DNA Tribes” 187–​8; “eBay Bones” 186–​7; and embodiment 194–​6; and genetic tests 176, 187; “Human Map” 178–​82; and Indigenous people in genomic research 179, 180–​1, 184–​5,

186–​7; “Kennewick Man Attempts Cyber-​Date” 190–​1; “Kennewick Man Tells All” 189–​90; “Little Souvenirs” 194; and microchimerism 192–​4, 194–​6; “Microchimerism” 194–​8; and migration 196–​7; and NAGPRA 178, 192; and Ojibwe culture 194, 196–​8; and race in science 179; and settler colonial violence 179–​80; and technoscience 176–​9, 187–​8, 192; “Vial” 184–​5; see also TallBear, K. Erdrich, L. see LaRose eugenics 69, 134, 140, 141; see also tuberculosis Flick, L. 29–​30 Foucault, M. 203–​4; biopolitics and biopower 6, 62–​6, 72, 74, 76, 78, 79, 82 Genographic Project 145–​6, 178, 183 Goffman, E. 60, 218 Gold, S. W. 28 Harris, C.: “Whiteness as Property” 182 Havasupai case 149–​51, 182, 183–​4 Hogan, L. 156–​72; and the body 158, 159–​6 0, 166, 169–​70, 171; and cells, genes, and DNA metaphors 159, 169–​7 0, 171; the Chickasaw Removal 167, 170–​1 ; and connection to the land 157–​9 , 164, 168, 169, 171; Dwellings 157–​8, 168, 171; and history 159–​62, 164–​5 , 166–​7 , 169–​70; and maps 165–​6; “New Trees” 159, 167, 171; and Oklahoma 168–​9; “Old Man at War, Old Women” 158; and pre-​removal Chickasaws 166–​7; “Remembering” 167; and sacred geography 164–​5, 170, 171; Solar Storms 165; The Woman Who Watches Over the World 158–​66, 168–​9 , see also blood memory Hoover, E. 18–​19, 98, 100–​1 Howe, L. 126–​7; see also Miko Kings Hrdlička, A. 33, 34–​35 Human Genome Diversity Project 2, 145–​6, 150, 154n19, 178 human migration research 145, 146, 150

268 Index indigeneity 11–​12, 146–​7; genomic articulation of (TallBear) 147; see also DNA Indigenous concepts of healing 103–​4, 105–​6, 229, 232–​5; see also diabetes; Miko Kings Indigenous foodways 98–​100; as decolonization 101; food in boarding schools 99–​100; and Food Distribution Program 100; and food sovereignty movements 100; see also diabetes Indigenous knowledge 14, 98–​9, 100, 103, 150–​1, 164–​5, 180–​1 Ishi 25–​6 Jasanoff, S. 3, 145, 180 Jones, D. S. 4–​5, 32, 37 Jones, W. A. 39, 43, 66 Karitiana people 184 Kennewick Man 81, 148, 188, 189–​90, 191; and NAGPRA 148–​9; see also Erdrich, H. E. Kimmerer, R. W. 177, 198 Kleinman, A. 104, 105, 228–​9 Kovach, M. 13 Kraepelin, E. 203 Laffer, C. 36 Lakota people see Madonna Swan land-​based epistemologies 74–​5, 98, 100, 136–​7, 146–​7; see also Hogan, L.; Deloria Jr., V. LaRose 71–​81; and biopower 74; and boarding schools 73–​7; and the body 72, 75–​9; and the theft of human remains 80–​1; and Indigenous law 71–​2; and production of scientific knowledge 80; and tuberculosis 76–​9; and TB treatment 79–​80; see also NAGPRA; Pratt, H. R. Long, E. 37, 45, 47 Madonna Swan: A Lakota Woman’s Story 56–​71; and the body 67–​9, 82; and collaborated autobiographies 56; and Immaculate Conception missionary school 59–​60; and Lakota community 58, 69–​71; kinship ties 56–​9; and production of scientific knowledge 68–​9; Sanator 63, 67–​8; the Sioux Sanatorium 62-​the stigma of TB diagnosis 60–​1; TB treatment 64,

67–​9; tuberculosis symptoms 59–​60; see also Foucault, M.; tuberculosis McDermott, W. 32 medical experimentation 43–​7, 49n7; see also tuberculosis Meltzer, H. 44 Meriam Report 34, 40, 42, 43, 44, 73 Mihesuah, D. 91, 98, 107n1, 116, 117 Miko Kings: An Indian Baseball Story 118–27;​ Alikichi  124–​5; caring 123–​4; Dawes Allotment Act 122–​3; diabetes 118–​9, 123–​4; baseball 121–​2, 125, 126; forced acculturation 119–​20; and healing 123, 124–​6, 127; Indigenous ball games 118, 121; Hampton Institute 119–​20; nurses 118–​19, 123–​4; Ohoyo Holba 125–​6 Million, D. 7–​8 Mojica, M. 156 Momaday, N. S. 134–​8; Ancestral Voice 135; and blood quantum 136–​7; House Made of Dawn 134–​5, 136; “The Man Made of Words” 137; The Names 137; see also blood memory Moreton-​Robinson,  A.  12 Morgan, L. H. 183–​4 Morton, S. 81 Murphy, J. A. 41 My Body Is a Book of Rules 202–​27; and biomedical psychiatry 203–​7, 216; bipolar disorder 207–​8, 211; and blood quantum 221–​2; and the body and blood 210–​11, 221, 223; and brain visualization technologies 203–​4; and depression memoirs 217; and DNA metaphors 220–​1, 224; and DSM 204–​5, 208–​9; and the kindling model 206, 211–​12, 216; and kinship relations 220, 223; and the language of biomedical psychiatry 202, 208–​10, 213; and mental illness in popular culture 216–​19; and mixed heritage 207, 219; and pharmacotherapies 203, 206–​7, 212–​14, 218; and the politics of visibility 215, 219–​20; Prozac 206–​7; the stigma of mental illness 214–​19; Tumalth 211, 221, 223, 224 NAGPRA 73, 80–​2, 149, 182, 200n18; see also Kennewick Man; Erdrich, H. E. narrating illness 104, 105 Native American DNA 134, 145–​6, 151, 183, 220; as whites’ property

Index  269 183–​4; see also TallBear, K.; Erdrich, H. E. Neel, J. see diabetes Pima people see diabetes Pratt, R. H. 37, 38, 74, 76, 86n24, 119, 121 Reardon, J. 145, 146, 183–​4 relationality 12–​13, 146 Rose, N. 2, 7, 94, 203, 204–​5, 206, 210, 218 sanatorium see tuberculosis Schurz, C. 38 settler colonialism 2, 4, 7, 15, 16, 55, 57, 61, 66–​7, 71–​2, 76, 79, 82, 100, 103, 109, 162, 179, 189, 198–​9, 220; and the loss of traditional foodways 98–​101; and TB 66–​9, 76–​9; and trauma 103, 127 sexual violence 61, 224, 230–​1 Silva, C. 4, 26 sovereignty 3–​4, 10, 14, 20n5, 55, 91, 100, 104, 106–​7, 133, 146, 151–​2, 189, 227n21, 229; and the threat of DNA research 134, 147–​8, 149, 179–​80, 183, 191 sterilization of Indigenous women 69, 85n11, 162 Sturm, C. 138, 139, 142, 143, 170 TallBear, K. 134, 144–7, 151–​3, 157, 159, 176, 178, 181, 181–​2, 183–​4, 187; on genetic articulations of indigeneity 183–4; on genetic memory 144–​5; and H. E. Erdrich’s poetry 176; and the Havasupai case 150–1 Townsend, J. 36, 45, 46

trachoma 34, 39, 40, 47, 50n19 transnationalism 11 Tsosie, R. 3, 181, 182–​3, 200n16 tuberculosis: in the 21st century 48; and antibiotics 42; and blood quantum 36–​7; and boarding schools 27; death rates among Native Americans 32, 34, 48; and eugenics 29–​30; and gender roles 30–​1; as a hereditary disease 28–​9; and hygienic standards 41; and immigration restrictions 29–​30, 31; medical definition of 27–​8; and the new republic 28; prevention 29, 30, 32, 40–​1; and race 31–​2, 34–​7; and research on among Native Americans 33–​4, 44–​5, 67–​8; and sanatoria for Native Americans 42–​3; and thoracoplasty 43–​4, 67–​8; treatment in Indian Country 42, 64, 79–​80; and the virgin soil theory 15, ​ 35–​7; see also Madonna Swan Tuhiwai Smith, L. 47 Virgin soil theory see tuberculosis Vizenor, G. 15, 19, 21n13, 25, 136, 220 Washburn, F. (Elsie’s Business) 228, 230–​5 Washuta, E. see My Body Is a Book of Rules White Earth Nation 142–​3 Wilson, S. 13 Wisecup, K. 2, 4 Yellow Horse Brave Heart, M. 102–​3; and historical unresolved grief 103