Michelle A. Parsons. Dying Unneeded: The Cultural Context of the Russian Mortality Crisis. Nashville: Vanderbilt University Press, 2014. 224 pp. $59.95 (cloth), ISBN 978-0-8265-1972-6; $27.95 (paper), ISBN 978-0-8265-1973-3.

Reviewed by Jennifer Carroll
Published on H-Socialisms (May, 2015)
Commissioned by Gary Roth (Rutgers University - Newark)

Straight to the Source: Male Mortality in Post-Transition Russia

Michelle A. Parsons's book, Dying Unneeded, is a story of post-Soviet transition told through the eyes of those who were in middle age as the socialist system collapsed. It is also a story of statistics, an ethnographic exploration of the curious surge in early mortality among Russian males in the early 1990s, a time when male life expectancy plunged by more than seven years in Russia's urban centers. A favorite explanation for this phenomenon in public health literature is that heavy drinking led to this observed increase in early deaths. Parsons's analysis is motivated by her profound dissatisfaction with this explanation. Russians, she argues, have always consumed more alcohol, on average, than people in other world regions. If vodka culture is the only explanation, people in Russia should have been dying young all along. What was so different about the 1990s?

Parsons's primary thesis is that the belief held by middle-aged Russian men that they had nothing to contribute to society, that they were fundamentally unneeded, was causally related to the spike in early mortality. She argues, "excess mortality in Russia during the early 1990s was but a biological endpoint of political-economic processes that have psychosocial consequences" (p. 175). In elaborating this argument, Parsons argues that the mortality crisis of the early 1990s was fueled distally by the economic shock of the period immediately following Soviet collapse. More proximally, she argues, these deaths were caused by the subsequent shifts in social capital among the Russian population, shifts that were especially disruptive for those nearing retirement at the time of transition. "Just as they were poised to reap the benefits of the Soviet system," Parsons observes, "the system unraveled" (p. 80).

Parsons begins her book by setting the ethnographic stage. Each of the first five chapters elaborates a particular element of the lived experience of transition among members of this "unneeded" generation. The most theoretically substantial of these is chapter 2, "Paradox," in which Parsons highlights the fissures between classical social theories of structure and agency and the ways in which her Russian contemporaries engage with their world. Invoking the work of Anthony Giddens, Michel Foucault, and Pierre Bourdieu, Parsons pays homage to the foundational theories that elaborate some of the ways in which structure constrains human agency. She then urges the reader to consider that the opposite is also true—that "structure opens up possibilities for agency, even as it closes others off" (p. 53). In the context of the Soviet regime, Parsons argues, this means that even the restrictive policies and procedures enforced by authoritative state powers could be socially generative. Oppression led to innovation, creative resistance, and the formation of informal networks of exchange and mutual support that allowed people to get by. So, while a strict regime kept individual Soviet citizens from acting freely, that regime also gave its citizens roles, relationships, and responsibilities that could be tapped and manipulated where it was profitable to do so. State structure restricted human agency but also made agency possible.

Other early ethnographic chapters in Parsons's book deal with such concepts as urban space (prostor), the value of work, the legacy of World War II, and the economic effects of the Soviet collapse. Together, these chapters weave a narrative of the lived experience of transition. For many middle-aged Russian citizens, the costs of fighting fascism in World War II were great, but those sacrifices were justified by the benefits they planned to reap in the aftermath, in the bountiful Soviet society that their efforts would help to build. Integration into that society was achieved largely through formal labor practices. "Through work," Parsons argues, "the Soviet state gave people a place in society and enabled them to know others in society" (p. 92). Once the system collapsed, that sense of mutual intelligibility receded, and the sense of self-worth, of meaning, of usefulness, that accompanied earlier forms of sociality was lost along with it. Parsons observes, "Middle-aged workers were particularly vulnerable given the fact that they were close to retirement. They did not have the time to remake themselves, nor were they already retired and shielded from restructuring.... Suddenly, when their experience and connections should have been the most needed for the state and for others around them, they were unneeded" (p. 99).

In the period immediately following transition—a period, according to Parsons, of social and economic shock—common idioms of distress and resilience emerged from within the middle-aged population. Women were believed to be more resilient than their male counterparts. Parsons notes that child rearing and household management were typically female domains, which provided women with a sense of responsibility and of neededness even as their system of social cohesion was crumbling. Men, on the other hand, did not fare so well. As one of Parsons's informants said, "A lot of [men] lost their spirit. They took to drink. They were unemployed, without food. There was nothing to live on. They were thrown out. Millions of people were thrown out on the street from their work. They closed companies, factories ... what were people supposed to live on? I survived all of these hard years. I haven't taken to drink" (p. 113).

Parsons's main contribution appears in chapters 6 and 7, in which she tackles the matter of Russia's mortality rates head on. Chapter 6, "Mortality," offers the reader a closer look at the statistics of early death that characterized Russian male mortality in the early 1990s. During this time, life expectancy fell in every age group, but this decline was particularly severe among middle-aged men. The primary causes of death (cardiovascular disease, injury, and alcohol-related deaths) are known to be linked to a variety of behaviors, such as smoking, drinking, and poor diet. However, the prevalence of those behavioral risk factors remained stable during the 1990s, which means that blame must shift to socioeconomic factors. Parsons notes that there are several well-established social and psychological risk factors for cardiovascular disease. These include chronic stress, anxiety, and social isolation. When looking for these factors in Russia, public health researchers have often looked for the same indicators of these risks that one can find in the United States: lack of social support, acute catastrophic life events, and heavy work demands. According to Parsons, this approach is fatally flawed in that it does not incorporate the knowledge of Soviet social integration that ethnographic research has produced. In other words, social distress does not look the same in Russia as it does in the United States; in Russia, social risk factors manifest as feeling unneeded. "Being unneeded," she argues, "is a distal driver of the mortality crisis. Being unneeded translates social collapse to bodily death from cardiovascular and alcohol-related causes" (p. 11). Furthermore, "this view contests assumptions about Russian social relations and drinking, solving puzzles in the epidemiological literature" (p. 140).

Dying Unneeded offers a synthesis of existing anthropological knowledge for the sake of clarifying in no uncertain terms its relevancy to the science of public health. Many scholars before Parsons have scrutinized Soviet sociality, the actual consequences—political and personal—of neoliberal transformation, the lived experience of that transition, and even the unpredictable effects of engaging Western global health logics in the former Soviet sphere.[1] The value of Parsons's contribution lies in her ability to bring each of these studies into conversation with one another while grounding that synthesis in her own ethnographic data. For this reader, another hybrid anthropologist/public health researcher like Parsons, the connection between her epidemiological stipulations and her ethnographic analysis is extremely satisfying. She not only is able to draw a clear picture of the social etiology of mortality in Russia in the early 1990s but also demonstrates that Russian denizens already possess a conceptual understanding of how drinking, social determinants, and death are interrelated. If we want to understand how social distress is manifested in the life and death of Russian citizens, a sardonic anthropologist might say, perhaps someone should ask them. Much to my satisfaction, Parsons did.

In sum, Dying Unneeded is a provocative attempt to synthesize a vast body of theoretical literature for the purpose of clarifying a single but terribly important conclusion: Western public health researchers fundamentally misunderstand the social epidemiology of Russia because they fundamentally misunderstand Russia. This cause is extremely well merited, but the depth of the challenge Parsons took on is occasionally revealed in her text. At some points, Parsons's treatment of major theoretical concepts is too broad. Her formal discussion of neoliberalism, for example, runs for barely a page, despite her claims that the effects of economic reforms bearing this name are central to her conclusions. Furthermore, her only references in that discussion are to the work of Stephen Collier and Naomi Klein. Needless to say, an opportunity to engage with the broader literature on neoliberal ideology and the reality of so-called neoliberal economic reforms, especially in the post-Soviet context, was missed. At other points, Parsons's discussion seems rather narrow, unrelentingly informed by the epistemologies of her two professional disciplines. For instance, she uses anthropological terms like "emic" and epidemiological terms like "physiologic pathways" in a manner rather unforgiving of those who do not approach her text with a preexisting familiarity with these terms.

For this reason, the appropriate audience for this text is difficult to assess. For readers who are familiar with both the anthropological and epidemiological disciplines, this book serves as a model for successfully integrating qualitative and quantitative research. It is a case study in forcing ourselves out of our habitual perspectives to expand our understanding of human health and behavior. For those whose background lies in only one (or perhaps neither) of these human sciences, a bit of remedial study will be needed in order to follow Parsons as she leads the reader through a thick grove of cultural and theoretical concepts that are likely foreign to the reader. Nevertheless, her prose remains fluid, engaging, and easy to read from start to finish. In the right hands, this book is very teachable, and could add depth to any course on Soviet history, Eastern European area studies, medical anthropology, or global health.

There aren't very many books like this one. Erin Koch's Free Market Tuberculosis: Managing Epidemics in Post-Soviet Georgia (2013) and Salmaan Keshavjee's Blind Spot: How Neoliberalism Infiltrated Global Health (2014) come immediately to my mind as works that take a similarly global view on a local phenomenon in public health and do so from an incredibly rigorous theoretical standpoint. These texts are helping to redefine how anthropology speaks to public health and vice versa. These types of studies are terribly important, but still few in number. I hope that works like Parsons's may offer inspiration to other interdisciplinary researchers and that we might see more efforts like this one in the coming years.

Note

[1]. On scrutinizing Soviet sociality, see Elizabeth C. Dunn, Privatizing Poland (Ithaca, NY: Cornell University Press, 2004); Jennifer Patico, Consumption and Social Change in a Post-Soviet Middle Class (Stanford, CA: Stanford University Press, 2008); Alena Ledeneva, How Russia Really Works: The Informal Practices That Shaped Post-Soviet Politics and Business (Ithaca, NY: Cornell University Press, 2006); and Melissa L. Caldwell, Not by Bread Alone: Social Support in the New Russia (Berkeley: University of California Press, 2004). On consequences of neoliberal transformation, see Stephen J. Collier, Post-Soviet Social: Neoliberalism, Social Modernity, Biopolitics (Princeton, NJ: Princeton University Press, 2011); Jarrett Zigon, "HIV Is God's Blessing": Rehabilitating Morality in Neoliberal Russia (Berkeley: University of California Press, 2010); and Laura Adams, The Spectacular State: Culture and National Identity in Uzbekistan (Durham, NC: Duke University Press, 2010). On lived experience, see Katherine Verdery, What Was Socialism, and What Comes Next? (Princeton, NJ: Princeton University Press, 1996); Caroline Humphrey, The Unmaking of Soviet Life: Everyday Economies after Socialism (Ithaca, NY: Cornell University Press, 2002); and Alexei Yurchak, Everything Was Forever Until It Was No More (Princeton, NJ: Princeton University Press, 2008). On the effects, see Erin Koch, Free Market Tuberculosis: Managing Epidemics in Post-Soviet Georgia (Nashville, TN: Vanderbilt University Press, 2013); Michele R. Rivkin-Fish, Women's Health in Post-Soviet Russia: The Politics of Intervention (Bloomington: Indiana University Press, 2005); Jennifer J. Carroll, "Evidence Based Medicine and the Construction of Moral Agency in Ukraine," Cargo. Journal for Cultural/Social Anthropology 9, nos. 1-2 (2011): 25–50; and Salmaan Keshavjee, Blind Spot: How Neoliberalism Infiltrated Global Health (Berkeley: University of California Press, 2014).

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Citation: Jennifer Carroll. Review of Parsons, Michelle A., Dying Unneeded: The Cultural Context of the Russian Mortality Crisis. H-Socialisms, H-Net Reviews. May, 2015.
URL: http://www.h-net.org/reviews/showrev.php?id=44190

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