Seth Holmes Character Analysis

My Triqui companions often explain their everyday lives in terms of sufrimiento (suffering). But one of the sites of sufrimiento most frequently described by Triqui migrants is crossing the border from Mexico into the United States. Many times throughout my fieldwork, my migrant companions told me stories of their harrowing experiences. One of my friends was kidnapped for ransom with her four-year-old boy. […] One young man I know described burns on his skin and in his lungs after being pushed by his coyote into a chemical tank on a train. Another man explained that he was raped by a Border Patrol agent in exchange for his freedom. All my migrant companions have multiple stories of suffering, fear, danger, and violence at the border.
Early in my fieldwork, I realized that an ethnography of suffering and migration would be incomplete without witnessing firsthand such an important site of suffering for Latin American migrants.

Systems of migrant labor are characterized by a physical and temporal separation of the processes of reproduction of the labor force and the production from that labor force. The migrant laborer can survive on low wages while contributing to economic production in one context because the family, community, and state in the other context provide education, health care, and other services necessary for reproduction. In this way, the host state externalizes the costs of labor force renewal and benefits even further from the phenomenon of labor migration.
[…]
The separation of these processes is not a natural or a voluntarily chosen phenomenon but must be enforced through the meeting of contradictory political and economic forces. Systems of labor migration involve economic forces inviting and even requiring the cheap labor of migrants at the same time that political forces ban migrants from entering the country.

Traditional migration studies assumes a dichotomy between voluntary, economic, and migrant on the one hand and forced, political, and refugee on the other. The logic behind this dichotomy states that refugees are afforded political and social rights in the host country because they were forced to migrate for political reasons. Conversely, migrants are not allowed these rights because they are understood to voluntarily choose to migrate for economic reasons. The "push" and "pull" factor school of migration studies tends to assume that labor migration is entirely chosen, voluntary, and economic.
However, my Triqui companions experience their labor migration as anything but voluntary. Rather, they have told me repeatedly that they are forced to migrate in order for themselves and their families to survive. At one point during our trek across the border desert, Macario told me, "There is no other option left for us."

I attempt to portray and analyze the lives and experiences of Macario and my other Triqui companions in order to understand better the social and symbolic context of suffering among migrant laborers. I hope that understanding the mechanisms by which certain classes of people become written off and social inequalities become taken for granted will play a part in undoing these very mechanisms and the structures of which they are part. It is my hope that those who read these pages will be moved in mutual humanity, such that representations of and policies toward migrant laborers become more humane, just, and responsive to migrant laborers as people themselves. The American public could begin to see Mexican migrant workers as fellow humans, skilled and hard workers, people treated unfairly with the odds against them. I hope these recognitions will change public opinion and employer and clinical practices, as well as policies related to economics, immigration, and labor. In addition, I hope this book will help anthropologists and other social scientists understand the ways in which perception, social hierarchy, and naturalization work more broadly.

My body offered insights not only via experiences of the living and working conditions of migrant laborers but also as I generated particular responses from those around me. In many circumstances, my light-skinned, tall, student-dressed, English-speaking body was treated very differently from the bodies of my Triqui companions. The supervisors on the farms never called me deprecatory names like they did the Oaxacan workers. Instead, they often stopped to talk and joke with me, all the while picking berries and putting them into my bucket to help me make the minimum required weight. The social categories inscribed on bodies led to my being treated as an equal a friend, even a superior, while the Oaxacans were treated most often as inferiors, sometimes as animals, or machines. […] My body was treated as though it had and deserved power, whereas theirs have been treated repeatedly as underlings, undeserving of respect.

A few thousand [laborers] migrate here for the tulip-cutting and apple- and berry-picking seasons in the spring and live several months in squatter shacks made of cardboard, plastic sheets, and broken-down cars or in company-owned labor camps, often in close proximity to the multilevel houses of the local upper class that have picturesque views of the valley. The migrant camps look like rusted tin-roofed tool sheds lined up within a few feet of each other or small chicken coops in long rows. In the labor camp where I came to live, the plywood walls are semi-covered by peeling and chipping brown-pink paint. There is no insulation, and the wind blows easily through holes and cracks, especially at night. […] During summer days, the rusty tin roofs of the units conduct the sun's heat like an oven, regularly bringing the inside to over 100 degrees Fahrenheit. At night, the air is damp and cold, reaching below 32 degrees Fahrenheit during the blueberry season in the fall.

After my first few weeks living in a migrant camp and picking berries, I began to notice the intricate structuring of labor on the farm into a complicated hierarchy. In the case of contemporary U.S. agriculture, the primary fault lines of power tend to fall along categories of race, class, and citizenship. The structure of labor on the Tanaka farm is both determined by the asymmetries in society at large—specifically around race, class, and citizenship—and reinforces those larger inequalities. The complex of farm labor involves several hundred workers occupying many distinct positions, from owner to receptionist, field manager to tractor drivel, berry checker to berry picker. People on the farm often described the hierarchy in vertical metaphors, speaking of those “above” or "below" them, of "overseeing" or of being "at the bottom.”

Over the course of my fieldwork, many of my friends and family who visited me in the labor camp quickly blamed the farm management for the poor living and working conditions of berry pickers.
[…]
The stark reality and precarious future of the farm serve as reminders that the situation is more complex. The corporatization of U.S. agriculture and the growth of international free markets squeeze growers such that they cannot easily imagine increasing the pay of the pickers or improving the labor camps without bankrupting the farm. In other words, many of the most powerful inputs into the suffering of farmworkers are structural, not willed by individual agents. In this case, structural violence is enacted by market rule and later channeled by international and domestic racism, classism, sexism, and anti-immigrant prejudice. However, structural violence is not just a simple, unidirectional phenomenon; rather macro social and economic structures produce vulnerability at every level of the farm hierarchy.

John recognizes that the living and working conditions of pickers are so undesirable that each group will move out of this position as quickly as possible. The pickers come from the most vulnerable populations at any given time. As each group advances socially and economically, a more exploited and oppressed group takes its place. […] In one sense, this narrative of ethnic succession functions to justify the plight of the group currently at the bottom of the hierarchy. That is, it appears to foster the sense that it is all right that certain categories of people are suffering under poor living and working conditions at present because other groups have had to endure these conditions in the past. Some people begin to perceive this as a natural, evolutionary story.

The physical dirt from the labor of the indigenous pickers had become symbolically linked with their character, and at the same time the limited possibility of relationships between Shelly and the indigenous workers because of the language barriers had become symbolically projected as assumed character flaws onto the indigenous pickers themselves. In addition to bringing into relief the "de facto apartheid" on the farm, the profiles of the supervisors exemplify the range of responses to ethnic and class difference within an exploitative system.

During my fieldwork, I picked once or twice a week and experienced gastritis, headaches, and knee, back, and hip pain for days afterward. I wrote in a field note after picking, "It honestly felt like pure torture." Triqui pickers work seven days a week, rain or shine, without a day off until the last strawberry is processed. Occupying the bottom of the ethnic-labor hierarchy, Triqui pickers bear an unequal share of health problems, from idiopathic back and knee pains to slipped vertebral disks, from type 2 diabetes to premature births and developmental malformations.

Thus marginalization begets marginalization. The indigenous Mexicans live in the migrant camps because they do not have the resources to rent apartments in town. Because they live in the camps, they are given only the worst jobs on the farm. Unofficial farm policies and practices subtly reinforce labor and ethnic hierarchies. The position of the Triqui workers, at the bottom of the hierarchy, is multiply determined by poverty, education level, language, citizenship status, and ethnicity. In addition these factors produce each other. For example, a family's poverty cuts short an individual's education, which limits one's ability to learn Spanish (much less English), which limits one's ability to leave the bottom rung of labor and housing. Poverty, at the same time, is determined in part by the institutional racism at work against Triqui people in the first place. Segregation on the farm is the result of a complex system of feedback and feed-forward loops organized around these multiple nodes of inequality.

The ethnic-labor hierarchy seen here—white and Asian American U.S. citizen, Latino U.S. citizen or resident, undocumented mestizo Mexican, undocumented indigenous Mexican—is common in much of North American farming. […] Yet this is only a small piece of the global hierarchy. The continuum of structural vulnerability can be understood as a zoom lens, moving through many such hierarchies. When the continuum is seen from farthest away, it becomes clear that the local family farm owners are relatively low on the global corporate agribusiness hierarchy. When looked at more closely, we see the hierarchy on this particular farm. addition, perceptions of ethnicity change as the zoom lens is moved in and out. As mentioned above, many of the farm executives (as well as area residents) considered all migrant farmworkers "Mexican," whereas those in closer contact with the farmworkers came to distinguish between "regular Mexicans" and "Oaxacans," and those working in the fields themselves often differentiated among mestizo, Triqui, and Mixtec people.

The suffering of Triqui migrant laborers is an embodiment of multiple forms of violence. The political violence of land wars has pushed them to live in inhospitable climates without easy access to water for crops. The structural violence of global neoliberal capitalism forces them to leave home and family members, suffer through a long and deadly desert border crossing, and search for a means to survive in a new land. The structural violence of labor hierarchies in the United States organized around ethnicity and citizenship positions them at the bottom, with the most dangerous and backbreaking occupations and the worst accommodations. Due to their location at the bottom of the pecking order, the undocumented Triqui migrant workers endure disproportionate injury and sickness.

Why did the Triqui people think that the physicians working with them did not know anything? What was wrong with the doctor-patient relationship? Why was it so unhelpful in its present form? Could it be changed to be more helpful for my Triqui companions? What were the economic, social, and symbolic structures impeding such change? And how might anthropology speak to clinical medicine and public health?

As an anthropologist and a physician, I am concerned both with theorizing social categories and their relationships with bodies and with the possibility that suffering might be alleviated in a more respectful, egalitarian, and effective manner. My dual training has been at once stimulating and disorienting. The lenses through which cultural anthropologists and physicians are trained to see the world are significantly different, and at times contradictory. I have found the critical social analyses of anthropology incredibly important at the same time that I have valued the grounded human concerns of clinical medicine.

Around the time of the advent of the dissection of cadavers, the conception of disease transformed from an entity affecting the whole person to an anatomically localized lesion. It was no longer considered necessary for doctors to listen to patients describe their experience of the illness—their symptoms—in order to diagnose and treat. Instead, physicians began to focus on the isolated, diseased organs, treating the patient increasingly as a body, a series of anatomical objects, and ignoring the social and personal realities of the patient, the person. In the paradigm of the clinical gaze, physicians examine and talk about the patient's diseases, while the patient remains largely silent. In many ways, this can be seen as the advent of modern positivist science in which human, social, and historical contexts are considered irrelevant.

Years later, Abelino still tells me that he has knee pain and that "doctors don't know anything" (los medicos no saben nada).
After considering in some detail the course of Abelino's interactions with health care institutions, this common statement makes more sense. Several assumptions were made along the way, from the absence of stomach problems to his first return to work being "light duty," from his ability to read English to his being paid as an hourly worker, from his incorrect picking as the cause of his injury to his faking of the pain, from the importance of "Objective" biotechnical tests to the disqualification of his words and experiences.

Crescencio's headache is a result most distally of the international economic inequalities forcing him to migrate and become a farmworker in the first place and more proximally of the racialized mistreatment he endures in the farm's ethnicity and citizenship hierarchy. These socially produced headaches lead Crescencio to become agitated and angry with his family and to drink, thus embodying the stereotype of Mexican migrants as alcoholic and potentially violent. The racialized mistreatment that produces his headaches is then justified through the embodied stereotypes that were produced in part by that mistreatment in the first place. Finally, due to powerful economic structures affecting the migrant clinic as well as limited lenses of perception in biomedicine, this justifying symbolic violence is subtly reinforced throughout Crescencio's health care experiences.

Health care professionals cannot be blamed for their acontextuality. They, too, are affected by social, economic, and political structures. Much of their blindness to social and political context is caused by the difficult, hectic, and emotionally exhausting circumstances in which they work. It is caused also by the way medical science is thought and taught in the contemporary world. Most of these individuals have chosen their positions in migrant clinics because they want to help. They have a great deal of compassion and a sense of calling to this work. Yet the lenses they have been given through which to understand their patients have been narrowly focused, individualistic, and asocial.

Pierre Bourdieu's concept of symbolic violence has proven especially helpful for my understanding of the ways in which the order of inequalities described thus far has become unquestioned and unchallenged, even by those most oppressed. Symbolic violence is the naturalization, including internalization, of social asymmetries. Bourdieu explains that we experience the world through doxa (mental schemata) and habitus (historically accreted bodily comportments) that are issued forth from that very social world and, therefore, make the social order—including its hierarchies—appear natural. Thus we misrecognize oppression as natural because it fits our mental and bodily schemata through which we perceive it. […] Symbolic violence acts within the process of perception, hidden from the conscious mind.

Much like sand is considered "clean" when it is on a beach or in a sandbox but "dirty" when it is inside a house or on a child's hands, those considered Mexican, and therefore out of their proper place, are often referred to as dirty. Area residents and local newspapers used metaphors of "cleaning up the neighborhood" to indicate a project that functionally displaced those considered Mexican from their area by shutting down a labor camp, a day laborer pickup spot and an apartment building occupied primarily by Mexican migrants or U.S. Latinos.

If we social scientists are to research, theorize, and confront socially structured suffering, we must join with others in a broad effort to denaturalize social inequalities, uncovering linkages between symbolic violence and suffering. In this way, the lenses of perception as well as the social inequalities they reinforce can be recognized, challenged, and transformed. This book endeavors to denaturalize ethnic and citizenship inequalities in agricultural labor, health disparities in the clinic, and biologized and racialized inequities in society at large.

If health professionals responded to sickness by treating not only its current manifestations but also its social, economic, and political causes, we could create a realistically critical public health and a "liberation medicine." This latter term alludes to liberation theology, in which a reflective engagement with those who are poor and suffering leads to new ways of thinking and practicing theology in order to achieve social justice. While there is genuine need for the skills of narrowly trained, competent biomedical physicians, I am convinced this is not enough.
As shown by the health care experiences of Abelino, Crescencio, and Bernardo, medical skills practiced without recognition of the social structures causing sickness are doomed to address only the downstream, biological and behavioral inputs into disease. This leads to ineffective health care at best and complicit, injurious health care at worst.

Globally, and perhaps most important, the formation of broad coalitions of people is necessary in order to envision and work for a more equitable international economy such that people would not be forced to leave their homes to migrate in the first place.

My Triqui companions often explain their everyday lives in terms of sufrimiento (suffering). But one of the sites of sufrimiento most frequently described by Triqui migrants is crossing the border from Mexico into the United States. Many times throughout my fieldwork, my migrant companions told me stories of their harrowing experiences. One of my friends was kidnapped for ransom with her four-year-old boy. […] One young man I know described burns on his skin and in his lungs after being pushed by his coyote into a chemical tank on a train. Another man explained that he was raped by a Border Patrol agent in exchange for his freedom. All my migrant companions have multiple stories of suffering, fear, danger, and violence at the border.
Early in my fieldwork, I realized that an ethnography of suffering and migration would be incomplete without witnessing firsthand such an important site of suffering for Latin American migrants.

Systems of migrant labor are characterized by a physical and temporal separation of the processes of reproduction of the labor force and the production from that labor force. The migrant laborer can survive on low wages while contributing to economic production in one context because the family, community, and state in the other context provide education, health care, and other services necessary for reproduction. In this way, the host state externalizes the costs of labor force renewal and benefits even further from the phenomenon of labor migration.
[…]
The separation of these processes is not a natural or a voluntarily chosen phenomenon but must be enforced through the meeting of contradictory political and economic forces. Systems of labor migration involve economic forces inviting and even requiring the cheap labor of migrants at the same time that political forces ban migrants from entering the country.

Traditional migration studies assumes a dichotomy between voluntary, economic, and migrant on the one hand and forced, political, and refugee on the other. The logic behind this dichotomy states that refugees are afforded political and social rights in the host country because they were forced to migrate for political reasons. Conversely, migrants are not allowed these rights because they are understood to voluntarily choose to migrate for economic reasons. The "push" and "pull" factor school of migration studies tends to assume that labor migration is entirely chosen, voluntary, and economic.
However, my Triqui companions experience their labor migration as anything but voluntary. Rather, they have told me repeatedly that they are forced to migrate in order for themselves and their families to survive. At one point during our trek across the border desert, Macario told me, "There is no other option left for us."

I attempt to portray and analyze the lives and experiences of Macario and my other Triqui companions in order to understand better the social and symbolic context of suffering among migrant laborers. I hope that understanding the mechanisms by which certain classes of people become written off and social inequalities become taken for granted will play a part in undoing these very mechanisms and the structures of which they are part. It is my hope that those who read these pages will be moved in mutual humanity, such that representations of and policies toward migrant laborers become more humane, just, and responsive to migrant laborers as people themselves. The American public could begin to see Mexican migrant workers as fellow humans, skilled and hard workers, people treated unfairly with the odds against them. I hope these recognitions will change public opinion and employer and clinical practices, as well as policies related to economics, immigration, and labor. In addition, I hope this book will help anthropologists and other social scientists understand the ways in which perception, social hierarchy, and naturalization work more broadly.

My body offered insights not only via experiences of the living and working conditions of migrant laborers but also as I generated particular responses from those around me. In many circumstances, my light-skinned, tall, student-dressed, English-speaking body was treated very differently from the bodies of my Triqui companions. The supervisors on the farms never called me deprecatory names like they did the Oaxacan workers. Instead, they often stopped to talk and joke with me, all the while picking berries and putting them into my bucket to help me make the minimum required weight. The social categories inscribed on bodies led to my being treated as an equal a friend, even a superior, while the Oaxacans were treated most often as inferiors, sometimes as animals, or machines. […] My body was treated as though it had and deserved power, whereas theirs have been treated repeatedly as underlings, undeserving of respect.

A few thousand [laborers] migrate here for the tulip-cutting and apple- and berry-picking seasons in the spring and live several months in squatter shacks made of cardboard, plastic sheets, and broken-down cars or in company-owned labor camps, often in close proximity to the multilevel houses of the local upper class that have picturesque views of the valley. The migrant camps look like rusted tin-roofed tool sheds lined up within a few feet of each other or small chicken coops in long rows. In the labor camp where I came to live, the plywood walls are semi-covered by peeling and chipping brown-pink paint. There is no insulation, and the wind blows easily through holes and cracks, especially at night. […] During summer days, the rusty tin roofs of the units conduct the sun's heat like an oven, regularly bringing the inside to over 100 degrees Fahrenheit. At night, the air is damp and cold, reaching below 32 degrees Fahrenheit during the blueberry season in the fall.

After my first few weeks living in a migrant camp and picking berries, I began to notice the intricate structuring of labor on the farm into a complicated hierarchy. In the case of contemporary U.S. agriculture, the primary fault lines of power tend to fall along categories of race, class, and citizenship. The structure of labor on the Tanaka farm is both determined by the asymmetries in society at large—specifically around race, class, and citizenship—and reinforces those larger inequalities. The complex of farm labor involves several hundred workers occupying many distinct positions, from owner to receptionist, field manager to tractor drivel, berry checker to berry picker. People on the farm often described the hierarchy in vertical metaphors, speaking of those “above” or "below" them, of "overseeing" or of being "at the bottom.”

Over the course of my fieldwork, many of my friends and family who visited me in the labor camp quickly blamed the farm management for the poor living and working conditions of berry pickers.
[…]
The stark reality and precarious future of the farm serve as reminders that the situation is more complex. The corporatization of U.S. agriculture and the growth of international free markets squeeze growers such that they cannot easily imagine increasing the pay of the pickers or improving the labor camps without bankrupting the farm. In other words, many of the most powerful inputs into the suffering of farmworkers are structural, not willed by individual agents. In this case, structural violence is enacted by market rule and later channeled by international and domestic racism, classism, sexism, and anti-immigrant prejudice. However, structural violence is not just a simple, unidirectional phenomenon; rather macro social and economic structures produce vulnerability at every level of the farm hierarchy.

John recognizes that the living and working conditions of pickers are so undesirable that each group will move out of this position as quickly as possible. The pickers come from the most vulnerable populations at any given time. As each group advances socially and economically, a more exploited and oppressed group takes its place. […] In one sense, this narrative of ethnic succession functions to justify the plight of the group currently at the bottom of the hierarchy. That is, it appears to foster the sense that it is all right that certain categories of people are suffering under poor living and working conditions at present because other groups have had to endure these conditions in the past. Some people begin to perceive this as a natural, evolutionary story.

The physical dirt from the labor of the indigenous pickers had become symbolically linked with their character, and at the same time the limited possibility of relationships between Shelly and the indigenous workers because of the language barriers had become symbolically projected as assumed character flaws onto the indigenous pickers themselves. In addition to bringing into relief the "de facto apartheid" on the farm, the profiles of the supervisors exemplify the range of responses to ethnic and class difference within an exploitative system.

During my fieldwork, I picked once or twice a week and experienced gastritis, headaches, and knee, back, and hip pain for days afterward. I wrote in a field note after picking, "It honestly felt like pure torture." Triqui pickers work seven days a week, rain or shine, without a day off until the last strawberry is processed. Occupying the bottom of the ethnic-labor hierarchy, Triqui pickers bear an unequal share of health problems, from idiopathic back and knee pains to slipped vertebral disks, from type 2 diabetes to premature births and developmental malformations.

Thus marginalization begets marginalization. The indigenous Mexicans live in the migrant camps because they do not have the resources to rent apartments in town. Because they live in the camps, they are given only the worst jobs on the farm. Unofficial farm policies and practices subtly reinforce labor and ethnic hierarchies. The position of the Triqui workers, at the bottom of the hierarchy, is multiply determined by poverty, education level, language, citizenship status, and ethnicity. In addition these factors produce each other. For example, a family's poverty cuts short an individual's education, which limits one's ability to learn Spanish (much less English), which limits one's ability to leave the bottom rung of labor and housing. Poverty, at the same time, is determined in part by the institutional racism at work against Triqui people in the first place. Segregation on the farm is the result of a complex system of feedback and feed-forward loops organized around these multiple nodes of inequality.

The ethnic-labor hierarchy seen here—white and Asian American U.S. citizen, Latino U.S. citizen or resident, undocumented mestizo Mexican, undocumented indigenous Mexican—is common in much of North American farming. […] Yet this is only a small piece of the global hierarchy. The continuum of structural vulnerability can be understood as a zoom lens, moving through many such hierarchies. When the continuum is seen from farthest away, it becomes clear that the local family farm owners are relatively low on the global corporate agribusiness hierarchy. When looked at more closely, we see the hierarchy on this particular farm. addition, perceptions of ethnicity change as the zoom lens is moved in and out. As mentioned above, many of the farm executives (as well as area residents) considered all migrant farmworkers "Mexican," whereas those in closer contact with the farmworkers came to distinguish between "regular Mexicans" and "Oaxacans," and those working in the fields themselves often differentiated among mestizo, Triqui, and Mixtec people.

The suffering of Triqui migrant laborers is an embodiment of multiple forms of violence. The political violence of land wars has pushed them to live in inhospitable climates without easy access to water for crops. The structural violence of global neoliberal capitalism forces them to leave home and family members, suffer through a long and deadly desert border crossing, and search for a means to survive in a new land. The structural violence of labor hierarchies in the United States organized around ethnicity and citizenship positions them at the bottom, with the most dangerous and backbreaking occupations and the worst accommodations. Due to their location at the bottom of the pecking order, the undocumented Triqui migrant workers endure disproportionate injury and sickness.

Why did the Triqui people think that the physicians working with them did not know anything? What was wrong with the doctor-patient relationship? Why was it so unhelpful in its present form? Could it be changed to be more helpful for my Triqui companions? What were the economic, social, and symbolic structures impeding such change? And how might anthropology speak to clinical medicine and public health?

As an anthropologist and a physician, I am concerned both with theorizing social categories and their relationships with bodies and with the possibility that suffering might be alleviated in a more respectful, egalitarian, and effective manner. My dual training has been at once stimulating and disorienting. The lenses through which cultural anthropologists and physicians are trained to see the world are significantly different, and at times contradictory. I have found the critical social analyses of anthropology incredibly important at the same time that I have valued the grounded human concerns of clinical medicine.

Around the time of the advent of the dissection of cadavers, the conception of disease transformed from an entity affecting the whole person to an anatomically localized lesion. It was no longer considered necessary for doctors to listen to patients describe their experience of the illness—their symptoms—in order to diagnose and treat. Instead, physicians began to focus on the isolated, diseased organs, treating the patient increasingly as a body, a series of anatomical objects, and ignoring the social and personal realities of the patient, the person. In the paradigm of the clinical gaze, physicians examine and talk about the patient's diseases, while the patient remains largely silent. In many ways, this can be seen as the advent of modern positivist science in which human, social, and historical contexts are considered irrelevant.

Years later, Abelino still tells me that he has knee pain and that "doctors don't know anything" (los medicos no saben nada).
After considering in some detail the course of Abelino's interactions with health care institutions, this common statement makes more sense. Several assumptions were made along the way, from the absence of stomach problems to his first return to work being "light duty," from his ability to read English to his being paid as an hourly worker, from his incorrect picking as the cause of his injury to his faking of the pain, from the importance of "Objective" biotechnical tests to the disqualification of his words and experiences.

Crescencio's headache is a result most distally of the international economic inequalities forcing him to migrate and become a farmworker in the first place and more proximally of the racialized mistreatment he endures in the farm's ethnicity and citizenship hierarchy. These socially produced headaches lead Crescencio to become agitated and angry with his family and to drink, thus embodying the stereotype of Mexican migrants as alcoholic and potentially violent. The racialized mistreatment that produces his headaches is then justified through the embodied stereotypes that were produced in part by that mistreatment in the first place. Finally, due to powerful economic structures affecting the migrant clinic as well as limited lenses of perception in biomedicine, this justifying symbolic violence is subtly reinforced throughout Crescencio's health care experiences.

Health care professionals cannot be blamed for their acontextuality. They, too, are affected by social, economic, and political structures. Much of their blindness to social and political context is caused by the difficult, hectic, and emotionally exhausting circumstances in which they work. It is caused also by the way medical science is thought and taught in the contemporary world. Most of these individuals have chosen their positions in migrant clinics because they want to help. They have a great deal of compassion and a sense of calling to this work. Yet the lenses they have been given through which to understand their patients have been narrowly focused, individualistic, and asocial.

Pierre Bourdieu's concept of symbolic violence has proven especially helpful for my understanding of the ways in which the order of inequalities described thus far has become unquestioned and unchallenged, even by those most oppressed. Symbolic violence is the naturalization, including internalization, of social asymmetries. Bourdieu explains that we experience the world through doxa (mental schemata) and habitus (historically accreted bodily comportments) that are issued forth from that very social world and, therefore, make the social order—including its hierarchies—appear natural. Thus we misrecognize oppression as natural because it fits our mental and bodily schemata through which we perceive it. […] Symbolic violence acts within the process of perception, hidden from the conscious mind.

Much like sand is considered "clean" when it is on a beach or in a sandbox but "dirty" when it is inside a house or on a child's hands, those considered Mexican, and therefore out of their proper place, are often referred to as dirty. Area residents and local newspapers used metaphors of "cleaning up the neighborhood" to indicate a project that functionally displaced those considered Mexican from their area by shutting down a labor camp, a day laborer pickup spot and an apartment building occupied primarily by Mexican migrants or U.S. Latinos.

If we social scientists are to research, theorize, and confront socially structured suffering, we must join with others in a broad effort to denaturalize social inequalities, uncovering linkages between symbolic violence and suffering. In this way, the lenses of perception as well as the social inequalities they reinforce can be recognized, challenged, and transformed. This book endeavors to denaturalize ethnic and citizenship inequalities in agricultural labor, health disparities in the clinic, and biologized and racialized inequities in society at large.

If health professionals responded to sickness by treating not only its current manifestations but also its social, economic, and political causes, we could create a realistically critical public health and a "liberation medicine." This latter term alludes to liberation theology, in which a reflective engagement with those who are poor and suffering leads to new ways of thinking and practicing theology in order to achieve social justice. While there is genuine need for the skills of narrowly trained, competent biomedical physicians, I am convinced this is not enough.
As shown by the health care experiences of Abelino, Crescencio, and Bernardo, medical skills practiced without recognition of the social structures causing sickness are doomed to address only the downstream, biological and behavioral inputs into disease. This leads to ineffective health care at best and complicit, injurious health care at worst.

Globally, and perhaps most important, the formation of broad coalitions of people is necessary in order to envision and work for a more equitable international economy such that people would not be forced to leave their homes to migrate in the first place.