In Indigenous Bodies, Cells, and Genes, Joanna Ziarkowska maps how biomedicine has reshaped and controlled all aspects of Native American life. Principally, she explores how Native literature has responded to this phenomenon, with the conviction that such representations of illness and medicine contribute to cultural sovereignty. Native American literature, Ziarkowska contends, repeatedly intervenes in the hegemony of biomedicine. By resisting a reductivism that excludes the social and cultural contexts of illness, as well as Indigenous epistemologies of health and wellbeing, Native literatures become spaces wherein the ‘network of relationships into which an experience of illness is inscribed’ (229).
Ziarkowska’s framework of biomedicalization draws upon the work of Adele Clarke et al. (2003). As a concept, biomedicalization refers to the ‘multisited, multidirectional processes of medicalization that today are being both extended and reconstituted through the emergent social forms and practices of a highly and increasingly technoscientific biomedicine’ (Clarke et al. 2003, 162). But, in adapting Clarke’s work, Ziarkowska asserts that the results of such processes are profoundly uneven. In other words, Native Americans have been unequally ‘biomedicalized’, compared to non-Indigenous populations, in ways which perpetuate ongoing social and cultural inequities. Having achieved this, she then brings forth the various tribal epistemologies with which biomedical discourse is challenged in Indigenous literary texts. Varying in the degree to which they might complement or refute biomedicine, Ziarkowska places these literary texts into dialogue with biomedicine, collapsing disciplinary boundaries in a manner reflective of the holistic worldviews she considers. As part of the Routledge Research in Transnational Indigenous Perspectives series, Indigenous Bodies, Cells and Genes balances a transnational perspective of these issues, Indigenous knowledges, and Ziarkowska’s own positionality as a non-Native scholar working in Poland.
Ziarkowska’s monograph is thematically divided into four parts, each discussing a particular disease or discourse of biomedicalization: ‘Tuberculosis’, ‘Diabetes’, ‘Blood and Genes’, ‘Indigenizing Biomedicalization’. Each part has two chapters: the first considers the biomedical issues as they relate to Native communities, delving into the United States’ interconnected histories of medicine and cultural assimilation. The second chapter of each part turns to Native American literature. Here, Ziarkowska explores how select authors have reconfigured each discourse of biomedicalization. This chosen structure allows for a greater level of detail and specificity than is often seen in literary analyses of illness, wherein textual close readings might form the backbone of every chapter. Instead, Ziarkowska’s work is structurally rendered accessible and relevant to scholars working outside of literary studies, particularly historians of medicine.
A common theme across these chapters is the relationship between colonial oppression and health inequities. Beginning with the ‘crusade’ against tuberculosis at the start of the twentieth century, Ziarkowska explores how Native populations were bypassed as racially biased theories of susceptibility were adopted. Although Indian boarding schools, already institutions of cultural extermination, were largely responsible for Native rates of tuberculosis, the ‘virgin soil’ theory justified a reading of Indigenous bodies as physically inferior and less civilized. In Chapter 2, Ziarkowska’s readings of narratives of tuberculosis epidemics present Native bodies as a colonized site. In Madonna Swan’s autobiography and Louise Erdrich’s LaRose, protagonists strive to normalize the disease that is contracted by generations of children. Even as pupils’ health is threatened, the texts concentrate on preserving the cultural life of the communities that these very boarding schools sought to eradicate.
Chapter 3 turns to diabetes, and the way that biomedicine downplays the social and cultural determinants which contribute to high rates of the condition. Presenting the flawed hypotheses (including the ‘thrifty genome’ hypothesis) that were spurred by the mid-twentieth century advent of biotechnology, Ziarkowska illustrates how the relationship between diabetes and transgenerational trauma was largely overlooked. Yet this relationship is a common theme in fiction. Chapter 4 relays how the dominant, if not erroneous, biomedical explanations for high rates of diabetes are contested by Sherman Alexie and LeAnne Howe. Their fiction exposes how colonial practices have affected Indigenous food sovereignty and the quality of healthcare provision.
In the monograph’s third part, Chapter 5 charts the transferal of cultural connections and belonging from blood to genes. Though generative for writers including N. Scott Momaday, the concept of ‘blood memory’ is problematically related to federal policies of blood quantum. Similar problems have emerged as direct-to-consumer testing, amongst other advances in genetic testing, creates the construct of ‘Native American DNA’. Drawing on Kim TallBear’s scholarship (2013), Ziarkowska unpacks how these more recent extractive biotechnologies continue to objectify Native Americans In Chapter 6, Ziarkowska interprets Linda Hogan’s life writings within this shift from blood to DNA imagery. Despite TallBear’s warnings against conflating these discourses, Hogan finds it empowering to employ blood and DNA metaphors as a means of formulating a relationship between her body, land and ancestors.
Part Four stands as an exception to this established structure as Ziarkowska extends her methodology and theoretical framework towards future ‘sites of exploration’ (17). In Chapter 7, readings of Heid E. Erdrich’s poetic representations of pregnancy demonstrate how microchimerism, in the face of biomedicalization, can affirm Indigenous relational belonging. This chapter illustrates a wider claim in Ziarkowska’s work, that Native literature is not always antithetical to the biomedical advances it portrays, nor is it ‘anti-scientific’. Chapter 8 dismantles the biomedicalization of psychiatry through a poignant reading of Elissa Washuta’s My Body is a Book of Rules. The politics of visibility, underscored in Washuta’s critique of brain visualization technologies, have resulted in a common site of resistance for Native Americans and psychiatric service users. By way of conclusion, a brief coda returns to Clarke et al. (2003) in a brief discussion of community wellbeing and transformative storytelling in Frances Washburn’s Elsie’s Business.
Many of these texts will be familiar to critics of Indigenous literature. For those working in the medical humanities, Indigenous Bodies, Cells and Genes comprises an exciting introduction to this body of literature that extends beyond its most well-known writers. Ziarkowska brings together poetry, autobiographies, and short stories by Native writers who are frequently overlooked by scholarship outside of North America. As such, Indigenous Bodies, Cells, and Genes engages with an ambitious array of Native American writers, literary forms, and health crises. Consequently, it might be that the monograph is too broad in scope. It stretches beyond an analysis of one literary genre, or a single disease category. Instead, the book’s central ambition is to examine the function and significance of these varied literary interventions into the biomedicalization of Native Americans, which shed light on how biomedicalization itself might be newly theorized (14). Ziarkowska maintains a consistent analytical approach across these varying contexts, exploring the types of creative resistance employed against medical practices which overlook the social and cultural determinants of health. With an awareness of her own positionality, Ziarkowska exemplifies how knowledge from tribal epistemologies can be privileged in a critique of colonial biomedicalization, and how transnational cultural analyses might demonstrate a social responsibility to Native communities. This approach, if applied to the other settler colonial states, could productively bring to light the complex interplay between health, the coloniality of medicine, and Indigenous forms of creative resistance.
Given its 2020 publication, one cannot help but relate Ziarkowska’s timely arguments to the ongoing COVID-19 pandemic. An informed reading of the book’s first part, ‘Tuberculosis’, particularly underscores the need to refute racially-based theories of Indigenous susceptibility to infectious diseases. Moreover, Ziarkowska’s engagement with Cristobal Silva’s Miraculous Plagues: An Epidemiology of Early New England Narrative (2011) and David S. Jones’s Rationalizing Epidemics: Meanings and Uses of American Indian Mortality since 1600 (2004) draws attention to how current health crises might be situated in longer histories of coloniality. Ziarkowska, following her predecessors, fundamentally argues that narratives of epidemics ‘reveal ideological assumptions structuring social and geographic spaces as well as criteria for national belonging’ (26). As scholars in literary studies, Indigenous studies, and the medical humanities consider the interplay between fiction and this pandemic, Indigenous Bodies, Cells, and Genes is an instructive model to follow; Ziarkowska thoughtfully analyses health phenomena in ways which expand beyond individual narratives of diagnosis and treatment, towards collective accounts of pathologization. Importantly, Indigenous Bodies, Cells, and Genes serves as a guide for those attending to the cultural impact of COVID-19 on Indigenous populations or other minoritized groups, particularly for researchers who approach such topics as outsiders or from transnational perspectives.
References
Clarke, Adele E., et al. 2003. “Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine.” American Sociological Review, 68(2): 161–94.
Jones, David S. 2004. Rationalizing Epidemics: Meanings and Uses of American Indian Mortality since 1600. Yale University Press.
Silva, Cristobal. 2011. Miraculous Plagues: An Epidemiology of Early New England Narrative. Oxford University Press.
TallBear, Kim. 2013. Native American DNA: Tribal Belonging and the False Promise of Genetic Science. University of Minnesota Press.
Anna Kemball is an AHRC-funded PhD candidate in the School of Literatures, Languages & Cultures at the University of Edinburgh, having previously studied at the University of Leeds. Her thesis explores representations of health and wellbeing across a range of contemporary Indigenous literatures, bringing Indigenous literary studies and the critical medical humanities into closer relation. Her work on Māori representations of schizophrenia is published in the Journal of New Zealand Literature. Find her on Twitter @AnnaKemball.
