When anthropologists and other social scientists attend to chemical and industrial risks, we often focus on how toxics produce illness and disease through exposures that are sensorial, community-based, and derived from infrastructure. Embodied sense for chemicals has also informed different kinds of social and political action, a phenomenon well documented in environmental justice literatures. Whereas earlier scholarship spoke of particular sites and places as specifically toxic, more recently, scholars have gestured towards a much broader landscape woven by industrial legacies, economic logics, and an eerie mix of refusing to acknowledge and just plain ignorance of how 20th century infrastructures are killing us (Shapiro 2015; Jain 2013; Fortun 2012; Parr 2010). Shapiro, for example, describes how formaldehyde off-gasses in FEMA trailers “accumulate in the bodies of the exposed and reorient them to the molecular constituents of the air and the domestic infrastructure from which such chemicals emanate” (2015: 370). Attunement to the “chemical sublime,” Shapiro writes, gives rise to “molecular and relational appreciations” that point to embodied vulnerabilities. For those who suffer from chronic illnesses produced by toxics, it is “by virtue of this very capacity to be chemically wounded, even minutely so, that bodies bear revelatory power.”
My own work on embodiment, environment, and the politics of health is anchored in the contemporary asthma epidemic, and the care practices used by people who struggle to breathe in a toxic world. In this essay, rather than show how toxics trigger illness or produce disease, I describe how the sensorial experience of pharmaceuticals produce an affect of life and care in un-breathable times. Breathing in the chemosphere (Shapiro 2015) or in late industrialism (Fortun 2013) is manageable with drugs that quiet, calm, and desensitize the body. Or as Gregg Mitman writes while describing the cocktail of asthma drugs he and his son take daily, pharmaceuticals “alter the complex immune system relationships within our bodies so that we might never mind the outside environmental connections within the world in which we live” (Mitman, 2007, p. 206).
Asthma is a chronic respiratory disease characterized by low-level symptoms and acute attacks that include wheezing, shortness of breath, chest tightness, and a life-threatening inability to breathe. Asthma symptoms may be triggered by industrial and chemical exposures, as well as by organic matter, like cats and dogs, pollen and dust. These objects, of course, are difficult to untangle. Asthmatic bodies are pathologically sensitized to many kinds of environmental conditions, known and unknown. Today’s asthma treatments are designed to quell the modes of attunement produced by late industrialism; they’re anchored by pharmaceutical care regimes that include inhalers, nebulizers, and allergy medicines – chemicals of a different kind. Pharmaceuticals may have affect different from the toxic exposures that trigger disordered breathing, but they share technological, economic, and political genealogies and logics with the same systems that make our world increasingly un-breathable. Transportation technologies and infrastructures that keep us moving, for example, are kin to the medications that keep us working. These relationships between environment, medication, and breathing are not lost on asthmatics.
In interviews with people who suffer from disordered breathing, sensorial descriptions of triggers are mostly marked negatively. There were a handful of subjects, however, whose sensorial descriptions focused on medication rather than triggers. Paul was a severe allergic asthmatic, the kind who self-identified as asthmatic. Paul was the kind of asthmatic who told me he had lived with asthma his whole life, had been born with asthma. There are at least five different asthma phenotypes, but the most well-known (and understood) is allergic asthma, which often begins in early childhood. This is the type of asthma that Paul had lived with for 27 years. Raised in a small New England town, Paul was living in a post-industrial city in Upstate New York at the time of our interview. Indoor environments seemed to pose the greatest risk to Paul, but his sense of atmosphere was keen, as it is for most asthma sufferers. Stories of disordered breathing were anchored by environmental and embodied memories rich with sensorial experiences. What struck me in Paul’s interview, however – and a dozen or more interviews with childhood asthmatics – were memories of medication regimens.
Ali: What’s your earliest asthma memory?
Paul: As a child. Like two or three. I have photos of me – and I still have my old nebulizer from like the early ‘90s. It’s the box. I have photos of me in like a one piece footie pajamas with the face mask on and needing to use that, geez, I want to say like almost every night. Or it was regular. And actually, I have very fond memories of the smell of the medicine and the sound the machine makes. To this day, even the inhaler has a very like – oh yeah, this makes me breathe nice again. Like, it’s a good association in my mind. So yeah, very young.
A: What does it smell like? Is it when you use the inhaler?
P: It’s both [the inhaler and the nebulizer], but I specifically remember the nebulizer, it’s this like clean aerosol smell. It doesn’t have a chemical smell, it’s more of nice vapor kind of, I guess. And the older formulation of the – whatever the medicine was, you would get like significantly light-headed. I remember being like in elementary school and the nurse warning me about that. Like, oh, you should – this might make you light headed, you need to take like three minutes in between the puffs or the hit off the medication. Because it would make you a little bit like, oh yeah, it’s a little light headed, a little loopy for just a second. Then the newer stuff doesn’t. And I remember thinking, when my doctor told me, I was like, crap! I always looked forward to that little bit of – goofy for just like five seconds. Then the hum of the nebulizer, it’s just like – that’s what I would fall asleep to. And I remember, I remember you had to mix two medications in the little cup that twisted together on the machine. And I remember learning how – my dad teaching me how to do it with an eye dropper. The two different types of medication and then using the entire thing on my own. That was a big deal when I could use the nebulizer on my own.
Both evening and late night hours can be particularly difficult for some asthma sufferers. Many asthmatics describe bedtime rituals from childhood that include warm baths, cold night trips to fresh outdoor air, steam treatments, and of course, nebulizers; others describe waking up in the middle of night, long after falling asleep, unable to breathe. Paul’s medication memory is clean, however, rather than chemical. It was a clean, aerosol smell even though Paul recognized that he was breathing in and using a chemical machine. The treatment that allowed him to breathe was marked as “nice,” perhaps even comforting in the face of disordered breathing. This is not unlike the new car smell that Shapiro writes about – part of the post-World War II “American sensorium” that is associated with success and authenticity (Robb, 2014). Smells produce affect with potent cultural associations. In Paul’s case, it’s the smell of medicine that allows him to breathe.
The nebulizer treatment etched the final sound and feel of his childhood day. Chemical apparatus translated as care that was a “good association” for Paul. Coupled with the sound of the machine, and the smell of vapor through the breathing mask, was the feeling of light-headedness. The instantaneous loopy feel that confirmed the chemicals had hit the body’s system. This medicated feel is a potent contrast to the symptoms that arise when an asthmatic is met with a trigger – cigarette smoke, perfume, diesel exhaust, and noxious odors of unknown composition.
Alongside the feel for medication, Paul eventually learned the alchemy of treatments as well. Measuring and mixing different drugs, then depositing them into the machine that would allow him to breathe through the night. This was a chemical care ritual taught to Paul by his father, when Paul was old enough to mix the medicine on his own. Taking on medical care for oneself was a rite of passage allowed only when Paul could be trusted to make the medical mixture correctly. Self-care involves care for chemical apparatuses, too. This extends to inhaler technologies as well.
P: I had to go down to the nurse’s office 15 minutes before gym class every day and it was me and this other girl and we would both walk together from class. And it was a big deal getting out of class when you are in elementary school, to walk alone in the hallways to the nurse’s office. I remember the nurse there showed – I mean, you have to wait a certain amount of time after you inhale it so you don’t have that light-headed feeling. Then how to measure how much is left in the vials. If you drop it in water, I think if it totally sinks, then it’s full. Otherwise, it starts to float and you can judge how much is left in it. That was something she showed me. I still remember and I still do it to this day. Although nowadays they have these little counters on the back of the inhalers that tell you, you have 100 pumps left. It was just as normal as putting your socks on before your shoes. Oh yeah, this is what I have to do every day. Or this is what I have to be aware of.
In asthma care today, patient education is weighted towards treatment regimes that support adherence – using the right medication at the right time and observing when medications get low. Everyday treatment regimes parallel the more informal attunement to environments that produce symptoms. Asthmatics must pay attention to potential triggers, but there is also security in knowing that an inhaler will (likely) save you. The relationship cultivated between medication and self, is marked as life-giving in world where environment becomes un-breathable for some of us.
P: I like being able to have it in my pocket and like hear the solution inside of it. I like the way it tastes and smells. But if it’s in my pocket, I will like fiddle with it. I remember thinking that it represents life. This literally represents life to me. So I don’t like being without one. Or maybe it represents normalness. It represents health and breathing and goodness.
Paul’s description of his relationship to medication is striking when situated within the context of the contemporary asthma epidemic, a product of late industrialism where chemical affect has multiple valences, sometimes all within the same breath. A time when an albuterol inhaler is the prescribed response to disordered breathing triggered by transportation emissions, industrial release of toxic by-products, dilapidated housing, and climate change.
Pharmaceutical regimes produce a different kind of “bodily reasoning” (Shapiro 2015) than the chemicals that accumulate in the bodies of FEMA trailer inhabitants – an inversion of it. Daily asthma medication is designed to accumulate in the body to make asthma sufferers less reactive to their environment, rather than more reactive. For many asthmatics, the logic of daily controller medications is successful; chemical care desensitizes the body so we can carry on in un-breathable environments. Rather than a revelatory power that points to toxic worlds, lifesaving medications redirect the revelatory power of chemicals towards the good drugs that let us breathe at night.
Works Cited
Fortun, K. (2012). Ethnography in late industrialism. Cultural Anthropology, 27(3), 446-464.
Jain, S. L. (2013). Malignant: How cancer becomes us. Univ of California Press.
Mitman, G. (2008). Breathing space: how allergies shape our lives and landscapes. Yale University Press.
Parr, J. (2010). Sensing changes: technologies, environments, and the everyday, 1953-2003. UBC Press.
Robb, Alice. 2014. “When Your Car Has that New-Car Smell, It’s Luxurious. When Your House Does, It Can Kill You.” New Republic, March 10. https://newrepublic.com/article/116952/new-car-smell-formaldehyde-could-have-killed-fema-trailers
Shapiro, N. (2015). Attuning to the chemosphere: Domestic formaldehyde, bodily reasoning, and the chemical sublime. Cultural Anthropology, 30(3), 368-393.
This essay is part of Sensorial Engagements with a Toxic World, a special series curated by Chisato Fukuda.