My wife is a physician, and like many doctors was taught in medical schools that African Americans are susceptible to hypertension, and particularly salt-sensitive hypertension, as a result of genetic selection through conditions during the middle passage. I raised this possibility in chatting with Liana Richardson, a postdoc here at UNC, about her very interesting work on hypertension as a biomarker for stress over the life course, and in particular as a marker for high stress among African Americans. Her response was very interesting, and illustrates an example of cross-disciplinary information flows.
The slavery hypothesis states that the physically brutal experience of the middle passage provided a strong genetic selection effect whereby those better able to store salt and use it to maintain blood pressure in the absence of hydration and nutrition were more likely to survive the passage. This is a plausible hypothesis. However, this article by Williams, Mohammed, Leavell, and Collins claims:
The slavery hypothesis is a final example of the misuse of genetics in contemporary health disparities research…. A critical review of this hypothesis shows that it is inconsistent with the processes of population genetics, historical data on the scarcity of salt in Africa and on the level of mortality during the slave trade as well as on the proportion of mortality attributed to diarrhea. (86-87)
The citation is to Kaufman and Hall, “The Slavery Hypertension Hypothesis: Dissemination and Appeal of a Modern Race Theory,” Epidemiology 14:1 (2003) . It’s a very good article, but the summary in Williams et al. is not really right. As I read it, Kaufman and Hall demonstrate that the slavery hypothesis is unproven, and that it is taught, particularly in medical schools, as far more settled science than it actually is. They then provide a very enlightening historical treatment of the tendency to reify race and view racial disparities as rooted in biology, implicating the ubiquity of the slavery hypothesis in that history. Thus, as I read it, they have not established that the theory is false or inconsistent with knowledge about mortality rates, salt availability and so on, but just that the theory remains only plausible, not demonstrated. But refracted through Williams et al.’s summary, it becomes “evidence” against a biological basis for racial disparities in hypertension–which, at least to my reading, is substantial overreach.
The Kaufman and Hall article is a good example of a type of approach in medical sociology I call the Social Construction Of Dot Dot Dot approach: using historical and documentary methods to demonstrate that some condition is socially constructed; therefore, not rooted in Absolute Scientific Proof ™ and, by implication, somehow not really real. Other high-quality examples of this approach include Elizabeth M. Armstrong’s “Diagnosing Moral Disorder” on Fetal Alcohol Syndrome (FAS) and Abigail Saguy and Rene Almeling’s “Fat in the Fire?” on obesity.
Both of these are excellent pieces of scholarship; I do not mean to malign them (or, for that matter, Kaufman and Hall) on their own terms. But there is a tendency to interpret these findings as evidence that the conditions in question are not fundamentally real. I have three concerns with this tendency:
First, it undermines the effectiveness of research like that of Armstrong and Saguy & Almeling by attributing undemonstrated findings to it;
Second, it suggests, if only by implication, that other conditions are not socially constructed, since the debunking style implies without specifying a type of evidence that would establish a condition as being ontologically different from the one(s) under consideration; and
Third, it implies that the opposite of “socially constructed” is “real.” This is a fool’s errand for sociologists, as it cedes the scientific high ground to other disciplines and relegates whatever we study to the margins. As scholars in the Foucault and Latour traditions (and elsewhere) have shown, essentially any reality has a specific, contingent, sometimes even contentious, pedigree in the practices and discourses of its discovery/development. This does not compromise their real-reality, only the inevitability of that real-reality.