How to Have Theory in an Epidemic: Cultural Chronicles of AIDS / Edition 1

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Paula A. Treichler has become a singularly important voice among the significant theorists on the AIDS crisis. Dissecting the cultural politics surrounding representations of HIV and AIDS, her work has altered the field of cultural studies by establishing medicine as a legitimate focus for cultural analysis. How to Have Theory in an Epidemic is a comprehensive collection of Treichler’s related writings, including revised and updated essays from the 1980s and 1990s that present a sustained argument about the AIDS epidemic from a uniquely knowledgeable and interdisciplinary standpoint.
“AIDS is more than an epidemic disease,” Treichler writes, “it is an epidemic of meanings.” Exploring how such meanings originate, proliferate, and take hold, her essays investigate how certain interpretations of the epidemic dominate while others are obscured. They also suggest ways to understand and choose between overlapping or competing discourses. In her coverage of roughly fifteen years of the AIDS epidemic, Treichler addresses a range of key issues, from biomedical discourse and theories of pathogenesis to the mainstream media’s depictions of the crisis in both developed and developing countries. She also examines representations of women and AIDS, treatment issues, and the role of activism in shaping the politics of the epidemic. Linking the AIDS tragedy to a uniquely broad spectrum of contemporary theory and culture, this collection concludes with an essay on the continued importance of theoretical thought for untangling the sociocultural phenomena of AIDS—and for tackling the disease itself.
With an exhaustive bibliography of critical and theoretical writings on HIV and AIDS, this long-awaited volume will be essential to all those invested in studying the course of AIDS, its devastating medical effects, and its massive impact on contemporary culture. It should become a standard text in university courses dealing with AIDS in biomedicine, sociology, anthropology, gay and lesbian studies, women’s studies, and cultural and media studies.

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Editorial Reviews

From the Publisher
“Looking backward and ahead, How to Have Theory in an Epidemic is nothing short of a handbook of the meanings of AIDS: as human experience, as political reality, as public service action, and, not least of all, as moral engagement with one of the great challenges to meaning-making and unmaking in everyday life.”—Dr. Arthur Kleinman, Harvard University

“Paula Treichler’s essays are certainly among the most significant written on the subject of AIDS. They are, in fact, a model of what the field of cultural studies at its best can contribute to our thinking about urgent social and political issues. This is an essential book, one that will strongly affect the way people approach the subject of AIDS in the future.”—Douglas Crimp, author of AIDS: Demo Graphics

Choice Magazine
Treichler's primary arguments are that the AIDS epidemic is cultural and linguistic as well as biological and biomedical. . . . [A] series of case studies that document the epidemic, read its texts with some attention to contemporary theory, and explore what theory does or does not do in this epidemic.
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Product Details

  • ISBN-13: 9780822323181
  • Publisher: Duke University Press Books
  • Publication date: 7/28/1999
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 496
  • Sales rank: 1,026,994
  • Product dimensions: 6.00 (w) x 9.20 (h) x 1.40 (d)

Meet the Author

Paula A. Treichler is a professor at the University of Illinois, where she holds positions in the College of Medicine, the Institute of Communications Research, and the Women’s Studies Program. Her writings on AIDS have appeared in such journals as Science, ArtForum, October, Transition, and Camera Obscura. She is the coauthor of Language, Gender, and Professional Writing and A Feminist Dictionary and the coeditor of For Alma Mater,Cultural Studies , and The Visible Woman.

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How to Have Theory in an Epidemic

Cultural Chronicles of AIDS

By Paula A. Treichler

Duke University Press

Copyright © 1999 Duke University Press
All rights reserved.
ISBN: 978-0-8223-9696-3


AIDS, Homophobia, and Biomedical Discourse: An Epidemic of Signification

In multiple, fragmentary, and often contradictory ways, we struggle to achieve some sort of understanding of AIDS, a reality that is frightening, widely publicized, yet finally neither directly nor fully knowable. AIDS is no different in this respect from other linguistic constructions that, in the commonsense view of language, are thought to transmit preexisting ideas and represent real-world entities yet in fact do neither. The nature of the relation between language and reality is highly problematic; and AIDS is not merely an invented label, provided to us by science and scientific naming practices, for a clear-cut disease entity caused by a virus. Rather, the very nature of AIDS is constructed through language and in particular through the discourses of medicine and science; this construction is "true" or "real" only in certain specific ways–for example, insofar as it successfully guides research or facilitates clinical control over the illness. The name AIDS in part constructs the disease and helps make it intelligible. We cannot therefore look "through" language to determine what AIDS "really" is. Rather, we must explore the site where such determinations really occur and intervene at the point where meaning is created: in language.

Of course, AIDS is a real disease syndrome, damaging and killing real human beings. Because of this, it is tempting–perhaps in some instances imperative–to view science and medicine as providing a discourse about AIDS closer to its "reality" than what we can provide ourselves. Yet, with its genuine potential for global devastation, the AIDS epidemic is simultaneously an epidemic of a transmissible lethal disease and an epidemic of meanings or signification. Both epidemics are equally crucial for us to understand, for, try as we may to treat AIDS as "an infectious disease" and nothing more, meanings continue to multiply wildly and at an extraordinary rate. This epidemic of meanings is readily apparent in the chaotic assemblage of understandings of AIDS that by now exists. The mere enumeration of some of the ways AIDS has been characterized suggests its enormous power to generate meanings:

1. An irreversible, untreatable, and invariably fatal infectious disease that threatens to wipe out the whole world.

2. A creation of the media, which has sensationalized a minor health problem for its own profit and pleasure.

3. A creation of the state to legitimize widespread invasion of people's lives and sexual practices.

4. A creation of biomedical scientists and the Centers for Disease Control to generate funding for their activities.

5. A gay plague, probably emanating from San Francisco.

6. The crucible in which the field of immunology will be tested.

7. The most extraordinary medical chronicle of our times.

8. A condemnation to celibacy or death.

9. An Andromeda strain with the transmission efficiency of the common cold.

10. An imperialist plot to destroy the Third World.

11. A fascist plot to destroy homosexuals.

12. A CIA plot to destroy subversives.

13. A capitalist plot to create new markets for pharmaceutical products.

14. A Soviet plot to destroy capitalists.

15. The result of experiments on the immunological system of men not likely to reproduce.

16. The result of genetic mutations caused by "mixed marriages."

17. The result of moral decay and a major force destroying the Boy Scouts.

18. A plague stored in King Tut's tomb and unleashed when the Tut exhibit toured the United States in 1976.

19. The perfect emblem of twentieth-century decadence; of fin de siècle decadence; of postmodern decadence.

20. A disease that turns fruits into vegetables.

21. A disease introduced by aliens to weaken us before the takeover.

22. Nature's way of cleaning house.

23. America's Ideal Death Sentence.

24. An infectious agent that has suppressed our immunity from guilt.

25. A spiritual force that is creatively disrupting civilization.

26. A sign that the end of the world is at hand.

27. God's punishment of our weaknesses.

28. God's test of our strengths.

29. The price paid for the 1960s.

30. The price paid for anal intercourse.

31. The price paid for genetic inferiority and male aggression.

32. An absolutely unique disease for which there is no precedent.

33. Just another venereal disease.

34. The most urgent and complex public health problem facing the world today.

35. A golden opportunity for science and medicine.

36. Science fiction.

37. Stranger than science fiction.

38. A miserable and expensive way to die.

Such diverse conceptualizations of AIDS are coupled with fragmentary interpretations of its specific elements. Confusion about transmission now causes approximately half the U.S. population to refuse to give blood. Many believe that you can "catch" AIDS through casual contact, such as sitting beside an infected person on a bus. Many believe that lesbians–a population relatively free of sexually transmitted diseases in general–are as likely to be infected as gay men. Other stereotypes about homosexuals generate startling deductions about the illness: "I thought AIDS was a gay disease," said a man sitting near a friend of mine in an airport in October 1985, "but if Rock Hudson's dead it can kill anyone."

We cannot effectively analyze AIDS or develop intelligent social policy if we dismiss such conceptions as irrational myths and homophobic fantasies that deliberately ignore the "real scientific facts." Rather, they are part of the necessary work that people do in attempting to understand–however imperfectly–the complex, puzzling, and quite terrifying phenomenon of AIDS. No matter how much we desire, with Susan Sontag, to resist treating illness as metaphor, illness is metaphor, and this semantic work–this effort to "make sense of" AIDS–must be done. Further, this work is as necessary and often as difficult and imperfect for physicians and scientists as it is for "the rest of us."

I am arguing, then, not that we must take both the social and the biological dimensions of AIDS into account, but rather that the social dimension is far more pervasive and central than we are accustomed to believing. Science is not the true material base generating our merely symbolic superstructure. Our social constructions of AIDS (in terms of global devastation, the threat to civil rights, the emblem of sex and death, the "gay plague," the postmodern condition, whatever) are based not on objective, scientifically determined "reality" but on what we are told about this reality: that is, on prior social constructions routinely produced within the discourses of biomedical science. (AIDS as infectious disease is one such construction.) There is a continuum, then, not a dichotomy, between popular and biomedical discourses (and, as Latour and Woolgar put it, "a continuum between controversies in daily life and those occurring in the laboratory" [(1979) 1986, 281]), and these play out in language. Consider, for example, the ambiguities embedded within this statement by an AIDS expert (an immunologist) on a television documentary in October 1985 designed to dispel misconceptions about AIDS:

The biggest misconception that we have encountered and that most cities throughout the United States have seen is that many people feel that casual contact–being in the same room with an AIDS victim–will transmit the Virus and may infect them. This has not been substantiated by any evidence whatsoever.... [This misconception lingers because] this is an extremely emotional issue. I think that when there are such strong emotions associated with a medical problem such as this it's very difficult for facts to sink in. I think also there's the problem that we cannot give any 100 percent assurances one way or the other about these factors. There may always be some exception to the rule. Anything we may say, someone could come up with an exception. But as far as most of the medical-scientific community is concerned, this is a virus that is actually very difficult to transmit and therefore the general public should really not worry about casual contact–not even using the same silverware and dishes would probably be a problem.

The point is not merely that this particular scientist has not yet learned to "talk to the media" (see Fain 1985; and Check 1985) but that ambiguity and uncertainty are features of scientific inquiry to be socially and linguistically managed. Few scientists in the mid-1980s could produce more than common sense or contradiction–or both (as here: we can't be certain but the public should not worry). At issue here is a fatal infectious disease that is simply not fully understood; questions remain about the nature of the disease, its etiology, its transmission, and what individuals can do about it. It does not seem unreasonable that, in the face of these uncertainties, people's imaginations give birth to many different conceptions; to label them mis-conceptions implies what? Wrongful birth? Only "facts" can give birth to proper conceptions, and only science can give birth to facts? In that case, we may wish to avert our eyes from some of the "scientific" conceptions born in the course of the AIDS crisis:

AIDS could be anything, considering what homosexual men do to each other in gay baths (cited in Leibowitch 1985).

Heroin addicts won't use clean needles because they would rather get AIDS than give up the ritual of sharing them (cited in Barrett 1985).

Prostitutes do not routinely keep themselves clean and are therefore "reservoirs" of disease (cited in Langone 1985). AIDS is homosexual; it can be transmitted only by males to males.

AIDS in Africa is heterosexual but unidirectional: it can be transmitted only from males to females (cited in Langone 1985).

AIDS in Africa is heterosexual because anal intercourse is a common form of birth control there (cited in L. Altman 1985b).

Such assertions blur the line between the facticity of scientific and nonscientific (mis)conceptions. Ambiguity, homophobia, stereotyping, confusion, doublethink, them versus us, blame the victim, wishful thinking: none of these popular forms of semantic legerdemain about AIDS is absent from biomedical communication. But scientific and medical discourses have traditions through which semantic epidemics as well as biological ones are controlled, and these may disguise contradiction and irrationality. In writing about AIDS, these traditions typically include characterizing ambiguity and contradiction as nonscientific (a no-nonsense let's-get-the-facts-on-the-table-and-clear-up-this-muddle approach), invoking faith in scientific inquiry, taking for granted the reality of quantitative and/or biomedical data, deducing social and behavioral reality from quantitative and/or biomedical data, setting forth fantasies and speculations as though they were logical deductions, using technical euphemisms for sensitive sexual or political realities, and revising both past and future to conform to present thinking.

Many of these traditions are illustrated in an article by John Langone in the December 1985 general science journalDiscover. In this lengthy review of research to date, entitled "AIDS: The Latest Scientific Facts," Langone suggests that the virus enters the bloodstream by way of the "vulnerable anus" and the "fragile urethra"; in contrast, the "rugged vagina" (built to be abused by such blunt instruments as penises and small babies) provides too tough a barrier for theAIDS virus to penetrate (pp. 40-41). "Contrary to what you've heard," Langone concludes–and his conclusion echoes a fair amount of medical and scientific writing at the time–"AIDSisn't a threat to the vast majority of heterosexuals.... It is now and is likely to remain–largely the fatal price one can pay for anal intercourse" (p. 52). (This excerpt from the article also ran as the cover blurb.) It sounded plausible, and detailed illustrations demonstrated the article's conclusion.

But, by December 1986, the big news–what the major U.S. newsmagazines were running cover stories on–was the grave danger that AIDS posed to heterosexuals. No dramatic discoveries during the intervening year had changed the fundamental scientific conception of AIDS. What had changed was not "the facts" but the way in which they were now used to construct the AIDS text and the meanings that we were now allowed– indeed, at last encouraged–to read from that text. The AIDS story, in other words, is not merely the familiar story of heroic scientific discovery. And until we understand AIDS's dual life as both a material and a linguistic reality–a duality inherent in all linguistic entities but extraordinarily exaggerated and potentially deadly in the case of AIDS–we cannot begin to read the story of this illness accurately or formulate intelligent interventions.

Sources outside biomedical science, however, have helped shape the discourse on AIDS. Almost from the beginning, through intense interest and informed political activism, members of the gay community have repeatedly contested the terminology, meanings, and interpretations produced by scientific inquiry. Such contestations had occurred a decade earlier in the struggle over whether homosexuality was to be officially classified as an illness by the American Psychiatric Association (see Bayer 1981). In the succeeding period, gay men and Lesbians had achieved considerable success in political organizing. AIDS, then, first struck members of a relatively seasoned and politically sophisticated community. The importance of not relinquishing authority to medicine was articulated early in the AIDS crisis by Michael Lynch (1982): "Another crisis exists with the medical one. It has gone largely unexamined, even by the gay press. Like helpless mice we have peremptorily, almost inexplicably, relinquished the one power we so long fought for in constructing our modern gay community: the power to determine our own identity. And to whom have we relinquished it? The very authority we wrested it from in a struggle that occupied us for more than a hundred years: the medical profession."

Challenging biomedical authority–whose meanings are part of powerful and deeply entrenched social and historical codes–has required considerable tenacity and courage from people dependent in the AIDS crisis on science and medicine for protection, care, and the possibility of cure. These contestations provide the model for a broader social analysis, one that moves away from AIDS as a "lifestyle" issue and examines its significance for this country, at this time, with the cultural and material resources available to us. This, in turn, requires us to acknowledge and examine the multiple ways in which our social constructions guide our visions of material reality.

AIDS and Homophobia: Constructing the Text of the Gay Male Body

Whatever else it may be, AIDS is a story, or multiple stories, and read to a surprising extent from a text that does not exist: the body of the male homosexual. People so want–need–to read this text that they have gone so far as to write it themselves. AIDS is a nexus where multiple meanings, stories, and discourses intersect and overlap, reinforce and subvert each other. Yet clearly this mysterious male homosexual text has figured centrally in generating what I call here anepidemic of signification. Of course, "the Virus," with mysteries of its own, has been a crucial influence. But we may recall Camus's ([1947] 1948) novel: "the word 'Plague' ... conjured up in the doctor's mind not only what science chose to put into it, but a whole series of fantastic possibilities utterly out of keeping" (p. 37) with the bourgeois town of Oran, where the plague struck. How could a disease so extraordinary as plague happen in a place so ordinary and dull? Initially striking people perceived as alien and exotic by scientists, physicians, journalists, and much of the U.S. population, AIDS did not pose such a paradox. The "promiscuous" gay male body–early reports noted that AIDS"victims" reported having had as many as a thousand sexual partners– made clear that, even if AIDS turned out to be a sexually transmitted disease, it would not be a commonplace one. The connections between sex, death, and homosexuality made the AIDS story inevitably, as David Black (1986) notes, able to be read as "the story of a metaphor."

Ironically, a major turning point in the U.S. consciousness came when Rock Hudson acknowledged that he was being treated for AIDS. Through an extraordinary conflation of texts, the Rock Hudson case dramatized the possibility that the disease could spread to the "general population." In fact, this possibility had been evident for some time to anyone who wished to find it: as Jean Marx summarized the evidence in Science in 1984, "Sexual intercourse both of the heterosexual and homosexual varieties is a major pathway of transmission" (p. 147). But only in late 1986 (and somewhat reluctantly at that) did the CDC (1986c) expand on its original "4-H list" of high-risk categories: homosexuals, hemophiliacs, heroin addicts, and Haitians and the sexual partners of people within these groups. The original list, developed during 1981 and 1982, has structured evidence collection in the intervening years and contributed to the view that the major risk factor in acquiring AIDS is being a particular kind of person rather than doing particular things. Ann Giudici Fettner, AIDS reporter for the New York Native, pointed out in 1985 that "the CDCadmits that at least ten percent of AIDS sufferers are gay and use IV drugs. Yet they are automatically counted in the homosexual and bisexual men category, regardless of what might be known–or not known–about how they became infected" ("AIDS: What Is to Be Done?" 1985, 43). So the "gay" nature of AIDS was in part an artifact of the way data were collected and reported. Although, almost from the beginning, scientific papers have cited AIDS cases that appeared to fall outside the high-risk groups, it has been generally hypothesized that these cases, assigned to the categories of unknown, unclassified, or other, would ultimately turn out to be one of the four Hs. This commitment to categories based on monolithic identity filters out information. Shaw (1986) argues that when women are asked in CDC protocols "Are you heterosexual?" "this loses the diversity of behaviors that may have a bearing on infection." Even now, with established evidence that transmission can be heterosexual (which begins with the letter h after all), scientific discourse continues to construct women as "inefficient" and "incompetent" transmitters of HIV ("theAIDS virus"), passive receptacles without the projectile capacity of a penis or a syringe– stolid, uninteresting barriers that impede the unrestrained passage of the virus from brother to brother. Exceptions include Prostitutes, whose discursive legacy–despite their long-standing professional knowledge and continued activism about AIDS–is to be seen as so contaminated that their bodies are virtual laboratory cultures for viral replication. Other exceptions are African women, whose exotic bodies, sexual practices, or who knows what are seen to be so radically different from those of women in the United States that anything can happen in them. The term exotic, sometimes used to describe a virus that appears to have originated "elsewhere" (but elsewhere, like other, is not a fixed category), is an important theme running through AIDS literature (Leibowitch 1985, 73). The fact that one of the more extensive and visually elegant analyses of AIDS appeared in the National Geographic (Jaret 1986) is perhaps further evidence of its life on an idealized "exotic" terrain.


Excerpted from How to Have Theory in an Epidemic by Paula A. Treichler. Copyright © 1999 Duke University Press. Excerpted by permission of Duke University Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

A Note on the Text
Prologue 1
1 AIDS, Homophobia, and Biomedical Discourse: An Epidemic of Signification 11
2 The Burdens of History: Gender and Representation in AIDS Discourse, 1981-1988 42
3 AIDS and HIV Infection in the Third World: A First World Chronicle 99
4 Seduced and Terrorized: AIDS in the Media 127
5 AIDS, HIV and the Cultural Construction of Reality 149
6 AIDS Narratives on Television: Whose Story? 176
7 AIDS, Africa, and Cultural Theory 205
8 Beyond Cosmo: AIDS, Identity, and Inscriptions of Gender 235
9 How to Have Theory in an Epidemic: The Evolution of AIDS, Treatment, and Activism 278
Epilogue 315
Notes 331
Bibliography 387
Index 453
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