Risks of Citizenship and Fault Lines of Survival

This article probes the contradictions and unacknowledged risks inherent in the notion of citizenship today. We explore the possible fault lines that citizenship places on the notion of universality, namely the anthropology of contexts in which citizenship and biological self-preservation are being radically decoupled as well as the policies, techniques, and media (biological, health, juridical) through which such decoupling takes place.What concepts have anthropologists brought to the fore to address the emerging “fault lines of survival” embodied in the term citizenship? How have these concepts been taken up, becoming vehicles for resisting, or at least assessing, what has become of citizenship? Moving beyond narrowly conceptualized policy problems and calculations, this article also considers alternative pathways through which the “political” is being mobilized and through which a new politics of rescue appears. 401 A nn u. R ev . A nt hr op ol . 2 01 5. 44 :4 01 -4 17 . D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y U ni ve rs ity o f M an ito ba o n 11 /2 0/ 15 . F or p er so na l u se o nl y. AN44CH24-Petryna ARI 10 September 2015 12:53 THE FAILED DISTRESS SIGNAL On themorning of October 3, 2013, fishermen alerted the Italian coast guard that a vessel, drifting approximately one-quartermile from theMediterranean island of Lampedusa, was in trouble. The overcrowded boat carrying approximately 500 people from war-torn Eritrea and Somalia toward Lampedusa, one of the first destinations for migrants wanting to reach Europe from the coasts of North Africa, was capsizing. Some passengers set a blanket on fire to attract attention, but the improvised distress signal soon turned the boat into a fireball. Many of the drowned had first jumped into the water to escape the blaze. The local fishermen and the Italian coast guard recovered 359 bodies. The perilousness of the migrants’ journey, as exemplified by the failed distress signal, demonstrates the kinds of terrains on which the migrants’ last-ditch efforts for social, economic, and political survival are entangled and, indeed, overdetermined in their lack of success. Escaping political violence, instability, and scarcity of opportunity, the passengers knew, given maritime conditions, that setting sail was a risk: an overcrowded boat, high death tolls at sea, the prospect of being unwanted in Italy or anywhere else in the European Union. Yet, the halting way in which citizenship makes its first appearance in this tragic event requires further consideration. One day after the incident, on an official day of mourning honoring the dead, the Italian Prime Minister announced, “the hundreds who lost their lives off Lampedusa yesterday are Italian citizens as of today” (Pop 2013). This conferral of the privilege of citizenship to the dead rather than to the living points to the double tragedy wrapped up in the term. As the ghost citizens were being honored, the 155 survivors were reclassified as “clandestine immigrants”—illegal, subject to detention and deportation, and liable for fines under a law enacted by Italy’s previous government. In one symbolic act by the prime minister, the lethal nature of the boundaries of contemporary citizenship had been laid bare. The citizenship granted to the Lampedusa dead and denied to the living is an implicit yet clear admission that the unwanted will gain access to worlds of relative privilege either as dead bodies, or not at all. In an age of risk, citizenship provides no exemption; it is fundamentally at risk. This article probes the contradictions and unacknowledged risks inherent in the notion of citizenship today. The “defining ambiguity” at its heart is that citizenship represents “both the engine of universality and a break or limit upon it” (Bosniak 2006, p. 18). Rather than extolling the former phenomenon, this article explores the latter, focusing on contexts in which citizenship and biological self-preservation have been radically decoupled as well as the techniques, spaces, and media (biological, health, juridical) through which such decoupling takes place. What concepts have anthropologists brought to the fore to address what we call the “fault lines of survival” embodied in the term citizenship? How have these concepts been taken up, becoming vehicles for resisting, or at least assessing, what has become of citizenship? How are the limits of citizenship being probed along different lines, and what are the alternative pathways through which the “political” is being mobilized and through which citizens appear? As with other elements of the institutional framework of the nation-state, the concept of citizenship is now ubiquitous around the world, a primary nexus defining the relationship between the individual and the state. As a legal, political, and social category, modern citizenship developed alongside Western representational democracy and played a key role in the administration of European empires (Mamdani 1996). Yet, three or so decades into the rapid deregulation of global economies, the acceleration and intensification of international mobility, and the relentless marketization of all facets of social life, citizenship (similarly to the nation-state and democracy) emerges as an unstable concept. Instead of a binary matter of having citizenship or not, a spectrum of statuses, from full rights to precarious legal limbos, has emerged (Howard-Hassman & Walton-Roberts 2015). 402 Petryna · Follis A nn u. R ev . A nt hr op ol . 2 01 5. 44 :4 01 -4 17 . D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y U ni ve rs ity o f M an ito ba o n 11 /2 0/ 15 . F or p er so na l u se o nl y. AN44CH24-Petryna ARI 10 September 2015 12:53 At least two decades of anthropological, postcolonial, and feminist scholarship has argued that citizenship is never simply determined by formal frames of legal membership in a sovereign political community. Rather, it settles uneasily within those frames, while also remaining capable of challenging them through redefinition, resistance, and overt political action. Although the advantages of citizenship may be well established, they are neither the stable given that much of political thought has taken them to be (Benhabib 2004, p. 173) nor the universal aspiration of all people, as would be presumed in a Eurocentric worldview (Hindess 2004). Indeed, anthropologists (if not the wider scholarly community) have dispensed with the “presumption that liberalism and indeed democracy (even a purportedly radical one) have any particular privilege among ways of organizing the political forms of our collective lives” (Scott 1996, p. 21). A traditional concept of citizenship casts citizens as bearers of natural and legal rights that are (and must be) protected as a matter of birthright. Yet this regime of “citizenship-by-birthright” has always been subject to various limits and forms of surveillance and control. It has encompassed various practices that anthropologists have traced and that materially and symbolically establish links between persons and states (and also, crucially, serve as a connection to various systems of resource distribution). Such practices include the production and circulation of documents; civic and national rituals; public schooling; welfare and health care claims; disaster relief and other, often gendered and racialized practices capable of making and unmaking citizenship categories; and the recognition or delegitimation of the voices of the poor, migrants, disaster victims, patients, or welfare recipients. Probing the ambiguities, contingencies, and contested character of rights processes (Cowan 2013,Merry 2006,Wilson 2005), anthropologists ask howmodern nation-states (and the international system in which they are enmeshed) “have grown increasingly committed to and reliant upon their ability to make strict demarcations between mutually distinct bodies of citizens, as well as among different groups of their own subjects” (Torpey 2000, p. 12). Given questions ranging from which bodies will be included to which populations will be protected and what kinds of knowledge and documents must be leveraged, citizenship is an always historically specific act of boundary making with the “not-yet” or “less-than” citizens standing in the shadow of the term (Chavez 1992, Coutin 2007). We propose the notion of “fault lines of survival” to capture such shifting and often endangering experiential terrains and argue that they are distinguishable from formal definitions of citizenship that often draw clear distinctions between those who belong and those who do not. Fault lines register the simple fact that such distinctions have life and death stakes and that citizenship is an active fault. A fault line is a fissure between two surfaces or geological plates that can shift as a result of stress arising from plate tectonic forces and, thus, can be suddenly repositioned to create a new arrangement of the earth’s crust. As with geologic faults, fault lines of survival can change as a result of dramatic shifts in political systems in domestic and international spheres. Unexpected things can happen along new faults, as when displaced populations “raise up buried histories” to legitimize contemporary moral and political claims (Ballinger 2003). Such sudden shifts haunt more progressive assumptions of citizenship as seamlessly “leading to an improvement in social conditions which is recognized as such by the people concerned” (Hindess 2004, p. 308). Along such lines, we explore tension between legibility and invisibility, leitmotifs in the anthropology of citizenship that have shed light on the larger dynamics of citizenship’s contingent and at times perilous nature. CITIZENSHIP: TRAJECTORIES AND PARADOXES The end of the Cold War put abrupt theoretical reconfigurations of citizenship in dramatic relief. New post-Soviet countries arriving late to the game of nation-states, at a moment when the institutional frameworks of states were transforming in the face of globalization, were already www.annualreviews.org • Risks of Citizenship 403 A nn u. R ev . A nt hr op ol . 2 01 5. 44 :4 01 -4 17 . D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y U ni ve rs ity o f M an ito ba o n 11 /2 0/ 15 . F or p er so na l u se o nl y. AN44CH24-Petryna ARI 10 September 2015 12:53 undermined in the postwar international order. The idea of human rights, celebrated since the end of World War II as the secular “universal moral code” (Morsink 1999), added both hope and volatility to this process. Seeking to expand this code to all humanity following the atrocities of the first half of the twentieth century, the international human rights movement brought about legal and institutional improvements meant to secure the rights of those whose “right to have rights” had been denied owing to a lack of meaningful citizenship or for other reasons (Arendt 1951, Benhabib 2004). Postwar human rights were intended to operate where the protections of citizenship failed or did not reach. Though this aspiration often went unfulfilled (Allen 2013, Englund 2006, Feldman 2007, Jetschke 2010, Mokhtari 2009), in the last decades of the twentieth century, a declared commitment to human rights became the hallmark of civilized statehood. Leaders of post-Soviet states seeking domestic and international legitimacy, for example, embraced human rights principles in their new constitutions. Yet in both the former Eastern bloc and in established Western democracies, such moral restructuring led the “democratic sovereign to self-constitution as well as to exclusion,” rather than to enhanced cosmopolitanism (Benhabib 2004, p. 66). The spatiotemporal complexities of such exclusions from citizenship and wider rights regimes led to a recurrent question: How are human rights and self-preservation, biological or otherwise, being conjugated? In post-Soviet regions, legal protections remained ambiguous as persons born in certain parts of a multiethnic empire felt disadvantaged in the new “nations” in which they found themselves. For other groups facing intractable environmental and health threats and weak legal and medical systems, all legacies of a former regime, the very idea of citizenship was now charged with the superadded burden of survival. Although democratic state building coevolved with market orders, new inequalities were naturalized and administered in new political and technical ways. The problem of legibility, or of how actual citizens confronted identity and existence after “certain schemes to improve the human condition failed” (Scott 1999, Das 2004), entailed practices of veridiction and falsification (Foucault 2008) as well as negotiated protections that would herald the contested natures of citizenship to come. In her ethnography of the aftermath of the Chernobyl nuclear disaster, Petryna (2013) probed the scope of such critical political displacements through the figure of the biological citizen.Working among key scientific and political actors and exposed populations, Life Exposed captured how rational-technical interventions, both selective and strategic, altered the language of accountability and human rights in a new nation-state, while contributing to the open-endedness of the crisis. Joining patient families’ in their journeys through legal andmedical bureaucracies, Petryna tracked the growth of evidentiary regimes of risk of toxic exposure as they migrated into public spheres. Informal economies of knowledge, differential medical access, and Chernobyl “ties” became new resources that ensured social protections for people whose futures were now in the hands of experts of all kinds (Beck 1992).1 Biological citizenship thus elucidated the contested nature of scientific knowledge and, more centrally, the deep vulnerabilities faced by those citizens who did not make the cut. In this context, compensation no longer meant simple payment for past damages, but instead stood for myriad human attempts to balance or neutralize the forces that gave or took life. 1Beck’s concept of risk society highlights “a peculiar intermediate state between security and destruction, where the perception of threatening risks determines thought and action” (Beck 2000, p. 213). Yet in daily experiences of risk, the line between actionable and nonactionable knowledge is not always clear, as in the case of environmental disaster, population control (Greenhalgh 2008, Morgan & Roberts 2012), or prenatal testing (Gammeltoft 2014, Rapp 2000). Other core concepts such as “biosociality” (Rabinow 1996) and “laboratory life,” broadly conceived (Latour &Woolgar 1986), as well as feminist critiques of science as a distinct form of gendered politics (Haraway 1997) have helped shed light on the contested natures of scientific knowledge and how people navigate them. 404 Petryna · Follis A nn u. R ev . A nt hr op ol . 2 01 5. 44 :4 01 -4 17 . D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y U ni ve rs ity o f M an ito ba o n 11 /2 0/ 15 . F or p er so na l u se o nl y. AN44CH24-Petryna ARI 10 September 2015 12:53 The give-and-take of citizenship amid compounded uncertainties became part of a larger story drawn from post–Cold War Eastern Europe, where liberal-democratic forms of rule and marketization sought to eclipse paternalistic socialist states andwhere anthropologists borewitness to the unexpected ways in which postsocialist citizens made sense of ruptures between earlier histories, the pre-1989 past, and the capitalist present. Not only did this work challenge the perceptions of Western elites for whom the end of the Cold War spelled “the end of history,” but it also contributed sophisticated insights into the process of “transition,” whereby gradualist assumptions about change were tested in concrete contexts of articulated selfhood and belonging and in everyday claims to justice, life, health, and economic survival (Berdahl 1999; Borneman 1992, 2004; Bridger & Pine 1997; Dunn 2004; Manning 2007; Phillips 2008; Rivkin-Fish 2005; Szmagalska-Follis 2008; Verdery 1996, 1999; Wanner 1998). But the end of the Cold War also spelled transformation for citizenship globally. From the late 1980s, when the “new world disorder” (Anderson 1992) prompted anthropologists to take up citizenship as part of a turn toward then-new subjects such as nationalism and state-formation (Chatterjee 1990, 1993; Malkki 1995; Mamdani 1996; Scott 1990; Verdery 1999), to analyses of globalization and transnational neoliberalism in the early 1990s, anthropological scholarship would highlight how global mobilities “unbound” conventional thinking about the territoriality of the nation-state (Appadurai 1996, Basch et al. 1994, Gupta & Ferguson 1997, Levitt & Glick Schiller 2004). Moving to the Pacific Rim, anthropologists observed how transnational elites tooled a “flexible citizenship” that “both circumvent[ed] and benefit[ed] from different nation state regimes by selecting different sites for work and family relocation” (Ong 1999, p. 136). At the same time, the undoing of welfare in the United States and Europe in the 1990s motivated basic questions “about what makes an involved citizen and what rights, political and economic, should derive from citizenship” in the first place (Gordon-Zolov & Rogers 2010, p. 15). By the 2000s, with neoliberalization originating in the Global North, structural adjustment programs advanced in the Global South, and a diminishing role of the state in supporting communities and individuals, liberal democratic notions of citizenship were again being tested (Caldeira 2000, Lazar & Nuijten 2013, Muehlebach 2012, Ong 2006, Somers 2008). Povinelli (2002, p. 175) sheds light on how Australia attempted to juridically “reconcile, fairly and justly, institutions and ideologies of abstract citizenship with difference” and on the actual violence visited upon indigenous communities. Meanwhile, citizenship broke out of the national mold as the European Union developed the legal status of the EU citizen (Bellier&Wilson 2000, Ceuppens&Geschiere 2005, Fikes 2009, Shore 2004). Although this unbordering of citizenship opened unprecedented opportunities for Europeans, it went hand in hand with the rise of “integralist” and xenophobic ideologies on theEuropeanpolitical right seeking to purge the national body of unwanted strangers (Holmes 2000). In this context, some scholars highlighted the efforts of immigrants (and other minorities or diaspora) to belong (Hall 2002, Kosnick 2007, Renkin 2009, Thomas & Clarke 2006), whereas others offered compelling genealogies of the politics of taming difference (Bowen 2008,Mehta 1997). If andwhen other blocs of states (the AfricanUnion,Mercosur andUNASUR, ASEAN) adopt their own models of regional citizenship, such emerging legal categories and the politics of belonging that they trigger will require rigorous comparison. In the wake of 9/11, citizenship’s tectonic plates shifted once again as part of an aggressive politics of securitization. Anthropologists, focusing in earnest on how state actors recognize, name, and combat dangerous people and things, usually resorting to extraordinary means (Balzacq 2010, Bigo 2002, Fassin 2011, Feldman 2011, Jensen & Stepputat 2013), probed moral economies of an expanding “global war on terror” and “war on drugs” (Andreas & Bierstecker 2003, Blom Hansen & Stepputat 2005, Bourgois & Schonberg 2009,Wilson 2005). The figure of the migrant as an economic, cultural, and potentially terrorist threat justified an unprecedented expansion of www.annualreviews.org • Risks of Citizenship 405 A nn u. R ev . A nt hr op ol . 2 01 5. 44 :4 01 -4 17 . D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y U ni ve rs ity o f M an ito ba o n 11 /2 0/ 15 . F or p er so na l u se o nl y. AN44CH24-Petryna ARI 10 September 2015 12:53 detention centers “where regimes of police prevail over regimes of rights” (Fassin 2013, p. 219; de Genova & Peutz 2010) as well as sophisticated biometric data collection methods to track legal immigrants within and across borders (Amoore 2006). The urge to control clandestine maritime migration across EU borders spawned a hugely lucrative “illegality industry. . .[where] careers are made, networks created, knowledge and imagery circulated and money channeled in increasing amounts” (Andersson 2012, p. 7)—all part of an enterprise of preventing desperate asylum seekers from lodging claims on European soil. Further work is also under way on reframing human security (Hylland-Eriksen et al. 2010), the military and the militarization of everyday life (Lutz 2002, MacLeish 2013), “virtual warfare” (Whitehead & Finnström 2013, Sharkey & Suchman 2013), and reflections on the banality of security regimes (Feldman 2013, Follis 2012, Walters 2010). Such politics of securitization reached their fullest (and tragically ironic) consequences in the failings of Lampedusa, and other Lampedusas that came before and after. After approximately 800 people lost their lives in another migrant boat disaster on April 19, 2015, leaders of European nation-states scrambled to reconcile their waning commitment to humanitarian rescue operations with the urge to respond with military violence by targeting the “human smugglers,” who are said to be responsible for the migrants’ misery. Once again leaders displayed a willful failure to recognize that shutting off legal routes of entry only encourages more perilous journeys. The continued disputes on how to respond to theMediterranean crisis raise stark concerns aboutmoral duty toward, and responsibility for, fellow humans who are not categorized as fellow citizens. For example, what, precisely, allows the long-established custom of rescue at sea (Follis 2015) to shift significantly from assisting first and asking questions later, to an a priori orientation of not taking in any survivors, as advocated by the United Kingdom’s government in October of 2014 (Travis 2014)? In an age when new iron curtains separate the insecure from the securitized citizen, “what kind of political agency is possible for groups which are constructed as the threat that has to be eliminated” ( Jensen & Stepputat 2013, p. 214)? How do such moral shifts increasingly find “negative spaces” from which “those with privilege and standing could excuse themselves” (Stoler 2009, p. 256)?What threats are citizens “taught” to fear in a risk society (Greenhouse 2005, 2011, Gusterson et al. 2009, Masco 2014, Ochs 2011, Smith 2011, Walters 2009), and how do their everyday media deployments reinforce habits of indifference while disabling those of proactive rescue and democracy? In Thinking in an Emergency, Scarry (2011) provides a vital antidote to the unchecked executive powers that have justified the use of torture, civilian surveillance, and continuous war. She probes how an “equality of survival” (or the “universal access to the means of survival”), an assumed democratic principle, is built into everyday infrastructures and habits of rescue or mutual aid (on the latter, see Ferguson 2015). Shelter systems or life-saving cardiopulmonary resuscitation, useful in emergencies such as heart attacks or near drowning (Scarry 2011, p. 52), reinforces habits of thought among fellow citizens that can “guarantee” such a principle. Yet the new realities traced by ethnographers suggest that the ideal of “equality of survival”may bemore undone by infrastructure and, now, by nature than ever before. Exploiting the sheer physicality of geography, particularly the remoteness of islands, for the purposes of punitive detention and surveillance is not new (Kaplan 2005, Martin & Mitchelson 2009, Mountz 2010). Yet superimposing new border regimes on seas and deserts that are already hostile to human life constitutes a new securitizing technique (Dı́az-Barriga & Dorsey 2011, Mountz & Hiemstra 2012, Weber & Pickering 2011). As described in Mountz’s (2010) work on the use of remote islands as sites of detention for unwanted migrants, Australia’s “Pacific Solution” may be the most well-known instance of the offshoring of the undesirables. However, moving borders out to sea is in effect from the Caribbean to the Mediterranean to the Indian 406 Petryna · Follis A nn u. R ev . A nt hr op ol . 2 01 5. 44 :4 01 -4 17 . D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y U ni ve rs ity o f M an ito ba o n 11 /2 0/ 15 . F or p er so na l u se o nl y. AN44CH24-Petryna ARI 10 September 2015 12:53 Ocean (Mountz & Hiemstra 2012). Such enforced remoteness reinforces habits of indifference and bolsters noncitizenship’s lethal nature. Since the mid-1990s, through “prevention by deterrence,” US border patrols have “shift[ed] undocumented migration towards remote border regions such as the Sonora Desert of Arizona, where security is less intense but crossing conditions aremore difficult” (Cornelius 2001; also cited in De León et al. 2015). In an ethnographic, archaeological, and forensic study of some of the “busiest” crossing points along the southern US border, De León and colleagues (2015, p. 449) track the artifacts of “everyday practices of immigration law enforcement [that] are tangible and troubling evidence of how the state constructs the border as a space where exceptionalism frames the hunting down and capturing of noncitizens.” The disintegrating “trash” andmakeshift distress signals such as mirrors left by lives exposed or decomposing speak to negotiations of a precarious extralegal status and the impunity that resides in “state-crafted geopolitical terrains” (De León et al. 2015, p. 452; also see Cornelius 2001, Doty 2011, Nevins 2005). These are not passive zoneswhere people die “natural” deaths, but zones of social abandonment, spaces in which the illusion of a natural death is actively constructed, as has been shown in the work of Biehl (2013). In the midst of political and economic changes, when taken-for-granted social bonds weaken or disappear, such zones have emerged where the homeless, the sick, and the unwanted are left to die. In one such zone, an asylum called Vita in the southern Brazilian city of Porto Alegre, Biehl encounters Catarina Moraes, a young woman abandoned by her family and left to die. With familial, medical-scientific, and economic realities aligned against the young woman, Biehl asks, “What kind of subjectivity is possible when one is no longer marked by the dynamics of recognition or by temporality?” (Biehl 2013, p. 11). Catarina’s desire to belong to time is expressed in a (literal) effort of legibility. In her “dictionary,” she creates words and syntax where “verbs are missing” through which she reclaims her existence against myriad social agents patrolling the borders of obligation and indifference in late liberal (Povinelli 2011) and neoliberal times. The failed distress signals (blankets, mirrors, precarious “ties,” dictionaries) left behind in such unchecked zones leave anthropologists to document and confront the materiality of thwarted human fates, “fighting against the clock to collect items before they’re destroyed by sun, weather, or animals, or taken to a landfill” (Natl. Geogr. 2015). Indeed, the unexceptional and daily experiences of border crossers and marginalized citizens no longer (and perhaps never) required “the emergency” to suspend their legal protections (Agamben 2005). They, along with other subjects of racialized violence (Codrington 2014, Thomas 2011), have been navigating zones of indistinction all along. From an ethnographic perspective, then, “zones of indistinction” is too abstract an idea that does not corroborate to what experience at the fault lines of survival speaks: distinct moral and technical projects that often bind already endangered lives to improbable ideals, intense surveillance, and new authorities to enforce abstractions that are “now imbued with the force of self-evident reality” (Bessire & Bond 2014 p. 442; Bessire 2014; Ralph 2014). This truth cannot be ascribed to a “nature” that has an ontological status. Such a claim would strip that nature of raw political substance and would bring us back to “false foundations and fixities” (Fischer 2014). Politics has become biologized and naturalized (Kistner 2009, Rose 2006). Yet the much-invoked Foucauldian question of “who lives and who dies” requires a less atemporal view of the kinds of lives that are peopling these dynamics and deploying difference (Fassin 2012, Fischer 2014, Jackson 2005), as well as a more durable perspective on inequality, not just how lives are exposed but how they are left exposed. Moreover, what are the politics of rescue or nonrescue (Calhoun 2008, James 2010, Redfield 2013, Stevenson 2014, Ticktin 2014), and what is the responsibility of the citizen to the exposed not-yet or never-to-be citizen? In addition to grounding abstractions in their human consequences and realities (Nelson 2015), the nature of www.annualreviews.org • Risks of Citizenship 407 A nn u. R ev . A nt hr op ol . 2 01 5. 44 :4 01 -4 17 . D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y U ni ve rs ity o f M an ito ba o n 11 /2 0/ 15 . F or p er so na l u se o nl y. AN44CH24-Petryna ARI 10 September 2015 12:53 such boundary maintenance is increasingly central to a new anthropological study of citizenship. Efforts of self-preservation among migrants and noncitizens are indicative here, as are those among patients and environmental victims. Caught up in life-threatening conditions whose scope and needs exceed systems of response, they enter into a twenty-first-century risk-citizenship nexus in which a potential for dehumanization can widen. POLITICS OF RESCUE AND RIGHTS OF RECOVERY The sociopolitical aspects of public health triage are emblematic not only of such processes, but also of social and political innovations linked to care and potential “equalities of survival.” At present there are 26 million people infected with AIDS; only 7 million are getting the treatment they need. Amid uncontained and nonlocalized public health threats, including infectious pandemics such as HIV/AIDS, anthropologists have documented the working of an “AIDS exceptionalism” (Benton 2015) and the great deal of boundary work among health practitioners that has subjected marginal patient-citizens or migrant-individuals to almost torturous forms of calibrated care (Biehl 2009, Crane 2013, Livingston 2012, Nguyen 2010, Wendland 2010). Observing those calibrations firsthand, this time in the context of the 2003 SARS outbreak in China, Mason (2015) worked with health experts and “floating” populations to show how experts divided migrants into “those to be served and those to be governed,” a practice bolstered by narrow definitions of the “common good” imported from US health experts. At the height of the AIDS epidemic in Uganda, Whyte and colleagues (Whyte et al. 2013, Whyte 2014) wrote of triaging processes expressed in the “blanket sign” used by Ugandan nurses to decide which AIDS patients should be encouraged to pursue high-priced antiretroviral drugs: If patients bring a good blanket to the hospital, a sign of economic means, inform them of the drug and encourage them to buy it; if they are covered with an old sheet or a woman’s gown, nurses are told not to bother. In Venezuela, Briggs & Mantini-Briggs (2004) rendered normalizations of death in intimate detail, even for a preventable disease such as cholera, in terms of how breakdowns in public health and ingrained prejudices against indigenous peoples produced a modern medical tragedy. Yet such fault lines, often heavily medicalized and racialized (Fullwiley 2011, Montoya 2011, Roberts 1999, Rouse 2009, Wailoo 2011), can also create new developments. Twenty years after the publication of her seminal ethnography of violence and suffering among sugarcane workers in northeast Brazil (Scheper-Hughes 1993), Scheper-Hughes (2013, p. 5) notes a “revolution” in the decline of premature child deaths and “useless suffering” due to progressive state policies and cash transfers that allow mothers to nurture their children and “reward them for good citizenship,” despite the continuation of senseless youth killings in democratic Brazil. In the United States, until recently, death rates for all cancers were 12% lower among the insured than they were for the uninsured. That a “cure” for cancer was not merely hypothetical, but a reality out of reach for so many citizens, raises questions not only about who has a right to access medical goods and a right to health, but also about what social and political arrangements optimize paths to health—what arrangements make these paths so perilous, even fatal (Petryna 2013b)? Even with the goal of increasing access to health insurance, the Patient Protection and Affordable Care Act of 2010 doubled-down on those who were excluded from it, namely, the undocumented and the poor, unless such persons have medical emergencies (Hallowell 2015; also see Gálvez 2011). From local systems of mutual aid to international humanitarianism, anthropologists have explored health as a key fault line in which the paradoxes and prospects of citizenship find their most powerful expression. In scrutinizing dominant regimes of value, worthiness, and truth, such work also raises questions about the lingering effects of conflict and structural adjustment programs on 408 Petryna · Follis A nn u. R ev . A nt hr op ol . 2 01 5. 44 :4 01 -4 17 . D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y U ni ve rs ity o f M an ito ba o n 11 /2 0/ 15 . F or p er so na l u se o nl y. AN44CH24-Petryna ARI 10 September 2015 12:53 compromised public sector services (McKay 2012, Pfeiffer 2013) as well as about needed political reforms. How can conditions of care within health institutions enable larger societal shifts in how human lives are valued? Echoing Freedman (2005), health systems operate not just as providers of care, but as “core institutions” reshaping experiences of poverty and citizenship. Actual care, demonstrated within the highly interpersonal relationships of health, can signal broader societal shifts in the way human lives are valued. In this way, a rights-based approach to health can be seen as an incubator of broader political and social rights. In a recent chapter of rights-based progress, the judiciary has become a crucial arbiter and purveyor of care and access to technology. Anthropologists have explored various experiments in legal personhood and prospects of a rights-based approach. In a “judicialization of the right to health,” for example, health has, by and large, been redefined as a political matter of access to pharmaceuticals (Biehl et al. 2012). In Brazil, courts have been inundated with citizens’ legal challenges for access to a variety of medicines (including those that are on government lists, but out of stock). In postapartheid South Africa, Comaroff & Comaroff (2006) see the “judicialization of politics” more broadly as negatively affecting social mobilization, particularly in the field of HIV/AIDS. Class struggles, they argue, “seem to have metamorphosed into class actions” in an “ever mutating kaleidoscope of coalitions and cleavages” across citizens, governments, and corporations (Comaroff&Comaroff 2006, p. 26; Yamin&Parra-Vera 2010). In these legal-state-market ecologies, new kinds of patient-citizen actors have emerged, raising questions about how health is and should be achieved more generally in conditions of extreme inequality in which distributions of risk and disease are so intricately woven into the social and economic fabric (Ecks & Harper 2013, Han 2012,Whitmarsh 2008; also see Biehl & Petryna 2013, Keshavjee 2014). Here survival, as with health, is “never just one thing,” and underlying insecurities belie any single reduction of health to an “exposure-outcome” relationship. Such epistemological reductions obscure sociopolitical and environmental determinants (such as race, gender, educational status, access to clean water or sanitation, exposure to air pollution, and violence) and can authorize indiscriminate injury (on cancer, see Jain 2013; on tobacco, see Kohrman & Benson 2011; on indebtedness, see Han 2012; on migrant labor, see Holmes 2013; on drug abuse, see Bourgois & Schonberg 2009, Garcia 2010) and criminalization (on HIV transmission and involuntary detention of drug addicts, see Amon 2013). Writing on blunders in the intelligence sphere post 9/11, psychologists Tetlock & Mellers (2011, p. 552) state, “The closer scientists come to applying their favorite abstractions to realworld problems, the harder it becomes to keep track of the inevitably numerous. . .variables and to resist premature closure ondesired conclusions.”Emphasizing social positionality and institutional and historical context as sources of knowledge, anthropologists have consistently disabused public health analysts of their “favorite abstractions,” be it concerning the social origins of disease or the grip of formalist logics in public health research (Adams 2013a). Yet more work needs to be done. Working at the frontlines of the Ebola epidemic in Sierra Leone, Raphael Frankfurter observes how health care workers treat the afflicted “more as disease carriers than as humans with families” (cited in Fink 2014). Even in the face of a cruel and capricious disease, fault lines separating the blameworthy from the innocent are continually institutionally reinforced. “I am asking you to replace the word ‘victim’ with ‘survivor.’ We should all just start calling ourselves survivors” (Fugate 2013).Thesewere thewords of aUSgovernment disaster official who, in the wake of the 2012 superstormHurricane Sandy, implored an audience of concerned citizens to erase the word “victim” from their vocabulary.With somemodern risks exceeding the logistical capacities of states as well as other (humanitarian and security) frames of disaster response, the quote suggests that the promise of equality, even between fellow citizens (Engin & Turner 2007), www.annualreviews.org • Risks of Citizenship 409 A nn u. R ev . A nt hr op ol . 2 01 5. 44 :4 01 -4 17 . D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y U ni ve rs ity o f M an ito ba o n 11 /2 0/ 15 . F or p er so na l u se o nl y. AN44CH24-Petryna ARI 10 September 2015 12:53 appears to be at risk. In such contexts, ethnographies of disaster have shown the heightened role of “philanthrocapitalism” in defining terms of relief that often do not meet the needs of actual victims (Adams 2013b, Farmer 2012, Klein 2014). Disasters often strike the most vulnerable or they generate new social, political and economic inequalities through highly selective medical and legal criteria. Numerous communities have been exposed to and endangered by industrial toxins (Murphy 2006,Voorhees 2014), radioactive isotopes, pesticides, or reckless oil drilling and disposal processes (Cepek 2012, Kimerling 1991, Checker 2005, Sawyer 2004, Kirsch 2014), allowing certain social and political orders of care and disregard to take hold (Auyero & Swistun 2009, Bond 2013, Fortun 2001, Petryna 2013a). Imbued with the material technology of abstraction, inscription, and enumeration, disasters become key loci or “bureaucratic fields” (Bourdieu 1999, Gupta 2012) through which obligations to citizens are choreographed and overwhelming risks are domesticated and absorbed into the social. What chances do victims have of speaking through such domestications, or of being heard? “Stop calling me resilient. Because every time you say, ‘Oh, they’re resilient,’ you can do something else to me” (cited in Klein 2014). These words by New Orleans civil rights lawyer Tracie Washington suggest strong skepticism toward a favorite watchword—resilience—in policy spheres of disaster intervention where “survivors,” not victims, can be heard. Motivated by the idea that some people are better than others at adapting to adversity or significant stress, measures of resiliency aim to predict better outcomes of survival in medicine, improve performance in schools, create better citizens in emergency preparedness, or rebuild soldiers’ protective “internal frontiers” against incapacitating traumas in the battlefield (Sogn 2009). Such measures feed into broader psychosocial imperatives “to survive” in an age of risk and feed into a “political economy of crisis adaptation” (Lakoff & Collier 2008, Walker & Cooper 2011). As new lines between the normal and the pathological are sewn, so too are fabrics of political legibility that trump biology over victims’ words (Fassin & Rechtman 2009, Ticktin 2011). If biological citizenship signaled the normalization of overwhelming (radiation) risk that exceeded the logistics of political preparedness—a domestication of risk—then the words “don’t call me resilient” speak truth to the illusion of such domestication: how it works, how it can legitimate further disregard (“you can do something else to me”), and how it can obscure other truths and experiences.