Ask Author Anything (well, almost!): Andrew McDowell answers questions from his readers on Breathless

Each year in India more than two million people fall sick with tuberculosis (TB), an infectious, airborne, and potentially deadly lung disease. The country accounts for almost 30 percent of all TB cases worldwide and well above a third of global deaths from it. Because TB’s prevalence also indicates unfulfilled development promises, its control is an important issue of national concern, wrapped up in questions of postcolonial governance. Drawing on long-term ethnographic engagement with a village in North India and its TB epidemic, Andrew McDowell tells the stories of socially marginalized Dalit (“ex-untouchable”) farming families afflicted by TB, and the nurses, doctors, quacks, mediums, and mystics who care for them. Each of the book’s chapters centers on a material or metaphorical substance—such as dust, clouds, and ghosts—to understand how breath and airborne illness entangle biological and social life in everyday acts of care for the self, for others, and for the environment.

From this raft of stories about the ways people make sense of and struggle with troubled breath, McDowell develops a philosophy and phenomenology of breathing that attends to medical systems, patient care, and health justice. He theorizes that breath—as an intersection between person and world—provides a unique perspective on public health and inequality. Breath is deeply intimate and personal, but also shared and distributed. Through it all, Breathless traces the multivalent relations that breath engenders between people, environments, social worlds, and microbes.

In this SSHIFTB exclusive interview, Andrew further explores the themes of Breathless. He discusses implications for qualitative researchers, the emotional experience of TB non-disclosure, the benefit of metaphors in the TB space, and the inspiration behind it all. 

Read the full interview transcript here.

01:59  Gurher Sidhu, York University

“What inspired you to write this book? Could you tell us briefly about your book?”

07:28  Charity Oga-Omenka, University of Waterloo

“To what extent do researchers need to go build to to go to build relationships with the communities they work in? How else can qualitative researchers and social scientists who do not have these experiences connect with the communities they are working with?”

11:35  Justin Denholm, Royal Melbourne Hospital

“This is an astonishing book – what a beautiful piece of scholarship and prose! I appreciate the reflections on worthiness in the biopolitics of care, alongside Sufi theology and studying cloud formations for understanding TB pathogenesis. So good, and surprising, and provocative.

There was a moment in the “Mud” chapter where you are drawn into being complicit in not disclosing a history of previous tuberculosis treatment with the hope of facilitating better treatment for the patient. You breakdown each person’s motivation and perspectives for doing this. Can you tell us a bit more about what the emotional experience of that episode was like for you?”

Breathless: Tuberculosis, Inequality, and Care in Rural India by Andrew McDowell

21:02  Nora Engel, Maastricht University

“What a tour de force! Breathless is a real pleasure to read- it is deeply moving, scholarly enriching (the notes alone are like a treasure box!) and despite all the sadness, entertaining and very human at the same time. The book paves the way for an atmospheric turn in anthropology. It argues that we not only ought to pay attention to the people and their relationships, routines and practices, or to how the materials and their technologies, infrastructures and textures influence health and care, but also engage with the atmospheres in which people with TB and their caregivers live and with the biopolitics of atmospheric care that is provided. To do so it uses words (or atmospheric entanglements) such as breath, air, clouds, dust, mud, forests.

For the TB community, the ways you’ve described “atmospheres” within the book are unusual words and ways of describing TB and TB care. What would you say is the value of this type of anthropological, anthropological gaze on atmospheres and these unusual words for the TB community? What do you hope people could do with these insights?”

Transcript  Jen Furin, Harvard University

“The book paints a deeply compelling portrait of the social “atmospheres” in which people with TB live and weaves these social realities in with the biological reality of TB beautifully. In recent years, there has been growing acknowledgement in the TB space that social atmospheres matter in global approaches to TB service delivery. At the same time period, there has also been increased investment in shortening TB treatment and making diagnosis simpler and faster too.”

“Based on your work, do you think there’s ever going to be a time or threshold where the biological atmosphere could negate or minimize the social one? For example, if diagnosis could be done quickly, at home, like with COVID or treatment work completed in one month or less. Are there any perils to continuing to pursue this biological Holy Grail? What would the people you worked with and about what they say about this?”