On Losing Paul Farmer

-- By MarvinBell - 26 Apr 2022

The Start

When I was five or six years old and living in Jamaica, I watched a close family friend, “cuz,” succumb to an illness that my community refused to name. It was not until I came of age, moved to America, and had long since forgotten what “cuz” looked like that I learned that she died from AIDS. Two years into my dance and college career in D.C., my friend succumbed to AIDS. A few months after his funeral, my closest friend revealed that he had contracted HIV. Around this very same time, the CDC disclosed a study which found that about 1 in 2 black men who have sex with men (MSM) in the United States will be diagnosed with HIV if current HIV diagnoses rates persist. While recovering from my friend's death, and burdened by the thought of losing another and the near-certain possibility of contracting the virus, I felt mobilized to understand the root of what was happening around me. A part of me knew that my friend and cuz’s death and my other friend’s diagnosis were not by chance. An even larger part of me knew that there was a way to understand what was happening that would make me feel less like a victim. In the depths of my confusion and sadness, I found Paul Farmer.

What Farmer Meant to Me

For physician and anthropologist Paul Farmer, every ill person seemed to be a potential patient and every healthy person a potential pupil. “Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.” The duty of physicians – “the attorneys of the poor” – is therefore to solve the “social problems experienced by the poor.” Despite not being called to practice medicine, I desperately wanted to rise to the challenge Farmer issued “healthy person[s].” There was a way, I thought, that some of us outside of the medical field could work to ensure the “health of the community.” Reading Farmer’s words at that point in my life turned my apathy into passion. And while there was very little that I could do to change the realities of those in my life who either contracted HIV or succumbed to AIDS, I knew there was a way to add to discourse around the virus that drew attention from insufficient proximal explanations for higher HIV/AIDS risks among Black people and to the larger structural forces that conferred heightened vulnerability.

To Jackson

My journey first took me to Jackson, Mississippi, where between May 2018 and September 2018 I collected the oral histories of several queer men who were either living with HIV or AIDS or at “high risk” of contracting the virus. These oral histories allowed for a reflexivity that other methodological approaches did not, encouraging the men I spoke with to verbalize those often unspoken elements of their social worlds that they believed increased their risk of contracting HIV. I then situated these experiences in a biosocial context, aware that anything short of biosocial contextualization would be insufficient to capture the multiplicity of factors that conferred onto them heightened vulnerability. Such biosocial analyses, Paul Farmer, suggested, must draw freely on clinical medicine and social theory; they must link epidemiology to history, ethnography, and the political economy. And I now know that there is room for people like me—lawyers-in-training—to consider those legal forces that have shaped biosocial susceptibility. Farmer’s conceptualization of structural violence deepened my understanding of what was unfolding in Jackson and what was occurring in my life. It also led me to law school.

Talking to the Idol

I emailed Farmer several times throughout my time in Jackson, agitatedly asking him for advice. It wasn’t until September 18th, 2018 that I got a response. “Dear Marvin - It brings me great pleasure to know what my work has meant to you,” it started. In the four-paragraph email, he answered every question I had asked him over the months. His parting words were that I should not let my lack of medical training “disincentive me from examining and amplifying what is happening in Jackson.” “Anthropologists like you,” he ended, “can see things in ways others cannot. Please let me know if I can be of any further assistance.” I regret not following up, if only to let him know what his words meant to me.

Looking Forward

What made Farmer so impactful was his ability to reconcile the divergent ways anthropologists and medical practitioners saw the world and interacted with people. Where a medical practitioner might try to conceptualize harm in terms of categories of disease and pathology translated from the subjective illnesses of patients, an anthropologist might adopt a more holistic approach that situates harm socially, culturally, and even biologically. Paul Farmer’s “practice” was an empathetic and holistic science that recognized the variety of forces that conferred heightened vulnerability on certain populations; it also often succeeded in altering the course of disease progression by healing.

I only now see that I too am well-positioned to create a practice in service of those at heightened risk of contracting HIV/AIDS. In pursuit of this, I realize the importance of reconciling my background in anthropology with my current legal training. In reconciling these disparate traditions, I will better understand, diagnose, and treat harm while allocating remedies that merge lawyers’ inclination to identify ‘true’ facts in the face of ambiguity with anthropologists’ understanding of structural violence as the chief conferrer of direct and indirect harm to individuals.

I look at the next few years of my legal education with renewed clarity and purpose. It is clear to me what my charge is and who it will be in service of — people like “cuz” and the many who Paul Farmer dedicated his life to.

This, I think, is the best way to honor Paul Farmer.

Marvin, I was really moved while reading this. It was powerful, vulnerable, and honest. I think it shows how lived experiences, however personal they may be, inform you and make you a better lawyer than even some of the professors we’re learning from. Your piece reminds me of our conversation about the way HIV was discussed in our criminal law course, and it is clear to me now how much you withheld during that class, where students’ comments are just tallied up for participation points despite lack of depth and insight. But beyond the law school classroom, I hope that your career allows you to continue taking up the charge to flourish however you choose.

- Rubí

Rubi is right in all she says about the power of the draft.

Farmer lived an immense life, measured by the number of lives he changed. This is another powerful measure, more meaningful than fortune, certainly, to me: a form in which I hope as a teacher and a lawyer to aspire. A large life well lived leaves a large emptiness when it ends. Into that, other lives grow, including yours.

You work economically as well as powerfully. Through Farmer you can show th e lines between medicine and law, and medicine and anthropology. With a few more sentences you could close the triangle, by thinking a bit about your connection sides, anthropology and law It's the tacking back and forth between those two sensibilities, so well described by Clifford Geertz in the introduction to his Storrs Lectures, Local Knowledge that would get you there. Economical as you are, you can trim still more to make the space for what would be necessary.

Marvin, thank you for sharing such a personal and moving account about such a devastating virus. Like Rubí, I also thought of the discussion of HIV in our criminal law course. If I remember correctly, you shared an important post on the criminal law Courseworks about how criminalizing HIV does nothing to prevent the spread of the virus and actually deters effective treatment. It’s disheartening that some of our peers should even need that explained to them. I was also disappointed that the class discussion in crim that day hardly touched on how social identities play into the prosecution of HIV exposure, which I believe you noted in your Courseworks post, explaining that criminalization of HIV disproportionately targets marginalized groups. Somewhat relatedly, I wonder if the fact that Hinkhouse’s exposed partners were heterosexual women had any impact on the prosecution’s decision to charge. Based on the statistics and observations in your essay, it's conceivable that the response would not have been the same had Hinkhouse infected BMSM individuals.

Like Rubí said, it's clear how your lived experience makes you a better, more informed, and more compassionate lawyer than many. I feel very fortunate to learn from you.

Thank you again for sharing. - Tasha

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