Andrew Lakoff

Preparing for the Next Emergency

energy into productive responses. Here, the charitable sector served as an invaluable intermediary, able to respond spontaneously even where no ground rules were in place. One issue that quickly arose was coordination—a crucial effort required even while the extent of the threat remained uncertain. Early on it became clear that neither the public sector nor the charitable sector had set up institutional mechanisms for dealing with many issues. In response, the Federal Emergency Management Agency (FEMA) has coordinated with major charitable organizations such as the American Red Cross, the United Way, and community foundations to begin planning and addressing new emergencies as they arise. Many experts at the Urban-Hauser meeting agreed that these types of efforts should be more formalized and continued into the future. If a future disaster were either larger or more continual, even small delays could have serious consequences. An existing infrastructure is clearly vital. The IRS responded to the disaster by quickly recognizing more than 300 new charities, some narrowly targeted to help specific groups defined on the basis of occupation, employer, or geographical locale. This, too, was unusual. In response to the Oklahoma City bombing, by way of contrast, only a few new charities were set up. Some participants worried about the precedent that was set for charitable tax law. In particular, the IRS reversed past practices and allowed funds to be set up for particular groups (for instance, a group of employees for one employer) that previously would not have qualified as charitable classes. For these groups and others, the IRS waived a The tragic events of September 11, 2001, stirred the goodwill and charitable impulses of millions of Americans. The outpouring of concern, time, and money showed how incredibly generous people could be. At the same time, the relief effort was so large that, almost inevitably, it generated a fair degree of controversy, much centered on the charitable sector itself. Indeed, some attribute a downturn in charitable giving to the bad publicity surrounding such events as the distribution of September 11 charitable funds by the American Red Cross and other charities and the expenses incurred by some United Ways. Whether those anecdotal assessments are correct or not—many other events, such as a recession, occurred about the same time—the Urban Institute’s Center on Nonprofits and Philanthropy and Harvard University’s Hauser Center decided to bring together active participants in September 11 relief, representatives of the charitable sector, and researchers to exchange information on what they had learned. The goal of the session was not to praise or criticize the September 11 effort, but rather to ascertain future directions. Most participants felt that important lessons were learned on how to raise, manage, and disburse funds; coordinate functions; and work with the public and the press in the case of future disasters.

Distributed Preparedness: The Spatial Logic of Domestic Security in the United States:

This paper examines the genealogy of domestic security in the United States through an analysis of post-World War II civil defense. Specifically, we describe the development of an organizational framework and set of techniques for approaching security threats that we call ‘distributed preparedness’. Distributed preparedness was initially articulated in civil defense programs in the early stages of the Cold War, when US government planners began to conceptualize the nation as a possible target of nuclear attack. These planners assumed that the enemy would focus its attacks on urban and industrial centers that were essential to US war-fighting capability. Distributed preparedness provided techniques for mapping national space as a field of potential targets, and grafted this map of vulnerabilities onto the structure of territorial administration in the United States. It presented a new model of coordinated planning for catastrophic threats, one that sought to limit federal intervention in local life and to preserve the characteristic features of American federalism. Over the course of the Cold War, distributed preparedness extended to new domains, and following 9/11 it has moved to the center of security discussions in the US.

Two Regimes of Global Health

Lakoff distinguishes between and describes two contemporary regimes for envisioning and intervening in the field of global health: global health security and humanitarian biomedicine.

Adaptive will : The evolution of attention deficit disorder

The increasing prevalence of attention-deficit disorder among American school children was a source of significant controversy in the 1990s. This paper looks at the social and historical contexts in which ADD evolved in order to understand its emergence as a coherent and widespread entity. Changes in expert models of child behavior interacted with the formation of new identities around disability to shape a milieu in which the disorder could thrive. The pattern of affect control, of what must and what must not be restrained, regulated, and transformed, is certainly not the same in this stage as in the preceding one of court aristocracy. In keeping with its different interdependencies, bourgeois society applies stronger restrictions to certain impulses, while in the case of others aristocratic restrictions are simply continued and transformed to suit the changed situation (Elias, 1994, p. 125).

The Anxieties of Globalization: Antidepressant Sales and Economic Crisis in Argentina

This paper describes the role of market research firms in shaping the actions of key players in the pharmaceutical arena. It focuses on strategies for marketing novel antidepressants (selective serotonin reuptake inhibitors, SSRIs) to doctors in Buenos Aires during the Argentine financial crisis of 2001, posing the question of whether increased antidepressant sales were due to the social situation or to promotional practices. This case demonstrates how ‘pharmaceutical relations’ – interactions between doctors and pharmaceutical companies – are structured by a gift economy whose effects are monitored through the sales numbers produced by database firms. It suggests that the use of these numbers takes on special importance given the distinctiveness of both the Argentine context and the antidepressant market. More generally, the case points to the interpretive flexibility of psychotropic medication. In the Argentine setting, doctors’ prescription of SSRIs was dependent neither on a diagnosis of depression nor on a biological understanding of mental disorder. These drugs found a different means of entering the professionally mediated marketplace: doctors understood and used SSRIs as a treatment not for a lack of serotonin in the brain, but for the suffering caused by the social situation – the sense of insecurity and vulnerability that the economic and political crisis had wrought.

Vital Systems Security: Reflexive Biopolitics and the Government of Emergency

This article describes the historical emergence of vital systems security, analyzing it as a significant mutation in biopolitical modernity. The story begins in the early 20th century, when planners and policy-makers recognized the increasing dependence of collective life on interlinked systems such as transportation, electricity, and water. Over the following decades, new security mechanisms were invented to mitigate the vulnerability of these vital systems. While these techniques were initially developed as part of Cold War preparedness for nuclear war, they eventually migrated to domains beyond national security to address a range of anticipated emergencies, such as large-scale natural disasters, pandemic disease outbreaks, and disruptions of critical infrastructure. In these various contexts, vital systems security operates as a form of reflexive biopolitics, managing risks that have arisen as the result of modernization processes. This analysis sheds new light on current discussions of the government of emergency and ‘states of exception’. Vital systems security does not require recourse to extraordinary executive powers. Rather, as an anticipatory technology for mitigating vulnerabilities and closing gaps in preparedness, it provides a ready-to-hand toolkit for administering emergencies as a normal part of constitutional government.

Ethics and the anthropology of modern reason

In recent years, anthropologists have shown increasing interest in scientific, technical and administrative systems and their political regulation. In what follows, we suggest that a major concern in much of this work is a common interest in how, in relationship to these technical and political developments, ‘living’ has been rendered problematic. In the first part of this article, we suggest that these strands of anthropological investigation can be fruitfully analyzed by engaging the work of Alasdair MacIntyre, whose distinctive neo-Aristotelian approach has had an important influence on recent discussions of ethics in philosophy. In the second part of the article, we propose that the significance of this anthropological work lies not only in its descriptions of the specificities of local ethical formations, but also in its contribution to a broader understanding of what we propose to call ‘regimes of living’.

The Right Patients for the Drug: Managing the Placebo Effect in Antidepressant Trials

This article concerns the challenges faced by pharmaceutical researchers seeking to develop novel antidepressants. Based on ethnographic and documentary research into the drug development process, it shows how researchers try to manage the problem of the placebo response in antidepressant trials. The high rate of placebo response in these trials makes it difficult to demonstrate efficacy and often leads to trial failure. According to researchers, a major reason for high placebo response rates is the inability of standardized rating scales to define a coherent group of ‘drug responders’. They have developed alternative means of classifying patients in order to circumvent this problem and thereby improve the chances of trial success. In their search for ‘the right patients for the drug’, pharmaceutical researchers also provide an incisive critique of the epistemological assumptions underlying the clinical trial process.

Real-time biopolitics: the actuary and the sentinel in global public health

Abstract This paper analyses the mechanisms through which experts in the field of global health work to manage the future well-being of populations. It develops a contrast between two ways of approaching disease threats: actuarial and sentinel devices. If actuarial devices seek to map disease over time and across populations in order to gauge and mitigate risk, sentinel devices treat unprecedented diseases that cannot be mapped over time, but can only be anticipated and prepared for. The paper shows that a recent controversy over vaccination in Europe in response to the H1N1 pandemic can be understood in terms of the tension between these two kinds of security mechanisms.

The Indicator Species: Tracking Ecosystem Collapse in Arid California

This essay tracks the two-decade-long struggle to protect the delta smelt and other native fish populations in California. Through the case of the smelt, it asks how the goal of species preservation is integrated into contemporary governmental practice. What values are at play in efforts to sustain the existence of nonhuman life in a setting of intense competition over a diminishing and essential resource? What forms of knowledge are developed to gauge the health of threatened species, and what techniques are used to regulate the provision of water in the name of species protection? The essay suggests that smelt protection efforts are guided by two temporally distinct value orientations. The first is pastoriented, emphasizing the preservation of existing species as a good in itself. The second is future-oriented, focused on staving off an approaching ecological collapse whose onset is signaled by the smelt population’s decline.