Newsletter #63: Race, Medicine, and Indifference to Suffering, with Helena Hansen, Jules Netherland, and David Herzberg

by Mack Penner

I often think that the mass cruelty inherent in human societies that are organized by the logic of profit-making is made clearest in histories of medicine. There is something about the collision of capitalism, colonialism, and care that powerfully illustrates how brutalizing the organizing structures of our collective lives can be.

In their interview with The Dig on the racist, capitalist causes and contours of the American opioid crisis, Helena Hansen, Jules Netherland, and David Herzberg only intensified this sense for me. In the episode, they make plain that health problems like addiction which are so often treated as individual issues are in fact structurally caused. In this way, health problems come to look like a kind of predation, in which racialized and poor people are particularly subordinated to profit and white supremacy.

Historians Mary Jane Logan McCallum and Adele Perry wrote a great pamphlet-style book Structures of Indifference, which is incredibly effective at showing how structural determinants, which might seem abstract, are made real on the ground. McCallum and Perry take the September 2008 death of Brian Sinclair in a Winnipeg hospital as a case study of the ways settler-colonialism contributes to the dehumanization and associated poor health outcomes of Indigenous people. Sinclair, a non-status Anishinaabe man, died from a treatable infection after spending thirty-four unattended hours in the emergency room of the major downtown hospital in Winnipeg. McCallum and Perry historicize Sinclair’s death as an outcome of a structurally indifferent settler colonialism.

Listen to this week’s episode of The Dig here.

Without reducing Indigeneity to race, McCallum and Perry argue that the structures of indifference that led to Sinclair’s death were an effect of anti-Indigenous racism. In describing such racism, they carefully avoid the binary terms of debate in which “individual” and “structural” racism are assumed to be mutually exclusive categories. Instead, they argue that anti-Indigenous racism in settler-colonial societies always exists in both senses. This echoes the interview with Hansen, Netherland, and Herzberg, who mention that intent, malicious or benevolent, does not have a fixed relation to outcome in the history of the opioid crisis. The issue of intent clarifies what makes “structures of indifference” such a useful framing concept. If, in Canada, settler-colonialism is defined by an active investment in the creation of a white settler state, historical development has distributed that investment in particular ways. The hospital workers who were indifferent to Sinclair’s distress in the waiting room did not have to wake up before their shifts consciously eager to serve the ongoing Canadian settler-colonial project in order to do just that. As McCallum and Perry say, “In the medical field, racist practices are embedded in a long, nationwide history of racial segregation in hospitals, and notions of who is and who is not deserving of medical care are intimately tied to political, economic, religious, technological, and cultural influences.” While anti-Indigenous racism can and does manifest as malice, it can also appear as historically conditioned indifference. A similar kind of indifference can be noted across Hansen, Netherland, and Herzberg’s descriptions of the American opioid crisis and its racial-capitalist structure.

Further Listening In addition to Structures of Indifference, I have three recommendations from The Dig’s vast archive: on how colonialism and capitalism make us sick, check out this interview with Raj Patel and Rupa Marya; on care and capitalism, check out Gabriel Winant’s appearance to discuss his book The Next Shift; for another direct look at the opioid crisis, you can listen to Leo Beletsky’s interview from 2017.