Breathless

Each year in India more than two million people fall sick with tuberculosis (TB), an infectious, airborne, and potentially deadly lung disease. The country accounts for almost 30 percent of all TB cases worldwide and well above a third of global deaths from it. Because TB's prevalence also indicates unfulfilled development promises, its control is an important issue of national concern, wrapped up in questions of postcolonial governance. Drawing on long-term ethnographic engagement with a village in North India and its TB epidemic, Andrew McDowell tells the stories of socially marginalized Dalit ("ex-untouchable") farming families afflicted by TB, and the nurses, doctors, quacks, mediums, and mystics who care for them. Each of the book's chapters centers on a material or metaphorical substance—such as dust, clouds, and ghosts—to understand how breath and airborne illness entangle biological and social life in everyday acts of care for the self, for others, and for the environment.

From this raft of stories about the ways people make sense of and struggle with troubled breath, McDowell develops a philosophy and phenomenology of breathing that attends to medical systems, patient care, and health justice. He theorizes that breath—as an intersection between person and world—provides a unique perspective on public health and inequality. Breath is deeply intimate and personal, but also shared and distributed. Through it all, Breathless traces the multivalent relations that breath engenders between people, environments, social worlds, and microbes.

"McDowell's work fulfills its primary objective of creating a counternarrative focusing on atmospheric care for TB in India, and it shows how such an approach is both important and ought to be taken on by health care."—Annie James, H-Sci-Med-Tech

"In exploring tuberculosis through its 'breathlines', Andrew McDowell illuminates the relationships between social inequality and public health in rural North India. Focusing on the socialities of breath and disease across intimacies of kin and hierarchies of caste, McDowell asks probing questions concerning the diffusions and entanglements between everyday community relations and the increasingly neoliberal postcolonial management of health. Subtle and deeply sensitive, Breathless forces us to think disease beyond constrained paradigms of illness and cure." —Kaushik Sunder Rajan, University of Chicago

"Breathless immerses us in the dynamic ecologies of tuberculosis in rural India. Everyday disruptions to life—a cough, a dusty diagnostic machine, a muddy road—each contain lessons in how people endure disease. With sensitivity and insight, Andrew McDowell recasts global health in atmospheric terms. What results is a stunning ethnography of embodiment, inequality, vitality, and care." —Harris Solomon, Duke University

"Andy McDowell's Breathless is one of the finest ethnographies in medical anthropology I have read over my long career. So accessible and complete is its review of theory and scholarly contributions, that I believe an entire course in medical anthropology could be taught using this book and its connections to the relevant scholarly literatures. The book is beautifully written and its use of the trope of atmospheric entanglements as a golden thread connecting the chapters is a magnificent example of why and how social theory matters to anthropology and the humanities, but also to medicine and public health. Almost twenty years of fieldwork and scholarly deliberation have helped create a masterpiece. Greatly impressive!" —Arthur Kleinman, Harvard University