Book Reviews

Winona LaDuke. All Our Relations:
Native Struggles for Land and Life.

(Cambridge, MA: South End Press,
1999). 241 pp., US$16.00, paper.
Review by Laura A. Bathurst

Not often does one encounter a
book that describes environmental
degradation and oppression yet leaves
the reader with a feeling of hope.
Winona LaDuke's book, All Our
Relations: Native Struggles for Land
and Life does just that. LaDuke, a
well-known activist for native rights
and the environment, offers an
eloquently  written  critique  of
continuing  social  and  economic
practices  that  destroy  both  the
environment and Native American
cultures. Key to her analysis are the
ways in which indigenous peoples are
prevented from controlling their lands
and lives and the disastrous health
consequences that result. As activist
Katsi Cooks asks, "Why is it we must
change our lives, our way of life, to
accommodate the corporations, and
they are allowed to continue without
changing any of their behavior?" This
critical question, like the rest of
LaDuke's book, is relevant outside as
well as inside Indian Country.

Each chapter of LaDuke's
book describes how a distinct group is
struggling against powerful interests.
For example, Katsi Cook, a Mohawk
midwife, leads a fight to get General
Motors to clean up their Superfund site
of approximately 823,000 cubic yards

of PCB-contaminated materials. These
poisonous chemicals are concentrated
in the bodies of Mohawk women and
passed on to infants in breast milk.
Elsewhere in the book, LaDuke
discusses endangered panthers in the
south where the Seminoles of the
Florida Everglades are wrapped up in
efforts to save endangered species,
habitats, and life ways. In this case-
study, she highlights key issues of
cultural transformation, with radically
different  choices  of  Seminoles
resulting in the federally recognized
Seminole Tribe of Florida and the
unrecognized Independent Traditional
Seminole nation.

The Innu of Quebec and
Labrador ask the critical question,
"Who has the right to make the earth
anew, and how is it made so?" Low
level flights and sonic booms from
NATO training flights, as well as dams
built to supply "green power" to the
United States are key change-making
mechanisms to the lands of Innu people
who neither agree to nor benefit from
these  activities.  The  Northern
Cheyenne of Montana have been
ravaged by the health implications of
their proximity to coal mining.
Nuclear waste in Western Shoshone
territory is the focus of another chapter.
Not only was the 1951 Nevada nuclear
test site located on their lands, but
Yucca Mountain, also in Western
Shoshone Territory, is targeted to be
the "final" resting place for US nuclear
waste if the "Mobile Chernobyl" bill
ever passes through Congress and
across the President's desk.

Book Reviews

Interweaving  historic  and
contemporary sources and conflicts,
LaDuke shows how issues deemed
"economic,"   "environmental,"  or
"cultural" are interrelated  and in-
separable.  Contemporary corporate
practices consider short-term profits
over long-term human and environ-
mental costs.  LaDuke rejects the
division of human and environmental,
referring to Native American beliefs
that include animals, trees, rocks, and
other "natural phenomena" as living
beings that are related to human
beings. For LaDuke, to care for "all
our relations" is to care for ourselves,
and to neglect them is to neglect
ourselves.

LaDuke refuses to romanticize
anyone in the book, be they "noble
savages" or the bearers of "progress."
Rather, she looks at the dilemmas
facing "just plain folk," Native
Americans who are trying to come up
with solutions to devastating problems
that are the result of technologies
applied without proper safeguards.
Practices that result in severe damage
to "all our relations" and ourselves are
often rationalized by describing them
as scientific and necessary for progress.
LaDuke argues that Native practices
(such as forest management) are often
more rational and scientific than the
profit and ideologically driven prac-
tices of corporations. To an anthro-
pologist, it comes as no surprise that
non-Western and/or local knowledge
can be scientific and rational.  An
article in the New York Times that
came out soon after LaDuke's book,
for example, reported that researchers
have found scientific proof that the

indigenous Andean practice of staring
at the stars to determine the timing of
potato planting, so-called "madness,"
works. It turns out that their technique
accurately predicted drought years.
Nor does it come as a surprise that
some of what is sold as "progress" has
more to do with being "sold" than to
making progress.

LaDuke proposes to combine
the best of indigenous knowledge and
Western science to come up with
solutions that ensure that everyone has
access to clean air, water, and other
renewable resources. This book is a
must-read for anthropologists con-
cerned with health, the environment,
Native America, corporate America, or
who just want to be inspired by the will
to life present in each environmental
activist.

Christie W. Kiefer. Health Work
with the Poor: A Practical Guide.
(New Brunswick, New Jersey:

Rutgers University Press, 2000). 239
pp., US$18.00, paper.

Review by Seth Holmes

Written by an academic
cultural anthropologist, with health
professions students in mind, Health
Work with the Poor offers a unique
combination of social analysis and
practical suggestions for a broad
audience,  especially  health  pro-
fessionals working with poor people.

The book is split into three
major sections, followed by two short
appendixes. The first section considers

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Kroeber Anthropological Society Papers

what poverty is and why it exists.
Kiefer  begins  by  rejecting  the
dichotomy of deserving/undeserving
poor as well as the definition of
poverty simply as a lack of financial
resources.  Instead, he opts for an
understanding of poverty as a "social
problem" caused by inequality, with
"the poor" as its victims.  He sees
poverty as related to both the control of
economics and politics by those with
wealth and to the resultant breakdown
of "community," defined as shared
values, history, beliefs, etc.  Next,
Kiefer briefly moves through ethno-
graphic accounts of urban poor people
to show their behaviors to be
understandable responses to social
conditions. He states that, while poor
people are seeking the same basic
human needs as middle class people,
poverty requires them to have a "mind-
set that is fundamentally different from
the middle-class one" (34). He gives
an extensive list of questions to prompt
health professionals to consider the
effects of class, ethnic, geographical,
and gender context on the well-being
of their patients. The author closes this
section by calling the health care
worker to be humble in interactions
with patients and to advocate social
change.

In this first section, Kiefer
challenges  important  assumptions
related  to  poverty,  notably  the
conception of poverty as caused by the
moral unworthiness of the individual.
Rather, he understands poor people as
positioned by social structures. At the
same time, he maintains some aspects
of a structural-functional, "culture of
poverty" approach. In this way, the

understandable "mind-set" that poor
people develop in response to poverty
reinforces their poverty and implies the
need to change their behavior and
thinking. This may work to reinforce a
"blaming of the victim." In addition,
the author utilizes a social evolutionary
framework that seems naively nostalgic
of "traditional," "primitive" commun-
ities and pessimistic of modem, indust-
rialized societies. Finally, writing for
an audience of health professionals
limits Kiefer's critiques. Although he
challenges the power inequities in the
physician-patient relationship, he is not
critical  of  the   monopoly   on
"knowledge" and "truth" held by the
physician, or, more broadly, by
"Science."

In the second section, Kiefer
traces the history and politics of
poverty and health.  He begins by
showing how poverty is linked to
economic changes, racial and class
segregation, and the control of politics
by those with wealth. Next, Kiefer
examines welfare from the inception of
the Social Security Act of 1935 to the
fallout of Newt Gingrich's "Contract
with America." He critiques several
understandings of welfare recipients,
including those related to "teenage
pregnancy" and "violence." He uses
statistics to show that receiving welfare
does not increase unwed pregnancy
and that "street crime" is much less
costly than white-collar crime. Next,
Kiefer discusses health care reform and
the ways in which Medicaid, Medicare,
and welfare policies put the well-being
of poor people in the U.S. at risk. He
then considers the relationship between
health and poverty, seeing the causality

1 2 2

No. 88

Book Reviews

as multi-directional: poverty leads to
sickness,  and  sickness  increases
poverty. He argues that sickness is due
not merely to the behavior of the poor,
but to a mixture of structural forces as
well as poor people's lack of skills in
utilizing political power. He closes by
arguing that illness is a social problem
to be addressed on a societal level, not
an individual problem to be addresses
solely in the clinic.

In this section, Kiefer again
offers important critiques of common
understandings of poverty in the US
and makes social theory accessible to a
broad audience. His consideration of
health  and  poverty  as   societal
problems, not individual deficiencies,
is key. At the same time, the under-
standing of illness as related to a lack
of skills in poor people harkens back to
the culture of poverty paradigm
mentioned above. This theory is most
problematic in relation to his dichoto-
mizing of poor men into the ideal
types, "villager" and "warrior," which
may unintentionally reinforce the
stereotype of poor and colored men as
violent.

In the last section of the book,
Kiefer  explains  the  history  of
Community Health Centers (CHCs) in
the US and their implications for health
and poverty. He sees the CHCs as
community-empowering places of high
quality care that are at risk of
disappearance due to federal policy
changes.   He also   discusses the
possible  roles  for  the   health
professional in community organizing.
This section draws on his experience in
community action and as a member of
the board of directors of Lifelong

Medical Clinic, a Community Health
Clinic in Berkeley, California.

This last section offers an
optimistic look at the possibility of
social change, specifically related to
health, and provides practical sug-
gestions for advocacy. Problematic,
however, is Kiefer's optimism about
the good intentions and positive impact
of health professionals. This could be
balanced with an acknowledgement of
the many critical representations of
health workers and the effects of their
science and practices. In addition, this
section focuses primarily on changing
health care without much mention of
changing the social structures already
acknowledged to be exacerbating
sickness for poor people.

The book closes with two
useful appendixes. Appendix A is a
list of "Internet Resources for the
Study of Poverty," allowing the reader
to update their familiarity with social
policies in the US. Appendix B is an
interesting reflection on the author's
experience of facilitating discussion
courses on issues of social justice and
health, including several suggestions
for others wishing to teach similar
courses.

Health Work with the Poor is
an exceptional book offering social
analysis and practical suggestions to a
broad audience interested in health and
poverty. Despite its few problematic
threads, this book is a welcome
addition to the rare literature bridging
social theory and practical, social
action.

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Kroeber Anthropological Society Papers

Vilma Santiago-Irizarry.

Medicalizing Ethnicity: The

Construction of Latino Identity in a

Psychiatic Setting. (Ithaca: Cornell
University Press, 2001). 178 pp.,
US$16.95, paper.

Review by Angela C. Jenks

This book offers one of the few
extensive examinations and critiques of
the development and implementation
of "culturally sensitive" psychiatric
inpatient programs. Santiago-Irizarry,
a professor of anthropology at Cornell
University, focuses on three bilingual,
bicultural psychiatric programs for
Latino patients in New York City.
Originally a member of the programs'
evaluation team, she draws upon much
of the data collected at that time, but
with a new analytic approach and
purpose. While the evaluation team
was assigned the task of legitimating
the programs and offering recom-
mendations that could both be
implemented by local administrators
and replicated in other settings,
Santiago-Irizarry is concerned with
understanding the complexities behind
an emphasis on "cultural sensitivity,"
and    explores  the   unintended
consequences of its institutionalization.

Medicalizing Ethnicity is con-
cerned with the ways in which
"culture" and "ethnicity" are defined
and positioned within the sociocultural
domain of medicine and public mental
health care. By using the term "med-
icalizing," Santiago-Irizarry hopes to
underscore her focus on "the power
that medical discourses exert upon the
processes of ethnicity construction,"

and to "evoke the interaction of
mutually   articulating  categories,
processes, and practices-'culture,'
'the  medical,' 'ethnicity,'  [and]
'identity construction"' (4). This dis-
cussion is couched in a close examin-
ation of the wide-ranging negotiations
and   debates  that  led  to  the
establishment of the programs, as well
as the everyday activities and strategies
used to implement cultural sensitivity.

Santiago-Irizarry begins by
discussing the irony behind the
programs' implementation: while ad-
vocates viewed them as a much needed
vehicle for social and political change,
others saw the programs and the
concept in general as not only
discriminatory, but also as a self-
interested strategy on the part of Latino
mental health practitioners to increase
their own job prospects. Ultimately,
she suggests, the programs were
legitimated when the emphasis was
placed on demographic changes and on
understandings of "linguistic regres-
sion" (the notion that even bilingual or
U.S.-born Latinos, when faced with
stressful situations such as a mental
health crisis, will "regress," and be
most comfortable communicating in
Spanish). She continues by focusing
on the specific local conditions for
each of the programs, pointing to
variation according to their location in
the city and the patient population they
served.

In addition to these chapters on
the programs' localized debates and
circumstances, one of the most
valuable aspects of the book is her
concern with the way "culture" is
constructed and applied to psychiatric

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Book Reviews

care and policy making in general.
Santiago-Irizarry  points  to  the
construction of reified, essentialized
notions of culture, in which difference
is emphasized, and the dominant Anglo
culture is thus reaffirmed as the
"normal."   Within psychiatry, she
argues, though it is true well beyond
the field of health care, "culture"
becomes positioned ambivalently as
both pathological and curative; it is
both the problem and the solution.
"Culture" in this sense becomes
something only Others have. It can be
isolated from other areas of life, and
becomes a reservoir from which
relevant items can be drawn and then
inserted into various culture-free,
objective structures and institutions.
Those who have been defined as
culturally  "different,"  then,  are
ultimately placed in a situation of
having to perform their culture in order
to have access to social services. Just
as psychiatric patients must "make it
crazy," Santiago-Irizarry suggests, they
must also now "make it ethnic."
Ultimately, Santiago-Irizarry argues,
the worthy leveling agenda espoused
by ethnic activists and leaders had "the
unintended consequences of vitiating
their  efforts  rather  than  fully
empowering them" (2).

Santiago-Irizarry is successful
in    demonstrating   the     anti-
discriminatory intentions of calls for
cultural sensitivity, and in portraying
the difficulties and failures of ethnic
activism without condemning its goals.
Perhaps most importantly, she presents
her critique in a style and language that
is accessible to not only social
scientists, but to medical practitioners

and policy makers as well. The book,
however, unfortunately stops short of
an examination of what the processes
described mean for larger issues of
identity,  race,  nationality,  and
citizenship more generally, or of the
way anthropology itself has been taken
up and used in these debates.

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