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The Colonial Medicine of Settler States: Comparing Histories of Indigenous Health

Warwick Anderson

The history of Indigenous health connects inextricably with matters of geography and colonisation. 'Indigenous' usually connotes a place, often figured as marginal or isolated or developmental—as somewhere else.1 More pertinently, Indigenous status implies—or rather, is predicated upon—a history of colonisation and dispossession, with consequent resistance and adaptation to invaders and settlers. The term marks the contrast between original inhabitants and colonisers. The effort to identify some special Indigenous essence or type ultimately is futile since the status emerges out of political subordination under settler colonialism.2 The history of Indigenous health thus demands sensitivity to the impact of both colonialism and the incipient white nation-state. Moreover, it requires a critical awareness of the dark sides of contact, 'civilisation,' and 'development,' as well as an appreciation of the multiple implications of the related processes of assimilation, integration, and self-determination.3 1
      Since first contact with European invaders, Indigenous people on the whole have been sicker and died younger than non-Indigenous inhabitants of the same colony or state.4 These health disparities have lessened significantly in North America and New Zealand, but remain severe across Australia.5 During the late-twentieth century, some historians attempted to explain the initial colonial impact on Indigenous societies in biological terms. Thus infectious diseases swelled the 'ranks of death,' as Indigenous people suffered 'virgin-soil' epidemics, the natural result of 'ecological imperialism.'6 As most of these historians later conceded, such biological analysis tended to discount the unnatural effects of warfare, dispossession, and demoralisation on health and social organisation.7 Biological explanations of contemporary health disparities are largely out of fashion—the 'thrifty gene' hypothesis notwithstanding.8 Rather, historians of continuing Indigenous illness and disability now are more likely to address the lasting effects of racial discrimination, dispossession, family disruption, poverty, social marginalisation, and limited access to health care. As Mick Dodson reported to the United Nations Working Group on Indigenous Populations: 'We are all part of the world community of Indigenous peoples spanning the planet, experiencing the same problems and struggling against the same alienation, marginalisation, and sense of powerlessness.'9 2
      Just as attitudes toward the causation of Indigenous illness and death have changed, so have proposed solutions to health disadvantage varied over time. When Europeans moved into Australasia and North America, they frequently represented the original inhabitants as primitive nomads rambling over isolated yet strangely desirable territory. Indigenous people thus were cast as feckless, immature, and vulnerable. For some observers they were a dying or 'doomed' race, requiring only some perfunctory palliation of their passing.10 Others eventually recognised the potential—especially of those of mixed ancestry—for assimilation into the predominantly white national community so that problems of Indigenous health should gradually dwindle into ordinary problems of proletarian health.11 More recently, policies of 'self-determination' have allowed some Indigenous people to influence the framing of their communities' health problems and to participate actively in responding to their distinctive challenges of illness and disability. Yet it remains difficult for any settler society to invest seriously in people whose continuing existence etches in clear relief the illegitimacy and violence of the state. Settler states are more comfortable intervening to correct health disparities the more readily they recognise sufferers as similar to ordinary white citizens. While self-determination efforts assert difference and independence, and thus generally meet with state indifference or hostility, assimilation policies permit some basic civic recognition, thus demanding larger financial commitment and political attention from national leaders. Unfortunately, it seems even the illusion of autonomy is incompatible with delivery of government services. 3
      Aboriginal Australian health became a distinct historical issue in the 1970s during the period of self-determination. Before that, it was subsumed in accounts of contact and assimilation, or employed as colourful backdrop to medical biography, or lost in a sad footnote to the history of medicine in white Australia. Not surprisingly, anthropologists led efforts to situate more traditional Aboriginal ideas about illness in their proper social and historical context. When Janice Reid began her study of Yolngu health beliefs in 1974, it soon became clear that without carefully considering the history of contact with outsiders, notions of resilience, continuity, and change in disease explanation had little meaning.12 Later, as co-editor of a collection of essays on the health of Aboriginal Australia, Reid made sure to commission an historical introduction to the subject.13 4
      In their historical essay, Margaret-Ann Franklin and Isobel White provided a pioneering overview of the decline of Australian Aboriginal health, emphasising the influence of frontier violence, dispossession, herding onto reserves and missions, poor nutrition, and medical neglect. Assimilation policies after World War II had finally prompted investigation of the health conditions of outback reserves and missions, leading belatedly to recognition of the deplorably high Aboriginal infant mortality rate. In the 1960s and 1970s, some medical doctors, such as Archie Kalokerinos at Collarenebri and Max Kamien at Bourke, forcefully drew attention to the high prevalence of preventable disease in Aboriginal communities. After the 1967 referendum gave the Commonwealth government authority to legislate for Aboriginal Australians, federal funding for Indigenous health expanded, with white administrators and medical personnel initially controlling most projects. Many of them still were committed to preparing their charges for eventual assimilation. Then in 1973 the Labor government declared Aboriginal Australians to be distinct culturally and that they deserved the opportunity to determine their own future. In part, this represented a response to widespread Aboriginal activism, focusing on land rights and self-determination, and sometimes echoing the campaigns of the Black and Red Power movements in the United States of America.14 In 1991, Franklin and White concluded their survey hopefully, asserting there were 'signs that some whites in the community and government may be learning from Aborigines what Aborigines want and need, and acknowledging that local autonomy is crucial to the process of self-determination and self-management.'15 But even when the policy of self-determination briefly flourished it never accrued the resources necessary for success. In any case, this period of respect for Aboriginal involvement would prove disappointingly evanescent. 5
      More recently, even with the waning of self-determination, a few Australian historians have returned to the study of Aboriginal health. Notably, Gordon Briscoe examines critically the development between 1900 and 1940 of medical services for the Indigenous inhabitants of Queensland and Western Australia. The comparison is apt, since Queensland was perhaps the most segregated of the states while authorities in the west strongly favored assimilation. The priority in both places was to prevent the spread of Aboriginal disease into white communities: in Queensland this generally meant isolating and limiting the mobility of Indigenous people, yet at the same time in Western Australia it led to efforts to produce a dusky proletariat.16 6
      While Briscoe gives us a valuable demographic and institutional history of Aboriginal health and illness, others have taken up the study of medical discourses on Aboriginality. In Reading Doctors' Writing, David Piers Thomas conducts a detailed and telling analysis of the representation of Aboriginal Australians in the Medical Journal of Australia (MJA) between the 1870s, when they appear as a doomed race, and the late 1960s, when the term 'Aboriginal health' is coined. Displaying the influence of Michel Foucault and Edward W. Said, Thomas argues that research on Aboriginal people for most of this period was 'entangled with the politics of colonialism.'17 Although Thomas's study inevitably repeats much of the conventional history of ideas about Aborigines generated by physical anthropologists and human biologists (most of whom boasted medical qualifications), his book importantly illuminates the contributions of white medical activists. Many of these, like Barry Christophers, were affiliated with the Communist Party, and from the 1950s were agitating the letters pages of the MJA with demands for better Indigenous health services.18 7
      Historians across the Tasman have documented the development of Indigenous health services more extensively than their Australian counterparts. Raeburn Lange, for example, provides us with a richly contextualised social history of Mëori and government initiatives in public health during the early twentieth century.19 Although in Mëori Health and Government Policy Derek A. Dow deliberately focuses more narrowly on policy formulation, he adds nuance and detail to many of the technical issues that are less important in Lange's history.20 Dow argues that there was more Pakeha (non-Indigenous New Zealander) concern for Mëori health—and more Pakeha efforts to improve it—before 1900 than is generally assumed. In contrast, Lange seeks a usable history of Mëori-led community development and health work, a story of Mëori initiative and innovation. Indeed, to an outsider the most striking feature of the history of Indigenous health efforts in New Zealand is the involvement, and indeed dominance, of Mëori doctors and community activists. It is, as Lange points out, an early example—perhaps the first—of Indigenous health work designed and directed by Indigenous people. Maui Pomare, who graduated from a missionary medical college in Chicago in 1896, led the public health work, and in 1923 became minister of health. A brilliant scholar, Peter Buck (Te Rangi Hiroa) received his medical degree from Otago in 1900, and later became the head of the division of Mëori hygiene in the health department before he turned to the study of Pacific anthropology. Also in Buck's medical cohort was Tutere Wi Repa, a somewhat erratic promoter of community health work during this period. 8
      The contrast with Australia is stunning. For example, it was not until the 1980s that an Aboriginal Australian graduated in medicine. Unfortunately, neither Lange nor Dow suggests why New Zealand was so much more advanced. Lange perhaps comes closest to an explanation when he discusses the influence of the denominational boarding schools, especially Te Aute College, which in the 1890s provided a secondary education for the first generation of Mëori doctors and lawyers, and gave rise to the Young Mëori Party. It may be that this institutional accessibility has something to do with the small scale of the New Zealand social world, the persisting strength of many Mëori communities, and an unusually liberal polity that allowed both Mëori and women to vote. Whatever the explanation for their dramatic arrival on the scene, Pomare and Buck and others set about improving Mëori hygiene and living conditions with a special sensitivity and insight that derived from their own Mëori background. In a somewhat presentist fashion, Lange argues that these Mëori doctors were engaging in 'community development,' treating communities as 'partners,' and using their 'communication skills' to urge health reformndash;—that is, they were precursors of self-determination in Indigenous health work. 9
      Australian scholars will find the history of Indigenous health development in North America more depressingly familiar, even if USA policies anticipate Australian ones by at least a generation and the usual oscillation between assimilation and self-determination varies. Treaty obligations meant that American Indians received some perfunctory health care from the early nineteenth century, but it was not until John Collier, a social reformer from New York, became Commissioner of Indian Affairs in 1933 that Indigenous health was recognised as a major problem for the federal government. Collier initiated the 'Indian New Deal', promising conservation of Indigenous culture and resources, with protection of Indigenous health.21 Yet after World War II, the Commission on Reorganisation of the Executive Branch of the Government, led by former president Herbert Hoover, recommended integration of Indians into the general population and the 'termination' of special status. During the 1950s, the Republican administration promoted assimilation, withdrawing recognition of tribes, moving families from reservations to cities, and closing the Bureau of Indian Affairs. Other 'mainstream' government agencies took up responsibilities for Indigenous affairs. The Indian Health Service, a section of the Public Health Service dominated by white professionals, became the sole national health program for civilians in the USA. Throughout the 1960s, however, critics were demanding more community control and decentralisation of the health service and the training and hiring of more Indian doctors. To meet many of these demands, President Richard M. Nixon confirmed and endorsed in 1970 the drift toward a policy of 'self-determination'. But as in other examples of self-determination, community health programs never received adequate funding or support, and under the Clinton administration they were cut severely. Nevertheless, indices of Indigenous morbidity and mortality steadily improved in the USA during the post-war period.22 10
      The improvement in the health status of Canadian First Nations is also striking, although as elsewhere disparity with non-Indigenous health continues to prevail. Mary-Ellen Kelm describes the misery and resilience of the colonised Aboriginal people of British Columbia before World War II, their poor nutrition, social disruption, and the ravages of tuberculosis, which was rife in the reservations and boarding schools.23 Yet the 1940s marked a shift toward a larger federal role in ameliorating Indigenous conditions. In 1945, the Indian and Eskimo Health Services were transferred from Indian Affairs, part of the federal Department of Mines and Resources, to the Department of National Health and Welfare. As in the USA, federal services expanded in order to prepare Indigenous people for more efficient integration into the nation–state. Similarly, government commitment north of the border provided the resources and opportunities for greater Indigenous self-assertion during the 1960s, leading, perhaps ironically, to opposition to assimilation and demands for self-determination.24 As Kelm points out, there has always been a 'tradition of active and engaged response to the processes of colonisation that seeks to subvert those processes and reshape Aboriginal destinies in ways that are independent of the Canadian government.'25 11
      The diversity of Indigenous experience and the patchiness of historical analysis defy any simple transnational comparison of health development.26 Certain themes and patterns and common points of reference do emerge however. The devastating impact of dispossession, discrimination, alienation and poverty under settler capitalism is obvious. So too are the salience of Aboriginal activism and leadership, and the importance of national commitment to improving Indigenous health. Australia, the country tainted with the worst health disparities, is also historically exceptional, having failed to confer any special status on Indigenous people, avoiding any treaties, and only belatedly allowing national action or intervention. Additionally, the common association of assimilation with government intervention and investment, contrasting with the government neglect and indifference that self-determination often licenses, is evident at multiple sites. That is, it appears government action on health improvement is linked to civic recognition in the nation–state, to probationary forms of social citizenship—while Indigenous community control or autonomy may deflect national interest.27 Put bluntly, you can have 'culture' or government health services, but not both. 12
      Persistent colonial relations have characterised Indigenous health, although few historians have directly addressed this durable imperial logic.28 Strikingly, both Kelm and Thomas frame their historical analysis in terms of colonial medicine, reading representations of Indigenous people as colonial discourse, or showing how the colonising state impinged intimately on Indigenous bodies and social lives. But Kelm's meticulous attention to the affective, personal aspects of Aboriginal health care, to the more private consequences of colonial medicine, is still rare. We need more stories telling us about Indigenous health as a structure of feeling and as a moral sensibility.29 The field of Indigenous mental health may provide especially fertile ground for further study of the blighted intimacy of colonial power.30 13
      Although historians of medicine have just begun to focus on Indigenous health, the contemporary health care of Aboriginal peoples is already thoroughly historicised. 'History' figures in most arguments about Indigenous health policy. Indeed, discussion of Indigenous health is now one of the few ways for historical narrative ever to gain entry to medical journals. As more historians take advantage of this unique permit system, a more richly contextualised and comparative history of Indigenous health might come to inform and shape contemporary debate.
University of Sydney
 		14
   

Acknowledgment

 
I am grateful to Ian Anderson and Emma Kowal for their suggestions and comments on an earlier draft of this essay. 15


Notes

1. Mary Jane McCallum, "This Last Frontier: Isolation and Aboriginal Health," Canadian Bulletin of the History of Medicine, vol. 22 (2005): 103–20.

2. But see Chris Cunningham and Fiona Stanley, "Indigenous by Definition, Experience, or World View," British Medical Journal, vol. 327 (2005): 403–4.

3. Tim Rowse, ed., Contesting Assimilation (Perth, WA: API Network, 2005).

4. Stephen Kunitz, Disease and Social Diversity: The European Impact on the Health of Non-Europeans (New York: Oxford University Press, 1994).

5. Robin Fisher, "The Impact of European Settlement on the Indigenous Peoples of Australia, New Zealand, and British Columbia: Some Comparative Dimensions," Canadian Ethnic Studies, vol. 12 (1980): 1–13; David E. Stannard, "Disease and Infertility: A Look at the Demographic Collapse of Native Populations in the Wake of Western Contact," Journal of American Studies, vol. 24 (1990): 325–50; and Ian Anderson, Sue Crengle, Martina Leialoha Kamaka, Tai-Ho Chen, Neal Palafox, Lisa Jackson-Pulver "Indigenous Health in Australia, New Zealand, and the Pacific," Lancet, vol. 367 (2006): 1775–85. In this essay I focus on the major predominantly Anglophone settler societies, where the specific history of Indigenous health has been most readily recognised, though a more comprehensive survey should include the health of Indigenous peoples in other parts of the world, including the rest of the Americas.

6. Percy M. Ashburn, The Ranks of Death: A Medical History of the Conquest of America (New York: Coward-McCann, 1947); William H. McNeill, Plagues and Peoples (New York: Anchor Books, 1977); Alfred W. Crosby, "Virgin Soil Epidemics as a Factor in the Aboriginal Depopulation in America," William and Mary Quarterly, vol. 33 (1976): 289–99. See also Judy Campbell, Invisible Invaders: Smallpox and Other Diseases in Aboriginal Australia, 1780–1880 (Melbourne, Vic.: Melbourne University Press, 2002).

7. David S. Jones, "Virgin soils revisited," William and Mary Quarterly, vol. 60 (2003): 703–42.

8. Margery Fee, "Racializing Narratives: Obesity, Diabetes, and the 'Aboriginal' Thrifty Genotype," Social Science and Medicine, vol. 62 (2006): 2988–997; and Yin C. Paradies, Michael J. Montoya, and Stephanie M. Fullerton, "Racialized Genetics and the Study of Complex Diseases: The Thrifty Genotype Revisited," Perspectives in Biology and Medicine, vol. 50 (2007): 203–27. See also Philip D. Curtin, "The Slavery Hypothesis for Hypertension among African Americans: The Historical Evidence," American Journal of Public Health, vol. 82 (1992): 1681–86.

9. Mick Dodson, "Linking International Standards with Contemporary Concerns of Aboriginal and Torres Strait Islander Peoples," in Indigenous Peoples, the United Nations and Human Rights, edited by Sarah Prichard (London: Zed Books, 1995), 19, quoted in Stephen J. Kunitz, "Globalization, States, and the Health of Indigenous Peoples," American Journal of Public Health vol. 90 (2000): 1531–1539, 1537.

10. Frederick L. Hoffman, "Are the Indians Dying Out?" American Journal of Public Health, vol. 20, no. 6 (1930): 609–14; Daisy Bates, The Passing of the Aborigines: A Lifetime Spent Among the Natives of Australia (London: Murray, 1947); and Russell McGregor, Imagined Destinies: Aboriginal Australians and the Doomed Race Theory, 1880–1939 (Melbourne, Vic.: Melbourne University Press, 1997). See also Caitlin Murray, "The 'Colouring' of the Psychosis: Interpreting Insanity in the Primitive Mind," Health and History, this issue.

11. I make this point in Warwick Anderson, The Cultivation of Whiteness: Science, Health and Racial Destiny in Australia (Melbourne, Vic.: Melbourne University Press, 2002).

12. Janice Reid, Sorcerers and Healing Spirits: Continuity and Change in an Aboriginal Medical System (Canberra, ACT: Australian National University Press, 1983). See also William E.H. Stanner, "Some Aspects of Aboriginal Health," in Better Health for Aborigines: Report of a National Seminar at Monash University, edited by B.S. Hetzel, M. Dobbin, L. Lippman, and E. Eggleston (St Lucia, Qld.: University of Queensland Press, 1974), 3–13.

13. Janice Reid and Peggy Trompf, eds, The Health of Aboriginal Australia (Sydney, NSW: Harcourt Brace, 1991). See also Ernest Hunter, Aboriginal Health and History: Power and Prejudice in Remote Australia (Melbourne, Vic.: Cambridge University Press, 1993).

14. For example, the Aboriginal Medical Service established in Redfern in 1971 was modeled on the Black Panther Party's health centres—it became the progenitor of many more community-controlled Aboriginal health services. See Kathy Lothian, "Seizing the Time: Australian Aborigines and the Influence of the Black Panther Party, 1969–1972," Journal of Black Studies, vol. 35 (2005): 179–200. Of course, in acknowledging the impact of the Black Panthers I do not mean to diminish Aboriginal agency in these developments or to deny many other influences on activists in the 1960s and 1970s, including global anti-colonial movements. On the situation in central Australia see Clive Rosewarne, Petronella Vaarzon-Morel, Stephanie Bell, Elizabeth Carter, Margaret Liddle and Johnny Liddle, "The Historical Context of Developing an Aboriginal Community-Controlled Health Service: A Social History of the First Ten Years of the Central Australian Congress," Health and History, this issue.

15. Margaret-Ann Franklin and Isobel White, "The History and Politics of Aboriginal Health," in Health of Aboriginal Australia, edited by Janice Reid and Peggy Trompf (Sydney, NSW: Harcourt Brace Jovanovich, 1991), 1–36, 33.

16. Gordon Briscoe, Counting, Health and Identity: A History of Aboriginal Health and Demography in Western Australia and Queensland, 1900–1940 (Canberra, ACT: Aboriginal Studies Press, 2003). For Queensland, see also Ross Patrick, A History of Health and Medicine in Queensland, 1824–1960 (St Lucia, Qld.: University of Queensland Press, 1987); Rosalind Kidd, The Way We Civilise: Aboriginal Affairs – The Untold Story (St Lucia, Qld.: University of Queensland Press, 1997); and Leonie Cox, "Fear, Trust and Aborigines: The Historical Experience of State Institutions and Current Encounters in the Health System," Health and History, this issue. On Western Australia, see also Brian McCoy, "'They Weren't Separated': Missions, Dormitories, and Generational Health," Health and History, this issue. On the Northern Territory, see Suzanne Saunders, Disease Medicine, and Settlement: The Role of Health and Medical Services in the Settlement of the Northern Territory, PhD thesis, University of Queensland, 1992, and "'A Duly Qualified Medical Practitioner': Health Services in the Northern Territory, 1911–39," in Peripheral Visions: Essays on Australian Regional and Local History, edited by Brian J. Dalton (Townsville, Qld.: James Cook University Press, 1991), 251–67; and Lindsey Harrison, "Government Policy and the Health Status of Aboriginal Australians in the Northern Territory, 1945–72," in Migrants, Minorities and Health: Historical and Contemporary Studies, edited by Lara Marks and Michael Worboys (London: Routledge, 1997), 125–46.

17. David Piers Thomas, Reading Doctors' Writing: Race, Politics and Power in Indigenous Health Research, 1870–1969 (Canberra, ACT: Aboriginal Studies Press, 2004), 136.

18. On the physical or biological anthropologists, see also McGregor, Imagined Destinies, and Anderson, Cultivation of Whiteness. I have not discussed here at length the history of Aboriginal Australians as biological research subjects, choosing instead to concentrate on the later historical recognition of Aboriginal illness and the development of health services, though the availability of Aboriginal bodies for research purposes, along with the contemporary lack of interest in their health, arguably is part of the history of Indigenous health care.

19. Raeburn Lange, May the People Live: A History of Mëori Health Development, 1900–1920 (Auckland: Auckland University Press, 1999). See also Mason H. Durie, Whaiora: Mëori Health Development (Auckland: Oxford University Press, 1994).

20. Derek A. Dow, Mëori Health and Government Policy 1840–1940 (Wellington: Victoria University Press, 1999). See also his Safeguarding the Public Health: A History of the New Zealand Department of Health (Wellington: Victoria University Press, 1995). Linda Bryder and Derek A. Dow edited a Mëori health special issue of Health and History, vol. 3, no. 1 (2001)—their "Introduction: Mëori Health History, Past, Present and Future" is especially pertinent.

21. Lawrence C. Kelly, The Assault on Assimilation: John Collier and the Origins of Indian Policy Reform (Albuquerque, NM: University of New Mexico Press, 1983). For a detailed account of the effect of national policy on the actual delivery of care and preventive efforts, see David S. Jones, Rationalizing Epidemics: Meanings and Uses of American Indian Mortality Since 1600 (Cambridge: Harvard University Press, 2004). See also Stephen J. Kunitz and Jerrold E. Levy, "Dances with Doctors: Navajo Encounters with the Indian Health Service," in Western Medicine as Contested Knowledge, edited by Andrew Cunningham and Bridie Andrews (Manchester: Manchester University Press, 1997), 95–104.

22. Stephen J. Kunitz, "The History and Politics of U.S. Health Care Policy for American Indians and Alaskan Natives," American Journal of Public Health, vol. 86 (1996): 1464–73; and Christopher K. Riggs, "The Irony of American Indian Health Care: The Pueblos, the Five Tribes, and Self-Determination, 1954–1968," American Indian Culture and Research Journal, vol. 4 (1999): 1–22.

23. Mary-Ellen Kelm, Colonizing Bodies: Aboriginal Health and Healing in British Columbia, 1900–50 (Vancouver, BC: University of British Columbia Press, 1998). For Manitoba, see Paul Hackett, "From Past to Present: Understanding First Nations Health Patterns in a Historical Context," Canadian Journal of Public Health, vol. 96 (2005): S17–S21. See also James B. Waldram, D. Ann Herring, and T. Kue Young, Aboriginal Health in Canada: Historical, Cultural, and Epidemiological Perspectives (Toronto, Ont: University of Toronto Press, 1995); and Maureen K. Lux, Medicine that Walks: Disease, Medicine and Canadian Plains Native People, 1880–1940 (Toronto, Ont: University of Toronto Press, 2001).

24. Kelm, Colonizing Bodies; and McCallum, "This last frontier."

25. Kelm, Colonizing Bodies, p. 178.

26. For preliminary explorations, see Kunitz, Disease and Social Diversity; Stephen Kunitz and Maggie Brady, "Health Care Policy for Aboriginal Australians: The Relevance of the American Indian Experience," Australian Journal of Public Health, vol. 19 (1995): 549–58; and Kunitz, "Globalization." In the last essay, Kunitz claims that globalisation "may provide part of an answer to the destruction that states have visited upon Indigenous peoples" (p. 1538). Clearly, before we can achieve any satisfactory comparison of histories of Indigenous health we will need more national histories dealing with the late-twentieth century and an effort to encompass other Indigenous histories, including those of the peoples of Latin America and Asia.

27. On biomedical citizenship in the liberal colonial state, see Warwick Anderson, Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines (Durham, NC: Duke University Press, 2006).

28. See Linda Tuhiwai Smith, Decolonizing Methodologies: Research and Indigenous Peoples (London: Zed Books, 1999).

29. On moral sensibilities, see Clifford Geertz, "Found in Translation: On the Social History of the Moral Imagination," in Local Knowledge: Further Essays in Interpretive Anthropology (New York: Basic Books, 1983), 36–54. On structures of feeling, see Raymond Williams, Marxism and Literature (Oxford: Oxford University Press, 1977). This suggestion reflects some of the more programmatic statements in Ann L. Stoler, ed., Haunted by Empire: Geographies of Intimacy in North American History (Durham, NC: Duke University Press, 2006). For a particularly compelling account, see Bronwyn Fredericks, "Australian Aboriginal Women's Health: Reflecting on the Past and Present," Health and History, this issue.

30. On the development of Aboriginal mental health more generally, see Edmund McMahon, "Psychiatry at the Frontier: Surveying Aboriginal Mental Health in the Era of Assimilation," Health and History, this issue.

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