Month: February 2017

The Holofernes Complex: a new edition of Michel Leiris’ ‘Manhood’

L’Âge d’homme preceded by L’Afrique fantôme, by Michel Leiris. Paris: Gallimard, 2014. Edited by Denis Hollier, in collaboration with Francis Marmande and Catherine Maubon, Series: Bibliothèque de la Pléiade, n°600. 1456 pages, 38 ill., ISBN: 9782070114559.

by Emmanuel Delille

A new edition of L’Âge d’homme (available in English as Manhood)[ref]Leiris, M. (1992) Manhood: A Journey from Childhood into the Fierce Order of Virility, translated by Richard Howard. Chicago: University of Chicago Press.[/ref] by Michel Leiris (1901-1990), overseen by Denis Hollier, was published by the Bibliothèque de la Pléiade at the end of 2014. It constitutes the second volume of Leiris’ selected works, the first volume being La Règle du jeu[ref] Leiris, M. (2003) La Règle du jeu, ed. Denis Hollier, in collaboration with Nathalie Barberger, Jean Jamin, Catherine Maubon, Pierre Vilar, and Louis Yvert. Paris: Gallimard.[/ref]. The edition presents selected autobiographical texts in addition to L’Âge d’homme, including L’Afrique fantôme. (The latter is often translated into English as Ghostly Africa, but will be soon published for the first time as Phantom Africa in a new translation by Brent Hayes Edwards).[ref]Available in English in February 2017: Leiris, M. (2016) Phantom Africa, trans. Brent Hayes Edwards. Chicago: University of Chicago Press.[/ref] L’Afrique fantôme is an essay that is simultaneously controversial and foundational for French ethnology. Hollier’s editorial decision highlights Leiris’ contribution to the genre that we call autofiction, wherein autobiographical materials are rewritten using the techniques of fiction writing – in contrast to the raw journals kept by Leiris between 1922 and 1989. Hollier has proposed the general title L’âge d’homme fantôme[ref]Hollier, D. (2014a) ‘Préface’, in Michel Leiris, L’Âge d’homme précédé de L’Afrique fantôme, ed. Denis Hollier in collaboration with Francis Marmande and Catherine Maubon. Paris: Gallimard, XI.[/ref] to identify this corpus; following Edwards’ new translation of Phantom Africa, an English version of this title could be Phantom Manhood [ref]I am very grateful to Professor Brent Hayes Edwards (Columbia University), who answered my questions about his new translation and suggested Phantom Manhood as a general title in English.[/ref]

The volume is imposing; for this reason, my analysis focuses solely on L’Âge d’homme, the best-known of Leiris’ books among the general public (L’Afrique fantôme is the object of another review article, in the Japanese academic journal Zinbun).[ref]Delille, E. (2017) ‘Michel Leiris, L’Âge d’homme, précédé de L’Afrique fantôme. Édition de Denis Hollier, avec la collaboration de Francis Marmande et Catherine Maubon, (Paris, Gallimard, Collection: Bibliothèque de la Pléiade, n°600, 2014, 1456 pages, ill.)’, Zinbun: Memoirs of the Research Institute for Humanistic Studies, Kyoto University, 47: in press. [/ref] From my perspective, it is not, for all that, his masterpiece; however, this narrative has benefited from its long availability as a mass-market paperback, unlike L’Afrique fantôme. Of Leiris’ books, it is also the one closest to the genre of confessional literature: it reveals the author’s sexual obsessions, the pathological shame he felt, and how he turned to the psychoanalytic interpretation of myths to narrate his experience.

Hollier soberly recounts the book’s context: after a period of anguish and impotence, Leiris began psychoanalysis in 1929 with Adrien Borel (1886-1966), one of the first French psychoanalysts, on the advice of his friend Georges Bataille (1897-1962). He then joined the Dakar-Djibouti Ethnographic Mission (1931-1933) and published a long travel narrative, L’Afrique fantôme (1934). L’Âge d’homme soon followed (1935), although it only really began to take shape after a second series of psychoanalytic treatments (1933-34).

While Leiris was at the very beginning of his scientific career in the 1930s, it is obvious that he drew on two disciplinary genres in order to breathe new life into confessional writing: psychoanalytic and ethnographic narratives. Indeed, as in L’Afrique fantôme, Leiris began with the principle that writing in the subjective mode increases the value of the testimony contained in the book and brings it closer to the truth. Eight chapters tell the story of his childhood and adolescence until the age of reason: marriage, the publication of his first works, and the beginning of a scientific career. Parental figures, his brothers and sister, and his first romantic relationships haunt the narrative, even though the figure of the beloved brother is not as well developed as in The Rules of the Game (La Règle du jeu). Nevertheless, the text is not structured as a family drama in the strict sense; instead, the plot is organized around a painting by Cranach that represents two biblical figures: Judith and Lucretia (Cranach, 16th century). Leiris saw in this diptych a kind of crystallization of his obsessions: two women who personify the two faces, desired and terrifying, of his fantasy. At one and the same time, woman is the object of man’s imperious desire (rape of Lucretia) and triumphant against her rapist (Judith decapitating Holofernes). The influence of psychoanalysis allowed him to identify his fascination with Cranach’s diptych with the concept of the castration complex, which Leiris believed explained his anxieties: “By psychoanalysis, I hoped to free myself from this chimerical fear of punishment, a chimera reinforced by the absurd power of Christian morality – which one must never flatter oneself that one has altogether escaped.”[ref]Leiris, M. (1992) Manhood: A Journey from Childhood into the Fierce Order of Virility, translated by Richard Howard. Chicago: University of Chicago Press, 138. See also: Leiris, M. (2014) L’Âge d’homme précédé de L’Afrique fantôme, ed. Denis Hollier in collaboration with Francis Marmande and Catherine Maubon. Paris: Gallimard, 889-890.[/ref] In Freudian psychoanalysis, the castration complex designates the anxiety that results from the Oedipus complex, which is to say the love children have for their mother, as it is checked by paternal power. This infantile fear represents a certain renunciation of the maternal object, but also an irreversible loss: it thus constitutes an existential anguish, which makes it susceptible to displacement onto substitute objects.

Yet one of the most interesting aspects of this new edition is precisely that it draws attention to the biblical personage with whom Leiris identifies: Holofernes. Indeed, in his foreword, Hollier justly stresses the disappearance of Judith and Lucretia in the conclusion of L’Âge d’homme; they are replaced by masculine figures, suggestive of homosexuality, that are designed to be more harmonious with the psychoanalytic theme of castration.[ref]Hollier, D. (2014b) ‘Notice: David et Goliath ou la castration’, in Michel Leiris, L’Âge d’homme précédé de L’Afrique fantôme, ed. Denis Hollier in collaboration with Francis Marmande and Catherine Maubon. Paris: Gallimard, 1227.[/ref] He also reproduces some of Leiris’ corrected proofs, one of which is soberly entitled Psychanalyse (Psychoanalysis, December 1930).[ref]Leiris, M. (2014) L’Âge d’homme précédé de L’Afrique fantôme, ed. Denis Hollier in collaboration with Francis Marmande and Catherine Maubon. Paris: Gallimard, 31.[/ref] which Leiris had originally intended to insert before a dream narrative.

From a historical point of view, we know that the interpretation of symbols played an important role in the beginnings of psychoanalysis, particularly in the first half of the 20th century. This practice first appeared as a technique for interpreting dreams, with the goal of filling out the material obtained in the patient’s free associations while recounting a dream. For the therapist, it helped both to overcome mental blocks and to explain Oedipal fantasies to the patient. But psychoanalysts soon extended this practice to interpreting symbols in myths, religions, and literary texts; Freud himself based his analysis of infantile sexuality on Greek mythology and published an essay on the biblical figure of Moses.

Hollier also presents a previously unpublished letter written by Leiris to his wife, dated May 30th, 1932. It explains that Borel’s virtue lay in his having understood that Leiris wanted to play the role of a mythological character: he would stage himself in the form of a new Holofernes[ref]Hollier, D. (2014b) ‘Notice : David et Goliath ou la castration’, in Michel Leiris, L’Âge d’homme précédé de L’Afrique fantôme, ed. Denis Hollier in collaboration with Francis Marmande and Catherine Maubon. Paris: Gallimard, 1229.[/ref], in an autobiographical narrative where confession would have a cathartic function. Finally, Hollier observes that castration is also an explicit theme of two texts, contemporary with Leiris’ writings, that were published in 1930 in the journal Documents; this journal was edited by Bataille and lists Borel as one of its contributors.

These materials make a convincing argument that Leiris identified himself with a mythological character. It is unfortunate, however, that the editors chose not to present more context about the appropriation of psychoanalysis by writers of this generation, and that they even forgot to list Borel in their index. This oversight is all the more curious because the very interesting appendices of this new edition contain a Note remise au docteur Borel (Note delivered to Doctor Borel, 1929)[ref]Leiris, M. (2014) L’Âge d’homme précédé de L’Afrique fantôme, ed. Denis Hollier in collaboration with Francis Marmande and Catherine Maubon. Paris: Gallimard, 912.[/ref], followed by Projets de mémoires (Ideas for Memoirs, 1930)[ref]Ibid., 913-915.[/ref], extracted from Leiris’ journal and contemporaneous with his psychoanalysis – a corpus of texts which should have been compared with those written by other former surrealists who undertook psychoanalysis with Borel.

And yet evidence indicating that these texts represent collective practices is not lacking, and editors might have remembered that in the Bible, Judith’s victims include not only Holofernes, but his army as well! Because in addition to Leiris and Bataille, we must also take into account Jacques Baron, Raymond Queneau, Colette Peignot (pseudonym: Laure), and Boris Souvarine, all of whom were in therapy with Borel. Moreover, Borel was not only a confidant of but also an intermediary between the members of this group, as their correspondence demonstrates. For example, in 1934, Baron revealed to Leiris that he too had taken the initiative of asking for help: “I’m not joking, but I’m heading to Privas to visit Doctor Borel! Tell no one about this idiocy, but I’m dreaming: I have all of hell in my head.”[ref]The original French text: “Je ne rigole pas, mais je pars pour Privas rendre visite au Docteur Adrien Borel. Ne souffle mot à personne d’une telle idiotie mais je rêve: j’ai tout l’enfer dans la tête.” Leiris, M. & Baron, J. (2013) Correspondance 1925-1973. Nantes: Joseph K., 149. The English translation here, by Marie Satya McDonough, is literal, because Baron’s expressions are not clear in French. We know that he suffered from depression after the War, but we must be wary of retrospective diagnoses. See also: Delille, E. (2016) ‘Michel Leiris & Jacques Baron, Correspondance. Édition établie, annotée et préfacée par Patrice Allain & Gabriel Parnet (Nantes, éditions Joseph K., 2013, 192 pages)’, Zinbun: Memoirs of the Research Institute for Humanistic Studies, Kyoto University, 46: 213-215.[/ref] That same year, Leiris wrote to Bataille: “If you see Borel after receiving this letter, give him my regards and tell him that I am trying hard to be good.”[ref]Bataille, G. & Leiris, M. (2008) Correspondence, trans. Liz Heron. Chicago: University of Chicago Press/Seagull Books, 105.[/ref] Similarly, in 1943 he wrote him about the posthumous publication of a text by Peignot: “Did you receive the Histoire d’une petite fille? All the copies planned have now been distributed, except Borel’s (but I expect to go and see him within a very few days).”[ref]Ibid., 160.[/ref] We thereby see how in the 1930s, psychoanalysis was a collective practice, much like automatic writing, introduced in The Magnetic Fields (Les Champs magnétiques) in 1920.[ref]Available in English as The Magnetic Fields: Breton A. & Soupault P. (1985) The Magnetic Fields, translated and introduced by David Gascoyne. London: Atlas Press.[/ref]

This intellectual social scene, enthusiastic about psychoanalysis, also had an impact on academic psychology. For example, after the suicide of the eccentric writer Raymond Roussel (1877-1933), Leiris was tasked with editing How I Wrote Certain of My Books[ref]Roussel, R. (2005) How I Wrote Certain of My Books, edited by Trevor Winkfield and introduced by John Ashbery. Boston: Exact Change.[/ref] (Comment j’ai écrit certains de mes livres, 1935), a posthumous autobiographical essay. The project led him to contact the psychologist Pierre Janet, a professor at the Collège de France and Roussel’s psychotherapist, in order to reconstruct his illustrious patient’s last days. Bataille would repeat the gesture in consulting Borel with regard to the posthumous edition of Peignot – and that is not all: in 1937, Leiris would join Bataille in founding a Société de Psychologie Collective, with Borel and Janet! This Society’s goal was to study the psychological factors in social facts. While it may be argued that this information is well-known, unfortunately the existing historiography on the crossed histories of psychoanalysis, psychology, and early 20th century avant-gardes reveals that the collaborations between the literary world and academic psychology are relatively unknown. I am thinking in particular of Alexandra Bacopoulos-Viau’s research,[ref]Bacopoulos-Viau, A. (2012) ‘Automatism, Surrealism and the Making of French Psychopathology: The Case of Pierre Janet’, History of Psychiatry 23(3): 259-276.[/ref] which is well documented but too focused on Breton, and where Leiris is literally forgotten. Beyond Borel and Janet, Leiris would consult other psychotherapists after the war, including Julián de Ajuriaguerra (1911-1993), who would later become, like Janet, professor at the Collège de France. To sum up, it would have been interesting to establish the similarities and the differences between L’Âge d’homme and the accounts, diaries, and fictions that Leiris’ contemporaries left on the practice of psychoanalysis.

Emmanuel Delille is a historian of medicine and health, currently Visiting Scholar at the Max Planck Institute for the History of Science. He is an Associate Researcher at the Centre d’Archives en Philosophie, Histoire et Édition des Sciences (CAPHÉS, École Normale Supérieure, Paris) and at the Centre Marc Bloch (CMB, Humboldt University, Berlin). One of his major interests is the history of psychiatry: intellectual networks and comparative history between France, Germany, and North America – particularly Canada. Other research projects include the history of the French psychiatric hospital Bonneval (Eure-et-Loir) and the history of the French scholarly society “L’Évolution Psychiatrique” (created in 1924). His work in intellectual history focuses on epistolary material, above all, letters between scientists involved in scholarly networks.

Thinking in Cases – a call for submissions to History of the Human Sciences.

As part of our celebration of the work of the incomparable John Forrester, History of the Human Sciences (HHS) is hosting a review symposium around John’s final work: Thinking in Cases (Polity: 2017). The first essay in this collection ‘If p, then what? Thinking in cases’ was originally published in HHS back in 1996: (http://journals.sagepub.com/doi/abs/10.1177/095269519600900301)

As part of our efforts to showcase the work of new and emerging scholars, HHS invites expressions of interest from all early career researchers (a flexible definition) whose work bears in some way upon the work John started with ‘Thinking in Cases’. We welcome anyone who would like to contribute to such a dialogue with John’s work, and with each other.

If interested, please send a short expression of interest (max 200 words) to the email address below, outlining your strengths as candidate for inclusion in such a review symposium. Depending upon response, we anticipate final contributions of c.3,000 words.

Deadlines:

 – Expressions of Interest: Monday 13th March, 2017.

 – Submission of Contributions: 31st October, 2017.

 – Publication in HHS: 2018.

If you have questions, please email Chris Millard: c[dot]millard[at]Sheffield[dot]ac[dot]uk

We look forward to hearing from you,

Felicity Callard (Editor-in-Chief) & Chris Millard (Reviews Editor)

What is philosophy of medicine good for?

An Interview with Cornelius Borck on his recently published book, Introduction to Philosophy of Medicine (in German: Medizinphilosophie. Zur Einführung, 2016. Junius: Hamburg)

by

Lara Keuck

Philosophy of medicine is booming. In the past decade or so, several special issues, textbooks and anthologies have been published that promise to chart the field. One of the most recent additions to this body of literature is The Routledge Companion to Philosophy of Medicine, edited by Miriam Solomon, Jeremy Simon and Harold Kincaid. While the editors strive to include a broad array of perspectives, their ‘predominant thread is the philosophy of medicine treated as part of the Anglophone philosophy of science tradition’ (p.2).

Earlier last year, Cornelius Borck, Professor of History of Medicine and Science Studies at the University of Lübeck in Germany, published a quite different book. Introduction to Philosophy of Medicine (in German: Medizinphilosophie. Zur Einführung) advocates a closer affiliation of philosophy of medicine with history, anthropology, and social studies of medicine, as well as with the phenomenological tradition in philosophy, moving it away from the predominant thread of analytic (and Anglophone) philosophy of science.

As more and more fields of life become medicalized, and indeed often seem to be inevitably medical, Borck urges his readers to stand back, and to look at the ‘functioning logics’’ (Funktionslogik) of evidence-based medicine, biomedicine, or palliative medicine from a critical distance. He puts the distinction between experiencing an illness and having a disease up front, and makes a strong argument that philosophy of medicine ought not be reduced to serving medicine in clarifying biomedical concepts of disease. Rather, philosophers of medicine should think about health and illness as phenomena of human life, for which medicine provides but one ‘pattern of interpretation’ (Deutungsmuster).

Borck exemplifies past and present approaches of medical reasoning. He opposes pre-modern doctors’ attempts of accompanying people through their illness to current trends of overly focusing on intervening medically into human conditions. Borck is not hesitant to make normative judgements, but they are carefully weighed, and they neither lend themselves to a general cultural pessimism nor to a naïve belief in technological progress. Drawing on a broad array of historical studies, the book rather wants to sensitize its readers to, first, an understanding of how medicine became the authority in providing, or at least searching for, scientific explanations for disorders of biological functioning; and, second, a critical engagement with this authority: birth, illness, pain, and dying became medical problems and to-be-solved ‘puzzles’ (Rätsel) of biomedicine. But are these really ‘problems’ that can, and should, be solved? Philosophy of medicine, in Borck’s reading, ought to be informed about medical developments, while propagating a philosophy of health and illness of its own that does not uncritically follow current medical trends. How does this interplay between closeness and distance work? And could this programmatic vision for philosophy of medicine work as an agenda for medical humanities?  I put these questions directly to Cornelius Borck, during a conversation that took place in Berlin and Lübeck, over December 2016

Lara Keuck (LK): I read your book as an invitation to think about what medicine is good for. You distance yourself from other approaches to philosophy of medicine that seem to be united by the basic assumption that medicine (if practiced well and based on solid scientific grounds) is good per se. You identify these approaches with Anglophone philosophy of science and the German tradition of theory of medicine. Do you think that these traditions are in principle ill-suited to address the questions that you raise?

Cornelius Borck (CB): I very much like your description of my book as ‘an invitation to think about what medicine is good for. There can be no question that medicine deals very effectively with many different medical problems and that access to affordable medical treatment is a high common good. As a specialized branch of philosophy of science, philosophy of medicine can thus zoom in on the ways in which biomedicine structures and organizes its practice, how it generates knowledge and orders it to explanatory theories, how its concepts articulate with decision strategies, how access to treatment is regulated and costs and benefits are distributed, etc. Unlike most other sciences, however, medicine does not start with an open search for knowledge; it cannot start from scratch, so to speak, as it deals with human suffering and illness. Illness and suffering precede any science; they call for medical intervention, which in turn shapes and formats states of illness into medical problems. Philosophy of medicine as the reasoning about the fundamental problems medicine is concerned with, should not start with an analysis of the problems as defined in medical practice but open its analysis to the formatting of these problems by medicine. Illness and suffering obviously go far beyond the boundaries of medicine, and medical practice addresses them explicitly and in scientific ways. Philosophy of medicine should hence also comprise a reflection about how it addresses health and illness.

LK: A couple of years ago, you co-edited a book called Maß und Eigensinn (‘Rule and Obstinacy’) that presented historical studies on medical sciences inspired by the work of the French epistemologist Georges Canguilhem. Your new book ends with the statement that philosophy of medicine can help society to articulate its obstinacy (Eigensinn) vis-à-vis medicine. Obstinacy captures only part of the meaning of ‘Eigensinn.’ In German, the term can also be applied to a person who shows integrity and self-coherence in her stubbornness. What does the concept mean to you?

CB: Well spotted! You are probably right in pointing this out as an idiosyncrasy of mine. Here, however, I had in mind what I regard the biopolitical relevance of philosophy of medicine: because biomedicine is so deeply entrenched in the current understanding of life and health, it defines almost every health related issue as a biomedical problem and assigns its interventions as the only salient solutions. Biomedicine’s descriptions of life-and-health-related problems tend to be taken as imperative and peremptory, without asking whether they serve a meaningful understanding of life and health – which obviously transgresses the limits of medical definitions in most instances. In his famous treatise on The Normal and the Pathological, Canguilhem determined the living as that form of being which not only follows rules and norms but establishes them in the first place – because of its obstinacy. Without such an obstinacy and autonomy life would simply not exist. This was the core idea of the book he finished in 1943, the same time he was an active member of the Resistance – and I think this is still an important message.

LK: While your book urges for more critical distance within philosophy of medicine, it is also filled with much details about recent developments, for instance in evidence-based medicine and palliative medicine. Could you elaborate a bit on how this interplay between closeness and distance to your subject of inquiry works? Do you regard this as a general methodology for philosophy of medicine?

CB: Many thanks for this zooming-in as it provides me the opportunity to state clearly that I do not conceive of philosophy of medicine as the search for a completely different form of medicine or as a credo for alternative and holistic medicine. On the contrary, I want to open philosophy of medicine and bring in the ‘critical distance’ you mention for discussing how well it serves in addressing the needs of particular patients. Evidence-based medicine (EBM) is the currently dominating framework of biomedicine and there is probably hardly a better way of doing medicine than ‘the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients,’ as David Sackett and his colleagues defined EBM. However, patients suffer from many different diseases with particular conditions and under very specific circumstances. The available evidence from clinical trials and other studies certainly offers important information, but for systematic, epistemological and pragmatic reasons this cannot cover every condition. A proper analysis of the details of EBM thus brings in critical distance as it reveals, for example, how EBM turns complex clinical conditions into discernible, treatable disease states and measurable treatment effects. Intended as the most accurate picture of the problems biomedicine has to deal with, EBM exerts a tendency to mistake the composite of EBM units for the world of medicine. And on another, more political and health-systems level, EBM introduced new forms of governance and regulation that increased transparency by linking medical services to cost effectiveness. Transparency is an important issue for democratic governance, but instead of opening new arenas for political debates on the health system, the decision-making often gets delegated to the anonymous power of statistical data.

Palliative care is an important topic for my analysis for two very different reasons: as a form of medical practice in the absence of curative treatment, it offers to explore how biomedicine deals with its own failure – and here I see a highly problematic medicalization of terminal care and dying, following on from the medicalization of birth. At the same time, palliative care operates in situations when medicine is cut off from its routines of effectiveness and hence allows us to study forms of practice adapted to individual needs. Where medicine gets disconnected from the imperatives of the perfect cure, a plurality of practices surface, which generate forms of significance and meaning which got lost with biomedicine’s effectiveness. In the absence of effective curative treatment, palliative care provides a window onto some of the other dimensions involved in medical practice that EBM and biomedicine have pushed to the side. At stake here is an ontology of disease conditions and states of illness according to a tinkering logic of care rather then the epistemology of biomedicine. Here, I see a special potential for phenomenology and the phenomenological analysis of states of illness.

LK: You extensively draw on anthropological, sociological and historical work in your book. Why did you decide to flag it as an introduction to philosophy of medicine?  You make clear that you are critical about the term ‘medical humanities.’ Yet, your book seems to me a prime example of both the fruitfulness of cross-talk between the meta-disciplines studying medicine and the importance of educating medical students (and society at large) to not only think about what is technically possible, but also about the limits of medical interventionism.

CB: I have already explained why philosophy of medicine should be more than the branch of philosophy of science specializing in medicine. As such a fundamental questioning, philosophy of medicine must build on the insights from science studies, anthropology and historical epistemology. If my book also serves as an introduction to medical humanities properly understood, I have no problems with that. In their present form however, ‘medical humanities’ often functions as a term describing an array of attempts to adapt biomedicine to the needs of patients without questioning the way biomedicine defines their problems. A good medical education must include some form of medical humanities and it should also offer some philosophical reflection on how biomedicine operates as a scientific practice – and in addition, philosophy of medicine should be the ‘cross-talk between the meta-disciplines studying medicine,’ as you just described it. Biomedicine has generated a wealth of possible and effective interventions. The problem with the technically possible is less the risks and costs involved, but the inherent tendency to foreclose a proper discussion about benefit. The limitations of medical interventionism transpire not along the limits of the technically possible but along their unlimited extension.

LK: Recently, Mark Zuckerberg, the founder of Facebook, and his wife, Priscilla Chan, advertised that they wanted to spend 100 billion dollars in biomedical (and bioinformatic) research, announcing the aim to eradicate all diseases by the end of this century. Your book reveals puzzle-solving to be the ‘working mode’ (Arbeitsmodus) of biomedicine and you argue that this is an ‘unattainable phantasm’ (uneinholbares Phantasma). You oppose philosophy of medicine to this reductionist understanding. Do you see a role for philosophers of medicine in publicly raising their voices in light of such news?

CB: The aim to treat more diseases and to treat them more effectively is very laudable. But it must be added that, on a global scale, the most pressing health problems are already now treatable and effectively manageable. Clean water, healthy food and good hygiene are still the most important factors determining health and disease epidemiologically.  Any initiative to eradicate disease by fostering biomedical research and bioinformatics is hence a very Western and elitist program. But that is another problem and not your question. Living without disease is an old dream, the hope for a new paradise. My suspicion about the Zuckerberg and Chan vision is that to eradicate all diseases does not lead to utopia but to an inhuman dystopia of perfected life, mistaking the ‘absence of disease’ with proper health – to echo the famous definition by the WHO. Alas, my scepticism regarding the Zuckerberg and Chan initiative does not rely on the assumption that diseases are necessary requirements for a meaningful life; it revolves around the understanding that frailty and failure are part and parcel of life itself – and not only of its defective forms. Strictly speaking, life can only be perfected by bringing it to its end. Philosophy of medicine can and should explain why the aim to eradicate disease is good but the underlying vision mistaken; and by the way, the Companion to Philosophy of Medicine you mentioned in the beginning is a nice example of how also the Anglophone branches of philosophy of medicine open up to this.

LK: Imagine Zuckerberg and Chan, inspired by the Human Genome Project, decided to reserve 1 % of this 100 billion dollar programme for the medical humanities. What should be done?

CB: They should, indeed, decide so, but for the form of cross-talk you mentioned! Since the Humane Genome Project we have ELSI, the study of the ethical, legal and social issues of biomedical research. This is more than a mere ‘nice to have,’ because it is important to explore these issues together with the scientific projects. But as it is implemented today, ELSI research follows rather the scientific agenda than interacting with it, and hence, discussion has started about how ELSI research can be better integrated in and connected with on-going biomedical research. In a similar way, medical humanities should be conceived not only as a training program but as a research area, interconnected with biomedical research. A substantial proportion of the 1 billion dollars should be hence allotted to patient groups and for citizen science projects, for articulating, fostering and incorporating their views, needs and values into the biomedical research agenda. And I would apply to Zuckerberg and Chan for funding an interdisciplinary PhD program in philosophy of medicine, offering philosophical reflection in combination with social studies and an immersion in clinical and lab-based research. Instead of specializing philosophers in a subfield, the program would train a new generation of cross-talkers with a thorough understanding of the articulation of research, needs and problems of the many actors in the health system. Their expertise and mediation will be required.

Lara Keuck specializes in history and philosophy of biomedical knowledge. She leads a junior research group on “Learning from Alzheimer’s disease. A history of biomedical models of mental illness”. The group is based at the Department of History at Humboldt University in Berlin, Germany, and is funded through ETH Zurich’s “Society in Science – The Branco Weiss Fellowship”. Together with Geert Keil and Rico Hauswald she has just published an edited volume on Vagueness in Psychiatry (Oxford University Press, 2017).

Cornelius Borck studied medicine and philosophy and is director of the Institute of History of Medicine and Science Studies of the University of Lübeck, Germany. Before coming to Lübeck, he held a Canada Research Chair in Philosophy and Language of Medicine at McGill University in Montreal. Beyond philosophy of medicine, he works on the history of brain research between media technology and neurophilosophy and on  the epistemology of experimentation in art and science.

Medizinphilosophie. Zur Einführung is out now from Junius Verlag.