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

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.