Conflicted Doctors: A Review of Copeman, Veins of Devotion

Veins of Devotion: Blood Donation and Religious Experience in North India.
Jacob Copeman
Rutgers University Press, 2008.

Reviewed by Leo Coleman (Ohio State University)

Jacob Copeman’s Veins of Devotion: Blood Donation and Religious Experience in North India explores contemporary anthropological themes of technological imaginaries, biomedical exchange, and changing local meanings of self and substance in a study of how religious devotional sects in India, focused on charismatic saintly leaders, have employed blood donation as a new kind of religious gift-giving. In these sects, collective acts of blood donation are figured as a merit-seeking activity with a specific utility defined in this-worldly, social terms. Copeman aims to reveal the meaning of this practice both for blood bank policy and procedure and for religious and political practice in the subcontinent.

The ethnographic core of the book is devoted to the very Indian phenomenon of mass donation of blood by devotees of various sects, or members of voluntary organizations, at special commemorative “camps” organized on important anniversaries and holidays. In Delhi, where Copeman did his fieldwork, there is a shortage of transfusable blood (the situation is different in other Indian states), and since the Supreme Court of India outlawed paid donation in 1998, drawing on the “public policy orthodoxy . . . that the safety of donated blood is far greater when deriving from voluntary, non-remunerated donors in an anonymous system of procurement” blood banks have had to find new ways to recruit and retain donors (p. 2). In most Western countries, he tells us (p. 11), blood banks rely on a cadre of “regular, repeat, voluntary donors” who give blood every three months at routinely scheduled locations in their workplaces or schools. This, for Copeman, represents the rational, modern form of blood-procurement practice, and it is explicitly counterpoised against the relatively coerced situation—currently the dominant form in Delhi—where a person is solicited to donate blood to replace that transfused into a sick family member, or where he or she gives blood on an exceptional occasion.

In the index of the book, indeed, under temporality, one finds the subheadings “charismatic (one-time)” and “rational (repetitive)” keyed to these discussions in the text. Somewhere in between the rational and the charismatic, thus defined, lie the blood donation drives of the Nirankari and Dera Sacha Sauda devotional sects, marked by “religious spectacles” of devotion, world records in numbers of units donated, and their cultivation of a largely poor, often malnourished, and irrationally enthusiastic cadre of blood donors. Yet the practices of these sects are also characterized by their close integration with blood banks and secular social service organizations, who in turn have adapted some charismatic motivational practices from the sects.

The gurus of such sects, Copeman argues, are adepts of a “biospiritual medical creativity” that transforms impure religious gifts and wasteful expenditure into useful gifts directed toward society. Copeman is equally curious about the biomedical consequences of such a devotional motivation for blood donation, and the religious consequences of such an apparent reverse of self-purifying religious devotion into social utility. The latter shift occupies his most sustained theoretical attention, and he examines throughout the new concepts of virtue and utility that appear in the devotional blood-donation camps—culminating in the “virtuous utility” (his term) that describes both the theology offered by the gurus of the Nirankari and Dera Saucha Sauda sects, and a more-widely-shared Nehruvian ethic of self-sacrifice for national development. In this practice, compounded of blood-banking policy, religious reform, and nationalist sentiment, “Gurus are the porous membranes through which, in a kind of spiritual osmosis, devotees pass into inimitable versions of modernist practice both like and unlike those with which we are familiar” (147).

Copeman’s best, most lively sections focus closely on the recent history of these sects, and how they have worked with blood banks to figure the donation of blood as a polyvalent, multidirectional gift. He tells of one living guru’s visit to a blood bank, where, when the time came for the guru to offer the blood-bank workers the traditional token of their contact, the prashad, it came in the form of a written promise to stage regular blood-donation “camps” and supply the blood bank with pints of his devotees blood. The devotees, in turn, tell Copeman of the special power and potency of their donated blood—it will save lives, and more, will save young men and women who will go on to have children, so the merit of the donated blood will extend outward to multiple anonymous recipients and succeeding generations. Meanwhile, to each person who receives the transfused blood of a devotee, the moral substance of devotion will be transferred and they, too, will come to devote themselves to the donor’s guru, thus increasing the fame and power of the guru and of the religious community he leads.

For me, the most compelling argument of the book is that there is a reconfiguration of Indian dan—the religious gift, usually nonreciprocal, alienable, and impure—in its encounter with the legal reform of blood procurement and donation practices in India. Copeman documents in salutary ethnographic detail the anxieties of individual donors and their heroic and very creative recastings of cultural ideals in order to conform to the biomedical obligation to give, and to give anonymously and without reward. In particular, Copeman draws well the contradiction that his ethnographic material presents to the standard readings of Indian dan as the “poisonous” gift that must be given away to purify the donor. In the donation-theologies of the sects he studies, the “social” gift of blood is itself pure and the act of giving also purifies the donor (see especially 100-103). Identifying this transnational, hybrid gift-ideology is the signal merit of his study, a merit which is doubled by Copeman’s device of folding the “purity” of the gift of blood over the biomedical “safety” of the blood supply and pointing out their mismatch at various crucial junctures. He documents the perils of a blood supply sourced from devoted, enthusiastic, motivated donors (as against the norm of the disinterested, unremunerated donor), and aims to address “the key but hitherto overlooked public policy question: might religiously inspired blood donation produce blood that is medically unsafe for transfusion?” (78).

Overall, Copeman aims to avoid “analytic moral panic” (p. 9) when confronted with the not always totally free, disinterested, and voluntary giving of body-substance for biomedical use. He wants to avoid the presumption that poor Indians are always being exploited when they are made, collectively, a source of biological material for donation and exchange (when they become, in Lawrence Cohen’s term, “bioavailable”). I applaud his desire to seek new descriptive terms for the efflorescent practices of biological donation that he (and others, including Cohen) have drawn our attention to, and especially the attempt to move beyond a singular understanding that commoditized and depersonalized practices of “donation” represent the total occlusion of prior practices of gift in which moral connections were sustained by the passage of meaningful things between people. Yet the back and forth between biomedical concerns and religious practice does not ultimately issue in useful comparisons between the bioethical reasoning of blood-bank policy and the religious thought—whether “traditional” or relatively ad hoc—of his informants, nor offer any rigorous conclusions beyond the rather obvious (anthropologically speaking) assertions of creativity, of incommensurability with “Western” norms, of the inutility of “alien imposition” narratives.

In some respects, this is merely a personal reservation—I am only a partial insider to the ethnographic field that Copeman has composed here (I am an anthropologist of Delhi, and of governmental and economic reform, but not a medical anthropologist). I need more guidance into the specific bioethical and medical-anthropology debates to which Copeman is responding than he provides. More specifically, I would appreciate engagement with the ambivalences and anxieties of these debates, alongside those of the Indian devotees; their status as secular beliefs structurally parallel to Indian notions of gift, and poison, and purification, rather than simple assertions that the biomedical literature does not begin to cover the richness of his ethnographic field. The book as it stands is indeed ethnographically rich, and an interesting contribution to the study of local meanings of technology and social and legal and religious reform in confrontation with bioethical regimes. But Copeman begs a number of questions about gifts and how we analyze them, and his procedures raise larger questions about anthropological thought and what counts as an anthropological topic. In my view, this book is indicative of the limits of anthropology’s increasing reliance on a reductive social theory borrowed from policy and bioethics.

Copeman often analyzes his material with metaphors drawn from blood banking practices themselves. The “social” gift of blood is spoken of as “centrifugal,” drawing on the common—and much publicized in India—practice of separating out the component parts of blood in a centrifuge in order to use them for specific therapies: platelets for a clotting disorder, plasma for a patient in urgent need of a non-typed transfusion, and so forth. By dividing each unit of donated blood in this manner, it can be used for more, and more specific, patients, a fact which Indian donor-devotees interpret as both increasing the merit and the extension of each act of donation. At times, this doubling of technical detail and analytic vocabulary, this attempt to take his theoretical language from the ethnographic context of his work, succeeds—it does provide Copeman with a set of terms to which he can return as he moves across various literatures and debates in the contemporary anthropology of South Asia. Yet, partly because of this choice of an invented analytic vocabulary, Copeman’s interpretations are consistently, too consistently, governed by a set of overdrawn dichotomies and by tendentious equations between them. This is exemplified by his reliance on the idea of the centrifuge.

“Blood donation,” he writes (p 125), comparing it against the public fast as a mode of social protest in India, “extends the body into the world, while fasting withdraws the body from it.” Blood donation is established as a centrifugal and therefore “social” form of devotion and ascesis, as against the “centripetal” (individual- or guru-focused) asceticism of the religious adept seeking salvation, and also as a mediating technological device that allows people to participate in an otherwise abstract national body. The public, spectacular, and politically transformative fasts of Gandhian social protest cannot be so easily contained, and Copeman can only offer unsatisfactory attempts to deal with the problems raised by his own vocabulary, the problems he invents for himself about directionality and the relatively “modern” or “religious” nature of types of gifts. For example, he writes in his conclusion that “centrifugal movements are frequently structured through centripetal patterns” (172) in that donors might conceive themselves as giving to a guru, and thence to “society,” rather than to an anonymous “recipient.” But what might be a valid ethnographic observation about the subjective transformation of a binary notion of the gift-relationship into an (at least) triadic one is obscured by the synthetic language of centripetal/centrifugal. Throughout, and more broadly, the details of Copeman’s arguments are strong, but the postulated change, whether the intrusion of utility into religion, the “making social” of gifts (what are gifts, even dan, if not social?), or the extension of religion into a secular (or at least technological) act seem primarily derived from abstractions about religion, society, self, and altruism—or from ethical thought experiments.

In Chapter 3, where he introduces this key term, “making social,” Copeman takes up and expands on the symbolic logic of the gurus themselves, and situates it in a “reformist” tradition within Hinduism. The gurus ennoble (his word) their particular forms of religious practice by emphasizing the social utility of the “miracles” they exhort their devotees to achieve—vast numbers of pints of blood donated, and so forth, are celebrated as “useful” giving, as against the giving of money to temple priests in unreformed Hinduism, the this-worldly material logic of life-saving blood donation is stressed above the mystical other-worldly logic of more traditional religious gifts—p. 124.

The analytic term here, “making social,” while adapted from the guru’s invocations of “society” as the recipient of the donated blood, is more directly drawn from Marilyn Strathern’s quite culturally located studies of how “society” has, in contemporary Britain, become the recipient of “useful” action by things like Science, or The University, conceptually bracketed off from it, and thereby justified in their existence apart from society by a beneficial relationship to it (50-51). But how relevant to the Indian material Copeman presents, and to his style of analysis, is this Strathernian argument from post-Thatcher Britain? It would surely be sufficient for a work of medical anthropology to draw on Strathern to document the ways that medicine and religion contribute languages to each other, or to argue that new relations to the social body are established through charity in a context of neoliberal state retrenchment (p. 179-180). Strathern’s influence is further discernible in Copeman’s implicit emphasis that we live in a world where people are endlessly recasting and recoding their notions of the ultimate, the good, and the possible, especially in contact with technological possibilities that reposition established ways of being, and being together. Yet the anthropological force, and ethnographic specificity, of these arguments—whether for India or for an anthropology of medical technology—is muddied by the choice to leave Strathern’s own claims unlocated in space or time, so that “making social” becomes a term for any gift that can be said to be anonymous, directed outward, and thereby the vehicle for a kind of “modernist” utility. The possibilities of comparison between bioethical regimes and religious reform, between British governmental ideologies and Indian donation practices, or Indian ideologies and international “best practices” in their locational and cultural specificity are not pursued. They are equated through the appropriation or invention of a term.

This relates to a more specific problem in terms of the structure of the book. In his various deployments of the notion that religious reform in contemporary India is proceeding through a process of the “making social” of the gift, Copeman is attentive to the restrictive definitions of “society” current in contemporary political discourse in India, and to the non-universality of ideas like “India” and “Indian,”—we might say that “society” itself never refers to all of society, and certainly not in the context of the imagined Indian society to which sectarian devotees give their blood. Copeman himself notes, for instance, that the Dera Sacha Sauda sect has made efforts to become the exclusive provider of donated blood to the Indian army, and that many donors he interviewed dreamed that their blood would go to a soldier (Ch. 6). But he cabins this ethnographic data well away from his more embracing argument (Ch. 3) that devotional gifts are “social,” so he does not directly broach the relationship between what is meant by “society” in specific articulations and his analytic that gifts are “made social.” On the one hand, he offers the notion that anonymous, disinterested blood donation impels freely given gifts of blood toward an anonymous “m/any” (his orthography)—and he argues in Chapter 7 that the devotional donations he studies are also understood through a long-standing modernist aim of “national integration.” On the other hand, his interlocutors imaginatively delimit the “good” recipient of their pure and purifying gift. While Copeman delineates well the subjective meanings which inhabit this anxiety-ridden space of donation, the larger question remains: when, and in what ways is this delimitation or opening up of the recipient “society” relevant to the structural consequences of the gift?

It is just such questions which are left unaddressed by Copeman’s constant recourse to the thematic of utility. Indeed, at times one feels that this book is an attempt to define a new subfield in the anthropology of utility: Copeman says that the “intensity of some Indian’s embrace of utility” in their willing transformation of religious devotion into acts of biomedical donation and even self-sacrifice “pushes its logic to its limits and therefore enables us to see it afresh, not as the detached concept against which ethics and virtues are inevitably composed and defined” (68). He demonstrates that the sects he focuses on, alongside other groups involved in promoting blood donation, all emphasize the “useful” nature of this gift, and an ethic of voluntary service in order to contribute to society. He quotes Nehru on the modernist merit of useful actions of service as against religious asceticism and world-renunciation, the “good of mankind” substituting for salvation (69-72). Meanwhile, countervailing notions of good outcomes are in tangible conflict in the blood donation camps: “Doctors . . . condemn the one-time mass camps for being pointless and wasteful, seeking to convert them into events of predictable regularity. . . . While the Dera Sacha Sauda may ostensibly have moved away from ‘wasteful’ devotional activity toward practices of virtuous utility, from the point of view of doctors, utility valorizing organizations such as the Sacha Sauda smother utility in their quantitative embrace. Conflicted doctors hardly know whether to encourage or to attempt to suppress such unrestrained donation episodes” (111).

Copeman thus tends to find “utility” everywhere in any calculative or evaluative act (except, of course, the calculations and evaluations of pre-modern religious thought, which are read through the modernist rejection of their calculative reason as scholasticism or wasteful expenditure—though why we should pay more attention to the refinements of a religious calculation about donated blood than to similar calculations about a lock of donated hair is not a question this study, already focused on the utility of the gift of blood, can address). At the same time, and in the same moment, Copeman overdraws analytic contrasts between the social and the religious, the useful and the spiritual in order to underscore his ethnographic discovery that in practice they are intertwined. Utility is constantly talked about here by different actors, under various different names, and other notions of utility from Adam Smith and Mandeville to MacIntyre and Macfarlane make their appearance. All of this recourse to utility both as an ethnographic datum and as philosophical and (at times) metahistorical object of reflection is justified, at the outset, by Copeman’s animadversion against “widespread anthropological characterizations of utility as something diametrically opposed to culture, ethics, and quantitative value” (p. 4). He specifies that this dichotomy is “particularly widespread in medical anthropology.” I am not a medical anthropologist, so I leave this last refinement for others to evaluate, but the larger claim seems, to me, to be deeply problematic. Anthropologists have long argued that more is at stake in all gifts, modern or not, than a binary of utility and festive inutility can capture, nor can the latter term be rewritten as social function.

Mauss did not simply argue (as Copeman suggests) that gifts “have utility in establishing relations and social solidarity” (though that is one standard academic gloss). Nor does it follow that the unreciprocal, alienable, and impure attributes of Indian dan are in conflict with the Maussian gifts, or that dan is “purely” salvific and other-worldly because of those attributes. Yet, Copeman says that Jonathan “Parry has demonstrated the limited applicability of Mauss’s The Gift to Indian categories of dan” (52) for these reasons. This latter argument sets up his larger claim that the gurus’ “biospiritual medical creativity” is revealed in the ways devotional gifts are “made social.” Copeman’s reductive glosses on both Mauss’s argument and the use to which Parry put it miss the specifically anthropological utility of the study of the gift. The gift as Mauss and Parry both study it is pursued through an analysis of obligation or debt—which are relational social facts in a way that virtue and utility are not.

I would suggest that at the level of anthropological theory there is a larger convergence between religious giving and blood bank “charity,” which might become a fruitful avenue of comparison across ethical regimes and actual practices. The problem identified by international blood bank orthodoxy and the problem offered to anthropological theories of the gift by Indian dan is fundamentally the same. In both cases, the unachievable aim is a totally alienable gift, one which does not involve a return and in which the relation created by giving is immediately and absolutely quit. In a footnote—his first—Copeman points out that in the literature which underwrites the international blood-banking orthodoxy, “the normative practice of not telling the recipient about the donor or the donor about the recipient is [understood as] a means of avoiding indebtedness” (185n.1). Parry’s insights into the non-reciprocated, totally alienated form of Indian dan similarly highlight the terms that Mauss arrived at for the study of the gift—obligation, debt, and spirit. It is precisely debt that is at the heart of any donation or gift, and it is the shared problem of erasing debt without reciprocation which presents itself as the ideological problem par excellence in the “donation theologies” not just of Indian sects, but of international blood banking practice itself.

Copeman’s discussions of the “making social” of dan, of “centrifugal” donation practices, of “virtuous utility” and “biomedical spiritual creativity” will no doubt, for a medical anthropology audience, provide excellent material for classroom discussions with “conflicted doctors” or curious ethicists. But a more disciplinary anthropological audience (including medical anthropologists) may remain dissatisfied with the way this project is suspended between policy reason and social theory. Copeman treats complex anthropological arguments as interesting area-specific or historical background, but does not ultimately engage our substantive concerns with the nature of, say, the gift, or any other ethnographically-observable social institution. As Mauss put it, in any gift “it is indeed something more than utility that circulates.”

Leo Coleman is Assistant Professor in the Department of Comparative Studies at The Ohio State University. He has conducted ethnographic and archival research in Delhi and elsewhere in India.