Theorising liminal states of health: A spatio-temporal analysis of undiagnosis and anticipatory diagnosis in the shadow of toxic pollution

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Abstract

This paper demonstrates how greater engagement with liminality – as a concept and lived experience – can expand scholarly conceptualisations of health/disease in contaminated spaces. Drawing on ethnographic fieldwork conducted in Sri Lanka's dry zone between 2013 and 2017, I focus on residents' encounters with chronic kidney disease diagnosis in a region where the causes of illness are uncertain, the consequences of disease are often deadly, and the possibilities of developing sickness in the future are both unpredictable and ever-present. Specifically, I examine how residents of kidney disease hotspots negotiate various attempts to categorise them as being, or not being, healthy in ways that give rise to experiences of liminality. Building on work in feminist disability studies, I conceptualise “undiagnosis” and “anticipatory diagnosis” as two such liminal states of health that reconfigure medical and social practices in the dry zone. As part of this analysis, I explain why residents are so reluctant to get screened for kidney disease and demonstrate how they strategically mobilise moments of “undiagnosis” to resist patient subjectivities and prolong existing lifeways. I then turn to a discussion of anticipatory diagnosis, which describes the practice of re-classifying residents of disease hotspots who are not yet sick as embodying the potential to become ill at any time. Frequently deployed by the state, medical practitioners, and non-dry zone communities, I demonstrate how this practice collapses categories of “at-risk” and “diseased” in external categorisations of residents' future health status. In short, liminality comes to be embodied through the constant anticipation of disease despite uncertainty about who will actually become sick and why. Tying these experiences together, I elucidate how geography matters to the constitution of liminal states of health and crucially demonstrate how this liminality helps reproduce place attachments as well as forms of geographic differentiation in the shadow of toxic contamination.

Original languageEnglish
Pages (from-to)363-377
Number of pages15
JournalTransactions of the Institute of British Geographers
Volume47
Issue number2
DOIs
StatePublished - Jun 2022

Bibliographical note

Funding Information:
American Institute of Sri Lankan Studies. National Science Foundation (Grant number: 1633991). Social Science Research Council. Society of Woman Geographers.

Funding Information:
American Institute of Sri Lankan Studies. National Science Foundation (Grant number: 1633991). Social Science Research Council. Society of Woman Geographers. This paper has benefited from conversations with Camelia Dewan, Aparna Parikh, and A. Marie Ranjbar, as well as with faculty in the Department of Geography at Dartmouth University, who all provided amazing feedback on previous versions of this paper. It has also been greatly sharpened by the generous and constructive comments of three anonymous reviewers and Matt Sparke. I am deeply grateful for their time and labour in moving this manuscript forward. I am also indebted to Dilni Abeyrathne and Nick Lally for their help designing the map in this paper. Finally, this paper could not have been written without the generosity and hospitality of residents in Padaviya and Sri Pura: thank you for sharing your lives, stories, and struggles with me.

Publisher Copyright:
The information, practices and views in this article are those of the author(s) and do not necessarily reflect the opinion of the Royal Geographical Society (with IBG). © 2021 Royal Geographical Society (with the Institute of British Geographers).

Keywords

  • Sri Lanka
  • crip time
  • dry zone
  • health
  • liminality
  • mystery kidney disease
  • toxic geographies

ASJC Scopus subject areas

  • Geography, Planning and Development
  • Earth-Surface Processes

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