Hunger Strikes: Legal and Ethical Challenges

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Assignment 1


 

 

Introduction

Terminology

Prominent hunger strikes in history

Introduction to the state of research

“Triangle” of forms of self-directed violence

On the effectiveness of the political tactic / social movement aspects and resistance movements in national contexts

Legitimacy and communication

Force feeding

Medical ethical challenges

Force feeding as torture

Legal implications / human rights questions

Anthropological developments

Anthropological “blanks” / challenges of prison ethnography

Gender critique

 

Bibliography

 

 

 

 

 

 

Introduction

In 2007 official US government documents leaked to the public. Among them were the Camp Delta Standard Operation Procedures [CDSOP] as of 2003 and an updated version of 2004. These documents were detailed descriptions and instructions on the organization and treatment of the prisoners of one of the world’s most controversial prisons – Camp Delta, Guantanamo Bay. In the 2003 version, hunger strike was categorized as the refusal of 9 consecutive meals or fluids for 48 hours. (Department of Defense, Joint Task Force-Guantanamo 2004, 19.4) With the paradigms, definitions and treatment procedures roughly remaining the same, what stands out in the 2004 document, is that the term “hunger strike” has been changed to “voluntary total fasting” (Department of Defense, Joint Task Force-Guantanamo 2004, 19.2). That change in language coincided with a drastic increase in hunger striking prisoners in 2003 and 2004. Ever since then, Guantanamo Bay prisoners have employed hunger strike as a prominent form of protest / resistance.

This change in language not only demonstrates the discursive power of language and the importance of meaning in language, but it also shows how contested the field of “hunger strike” actually is. It shows the fight for a power of definition / sovereignty of interpretation and gives a hint of the different parties and positionings involved, e.g. the hunger striker, the state actor that is being protested against, the public audience etc.

In this paper, I want to discuss the hunger strike’s terminology and roughly trace a historical overview of those cases of hunger strikes, most discussed in the academic literature. I also want to review some of the main academic strands that have shed light on hunger strike as a form of protest and debate the meanings and formations, ethical challenges, legal aspects and gender issues of hunger strike. This shall be understood as a “branching out”, a venture into the many different perspectives and possible frameworks. I furthermore want to draw out ethnographic challenges and try to get to the bottom of the lack of fieldwork and use of primary sources in order to provoke relevant questions concerning future anthropological fieldwork on hunger strikes.

 

Terminology

Just like with the Guantanamo case, a vast amount of hunger strikes take place inside of prison by political prisoners. A partly legal, partly humanitarian and at times public debate around the categorization of political prisoners has been held for decades. There are different approaches to what constitutes a political prisoner. They might focus on the motivation and categorization of the – possibly political – offence (Grant 2011, 114), on a claim or campaign for political status (Sweeney 1993, 10) or denounce the conditions of trial and detention and policies more general. Here, I do not want to elaborate on the terminological debate on different concepts of political prisoners. I rather want to introduce different terms used for the specific phenomenon of “hunger strikes” and state why my research will continue to employ the most general and widely spread term.

The term “hunger protest” might seem a bit dated in light of current research, yet it is quite interesting to note that it was one of the terms, employed in early scientific research on the Irish hunger strikes (c.f. (Gannon 1920, 454). There was no real differentiation between the terms hunger strike and hunger protest. However, in the Irish republican resistance not only the term, but also the practice of “striking” was very rooted within the resistance movement[1]. It might be because of that, that the term strike became more common specifically in the Irish context.

A term that is still quite prominent in the current debate is “death fast” (c.f. Andriolo 2006; Graitl 2012; Anderson 2004). It is a term, that is very close to what the Russian revolutionist Vera Figner, who herself was on hunger strike in prison, called “fast until death” (Michelsen 2016, 100). Yet again, there seems to be no major categorical difference between hunger strike and death fast. The anthropologist Karin Andriolo uses the terms simultaneously.  The World Medical Association refuses the term death fast as it implies that death is the ultimate outcome. Regarding most forms of political hunger strike (the WMA differentiates between different forms and motivations of hunger strike) the physician’s role is seen in its positive sense as a mediating role involving constructive dialogue (“WMA Declaration of Malta: A Background Paper on the Ethical Management of Hunger Strikes” 2006, 37). Thinking of hunger strike as a “death fast” would cancel out the possibility for mediation as it seems to leave no leeway for discussion.

Omitting the “death” but sticking to “fast” as in the term “political fast” is sometimes perceived as a concept that does not focus on the use of violence but rather puts emphasis on the nonviolent aspects of the phenomenon. Therefore it is often used when talking about Gandhi’s political fasts, that were so strongly characterized by their emphasis on “love” and “peace” and “nonviolence” (Bala 2008).  In my analysis the layers of violence that underlie hunger strikes are central to understanding the meanings behind them, therefore I reject the term political fast in my further considerations.

The aforementioned “voluntary total fast” seems to be more utilized in the medical literature and is often understood in very medical-technical terms. My understanding of the term hunger strike shall remain broad and open. I focus on hunger strike as a form of political resistance, mostly taking place in prison, where the politically motivated hunger striker abstains from food out of protest and therefore employs a form of self directed violence. The often called “dry fast” which adds the refusal of any liquids and is therefore much more physically threatening shall be named for the sake of completeness. Historically, the dry fast has occurred in much less cases and in the following analysis, I shall not elaborate on the specific aspects, that are exclusive to the dry fast and differentiate it from the hunger strike.

I also want to mention some broader terms, which sometimes function as umbrella terms, like “protest suicide” and “political self sacrifice”. These umbrella terms correspond with a general field of literature which mainly focuses on three forms of self directed violence: Suicide attacks, hunger strike and self immolation (protest burning). These terms are very widely spread because of the broad range of academic literature on that “triangle” of self directed violence. When looking at the suicide attack / human bomb discussion, the terminological debate is much more extensive.

Prominent hunger strikes in history

In the past 120 years, hunger strikes have emerged as a globally employed form of political protest. Hunger strikes are not connected to a certain time. They did and do not happen at any particular place and do not take the same shape let alone express a single ideological message. Many different links and connections can be drawn between the various global cases of hunger strike. (Grant 2011) At the same time, it is important to acknowledge that a single history or chain of development cannot be (re-) constructed. It is insightful to acknowledge Allen Feldman’s analytical approach to political violence, namely that political practices may appear appallingly similar, but need to be read and deconstructed within their specific contexts and meanings (Krohn-Hansen 1997, 235). Therefore different cases of hunger strikes need to be understood as culturally specific and within their local contexts under historical, social, political and economic conditions. Collective memories, cultural consciousness and symbols need to be taken into account. The sociologist Kevin Grant poignantly simplifies that message, when he writes: “Hunger is a universal experience of diverse significance, and the hunger strike was, and is, a versatile form of political protest.” (Grant 2011, 115)

In his groundbreaking and widely influential ethnography Formations of violence: the narrative of the body and political terror in Northern Ireland Allen Feldman draws out how comparing or legitimizing one hunger strike to another can be misleading, using the Irish Republican movement as an example.

Within the Republican movement, the 1920, 1972, 1973, and 1976 Hunger Strikes may have been retrospectively appropriated as expressing a single ideological message, but that does not necessarily imply that they had comparable ideological intentions, common structural origins, and shared performative codes. (Feldman 1991, 219)

Hence I want to emphasize that there is not one “norm” of hunger strike, just as there is not one “history” because all of the different local contexts, histories, developments, approaches, symbolisms, memories and meanings need to be taken into account. Nevertheless, hunger strike has become a major form of political protest in the last decade*2 decades, that has occured around the globe and has been employed in various different contexts. Therefore I want to give a short history of hunger strike globally by naming the cases that are most prominent in the academic literature. I believe, that stating such kind of history is furthermore problematic, because by naming certain cases, I exclude others and therefore create and feed into a hegemonic process of knowledge production. Another aspect, why such a history has clear limits lies in the nature of the hunger strike in prison itself. We only know about certain cases, because the knowledge has “left” the prison and reached e.g. a solidarity network, the public, an academic discourse assumingly by being documented. What about those cases of hunger strike in prison, that have not been documented? I hypothesize, that hunger strikes have been employed in colonial contexts predating the late 19th century, but have simply not been recorded. For now, this cannot be proven or investigated and remains a hypothesis. But it can help raise general questions on the transfer of knowledge regarding historical cases of hunger striking in prisons. How do we trace the transfer of knowledge regarding hunger strikes in prison? How are we able to find, possibly confidential information on earlier hunger strikes? How do we trace / research the suppressed cases of hunger strike, that did not reach the media, that did not come out with surviving hunger strikers, that were not communicated through a broader political support network / campaign that shared the hunger striker’s cause? Nevertheless, the following cases provide an overview of some different contexts and help frame a history of hunger striking of the 20th and early 21st century. They represent the cases, that are most frequently written on in academic scholarship.

One of the earliest findings traces a form of hunger strike back to pre-Christian Ireland. Before the introduction of Christianity in the 5th century, the Celtic plebeian were shaming their enemy by starving themselves on the enemy’s doorsteps. This practice of troscad  (fasting) was therefore used against a more powerful enemy as a form of “social and economic protest” (Sweeney 1993, 11) against a debtor or offender. Proof of this exists, because the troscad established itself within Irish Christianity as well and became part of the – originally orally transferred – Brehon Laws that were recorded and solidified with the advent of Christianity. (Sweeney 1993)

In the late 19th century[2] many Russian Revolutionists that were protesting in opposition to the tsar were imprisoned, mainly in Siberia, under horrific conditions. There have been numerous cases of hunger strikes in russian prisons, partly undertaken by individuals alone, partly undertaken collectively in prison – sometimes even in coordination between the male and female prisons. Female hunger strikers were a main part of the movement and hunger strike’s catalyst. Numerous hunger strikes lead to deaths by hunger strikers. (Grant 2011; Kennan 2012; Figner 1991)

In the early 20th century, many British suffragettes went on hunger strike in prison, Marion Wallace Dunlop being the first of them in 1909.  Amongst other reasons, she went on hunger strike because she wanted recognition as a political prisoner. The British suffragette movement referenced the “Russian method” (Grant 2011, 114) in connection to their implementation of the hunger strike as a protest form in prison. There are many other aspects, that connect the British suffragette movement with the Russian revolutionary movement, e.g. through political networks that were emerging because of the many Russian revolutionaries in exile in Great Britain. Kevin Grant notes “[t]he genealogy of the hunger strike as an international tactic of political protest begins with the transfer of this tactic from Russia to Great Britain in the early twentieth century.” (Grant 2011, 114) Less mentioned in light of the British suffragette movement are the hunger strikes by suffragettes of the Irish republican movement[3] as early as 1912. It was the Irish suffragettes[4], who undertook the first hunger strikes in 20th century Ireland – where the hunger strike came to be a highly employed, socially relevant and highly publicized form of protest that has been of great academic interest. Shortly after the marginalized hunger strikes by the Irish suffragettes, the Irish republican movement incorporated hunger strikes in prison. Thousands of hunger strikes occurred in the Irish revolutionary era between 1916 and 1923. (Grant 2011, 141)

Indian nationalists undertook hunger strikes against the British from 1918 until India achieved its independence in 1947. Hunger strikes were popular in the nonviolent as well as the violent wing of the Indian resistance. Of course Mohandas Gandhi was one of the great pioneers of the nonviolent resistance movement who went on 17 hunger strikes overall. Gandhi manifested a very different approach on hunger striking, which is why his hunger strikes are often called “protest fasts”. He fasted without being imprisoned, but as a form of resistance with love, a fast with love (Srivastava 2003; Grant 2011).  It is noteworthy that his first hunger strike was in Durban, South Africa. This shows that connections cannot only be drawn to the hunger strikes in the colonizers home (Great Britain) but also to other colonies like South Africa.

In South Africa, hunger strikes became widely and very coordinately used during the Anti-Apartheid movement, mainly since the 1960s[5]. The level of coordination is represented by the example of 800 prisoners who began a coordinated, nationwide hunger strike in 1989 that effectively forced the government to release them. (Buntman 2003, 25) It is quite interesting to note, that the aforementioned term “voluntary total fast”, as the language used by the US government for the hunger strikes in Guantanamo, was also used in official South African documents concerning the medical treatment of imprisoned hunger strikers. The South African hunger strikers gained a public relevance through their most notable representative Nelson Mandela, who went on hunger strike multiple times during his 27 year long imprisonment. A striking example of the paradox and suppressive approach the South African government employed towards hunger strike, is the murder of the activist and founder of the Black Consciousness Movement Steve Biko. During prison interrogation in 1977 Biko was brutally tortured and died shortly after an inhumane 1,100 kilometer drive to the next hospital prison. He was left to die of his torture wounds. The police grotesquely claimed that Steve Biko died due to a hunger strike. Many political prisoners died of torture during the Apartheid regime. Usually the police claimed that their cause of death was self-hanging – an arguably less politicized form of self directed violence.

One of the most well documented hunger strike campaigns in the 20th century is that of the Irish Republican Army and the Irish National Liberation Army in Northern Ireland in 1981. The political prisoner Bobby Sands died after 66 dies on hunger strike in Long Kesh prison[6] in 1981. 9 more prisoners died during that hunger strike until it was ended on October 3, 1981. The prison was closed in 2000 as a result of the Good Friday agreement and partial demolition began in 2006. The 360 acre area is currently being redeveloped into showgrounds, amongst others to host Northern Ireland’s biggest agricultural event – The Balmoral Show.[7] Because the hunger strikes in Northern Ireland are so well documented, there are also many different interpretations on their connection to history. Sweeney tries to trace the development of hunger striking in Ireland and connects the imagery of death through hunger striking to sacrilized imageries of resistance (e.g. martyrdom and immortality) through connotations of the sacrificial motifs that arouse in connection to the 1916 Rising and their following executions. (Sweeney 1993) This however contradicts Allen Feldman.

One of the longest and most deadly hunger strikes of the 20th century began in Turkey in October 2000. The collective strike has continued for longer than 2 years and claimed at least 107 lives. (Anderson 2004) Political Prisoners made up one-sixth of the total prison population. The hunger strike was coordinated jointly by 11 of the radical left-organizations in Turkey who organized to protest against the different government policies that enable the ongoing imprisonment of political prisoners / imprisonment for political offence. (Koçan and Öncü 2006) The protest was also directed against the announced construction of a new prison that was supposed to only allow for isolated solitary confinement with no contacts to legal advocates or family members. (Anderson 2004)

Another case of collective hunger strike, that has gotten a lot of academic notice is the prisoners hunger strike in Guantanamo Bay. Hunger strikes have been undertaken in Guantanamo Bay prison almost since it became an interrogation centre for terrorist suspects in 2002 with roughly 200 prisoners going on hunger strike simultaneously. (Annas 2006; Center for Constitutional Rights 2005) An important aspect is the U.S. military’s efforts to conceal the scope and significance of the widespread prisoners’ protests. (Center for Constitutional Rights 2005) The hunger strikes have drawn attention[8] to the US government’s controversial prison on the Cuban island, the absence of the prisoners’ legal status / international classification and violation of international law.

Possibly one of the largest hunger strikes in global history began in 2013 in prisons in California when 30,000 prisoners joined for their hunger strike. What was furthermore impressive about the California Prison hunger strikes was how the hunger strike overcame boundaries of race and class and created a “sense of collective existence and solidarity as a prison class.” (Guenther 2015, 35)

Hunger strikes have also been an integral part of the refugee movement since the 2000s. Non citizens have been on hunger strike outside of prison and inside of prison / detention centres / deportation camps. As the hunger strikes have been undertaken in different places and by various groups (e.g. Zimbabweans in the UK, Iranians and other refugees in Athens, different refugees in French deportation camps) they do not need to be categorized in the same way. However it makes sense to name them together at this point in my paper, as a lot of the hunger strikes were organized around similar demands and are often understood in collective terms as a struggle for human rights and citizenship. (McGregor 2011)

One of the latest cases, that has gained little academic, but a fair amount of public attention was the hunger strike of the “iron lady of Manipur” Irom Sharmila who ended her 16 year long hunger strike just recently in August 2016.

 

Introduction to the state of research

As a highly contested form of protest that occurs globally, hunger strike has been researched and looked at in various different academic disciplines. It is striking, how many different academic fields have incorporated hunger strikes within broader frameworks of analyses and research fields. Sometimes hunger strikes just come up as examples for certain ideas, theories and case studies. But in some cases hunger strikes have been in the centre of academic debate, see for example the ethical debate on force-feeding held in the field of medicine.

“Triangle” of forms of self-directed violence

In correspondence with the general terms mentioned in the terminology part, a main part of academic literature analyzes the three forms of self directed violence of suicide attacks, protest burning and hunger strikes together, often drawing comparisons between the three. These perspectives can be positioned within the broader field of political science / international relations. They often tend to feed into a hegemonic discourse. The work is often trying to understand the “phenomena” in order to look for responses. These responses differ according to which form of self-directed violence the researchers are talking about. With suicide attacks, the academic discourse evolves much more around the question of how to “contain the threat”. Suicide attacks are seen as a threat, a problem that needs to be resolved. Whereas with hunger strikes there is hardly any literature asking how to “get rid of hunger strikes” or how to stop the phenomenon. Yet, more often than not it seems to be of central concern how to “respond” (Dingley and Mollica 2007, 460) so to say as a milder version of the “control strategy”. (Dingley and Mollica 2007; Linos 2010; Fierke 2013; Michelsen 2016; Wilcox 2015)

On the effectiveness of the political tactic / social movement aspects and resistance movements in national contexts

A lot of the literature from political science (mainly International Relations, Political Theory) looks at the collective movement as such and incorporates hunger striking into a social movement theory, mostly focusing on the nonviolent aspects of the movement and its employed forms of resistance. (Dingley and Mollica 2007; Stephan 2003; Zunes, Kurtz, and Asher 1999) It often understands the hunger striking as one tactic of a movement and looks at different layers of effectiveness in terms of a social movement “strategy”. For example does the literature analyze how the hunger striking creates followers and therefore only turns into a collective movement through the tactic. This is exemplified by Kevin Grant (2011) who looks into how the suffragettes adopted the “Russian method” (Grant 2011) and in what ways that led to a success or rather in more general terms, what affects that had on the social and political spheres. These approaches are predominantly more rational and instrumental that look at different political opportunities and evaluate the outcome of the movements.

With the help of the social movement theories, collective hunger strikes can be understood as part of political campaigns. (Dingley and Mollica 2007, 460) Often these theories look at the political campaigns as nonviolent movements, when the collective movement as such might actually encorporate both violent and nonviolent means. Therefore employing a framework of nonviolent resistance might cut it short and not thoroughly reflect on the broad range of the collective movement. The analysis is confined to the prison itself and does not relate to the outside. Therefore these frames might only be able to portray a limited analysis of a certain movement. Examples of these portrayels are Nelson Mandela’s nonviolent resistance, even though he was the co-founder of the armed Anti-Apartheid wing Umkhonto we Sizwe. Another example is the portrayal of the nonviolent hunger strikes of Bobby Sands et al, even though they were actually understanding their resistance inside of prison as a part of a broader resistance, that was meant to use militant violent means of resistance outside of prison as well. Allen Feldman describes it as a continuous struggle in which the violent resistance was supposed to happen simultaneously outside of prison. Hunger strikes were, so to say, the other side of the coin. (Feldman 1991, 220)

There is a large amount of scholarship that looks at resistance movements in national contexts, where again, hunger strikes come up as a specific tactic used. It often looks at how violence has been used as a means of resistance against others historically. Very often, the scholarship also tends to focus on hunger strike’s aspects as a protest tactic and its effectiveness. Again, these theories tend to lean towards framing the tactic as one of nonviolence. (Andriolo 2006; Scanlan, Stoll, and Lumm 2008; Dingley and Mollica 2007; McEvoy, McConnachie, and Jamieson 2007) An example of this is Gene Sharp’s concept of political jiu jitsu. Sharp, one of the pioneers of theory on nonviolent resistance, describes the effectiveness of political jiu jitsu. By remaining nonviolent while continuing their struggle, the resisters improve their own power position and the opponents, by continuing to violently repress, weaken theirs. (Sharp 1989) He looks at different cases, where this applies. Here, the question of power relations becomes obvious. Pramod Kumar Srivastava questions power structures and hierarchies within the anti-colonial resistance in India and looks at how the hunger strike shifted power dynamics through the uniqueness of its “nonviolent weapon” character. (Srivastava 2003) In that sense, he focuses on the effectiveness, but also describes exactly what Sharp has called political jiu jitsu.

Predominantly, hunger strike seems to be seen as a tactic of political resistance, not a way to political empowerment of the self and the community in which the hunger striking individual situates her or hisself, or the “audience” of the hunger strike. Some scholarship does touch on the question of empowerment / sovereignty. Anthropologist Esmail al-Nashif steers into that direction when he describes how the hunger strike can be understood within an “arena of confrontation”(al-Nashif 2004, 72) where the body is a site of contestation between colonizer and colonized, with the hunger strike – as a form of counter-domination-relocating the body into its liberated zones. (al-Nashif 2004) The idea of bodily inscription connected to hunger striking is taken up by other researchers as well. (Michelsen 2016; Enns 2004; Fierke 2013) Natalia Linos uses the term “oppressed body” (Linos 2010) to refer to the bodies oppressed by occupation. Political and structural violence not only controls, subjugates, abuses and occupies the body but also threatens the identity and integrity of both the individual body and the social body. Of course, the idea of bodily inscription through or within power relations is based on Foucault’s productive and multidimensional notion of power:

But the body is also directly involved in a political field; power relations have an immediate hold upon it; they invest it, mark it, train it, torture it, force it to carry out tasks, to perform ceremonies, to emit signs. (Michel Foucault 1979, 25)

Therefore, imprisoned bodies can productively challenge power relations when reclaiming their body through the hunger strike, which leads to a restoration of sovereignty (Andriolo 2006; Fierke 2013; Linos 2010) Through that act of productiveness and empowerment through self directed violence, the hunger strike constitutes the possibility of – or rather – enacts political subjectivity. Patrick Anderson looks at these questions when analyzing the Turkish hunger strikes on a theoretical level. He looks at how the hunger strike can be understood as an embodied performance of political subjectivity that challenges the state’s sovereignty. In relation to that notion of subjectivity he usefully theorizes the hunger strike as a fusion of subject and object of state violence into a single body. He explains how the hunger striker makes herself / himself the subject of the violence s/he is already the object of. (Anderson 2004; Cabot 2014) In this context, I want to quote a former hunger striker interviewed by Allen Feldman:

The H-Blocs changed the whole way you thought about your body. … From the moment we hit the H-Block we had used our bodies as a protest weapon. It came from the understanding that the Brits were using our bodies to break us. (Feldman 1991, 179)

Legitimacy and communication

The question of legitimacy of the violence seems to be central for many different theoretical approaches. The communicative side / perception of the hunger strike is central when it comes to constructions of legitimacy. Aogán Mulcahy (1995) goes so far as to say, that hunger striking itself is a fight to legitimize the cause. There are a number of scholars who look at hunger strikes as acts of communication. (Graitl 2012; Wee 2007)

Often, three main communication groups of recipients are categorized. One of them is the media. The media has always played a big role in legitimizing or “crashing” a movement. Lionel Wee (2007) and Lorenz Graitl (2012) look at the media’s role and the media’s representation of hunger strikes. The media can frame hunger strikers as political agents and the movement itself as one of legitimate resistance and therefore generate sympathy and support in the public through the media’s portrayal. (Grant 2011, 11) Or it can frame hunger strikers as deviants who are politicized and delegitimized. (Fierke 2013)

Through the media, but also by other means of representation like press releases, flyers and online contributions from a support network, formulation of concrete demands and the distribution of these, the hunger strike is communicated to the “home audience” (Dingley and Mollica 2007). Meaning the “own community” and a solidarity movement or other communities that sympathize with the protest.

State actors / political elite / political decision-makers are another main target of communication. They are forced to react in the face of a death under their command. On a communication level, they can start talks and negotiations with the hunger strikers. Often, state actors employ some form of a propaganda campaign in the public to delegitimize the hunger strike and its cause. Other political reactions are release of the hunger strikers or a change of policy. Nevertheless, in most cases the  stable reaction of the political target is the violent reaction of force feeding. (Michelsen 2016; Howland 2013)

Force feeding

Force feeding seems to go hand in hand with hunger strikes by prisoners. In the academic literature, there are contradicting opinions on when force feeding has been established as a method of reaction. George Kennan describes cases of female political prisoners being force fed in the revolutionary movement in opposition to the tsarist regime in the late 19th century. (Kennan 2012, 266) Kennan was a US-American journalist / travel writer / “explorer” who gives a thorough account of the Russian penal system including detailed description of the political prisoners’ movement and resistance within prison including accounts of different hunger strikes. Kevin Grant (2011) and Nicholas Michelsen (2016) account the introduction of force feeding to the British state’s reaction to the suffragettes’ hunger strikes in the early 20th century.

Medical ethical challenges

Volker Leschhorn was the prison physician at the West Berlin prison of Moabit in 1981, when a nationwide hunger strike by RAF prisoners (Red Army Fraction) took place. Leith Passmore summarizes the tragic and highly publicized suicide of the prison physician:

As head of the Moabit prison hospital in Berlin, Leschhorn had refused to comply with official demands that prisoners be force-fed and in his attempts to find non-violent resolutions, he was deemed to have ‘shown indefensible solidarity with terrorist prisoners’. Distraught at the subsequent investigation into his conduct, he wrote in his suicide note: ‘I cannot take this persecution anymore. I meant well.’ Leschhorn’s despair is representative of the complex set of pressures at play during a hunger strike. (Passmore 2012, 481)

This story illustrates how physicians become trapped between the competing interests at play during a hunger strike. A major body of scholarship on hunger strike emphasizes the ethical issues for medical providers raised by the hunger strike in prison and scrutinizes the question of force feeding as a medical practice. The medical discourse is led by physicians, medical associations and academic works on medical ethics, which can even be considered the academic field with the most single focus on hunger strike, while being one of the most extensive discourses on hunger strike at the same time. There are numerous ethical challenges evolving around force feeding in relation to physicians’ responsibilities. Physicians are the ones that medically determine, whether a prisoner is on hunger strike. They are the ones that must medically attend to the prisoner. They are also the ones that determine whether a hunger striking prisoner is still mentally capable of being responsible for his or her own actions and therefore remains legally capable to act on her or his own will and eventually they are also the ones who undertake the force feeding. The relationship between the hunger striker and the physician is a sensitive one that should always ensure a certain degree of confidentiality. (“WMA Declaration of Malta: A Background Paper on the Ethical Management of Hunger Strikes” 2006) Medical implications of the hunger strike are very central to the issue[9] and the physicians are challenged in their decision making processes regarding a possible force feeding. (Annas 2006; Chalela and Lopez 2013) In the World Medical Association’s declaration on hunger strike it is stated, that “[f]orcible feeding is never ethically acceptable.” (WMA Declaration of Malta on Hunger Strikers 2006) Yet, force feeding has become the standard response to hunger striking in prison  (Michelsen 2016) and therefore poses existential questions for the medical community.

 

Force feeding as torture

From the prisoner’s point of view, force feeding is a traumatic way of prison torture. (Howland 2013) Therefore hunger strike cannot only be seen as a form of self directed violence. Most of the time it evokes a violent consequence, a form of torture directed towards the hunger striker from the state actor through the force feeding practitioner.

Legal implications / human rights questions

“The uses of physicians to aggressively break a prison hunger strike raises not only medical ethical but also legal issues” (Annas 2006, 1378). In cases of hunger strike, medical and legal questions are entangled and the discourses overlap. The question of accountability, implied in the ethical medical discourse, is also a legal issue, that shows similarities to different contexts regarding self directed violence / self harm, like suicide attempts or mental illness. In many cases, the physician decides if and when the hunger striker is not responsible or rather, cannot be held accountable for his or her own actions including the decision to go and remain on hunger strike. This creates an “ethical moment” that is highly legally challenging.

Through the state actors’ agency to force feed hunger strikers “the practice of force feeding fundamentally reasserts for these state actors what Mbembe (2003:11) calls ‘the ultimate expression of sovereignty … the power and capacity to dictate who may live and who must die.” (Howland 2013, 109) Understanding force feeding in relation to necropolitics opens up a new discourse, that has not been thoroughly discussed.

Another legal issue in regards to force feeding is the question of the prisoners’ legal status itself. Amanda Gordon (2011) demonstrates how state actors get away with human rights abuses by looking into the different legal implications of Guantanamo Bay prisoners and prisoners, that are detained on US-American mainland.

Anthropological developments

I now want to funnel in on recent anthropological developments towards approaches on hunger strike. An anthropological approach on hunger striking is especially useful, because it knows how to position, understand and explore the aforementioned concepts whilst taking the hunger striker’s agency into account. There is great anthropological value in looking at the recurring concepts of political subjectivity, performance, embodiment, sovereignty and empowerment in relation to hunger striking. Yet, it needs to be noted, that there is surprisingly little ethnographic work on political prisoners in general and political prisoners’ hunger strike in particular. The most well known and probably the most influential ethnography was conducted and written by Allen Feldman (1991). Feldman is a pioneer in the ethnography of political violence who “analytically establish[ed] connections between the dynamics of violence and bodily and spatial symbolism and collective memory” (Krohn-Hansen 1997, 263) Newer ethnographic studies look at hunger strikes undertaken as part of the refugees’ resistance movement. (Però 2007) Heath Cabot has conducted ethnographic research in Athens with asylum seeking refugees and mainly tackles questions regarding the migration apparatus and refugees’ claims of belonging in light of what he calls “krisis”. He also analyzes the hunger strikes that took place in Athens in 2010.

Prisoners have often used this tactic – in Ireland, Iran, and, of course, at Guantanamo – and here we see it used by “prisoners” of bureaucracy and law, who have no other leverage than their own bodies. In an important sense, however, these Iranian hunger strikers also employed their suffering bodies to expose and render transparent the hidden violence instantiated through bureaucracy and law. (Cabot 2014, 214)

It is interesting that Cabot analyzes refugees’ hunger strikes that took place in public within a similar framework as hunger strikes in prison. That is, he frames Greece and its bureaucracy and law as a prison and the refugee as a prisoner of that bureaucracy and law. In light of Patrick Anderson’s analysis, this can be understood as similar to what Anderson understood as a form of fusion of violence.

Anthropological “blanks” / challenges of prison ethnography

It becomes quite clear, that little ethnographic work on hunger striking in prison and prison ethnography in general has been conducted. (Rhodes 2001) One of the few Anthropologists that has conducted ethnographic research in prison is James Waldram. Even though his research focuses on different issues, like the treatment of Aboriginal prison communities or prison-based sex offenders, he is very familiar with the challenges of prison ethnography. It is refreshing and motivating, to see that Waldram reflects on the lack of anthropological research concerning prisons and confronts the anthropological community’s “reasoning”:

Few anthropologists are willing to venture into the belly of the beast for three basic reasons: (1) prison inmates are not embraceable research participants in a discipline strongly focused on the innocent, disempowered and disenfranchised; (2) it is often assumed that inmates will be uncooperative and too difficult to work with; and (3) prisons are highly regulated environments that constrain more than they enable research. (Waldram 2009, 4)

This must be read in a context in which Waldram focuses his research on those “justly” imprisoned, excluding political prisoners. However, when looking at political prisoners and thinking about possible ethnographic prison research, these general concerns still apply. By giving a detailed account of some of the practical challenges he has encountered, Waldram opens up a somehow closed up mindset towards the impossibility of research in prison.

Ethical challenges arise in the anthropological research on political prisoners on hunger strike, just as they do in every research field concerned with the issue. Coretta Philips and Rod Earle are critiquing that prison ethnography has been ignoring the researcher’s subjectivity, power dynamics between the researcher and the field, especially how these are affected by the researcher, and questions of access and sensibility for the most part. (Phillips and Earle 2010) In light of the amount of scholarship from other disciplines that deals with ethical challenges that arise, this “ignorance” is striking. Questions concerning anthropological, especially methodological approaches need to be asked. Why is there so little ethnographic work involving hunger strikers as subjects? One could even go further and argue, that on top of ethnographical research being challenged, anthropological expertise on hunger strikes in prison is for the most part limited to purely theoretical debates. Furthermore, this abstract approach silences other narratives by simply not mentioning what sources have been used. In fact, when reviewing the literature, I sometimes had trouble finding out, whether the author has conducted some form of research other than a literary review to contribute to a theoretical debate that then becomes confined by abstract academic boundaries. In the anthropological field, where accessibility from the researcher’s perspective and the subject’s agency and personal experience – in this case of the hunger striking prisoners, the jailers and wardens and prison physicians – are so crucial to gaining an understanding, it is striking that a methodology is not talked about. I am not claiming, that every academic argument needs to be supported by ethnographic research. Participant observation is in its true sense impossible. Hierarchies are central and restrictive to the research environment. I acknowledge the difficulties that restrict research possibilities and I do not have an answer to a simple way around it. But I am calling for an improvement in transparency and a debate around these challenges in order to tackle the restrictions and find new ways. What can be seen in the purely abstract debate is that most research does not make use of primary sources either – even though primary sources are out there. As demonstrated by categorizing hunger strike as communicative act, a lot of documents, statements and political speeches, websites, solidarity network’s discussions, publications of lists of demands, etc. exist and have been made public, because that public communication is a central element of the hunger strike. Furthermore, literature – often in the form of autobiographical writings[10] – might be used as another primary source for the analysis which might uplift the cross-quoting.

Gender critique

Female political prisoners can be seen as protagonists of the hunger strike in the late 19th and early 20th century. Yet, a framing of that protagonist perspective is missing in the scholarship. There are multiple accounts of suffragettes in Great Britain and other cases of female hunger striking have been documented and analyzed as well, but a perspective that criticizes the lack of women’s subjectivity in prison is hardly employed in these accounts. As the hunger strike can be seen as an act of self-empowerment in which the hunger striker reclaims his or her body, focusing on women’s subjectivities would further contribute to a critical debate on hunger strike. This focus might not be exclusive, because hunger strike has often been a part of a broader movement. Yet, while often being on the active forefront of these movements most of the scholarship focuses on either men or both women and men together on hunger strike without reflecting on a prevailing hegemonic discourse of missing female agency, subjectivity and resistance and violence.

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[1] e.g. general strikes by the Irish transport and workers union

[2] From at least the late 1870s.

[3] A great case study for the intersectionality of resistance movements, as it incorporates elements of the struggle for women’s rights, political independence as a republic and the fight against class rule.

[4] Namely Hanna Sheehy-Skeffington was the first Irish suffragette who went on hunger strike in prison.

[5] The number of political prisoners sharply inclined after the Sharpville shootings in 1960, which led to a growing prisoner’s movement. (Kalk and Veriava 1991)

[6] Also known as Maze prison. Long Kesh was also the site for the so called Blanked protest and the Dirty Protest.

[7] I recommend a short trip to the new domain www.mazelongkesh.com as an excursion on political sites as contested space and on the (re-)writing of history and its narratives. The website, as well as the vision of the Maze Long Kesh Development Corporation investing in the redevolpment is titled “MazeLongKesh. From peace to prosperity.” For rehabilitation and a different historical approach, I advice to visit www.prisonsmemoryarchive.com afterwards, a collection of 175 filmed walk-and-talk recordings with those who had a connection with Long Kesh Prison during the conflict with participants ranging from prison staff, prisoners, relatives, teachers, chaplains, lawyers, doctors, probation officers and maintenance workers. The Prison Memory Archive is an impressive research project that combines documentary, academic research and oral history.

[8] The Guantanamo Bay prison has been scrutinized to harsh public critique for various reasons with critique growing due to different incidences.

[9] In the Camp Delta SOP hunger strike is listed as a “Medical Problem” (Department of Defense, Joint Task Force-Guantanamo 2003, Section III).

[10] Examples for autobiographical writings by political prisoners that undertook hunger strikes in prison as a means of resistance are Vera Figner’s “Memoirs of a Revolutionist” (Figner 1991), Huey Newton of the Black Panther movement (Newton 1995) or Emmeline Pankhurst (Pankhurst 1914) who also elaborated on her experience of being force fed. Another aspect of these autobiographical works, is that they can be seen as means of resistance themselves, especially autobiographical prison narratives have been understood as means of resistance, a way for the prisoner to transform and regain agency and power. (Gready 1993; Gready 2003)

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