In July 2012, the United States Food and Drug Administration (FDA) approved the commercial use of an antiretroviral pharmaceutical to prevent HIV. This method of preventing HIV is known as HIV pre-exposure prophylaxis (PrEP). The single pharmaceutical product approved for commercial use as PrEP is manufactured by Gilead Sciences, Inc (Foster City, CA) and sold under the brand name Truvada. This dissertation traces the development, commercialization, and implementation of Truvada as PrEP from an anthropological perspective, including by exploring several elements of the political economy of health, such as processes of innovation in drug development. The dissertation also displays how this novel method to prevent HIV emerges from a long history of HIV prevention in which the intimacy of ‘at risk’ individuals has been managed through techniques of discipline, including those that encourage individuals to engage only in ‘safe’ sex and to speak to physicians and investigators about their ‘risky’ practices. At the same time, this historical and ethnographic research marks an important shift in the value systems of antiretroviral markets, which once stitched together public interests (of the state and its citizen) and private interests (of the pharmaceutical industry) through the moral imperative to save life and are now strengthening public-private partnerships in order to secure health and manage sexual pleasure. By following the product life of Truvada from early moments in the antiretroviral market when Gilead obtained licenses for its pharmaceutical components into present day clinical care, where providers are prescribing Truvada as PrEP to augment sexual pleasure, this account brings together intimacy and innovation to show how they have become intertwined and inseparable. Thus, the dissertation argues PrEP is an intimate innovation.

This dissertation explores relationships between the living and the dead that are mediated by digital technologies including online memorials, social media accounts, smartphone apps, and virtual reality platforms. As digital media make possible new forms of presence, I ask what the implications are for how grief is experienced, whether and how relationships continue after death, the form that these relationships take, and the ways that they are structured by particular media. I consider what the implications of these emergent relationships are for both models of grief and for theories of mediation.

This ethnography is based on over a year and a half of fieldwork in San Francisco, Chicago, and online. I restricted my fieldsite to the English-speaking world, and my interlocutors were in Britain and Australia as well as the United States. Through interviews and participant-observation, I explored their digital practices and the impact of these practices on their experiences of grief and connection with the dead. The dissertation uses a case-study approach, with each chapter exploring a different digital media through one relationship that takes place on that media.

My findings demonstrate that relationships with the dead not only persist, but can also deepen after death. I argue that the intimacy engendered by these relationships, as well as the forms of reciprocity that they entail, confound contemporary models of normal grief—including those that embrace “continuing bonds” with the dead. The relationships that I describe are often melancholic, organized around the many absences that death introduces. They are also in some way sustaining for both the living and the dead, producing and reproducing them in relation to each other. I use the concept of animation to unpack the particular form of mediation involved. Animation draws attention to forms of presence that do not rely on a one-to-one correspondence between the figure and its iteration, but are rather enriched by the variability, multiplicity, and sometimes even the sparseness with which they are “drawn.” It also invites us to consider how the dead might be animating digital technologies, breathing life into the media through which they encounter their loved ones.

This manuscript is an ethnography about people, typically young (14-25) but not exclusively so, and families seeking care in early psychosis clinics, and the psychiatric professionals who provide them with services. I offer insight into living and working in the midst of potential psychosis. I attend to psychosis as experience rather than psychiatric symptom, as something beyond a label that can be assigned to individuals correctly or incorrectly. This study neither tests nor tables the question of what early psychosis is or whether or not early psychosis can be identified and treated. Instead, I show how experience comes to be declared or dismissed as psychosis iteratively through conversations between young people, clinicians, and family members. Diagnosis then proceeds both formally and informally through processes that attempt to order odd, fleeting experiences by chronology and conviction, thereby rationalizing what resists making sense. And yet, in early psychosis clinics diagnostic uncertainty continues to simultaneously demand and destabilize the clinical application of psychiatric categories. I attend carefully to moments of failure, resistance, and destabilization in early identification and intervention. It is within these sites of profound uncertainty that alternative possible explanations and desires emerge—to be personally addressed by a voice that no one else hears, to be worthy of trust and psychotic, to be listened to. Anthropology widely theorizes psychosis as a condition of madness and as extraordinary, most typically through the lens of schizophrenia. This literature highlights the spectacular and unusual aspects of psychosis, its ruptures. Psychosis emerges as an extreme of human experience, distinct from the ordinary and as something that threatens subjectivity across multiple domains. This study, based on 12 months of ethnographic fieldwork access to specialized US early psychosis clinics, shows that in the scene of early psychosis, the symptom evades discernment in its ephemerality, its subtlety, its truth. Psychosis continues to evade rationalization not necessarily because of its extraordinary character, but also in its proximity to reality. I look to the accounts of psychosis shared herein as helping to elucidate ordinary experience not because they are extreme or opposing versions, but because they are in fact ordinary. The widely maintained premise of psychosis as extraordinary, bizarre, and spectacular leaves much of psychotic experience unrecognized and establishes in advance the fact of its unfamiliarity. While anthropology has widely theorized psychosis as extraordinary, my fieldwork poses a new question: if psychosis can be so ordinary, how mad must the ordinary be?

In U.S. Emergency Departments, I try to understand concerns around safety as responses to the systemic conditions produced by a capitalism, a healthcare system that provides ‘just-in-time’ care, and concerns around liability that justify coercive interventions. In this dissertation, I examine safety as it is negotiated by different actors in the hospital. I survey the economic conditions that shape scarcity and triage. I examine the pressure of legal demands on placing involuntary psych holds. I talk to healthcare workers about their experiences with violence. And I critique demands for increased securitization. I draw from interviews and ethnographic observations conducted among consenting people in Bay Area Emergency Departments for medical attention, as well as the hospital staff, healthcare workers, administrators, and security guards who worked there from 2021-2022. In this work I call for an abolitionist approach to safety that addresses root-causes of conflict and expands the capacity for people in Emergency Departments to navigate difficult situations.

This dissertation examines the social, political and economic context of Cuba’s biopharmaceutical sector and its expanding global footprint, shaped by socialism. I examine the counter-current technology transfer of Cuban biopharmaceutical innovation, specifically, their novel therapeutic cancer vaccines. My research brings together the anthropology of pharmaceuticals, science and technology studies of the Global South and post-socialist studies, affording a new analysis of the relationship between political economy and scientific innovation. I conducted ten months of ethnographic research over four years with clinicians, researchers, administrators, regulators, drug marketers, tobacco workers, former patients and others involved with Cuban cancer vaccines, both in Cuba and in a collaborating cancer center in the US.

Investigating the expansion of socialist biopharmaceutical innovation, I found new ways of thinking about the relationship between people, tumors and tobacco. My findings reveal a pharmaceutical sector growing through medical solidarity, offering an alternative approach to thinking about value. I show how Cuban “therapeutic vaccines” are linked to a term increasingly circulating in Cuba known as “cronicidad,” referring to the goal for the patient with terminal cancer to be reintegrated into their social milieu. Drawing on interviews with Cubans involved in tobacco production as well as biotech researchers working in cancer vaccine development, I introduce a new term, “biocompanion,” to conceptualize chronic relations between humans, tumors and tobacco.

In this dissertation, I argue that in eastern Congo, war is not lived as rupture, as a project that, once accomplished, will end. Instead, violence is understood to be an enduring force that is deeply imbricated in social life and political and economic attachment. It follows then that, in the context of a violent history and an uncertain present, life is not that which comes into being after war, when the cessation of spectacular violence allows the resumption of everyday practices, the recommencement of ordinary routines. Instead, where violence is inescapably ordinary, war is experienced as an injurious, constitutive, and ambivalent force. The lives it shapes are neither determined by nor devoid of mourning, but, as elsewhere in the world, characterized by pleasure and pain, intimacy and fear, bitterness and beauty. An ethnographic exploration of a particular experience of war in North Kivu, DRC, this dissertation is an account of these lives.

This dissertation draws on approximately 18-months of fieldwork (2015-2017) based in Timika, West Papua, the politically contested easternmost region of Indonesia. I take the Indonesian state’s radical denial of violations of human rights in the region – the public declaration at the United Nations that such allegations are a “hoax” – as an opportunity to consider alternative evidentiary modes and epistemic frames through which to narrate what can be said to be happening in West Papua. If epistemic uncertainty is a daily reality for most Papuans, I explore how a kind of motivated uncertainty or ambiguity allows for the possibility of other ways of knowing and remembering that produce living (poetic) archives disruptive of the state’s desire to produce “truth beyond dispute” (Mbembe 2001). I argue for a poetic epistemology that is both a methodological intervention – an ethnographic mode of both knowing and writing – as well as an ethnographic observation of a kind of knowing that emerges through these daily conditions of uncertainty.

Through an ethnographic study of the practices surrounding pediatric health in post-Cold War Lat-via, a unique site at the intersection between Russia and the European Union, this dissertation argues that Latvians measure the moral rectitude of their nation by the straightness of their children’s spines. By attending to parents and medical professionals who are actively shaping young children’s bodies to collective standards and, at the same time, engaging in individualized haptic early childhood care, the dissertation draws connections between medicine, parenting and nationhood. This study explores the health practices enacted by a fringe group of parents involved in body-intensive parenting, as I refer to it, and implemented through a state-mandated physical exam for young athletes. I pay particular attention to the corporeal aspect of caring for young children, or “managed corporeality,” which is aimed at transforming them into healthy adults.

The dissertation traces Latvia’s larger healthcare goals for children in the context of a mass fainting event during the 2015 Youth Song and Dance Festival and ensuing perceptions that the fragile na-ture of Latvian children threatens the future of the nation. I further highlight the specific attention to musculoskeletal issues in the public health sector and among parents. In particular, I describe how fears of physiological asymmetry influence early childhood care in the case of a condition referred to as a “baby tonuss” and learning the proper way of caring for an infant, known as “hendlings.” I trace the origins of these practices to the Soviet period, but demonstrate how despite parenting attitudes that seek to counter the Soviet past outright, concerns regarding bodily straightness are widely incorporated into the way body-intensive parents raise their children. This is significant because in other areas of pediatric health, the Soviet legacy is seen as an obstacle to be overcome. Nursing newborns in Latvia, for example, can be viewed in the context of “intergenera-tional lactation trauma,” while Latvian women’s resistance to liberal feminism is rooted in the Soviet period, which deprived the previous generation of intimacy with their children. The unique geopolitical location and history of Latvia allows for the exploration of a particularly Latvian morality and aesthetics that I refer to as “straight-back morality” or the physiological and metaphorical value of the “straight-spine,” allowing the dissertation to contribute to conceptualizing global fascination with moral straightness, normativity and nationalism.

This dissertation follows the practices of Black subsistence fishers along the tidal Anacostia River in Washington, D.C. and Maryland. I argue that in their comings and goings and doings at the banks of the river and within adjoining spaces contaminated by decades of pollution, they unsettle the proper and propertied logics otherwise dictating the course and feel of the riverscape. Against a backdrop of heightened redevelopment and increased scrutiny stemming from public fish consumption advisories, I present how fishers continue to go tightlining; improvise with refused materials; follow the river’s tendencies to erode, flood, and fill in with sediment; tie knots and loops; and clean their fish hauls. These practices amount to metaphorical and material ways of staying despite the many reproductions of property ushering in waves of racialized displacement and a state of overexposure. In keeping close with an as not-yet-fully-remediated river, sometimes taking contaminated fish home for food, fishers improperly take hold of the river in ways that rival (proper)tied notions of ownership and belonging. Through these everyday movements, they hone expansive notions of the self and maintain abundant relations with an imperfect riverscape.

Refractive Cogito explores the production of intersubjective intimacy through psychotherapy and visual technologies. I have conducted one year of ethnographic research in Argentina, a global center for psychotherapeutic treatments. In Buenos Aires, I researched “systemic couple therapy.” This therapeutic model utilizes visual technologies like the one-way mirror or Closed Circuit Television in order to allow teams of therapists to observe or supervise live sessions of therapy. Building on my “observant participation” of live sessions of therapy, I argue that this setting exemplifies how late modern affectivity is mediated through the optical apparatus, which includes visual technologies but also the anonymous gazes of the observing therapists and the ethnographer’s I/eye. This visual mediation foregrounds the emergence of the “couple image,” an interpersonal imaginary that filters the normative reproduction of coupled intimacy.

Adding to research on therapeutic lifeworlds in Latin America, the work challenges the notion that modern institutions such as psychotherapy and the romantic couple have produced reflexive and self-transparent identities. I draw from the systemic setting to describe a constitutive non-coincidence and visual dispossession of late modern subjects in respect to themselves. I contribute to qualitative methodology defining ethnography as a genre of presence that involves the use of non-conscious imagination. To consider the ethnographic enterprise as an experience of refractive dispossession, I describe sessions of hypnosis I underwent to as a patient/researcher during my fieldwork.