Anti-Immigrant Racism

Trump’s Anti-Immigrant Racism Represents an American Tradition

By PAUL A. KRAMER New York Times

President Trump has inspired widespread outrage and disgust with his crude, racist disparagement of Haiti, El Salvador and African nations and the predominantly black and brown immigrants from these places.

As horrifying as this remark was, his groundbreaking transparency provides an opportunity. Racism has long fueled United States immigration exclusions and restrictions, but these days it’s rare to hear rhetoric that openly reflects this reality, providing us a chance to delve into its roots and implications.

We’ve grown accustomed to the dog-whistling of anti-immigrant racism. Where blood, purity and civilization were once its everyday vocabulary, anti-racist and immigrant rights activism have, at least until recently, succeeded in forcing such talk underground. Our era’s seemingly race-neutral languages of security, legality, culture, productivity and assimilation are often strongly inflected with racial meanings, but they’re subtler and deniable, attracting far less opposition than, say, likening countries to outhouses.

Public utterances like Mr. Trump’s have and should inspire outrage, but we need to go deeper, challenging the racist views — both flagrant and soft-pedaled — that have long shaped America’s immigration policy. And we need to ask hard questions about the ways racism has decisively, durably shaped the immigration debate in ways that usually go unnoticed.

The truth is, many of the United States’ early policies toward immigrants were conceived in recognizably Trumpian terms, in substance if not in tenor. The president’s headline-making sentiment that people from countries like Norway (read: white people) were preferable would have been recognizable to the founders.

The nation’s first naturalization law, from 1790, closed off United States citizenship to all but “free white persons of good character.” People of African descent were among the first migrants singled out for surveillance and exclusion, as they sought entry to the country or moved between states. State repression of black migrants transformed them into America’s first “illegal immigrants,” laying the groundwork for durable associations between law, morality and the need to keep people of color, quite literally, in their “place.”

The racialization of United States immigration law took off in the decades following the Civil War. Beginning with the Chinese, migrants from Asia were the early targets; beginning in 1917, an “Asiatic Barred Zone” (with latitude and longitude markers laid out clearly in the legislative code) kept out migrants from an imaginary mega-region that stretched from contemporary Turkey to Papua New Guinea.

In the aftermath of World War I, a new “national origins” quota system sought to turn back the American demographic clock, with European immigrants admitted in proportion to the presence of their “nationality” in the American population based on earlier censuses. It was “Make America Great Again” for a eugenic age. Hitler was a fan. America appeared to be “a young, racially select people,” he wrote admiringly in 1928, by “making an immigrant’s ability to set foot on American soil dependent on specific racial requirements,” among other factors.

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The United States’ unapologetically racist immigration codes — with Asian exclusion and “national origins” at their core — survived the Great Depression, World War II, and the beginnings of the Cold War and decolonization; the presumption that the United States was or should be a white fortress in a mostly colored world was backstopped by science, religion, scholarship and popular culture. American law did not allow Asians to obtain citizenship until 1952.

Under the pressure of anti-racist and immigrant rights pressure, the system fell in 1965 with the passage of the Hart-Celler Act, which foregrounded family reunification, refugee admissions and the entry of the highly skilled and educated. But racism persisted in both policy enforcement and popular attitudes.

New caps on Western Hemisphere migration — flying in the face of United States demand for workers, an entrenched labor migration industry and poverty and repression in Latin America that forced thousands into exile — outlawed decades-old migration flows. In the 1990s new nativist movements directed against Latin Americans arose, as well as efforts to eliminate migrants’ rights to basic services and the expansion of immigrant incarceration and mass deportation. In the aftermath of Sept. 11, the principle that immigrants from Muslim-majority countries required special scrutiny and restriction was central to the remaking of immigration policy in the name of national security.

The prevailing questions we’re conditioned to ask about immigrants have all been deeply shaped by histories of racial restriction. Can “we” assimilate and civilize “them”? Will “they” — despite their negative features and the risks they pose — make “us” wealthier and more powerful? Will “they” sap “our” resources?

This past week, liberals, progressives and others protesting Mr. Trump’s comments about Haiti, El Salvador, and the countries of Africa understandably rushed to defend them as beautiful, dignified places unworthy of his vulgar derision. But in this defensive posture of response, which inadvertently legitimates the questions it answers, one can also feel the overwhelming presence of racist suspicion and hostility roaring out of the past into our time.

We will not, ultimately, succeed in deposing Mr. Trump’s hateful, racist approach toward immigrants unless we refuse not only his nastiest word choices, but also the underlying questions he and others insist we ask.

We can choose to ask different questions: To what extent are the countries of the global north implicated in forces that prevent people in the global south from surviving and thriving where they are? In what ways do restrictive immigration policies heighten the exploitation of workers? How does the fear of deportation make migrant workers easier to discipline, hurt and rob? In what ways does mass migration from the poorer parts of the earth to centers of wealth and power reflect the larger problem of global inequality?

Elites in the United States and elsewhere — long before Donald Trump’s presidency — have long known they could sustain their power by capitalizing on, deepening and, where necessary, inventing divisions between self and other, friend and enemy. This political strategy, with troubling successes to its name, has been updated and rescaled for our globalized age, in which the fault lines are those of bordered nationality: There will be no protection offered from polluters or health insurance companies, but the threat of Muslims and Mexicans will be met.

To the white nationalists’ war cry against migrants, “You will not replace us,” we can and should reply, as have many before, “You will not divide us.”

Paul A. Kramer is an associate professor of history at Vanderbilt University and the author of “The Blood of Government: Race, Empire, the United States, and the Philippines.”

What Happens When You Go Under

By HENRY MARSHJAN. 3, 2018

ANESTHESIA 

The Gift of Oblivion and the Mystery of Consciousness 

By Kate Cole-Adams 

400 pp. Counterpoint. $28.

A Doctor’s Notes on Anesthesia 

By Henry Jay Przybylo 

240 pp. W.W. Norton & Company. $25.95.

A few years ago I suffered a retinal detachment that required fairly urgent surgical treatment. The surgeon came to see me on the morning of the operation and said that I could choose between local and general anesthesia. The thought of having three large needles stuck into my eyeball, and the vitreous humor then being sucked out while I was awake, did not appeal. I thought of the lines from “King Lear,” spoken by Cornwall as he cuts out Gloucester’s eyes: “Out, vile jelly!” To my surgeon’s obvious relief I opted for a general anesthetic — it is much less stressful to operate on unconscious than conscious patients, especially if they are your professional colleagues. There was a certain irony to this as my neurosurgical practice largely involved removing brain tumors from my own patients while they were awake, under local anesthetic.

At this point an anesthesiologist burst into the room — he must have been listening at the keyhole, awaiting my decision. He rapidly assessed my fitness for anesthesia and 30 minutes later he was putting a needle into the back of my hand and injecting the drug propofol. I was asleep, as doctors say — although the state of being anesthetized has nothing in common with sleep — within a matter of seconds.

Anesthesiologists (anesthetists in the British idiom) are the unsung heroes and heroines of modern medicine. It would be impossible without them. Their duty is to keep us unconscious and pain free, while the more conspicuously heroic surgeons do their work. Patients, therefore, see very little of them and probably do not realize that during surgery their lives depend much more on the skills of the anesthesiologist than on the surgeon’s.

As the anesthesiologist Henry Jay Przybylo explains in “Counting Backwards,” the word “anesthesia” means “without feeling,” but a modern general anesthetic is about much more than just rendering a patient unconscious. It also involves analgesia, the prevention of pain; anxiolysis, the relief of anxiety; and amnesia, the obliteration of memory. The latter is necessary because it is by no means certain that patients are fully unconscious when anesthetized — a problem explored at length in Kate Cole-Adams’s book “Anesthesia.

the central role that anesthetic drugs play in medicine, very little about how they work is known for certain. Equally remarkable is the fact that ether, the first agent to be used as a general anesthetic, was shown by Paracelsus in the 16th century to put chickens to sleep. He wrote that it “quiets all suffering without any harm and relieves all pain…” It remains mysterious as to why 300 years were to pass before it came to be used as a general anesthetic. Some would point to Kuhn’s scientific paradigms and argue that medicine wasn’t ready for such a shift in thinking, others that it reflects the entirely unscientific nature of premodern medicine and the blinkered self-confidence of doctors. There are, of course, many similar examples in the history of medicine — perhaps the most egregious being the failure of the medical profession to exploit Leeuwenhoek’s invention in the 17th century of the microscope and his discovery of microbial life, as discussed in David Wootton’s book “Bad Medicine.”

Several American doctors began to use ether as a general anesthetic in the 1840s. There were bitter disputes about who could claim to be the first, but what is clear is that ether was rapidly taken up by the medical profession. It is interesting to note that it was also widely used as a recreational drug in countries like Ireland and Poland, where it was used as an alternative to alcohol.

Ether is no longer used in general anesthesia, and has been replaced by different “volatile” agents — such as sevoflurane and isoflurane. The way in which these volatile anesthetic agents dissolve in oil led to the theory that they worked by interfering with the lipoprotein membranes of nerve cells, implying that all the brain’s neurons were inactivated by the drugs and that the unconsciousness of general anesthesia was complete. This theory is no longer believed and instead there is near-complete uncertainty as to how the agents do work. More recent research on injectable anesthetic drugs like propofol suggests that they interfere selectively with certain neurotransmitters and with the interaction between the cerebral cortex (where thought and perception resides) and the deep part of the cerebral hemispheres known as the thalamus, which acts as some kind of gateway between the cerebral cortex and the rest of the brain. In other words, it is by no means certain that all of your brain is “asleep” when you are anesthetized.

The possibility of “awareness under anesthesia” is obviously of deep concern to both anesthesiologists and patients and is reminiscent of the fear in previous ages of being buried alive after being mistakenly assumed dead. Awareness became a clinical problem in the 1940s with the introduction of the paralyzing drug curare. Until then, if an anesthetic was inadequate, the patient would start to wake up and to move. With curare this cannot happen and it is possible for patients to be awake and, since they are entirely paralyzed, for the anesthesiologist to be unaware of it.

Awareness undoubtedly can occur under anesthesia although there is much argument as to how often. A 2014 survey in the United Kingdom of three million cases of anesthesia suggested an incidence of 1 in 19,000 with not all the episodes causing distress. This survey relied on patients volunteering their memory of being aware, so it is possible that some chose not to report the experience and that the true incidence might be higher. The issue is further complicated by the possibility of implicit or “unconscious” memory as opposed to conscious or “explicit” memory. The “explicit” memories would be the horror stories of patients wide-awake but unable to move while being operated on, usually as a result of medical error. It seems that the paralysis is even more distressing than the pain and can lead to long-term psychiatric harm and PTSD. Implicit, unconscious memories of being awake under anesthesia are much harder to uncover.

Cole-Adams makes much of these sorts of hidden memories in her book, and of various experiments with hypnotizing patients before and after anesthesia to find them, but as she admits, the evidence is confused and contradictory. Nevertheless, some anesthesiologists are careful in what they say in front of anesthetized patients in case the patient is able to later recall what they overheard. This is quite unlike surgeons who, on the whole, are disinhibited extroverts when operating.

A good experience of anesthesia should be as routine and dull as a commercial airplane ride, with the added feature that the patient should have no memory of it. Both anesthesia and flight have become dramatically safer in recent decades and there is much in common between flying an aircraft and anesthetizing a patient — uneventful most of the time but occasionally terrifying and very occasionally fatal. The Patient Safety movement of recent years has been largely driven by anesthesiologists and analogies to aviation safety, which perhaps apply less well to surgery.

It is difficult to write an exciting book about modern anesthesia but Przybylo is thoughtful and workmanlike in his production, as he is, it is quite clear, when administering his anesthetics. Consciousness is an entirely subjective phenomenon and, perhaps inevitably given its subtitle, you will learn as much, if not more, about Cole-Adams’s own anxieties and preoccupations as you will about anesthesia in her book. The effect, as she streams her consciousness over many pages, can in itself be somewhat anesthetic.

Henry Marsh is the author, most recently, of “Admissions: Life as a Brain Surgeon.”

A version of this review appears in print on January 7, 2018, on Page BR19 of the Sunday Book Review with the headline: You’re Getting Sleepy.