Bureaucrats & Bleeding Hearts: Indigenous Health in Northern Australia.

Bureaucrats & Bleeding Hearts: Indigenous Health in Northern Australia. Bureaucrats & Bleeding Hearts: Indigenous Health in Northern Australia. By Tess Lea UNSW Press, 2008. Pp. 320 Price $49.95 (paper) Bureaucrats & Bleeding Hearts is a terrific book. It is asignificant intervention in the study of indigenous health, bureaucraticgovernance, and late liberal forms of cultural recognition. And it is anunrelentingly honest assessment of the routines of bureaucracy as theyare embodied in progressive demands for the improvement of indigenoushealth. Ingeniously combining the microsociology of Erving Goffman andHarvey Sacks with the critical theory of Foucault, Latour, Hacking, andothers; written in compelling and clear prose; and thick withethnographic detail, Bureaucrats & Bleeding Hearts is a must-readbook for scholars interested in the state of indigenous care inAustralia and the disciplinary nature of bureaucracies more generally. Max Weber long ago claimed that the iron cage of rationalityencased modern bureaucratic orders. Gone were the enchantments ofpre-modernity. In its place was functional specialization, clear linesof hierarchical authority, the expert training of managers, and rulebased decision-making. In ideal bureaucracies, social action wassubjected to rational operations that made actors proficient and actionsefficient. Weber was also quick to note that actual bureaucracies do notusually embody these ideal types. Bureaucrats & Bleeding Heartssituates itself squarely in the space where norm meets fact. Leainvestigates how the major purpose or result of ordinary routines withinthe health care bureaucracies is to place the self in the state and thestate in the self. As a result actual encounters with the problem ofindigenous wellbeing are continually deflected and dispersed. Bureaucrats & Bleeding Hearts is organized into three broadparts--the examination of the bureaucratic context of health care in theNorthern Territory; the routines by which health workers within thisbureaucratic context learn about indigenous health and health-delivery;and the practices of health workers in indigenous communities. Acrossthe ten chapters that compose the book, Lea seeks to unpack the'phenomenological grip of patterned behavior' that continuallyrepackages deeply lived experiences. Lea's text is thick with examples, smoothly integrated intothe book's conceptual structure. As readers move across thechapters they witness the ways that complex human experiences andunderstandings are condensed into bullet points and flow charts. Theylisten in as workshops that ask for participant response and reflectionend up functioning as incitements for confessions whose purpose is tobind the participant more tightly to the institution. They listen to themanagerial coproduction of policy prose whose purpose is to absorb,dull, or direct actions and emotion. Managers suggest words as right forcertain policy statements--say, "Stylish, business words" forneoliberal announcements (p. 38) As the words spill out and confidentialknowledge is leaked, ordinary bureaucratic workers are seduced into theprocess by which formulaic injunctions come to be understood as radicalinnovations. The fractally recursive nature of framing persons,policies, and populations comes to reflect the fractal nature ofbureaucratic form. The speed and intensity of policy initiatives supportthe lethargy of change. Exercises in understanding indigenous'culture' become one of the ways that indigenous culture ismade bureaucratically available ('the incorporated self enters apre-problematized encounter with a projected other, against which theincorporated self is defined and returned back to the interventionarylogic,' p. 193). Readers see the distancing techniques bureaucratslearn to evacuate embodied responses to abject poverty or to make itsomething manageable and (ac)countable. One such technique is the veryirony, sarcasm, and knowingness that bureaucrats use to reflect on thenature of bureaucracies. Here Bureaucrats & Bleeding Hearts makes apoint that critical theorists such as Peter Sloterdjik and Slavoj Zizekhave also made, though to different ends--that cynical reason signals aknowingness that, rather than compelling a subject to action, allows himor her to continue doing what they are doing. Thus Lea notes that ironictalk is 'an authentic expression of the individual struggling tooccasionally gain distance from the otherwise total compliance demandedof the institution' but it is also a means of 'sustaininginstitutional actions' (p. 31-2). Some readers might be bothered by the single-minded nature ofLea's argument or, and I think this is probably more true, by thefairly unvarnished, intimate description of the everyday lives ofwell-intentioned health care bureaucrats and workers. Her point isclear--how the very process of trying to separate a progressive selffrom 'them' (the bad state, the bad bureaucracy, the badmetropole) is digested back into the legitimacy of state, bureaucracyand metropole. But whether one agrees or not with the analysis,Bureaucrats & Bleeding Hearts is anthropology at its best. Itsassessments are backed with thick ethnographic detail. Itsinterpretations made in clear, strong, and compelling language. Arguewith me--the book says--if you have a better way of understanding thematerial. This welcoming of critical debate is especially important inpost-Intervention Australia, where, as Lea notes, the extraordinary isjust another ordinary turn of the bureaucratic screw. Elizabeth Povinelli Columbia University