Behavioral Failure and the Killer App: Reflections on Melancholy via AIDS Prophylaxis and the Indian Emergency

This post continues the last post’s brief speculation on the new figure of UID as a platform with “public health” as among its most effective “killer apps.”

Scary?

Several scholars have taken up this striking figure: here I want briefly to engage the critique of Usha Ramanathan in the journal Seminar. Her title, “The myth of the technology fix,” suggests the broad lines of the critique. Indeed it is hard not to be troubled by the promissary hype of UID boosters (suggesting a fruitful future engagement with the anthropology of technological hype and the varied arguments of Kaushik SunderrajanMike Fortun, Nik Brown, and many others).

Ramanathan begins with a diagnosis of public melancholy, to paraphrase the political theorist Wendy Brown, amid the apparent failure of the future-oriented progressivism of the development planning state: “The depths to which public morality has sunk evokes desperation, which seeks answers somewhere other than where the problem now abides, viz. in the human person. Technology and the machine can in the land of desperate optimism, seem relatively uncorruptible.”

The line of argument is familiar, from M.K. Gandhi’s Hind Swaraj to the critique of Nehruvian planned development. But if Gandhi could hold out for an ethic of the human and non-human set against certain extremes of machine life, by now Ramanathan suggests the human seems to have been altogether forfeited as a site of work.

If this melancholic condition holds, in which no movement at the level of the human is conceivable, in the context of the figure of duplication that haunts the entire moment and apparatus of UID, it is a condition of behavioral melancholy.  That is, persons, at least “public persons,” simply cannot be counted on to act morally. If behavior fails, tout court, then one needs a proxy for behavior: the machine.

I am moved to suggest this figure of a proxy for behavior given work from a very different context: that of the anthropologist Ryan Whitacre examining the emerging therapeutics of PrEP, pre-exposure prophylaxis for HIV as developed by the Gilead pharmaceutical corporation. At a UCLA conference organized by Mark McGrath to debate the impact of PrEP to which Ryan and I were invited, a dominant argument for the value of antiretroviral medication taken to prevent infection was that “behavior [i.e., condom use] has failed.” In the face of the utter failure of behavior, Gilead’s drug Truvada was offered as a proxy for behavior. [It is worth pointing out that these arguments were not made by Gilead representatives, who were not present at this conference. It may be worth pointing out that some of the activists making these claims were part of a welfare industry increasingly dependent on drug company funding.]

When behavior fails

One of Ryan’s several points, in the face of strenuous claims by several AIDS professionals that PrEP was necessitated by the failure of behavior, was that drug use is of course a behavior.

The point is neither to dismiss the power or utility of Truvada or PrEP nor to fail to acknowledge the experience of the activists that has led some to what I am calling behavioral melancholy.   Still, as scholars we note that PrEP may lead to a lifetime of the pharmaceuticalization of sex for many.  Truvada, used both to prevent as well as to treat infection, leads to a life course in which people who identify with particular terrains of risk consume the same drug both before and after seroconversion, a crucial clinical achievement but also brilliant corporate strategy and a validation of anthropologist Joe Dumit’s concept of the contemporary pharmaceutical capitalization of surplus health.

I mention this aside, on PrEP, as Ramanathan’s point similarly seemed to trouble an implicit or explicit claim for UID/Aadhaar as a proxy for behavior.

Ramanathan turns to the same and widely cited document on UID and Public Health I cited in the last post, and to the figure of the killer app. What is killer about the conception of public health as the “app” driving UID registration, as proposed in the document, is its coercive force. The ability to have access to more and more basic entitlements will be linked to the UID number: life will be inconceivable without it. Ramanathan challenges the “myth of voluntariness,” given the sheer force of the UID as it reorganizes the condition of life itself.

But in at least one sense, the form of coercion at stake works precisely through its “voluntary” quality. One is reminded of Emma Tarlo’s powerful reframing of the coercive sterilizations of the Indian 1970s’ Emergency. Unlike the powerful account in Rohinton Mistry’s novel A Fine Balance, when two poor men are literally dragged by goons into vehicles taking them to a surgical camp for forced operations, Tarlo shows through painstaking archival work in a Delhi resettlement colony how access to state-mediated land, food, employment, and minimal clinical care depended upon having the right identification papers, papers that marked one’s household as having given over a sufficient number of its members for the family-planning operation.

The state form under UID is not the state form under the Emergency. Increasingly, as Ramanathan points out, the state works not through operations but money. She cites the economist Jean Drèze: “The real game plan for social policy … seems to be a massive transition to ‘conditional cash transfers’ … If the backroom boys have their way, India’s public services as we know them will soon be history, and every citizen will just have a smart card – food stamps, health insurance, school vouchers.” Life will be conceived of as dependent on a series of apps, each associated with targeted cash transfer. The state is the platform for these apps. Health entitlement is the killer app as serious illness is, after all, a killer.

To return to the Jim Ferguson article cited in my last post: it is not clear that the shift to cash transfers is a priori a bad thing, or that its effects will represent the winnowing of a vibrant social state. It is not clear that the work of Jean Drèze is as contemptuous of the backroom boys as this particular citation suggests: a topic for another day. Next time, unless I am otherwise distracted, more on the Ramanathan article.

The ultimate proxy for behavior?

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