Thinking in, with, across, and beyond cases with John Forrester – interview with special issue co-editor Chris Millard

A new double special issue of History of the Human Sciences edited by Felicity Callard and Chris Millard has just been released. Chris Millard spoke to Hannah Proctor about how the special issue came about and how the contributions responded to, extended and celebrated the work of John Forrester.

HP: The special issue celebrates the work of the late John Forrester and specifically his essay ‘If p, then what? Thinking in cases’, published in History of the Human Sciences in 1996. The introduction to the special issue contends that the essay transformed understandings of what a case was – could you explain what was so significant about the essay?

CM: I think the essay managed to bring into focus the case, which is a particular part of the armory of the human sciences, a way of talking about a particular life or even a particular instance that has significance. Forrester ranges across disciplines looking at cases, looking at case law and, of course, looking at the psychoanalytic case that was extremely close to all of his work. And it gave people a way into a whole host of questions about how cases do the work that they do.

I don’t necessarily think that Forrester, answered the questions he posed. I don’t think that the essay was intended to answer questions. It was intended to to provoke. I still find the essay challenging and incredibly rich – new things come up whenever I reread it. The real power of it is that it doesn’t pretend to settle any questions, but it makes you aware of questions you were only half aware of before.

HP: Do you also think the essay is significant in terms of how it chimes with the overarching concerns of the journal?

CM: Yes, as I said I think it was about one particular weapon in the armory of the human sciences and so absolutely it resonates with the concerns of the journal. You can’t think of the human sciences without thinking about the relationship of cases to broader ways of understanding human beings, understanding human nature, understanding humanity. I think it’s quite rare that you get such a fundamental part of that way of understanding humans that’s so fundamentally brought to light in one essay and that spawns so many lines of thought that shoot off in different directions. Actually part of the problem with putting this special issue together was that it almost became unmanageable in its fertility, in the way that it provoked so many different people to run off with it in different directions. There’s just so much richness that it became almost bewildering at times, but in a good way.

HP: How did this special issue come about?

I was the reviews editor at the time and the essay collection Thinking in Cases landed on my desk. I didn’t know John Forrester personally but knew that he had died recently and I thought there were so many people that I knew working in and around the human sciences and around the history of psychiatry and psychosis who were working in ways that connected with this book so I thought let’s have a review symposium responding to it. And because the original essay was first published in History of the Human Sciences I thought that would be really apt. It’s all just snowballed from there. We ended up asking for contributions, I think of 3000 words, and people came back to us asking if they could write more. It was really driven by people who wanted to contribute and who had so much to say. It powered itself foremost. Scholars gave their time so freely, gave so much of their time and effort to producing these pieces and that’s what made it difficult, but also really wonderful to work with.

HP: I was struck re-reading Forrester’s essay that he emphasises in his discussion of psychoanalytic cases that the disclosures in any case are always matched by silences. Perhaps in some sense no case can ever really ‘succeed’ and failure is a theme that unites several of the contributions to the special issue – what is revealed when cases fail? Can failure take different forms? Can failures be generative?

CM: Yeah, I think when things fail or break down it’s almost more interesting than when they succeed, because success doesn’t lead you to question your premises but failure often does. Failure is a really emphatic event that lays bare the machinery of how the case is supposed to work. I think Erik Linstrum’s piece especially is about failure and it helps understand things like power. Sometimes in a Foucaultian idea of power, it ends up being so all encompassing that you wonder how things ever change at all. And yet when they fail you don’t have to look very hard for grounds for resistance or grounds for agency, which are the things that normally recede in that crude Foucaultian telling.

So, yes, failure is significant, but the impossibility of success is also significant, and I think they’re usefully kept distinct. I think what Matt ffytche’s article on the ‘impossible case’ of Luisa Passerini shows is that success isn’t always possible. But that impossibility is more interesting than thinking of it necessarily as a failure in conventional terms.

HP: Yeah, it’s such a good example of a new genre that emerges because the existing genres are not really adequate to the material.

CM: Yeah and ffytche’s article is a wonderful analytical survey of this these kinds of writing and the ways that when you push at the boundaries of autobiography or self-case making or autoethnography, or examine the way human beings narrate about themselves, it’s such a rich vein that spans disciplines. You know, you tend to think ‘oh this is about psychoanalysis and it’s probably about anthropology’ but there are so many other ways of human beings writing themselves and narrating themselves that show how even your most secure sense of who you are just collapses under the slightest bit of interrogation.

HP: The pieces in the special issue are striking in terms of their disciplinary range (which is also reflected in Forrester’s essay) – does this say something about the relative hetereogeneity of ‘case thinking’?

CM: The real gift in that paper and in all the essays in the book, was the ability to show that in any place where human beings are being talked about or are talking about themselves you can you can start to break them down to see how they work.

I don’t think we consciously decided this was going to be an interdisciplinary project. I don’t actually particularly like the word, which I think has become diseased by funding calls, going back 30 years, where you’re prizing interdisciplinary just because. But it’s a real credit to the flexibility and the richness of that essay that when we sent the call out and people responded, that we had no idea that people were working with and around cases or on Forrester in those ways. I think that’s one of the real bonuses of doing an open call but also having channels of circulation through a mailing list that can reach out to places and get cross posted in ways that that wouldn’t have been possible 25 years ago.

Mary Morgan’s paper, for example, is a really challenging and a really fantastic riffing off Forrester’s title in a way that I just found almost virtuosic and she wasn’t somebody who we would necessarily have had in mind to approach as our original call was aimed at early career researchers, but she responded. It was that enthusiasm where people, even though they weren’t necessarily being spoken to, wanted to come on board. They wanted to contribute. I don’t think I’ve ever seen that really before. People really love this essay, even if they have problems with it, they really want to talk about it.

HP: Many of the contributors reflect on the case history as a genre – both in terms of what that opens up but also in terms of its limitations – Maria Böhmer discusses the capacity of the case to ‘travel’, while Michael Flexer emphasises the linearity of case thinking and points to historical instances that ‘thinking in cases’ acted as a constraint – how do these interventions extend or challenge Forrester’s work on cases?

CM: I think the way that cases travel is really quite basic to their utility, in that they are a nice sort of parcelling up of either an exemplar or as an illustration of a particular principle. What Maria Böhmer’s essay does is it puts really useful empirical flesh on those bones. People wouldn’t be necessarily surprised that a case travels and circulates in networks, but when you have to dig down and find the examples, those examples can push back on how you thought the case travels: across from medicine to the more journalistic. The sensational ways in which the particular case of the man who crucified himself that she discusses were talked about. Getting into those empirical examples can be really useful.

Michael Flexer’s paper, which I’ll admit I found difficult, rattled around in my head for weeks after reading it because he’s trying to strip the case back to its bare bones. He’s asking, what is it that makes something emerge as something that might be made into a case in the first place? So it’s not taking the case as the starting point but is asking, how do we even know how the raw material emerges to get made into a case? What he does really clearly is show how even before you think you have a case you’re getting locked into a particular direction of travel, where a lot of other assumptions can very easily plug you in and push you forwards. He discusses the example of the AIDS pandemic, where all those prejudices around particular communities of men were just laid bare, especially because people could not understand where their case reasoning was pushing them.

HP: Erik Linstrum’s contribution discusses colonial cases and the challenge the kinds of individual traumas they documented posed to colonial rulers. Linstrum discusses how the kinds of testimonies contained in cases conflicted with the ideologies of the colonial rulers, suggesting that the case might be a disruptive genre that can exceed or confound attempts to generalise. Does this analysis point to ways case histories be treated as historical documents?

CM: Often when people talk of power in the human sciences, they’re talking about thoughts and ways of thinking and expertise and advice. All of that is real and effective, of course, but we’re not often talking about machine guns and police forces that keep people in place. I think part of what what Erik Linstrum’s paper does is it looks at the – I don’t want to call it soft power because I mean something quite different – but it look at the intellectual power relations that are involved in making people into cases and subjecting them to expertise.

And that just doesn’t work in an environment that is strafed by a very different kind of power and a very different kind of resistance. When you put different kinds of power and different kinds of attempts to enforce governance together – so here there’s the governance of the psychoanalytic overarching framework that puts people into a particular relationship with power but there’s also the militarised imperial power – and those just don’t fit. That really shows us, I think, something quite important about how power works, but also how it doesn’t. I think that what’s really in illuminating there is that failure of the case to do anything but sort of say, ‘Well, here’s some ‘natives’ and they have very strong murderous impulses towards their leaders. Oh, well, hang on a minute. No, we can’t say that.’ The colonial elite simply can’t use the case they’ve produced because it documents something that is impossible for them to acknowledge.  

This essay, like many in the Special Issue, I’ve read and proofed and been very close to and every time I re-read it I notice different things and find my head is spinning with connections. I don’t know if that’s solely a testement to Forrester’s work but it’s amazing that it’s generated such generorous and constructive responses. They bring his insights to their work. You don’t have to pull Forrester out of shape to have him talk to your work because it’s so open.

HP: Matt ffytche approaches the question of genre from a slightly different perspective, by focusing on an example of what he calls an ‘exploding’ or ‘impossible’ case – Luisa Passeri’s Autobiography of a Generation: Italy, 1968. Here the individual case history is destabilised by the forces of history, which seems to demand a different kind of narrative.  In Autobiography of a Generation, ffytche oberves, ‘the personal and the social… act as metonyms for each other’, but I wondered if that was also true of all cases in some sense?

CM: I’m fascinated by how people use ‘the social’ and the things that they think inhabit it and the power that it has and also doesn’t have. It’s sort of like a case in the way that it’s this incredibly amorphous thing that explains everything and therefore explains nothing.

I love Passerini’s book partly because it’s such a traumatic and chaotic mess that I think, well, if you can turn a chaotic mess into something brilliant then I’ve got some hope for some of my life. It’s so – I don’t want to say honest because honest makes it seem weirdly confessional – but it lays bare its own wiring in a way that I think is really powerful. And I think it makes it difficult because you’re never quite sure that you’ve got it. It never closes, it never satisfies, it never gives you that neat finish. And that’s life.

Being able to put that into a book – when every sinew of you when you’re writing a book is trying to close it and finish it and get it into this disciplined form – for a book to manage not to do that really impresses me.

I’m going to go back to the original thrust of the question about the comparison with the social. Whenever you write a human or a group of humans you’re always in the middle of personal agency and social/structural agency. There are so many frames of reference that are always already there, pulling out of focus. Going in and being able to think about the person and the social and history, about the way history impacts individuals without collapsing the social when you go down to the individual and without erasing the individual when you go to the structural but existing in neither and both of these spaces at the same time, I think that’s what she what she’s trying to do. She does have to flip between her psychoanalysis and her interviews and a broad sense of the history and it is chaotic but it’s not chaotic because she is a bad writer. It’s chaotic because the project she is trying to do can never actually succeed (to go back to the point we were discussing before).

It really illuminates the case by sort of showing it up, by showing how it is both inadequate and also kind of super adequate in that there’s too much in it. It’s like that classic Joan Scott thing about gender being an empty and overflowing category. I think of cases as telling us nothing and everything. They tell us nothing at all and far too much because of the way that they can connect to everything. They can explain everything and they can be explained by everything in a way that makes you really have to make some pretty serious choices analytically before you even start. You’ll never exhaust the case.

I think one of the things that used to annoy me when I was an undergraduate and postgraduate student when I looked at psychoanalytic practitioners who I was researching is that everything is so overdetermined. It used to really annoy me that there are 5678910 reasons for why one thing happened and then more and then more and more. That irritated me for whatever reason, but then you begin to see how everything makes some kind of sense because of the power of that that reading strategy, the strategy of reading everything through it and I ended up not hating it quite so much, but just being being really interested in what that does for your analytical possibilities.

HP: Did revisiting Forrester’s essay and reading these responses to it change or nuance how you think about cases?

CM: I think it has to have done. I mean, one of the things I think we haven’t touched on is how long this project has been in the works. Initially I think we sent out a call at the very beginning of 2018 so it’s been a long time. So yeah my thinking has absolutely changed.

I first read the essay, I think in the first year of my PhD ,and then again during my postdoc, and then again teaching. Every single time new things leap out to me and that isn’t always the case with even very good articles.

Having this group of people writing in their own different directions has really shown is the impossibility of case thinking even though it’s a very useful and usable concept. I still think it’s an impossible concept because case thinking is far too broad. It’s almost as if it’s so broad that it should collapse on itself and become useless but somehow it isn’t and so somehow it doen’t. I’m trying to write a book at the moment about how personal experiences of the things you’re studying might impact or be made clear or be made explicit in writing histories and how personal experiences are always already there and your case, the case of yourself, that’s always there in every history. And I think I’d go as far as to say, at least if this were on Twitter, I would say all history writing is displaced autobiography. I’m not ready to defend that actually but I still believe it and I think that ‘Thinking in Cases’ has really helped me show up what’s important in history writing and writing in general about humans in a way that I never would have imagined when I first downloaded it. This is a difficult essay. It’s really interesting but my god I don’t really get it and here I am still not really getting it 10 years later. Some essays are difficult because they’re difficult and some essays are difficult because they’re brilliant and I think Forrester’s essay is the latter.

I love Julie Walsh’s re-doing of Forrester’s essay ‘Inventing Gender Identity: the Case of Agnes’. I’ve read and reread it. I would never have thought that something as chaotic [as a case] could be as generous and as meaningfully generous that it could generate that reading of how gender identity is a process. There’s an awful lot of heat and not a lot of light around that issue at the moment. Julie Walsh’s essays cuts through that so beautifully and, again, in a way that reading Forrester’s original essay you’d think, where the hell’s that come from? I love how open and generous complexity and nuance can be, how the impossibility and the unfinishedness of cases can be bewildering and chaotic but it can be generous and open and compassionate.

‘Ghastly Marionettes’ – interview with Danielle Judith Zola Carr, winner of History of the Human Sciences’ Early Career Essay Prize

History of the Human Sciences is delighted to announce Danielle Judith Zola Carr (Columbia University) as the winner of the journal’s first Early Career Essay Prize for her essay ‘Ghastly Marionettes and the political metaphysics of cognitive liberalism: Anti-behaviourism, language, and The Origins of Totalitarianism’. Katie Joice (Birkbeck, University of London) was awarded a commendation for her essay ‘Mothering in the Frame: Cinematic Microanalysis and the Pathogenic Mother, 1945-67’. Congratulations to both scholars.

‘Ghastly Marionettes’ was included in our Special Issue on Cybernetics, published in February 2020, guest edited by Stefanos Geroulanos and Leif Weatherby. We spoke to the author about the essay, Hannah Arendt, Cold War liberalism and the place of intellectual history within the history of the human sciences.

HHS: First of all, congratulations on winning the History of the Human Sciences Early Career Essay Prize for your essay ‘Ghastly Marionettes and the political metaphysics of cognitive liberalism: Anti-behaviourism, language, and The Origins of Totalitarianism’. Can you tell us a bit about the piece?

DC: Thank you so much. It was a pleasure to publish with the journal. The essay actually originated as an early 2017 post-Trump piece, when I think everyone was reading The Origins of Totalitarianism. It was my first time reading it, and I was struck by how infused the book is– especially in its last third–with a castigation of the Pavolovian imaginary of the human, and how that imaginary of a human determined by stimulus and response was equivocated with this new Cold War concept of totalitarianism. So I started looking into that realised that nobody seemed to have written about that specifically in relation to Arendt

I think Arendt is a good figure to think with, because she encapsulates this emerging Cold War common sense– what many scholars now are starting to think about as Cold War liberalism. One of the questions in thinking about Cold War political ideology is this: What is this liberalism that happens in the postwar period going into the Cold War and how is it distinct from early twentiety-century liberalism? In the early twentieth century, there is a lot of space for thinking about technocracy, technologies and human engineering in relation to  the Progressive-Era emergence of social science, largely funded by the Rockefeller and Ford Foundation. There are critiques of the idea of engineering the human, but they are coming from the religious right and the labor left, not the liberals. What’s really distinctive about postwar liberalism is that this friendly relationship to social engineering disappears. Suddenly, Cold War liberals are thinking about the human as being something distinct from technology, as a being not determined by the same sort of push-button responses that you can use to control machines.

I thought that that gave an interesting vantage on to a question that is relevant to the history of cybernetics: why did cybernetics fail, while cognitivism was successfully taken up as a scientific movement? Many times, when we are thinking about information theory in the history of science, it’s easy to say that cybernetics is the basis of contemporary information sciences. Cerrtainly in some ways that’s true – particularly if we are thinking about the role of cybernetics in developing information theory and influencing the computerisation of many scientific fields. But equally, there’s something key about cybernetics that fails to take hold. What my essay tries to do is to show that there’s something going on in what we could call Cold War liberalism that makes that political project incompatible with cybernetics, but that makes it form the conditioning ground for cognitivism.

The approach that I take in the essay is part of my overarching method, which is to treat the history of science as intellectual history. The goal is not just to read the history of science alongside intellectual history, but to say we can do intellectual history within the sciences. This makes sense as an approach, because this is a moment when science has been popularised for mass consumption: the cybernetics conferences are being covered by major newspapers, for example, and you have this efflorescence of popular writing in the postwar period as ordinary people become interested in technology. The atomic bomb is this huge moment in American consciousness. You have a spate of high profile technologies that emerged through the infusion of federal funding into the sciences driven by the war. With the rapid ascent of the sciences, suddenly everyone is reading Norbert Weiner’s Cybernetics, and there is an exploding popular market for writing about science. This is also a moment of profound interdisciplinary fusion between the social and physical sciences, as Jamie Cohen-Cole has shown. So Origins of Totalitarianism—and liberal political thought in general—is happening in a moment in which the political thinkers are reading the scientists and the scientists are reading the political thinkers. It makes sense to take an historical approach  which thinks of these groups as literally talking to each other, because they were.

HHS: Before I ask you more about the essay itself I wonder if you could briefly talk about your PhD dissertation project and situate this essay in relation to your research more broadly.

DC: My dissertation is about a weird historical stutter: brain implants for a psychiatric disorder are invented for permanent intercerebral use in humans in the 1950s, then disappear after the 1970s, only to reemerge again in the early 2000s with no reference to their Cold War past. You have to understand, brain stimulation for psychiatric research and treatment was not a fringe technology in the fifties. The people who were working on it were going to conferences with all the other neurophysiologists; they were leaders in the field. This goes on into the 1970s, as people try to find the neurological basis for hunger, sex pleasure, aggression, and so on. As you go into the 1970s, this becomes explicitly political, as people are trying to find things like the neurological basis of race riots. For instance, here in LA, there was a collaboration between the justice department and the neurophysiologists who wanted to start a research centre to find the neurological basis of aggression, which is of course, a racialised aggression. And so in the 1970s, the question of neurological control becomes a political problem. There were literally congressional hearings about this specific technology, which then disappears and then comes back in the early 2000s with no reference to its contested history.

What the PhD thesis asks is this: why is that brain implants for psychiatric states—a technology that was technologically possible since the 1950s– politically impossible, politically incompatible with what we want to think of as liberalism. And why, moreover, is it now compatible with regnant political ideologies of the subject once again? This essay tells a little piece of that story, the part that has to do with what’s happening in the 1950s around ideas of determinism, mechanism, language, and freedom. It lays out how it came to be the case that, by the 1970s, this technology is seen as the limit case of Big Brother government, as technocratic overreach. It was like the apotheosis of what the antipsychiatry movement was going against. In its current revivification, the people behind it are data capitalists and DARPA, the science branch of the US military. And I think that tells us something about how political ideology has accomodated and conditioned itself  to changes in the value production from liberalism to neoliberalism—or however you want to periodize the 1970s to the present.

HHS: When you were introducing the essay, you were talking about this moment where behaviourism is dominant and then briefly challenged by cybernetics, but cybernetics doesn’t really succeed and cognitivism eventually ‘wins’, so to speak. You are clear that Arendt was not (and could not have been) a cognitivist but nonetheless suggest that she could be understood as a kind of proto-cognitivist in some sense.

DC: One of the axes that I wanted to grind is this paper was to more clearly elucidate the relationship between behaviourism and cybernetics. It’s not just that cybernetics goes against behaviourism, displaces it, and wins. It’s that cybernetics tries to replace behaviourism and fails, because it tries to replace the wrong thing– that’s what dooms it. Metaphysically– and this is really an essay about political metaphysics – cybernetics stays in the thrall of what it is about behaviourism that’s going to be nixed by cognitivism. And that’s an metaphysics that does not particularly allow for freedom. Of course, freedom and creativity are the things that dog cybernetics as the problem that it’s going to have to solve in order to be compatible with Cold War liberalism. What cybernetics shares with behaviourism is that it is premised on a metaphysics without transcendence.

Arendt is in many ways a good bellwether for what is shared in common by many postwar liberals. She is specifically saying that you have to have an outside to the world of mechanistic cause and effect; you have to have a space of non-determinism. That “outside” to the ordinary world is where we’re going to locate politics. So for Arendt, that space of the “outside” is going to be language, and language is not going to work mechanistically. I’m not saying that Arendt is a cognitivist, but I am saying that the pieces for cognitivism to succeed are already in place by the 1950s, by the time that she publishes The Origins of Totalitarianism. Cognitivism is taken up because it solves precisely the problems that she’s laying out.

HHS: Almost like it’s waiting in the wings.

DC: Exactly. There are two bad ways of doing the history of scienced. The first one—one that we all already know is wrong, is to look at a period of scientific contestation say, ‘Well, the scientific truth succeeded and the good guys won.’ But the second mistake—one that isn’t as clearly bad but that can be pernicious—is to solely focus on scientific practice, looking at what happens in the lab and identifying alliances between groups of people, instruments and object (blah blah blah, Latour). And I want to say that there is a way to let politics as such back in. It’s not that there is not a determining relation between political ideology and scientific thought, but there is a conditioning role between political ideology and scientific practice. This is especially true when we’re talking about the history of the human sciences that are asking questions like ‘what is the human?’

HHS: From reading your essay it seems that language is central to Arendt’s understanding of freedom. Could you explain why language had this significance for her and how it relates to her valorisation of spontaneity?

DC: As an anthropologist, I know this history best in terms of what happens with structuralism in the midcentury. There’s a move away from physicality and the material—this is the decline of functionalism–  and the rise of the idea that what’s human about the human has very little to do with the body or the physical environment. In French structuralism, particularly French structuralism, the human is comprised of symbolic systems. The subject is comprised in language. So you have a general movement away from the material and into what I call “linguistic idealism.” Arendt is part of that intellectual movement to say that what is human about the human is not tool use, it’s language.

Your question is also picking up on something that I was trying to do, which is to connect this fixation on language as a non-deterministic space with the resurgence of postwar vitalism. For midcentury liberals, there’s something about life, language and the cognitive subject that does not operate according to mechanism. And the fact that it isn’t determined by material laws has a political valence of “good,” basically. Language is key in all of these kinds of different sites as being the place where this political metaphysics is going to ratchet open a metaphysical space for the kind of freedom that’s central to Cold War liberalism.

HHS: What did Arendt mean when she spoke of the ‘psychic life of totalitarianism’? Or would it make more sense to say that she understood totalitarianism as the absence of psychic life or the negation of the psyche? You mention other contemporaneous projects that sought to understand totalitarianism from a psychological perspective – how was The Origins of Totalitarianism distinct from these?

DC: For Arendt, there is no psychic life of totalitarianism because it is the operation of totalitarianism to destroy what she would recognise as the psyche. And the way this idea of the mind as the zone of freedom comes together will be crucial in shaping the next thirty years of political common sense in the United States. Something interesting happens from the fifties to the seventies:  this idea that totalitarianism relies on an evacuated mind—one that is overdetermined by external forces– becomes key what will become the kind of antibureaucratic, proto-libertarian movement, that, by the 1970s becomes Silicon Valley ideology. There’s a wonderful book by Fred Turner called From Counterculture to Cyberculture that charts this development. You can also see it in, for instance, Marcuse’s One Dimensional Man and the critique of the bureaucratised, mass consumptive subject that happens in the Frankfurt School.

What you see happening is a kind of dialectical formation, such that, by the time you get to the seventies, the antipsychiatry movement– which is basically libertarian– is able to make strange bedfellows with the residue of this Cold War liberal discourse. One of the reasons that I picked Arendt to be my interlocutor here is not because she’s saying anything particularly fringy, but that she’s really giving voice to this ambient common sense: to think is the opposite of totalitarianism because for the behaviourist there is no such thing as the thinking subject, there’s no inside, there’s no mind. So the very presence of mind is a political presence.

HHS: I was intrigued by the term the ‘laboratory of behaviourism’ in the essay and wondered if you could define that or talk about how Arendt defined it.

DC: One of the craziest things that shakes out of doing close reading of Origins of Totalitarianism is that when Arendt talks about the camps as being a laboratory, it’s not a metaphor. She’s not saying the camps are like the behaviourist’s laboratory, she’s saying the camps are the behaviourist laboratory. This connects with stuff that will begin happening in psychology in the early 1960s, where people look at, for instance, Stanley Milgram’s experiments and say “You’re not showing us anything about totalitarianism; what you’re doing is totalitarianism.” This is where a lot of what will, by the 1980s, become bioethics begins to come from. It’s the idea that science is not necessarily telling us something about the world occurring elsewhere outside of the lab; politics and the creation of a certain form of human subject is occurring in the laboratory. One of the things I wanted to do was to connect what will become bioethics in the US with Arendt saying that the camps are a laboratory.

HHS: This also made me think of antipsychiatric discourse and its obsession with institutions and the question of how institutions relate to society or are metonyms for society.

DC: Completely! You see an anxiety about the possibility of creating a new form of the human in discourses like, for instance, Goffman’s idea of “total institutions.” This idea that there’s something fundamentally artificial about these institutions and that can be connected with what is happening in the 1920s and 1930s. Rebecca Lemov’s book World as Laboratory is really excellent on this, where you begin from the scientists end to say, we can use the world as a laboratory. We can run experiments on an entire town. The world itself becomes an experiment.

HHS: You cite Arendt discussing Pavlov’s dogs and I wondered if it’s significant for her that this is the dominant paradigm in the Soviet Union.

DC: Definitely. One of the crucial features of The Origin of Totalitarianism– and Cold War liberalism generally– is this formation of the concept of totalitarianism, specifically as a way of making equivalent the Soviets and the Nazis. The revisions to her book made just before it goes to publication show that she quickly added a lot of stuff about the Soviet Union in order to underline this equivocation. You have to remember, Pavlov is one of the leading scientists of the Soviet Union, and one of their claims to an illustrious scientifi heritage, and this matters in the scientific and ideological race with the Soviets.

HHS: At the beginning of this interview you said this originated as a post-Trump essay. I was wondering about parallels or analogies (or indeed the lack of them) that you see between the historical moment you’re analysing and the present moment. You talk about the collapse of liberalism and its postwar resuscitation, but you also have spoken about how Cold War liberalism was distinctive and I wondered how this relates to liberalism today.

DC: I think liberalism has a fundamental contradiction at its core. There is the idea that the body is something that’s common to all humans; this common body is going to be the basis of common knowledge and by implication also freedom and choiceboth epistemic democracy (like science) and political equivalence (like human rights). There’s an idea that a common body equals a common humanity. But the problem is that once you start taking the body seriously as something that can be governed and known through science, the question of whether the human is actually free emerges. The fundamental contradiction of liberalism continually reasserts itself and has to be solved: Foucault calls it the tension between discipline and ideologies of freedom. I want to suggest that this tension relates to the fact that liberalism is a political ideology that is perpetually collapsing.

What we’re seeing in the current moment is yet another implosion of liberalism. It is not identical, to but certainly has features that are in common with, earlier collapses of liberalism. My essay charts one attempt to recover liberalism from an earlier collapse, in this case Cold War liberalism’s attempt to salvage the wreckage of the failure of early 20th century liberalism. We are facing a similar problem today, one that should cause us to seriously reckon with whether liberalism is something we even want to attempt to reconstruct.

You have to hand it to Cold War liberals, at least they understood that something had gone fundamentally wrong, and there was going to have to be a metaphysical recalibration in the heart of what liberalism was in order to fix it. Our problem now is that for current liberals, all their answers to this crisis are nostalgic. Liberals today don’t understand that the crisis is structural, fundamental and integral. They don’t understand that what liberalism is is going to have to be reconstituted. There’s a general failure of liberals to apprehend the magnitude of the failure that Trump represents.

There’s a lot of talk now about QAnon and conspiracy theories and this almost mystical side of American fascism. I think that we have to think about that as being a response to the evacuated technocratic forms of governance that marked liberal governance from Clinton to Obama. It’s a form of governance in which you have this ascent of elite technocratic knowledge that says “There’s no need for politics here, experts will decide everything because the technocrats know best.” And as is always the case with technocracy, it has produced a hunger for politics as such. So I would say that it is possible to make sense of the present moment as a rupture of political theology—that is, of metaphysics.

In my view we have to accept that there is a resurgence of the political and directly incorporate it into our work. What this looks like for historians of the human sciences is not just a fixation on infrastructure studies or actor network theory, both of which are ways of trying to get ‘reality’ back into the humanistic inquiry that has been dominated by exactly the sort of linguistic idealism that I discuss in the paper. There’s no way out except to directly reckon with politics. So, in short, we need to become historical materialists.

HHS: That seems like a great place to conclude – thank you!

(Interview conducted by Hannah Proctor)

Include everything

The December 2018 issue of The History of the Human Sciences presents a collection of essays dedicated to understanding the historical, political, moral and aesthetic issues in totalizing projects of late modernity – ‘The Total Archive: Data, Identity, Universality.’ Here the issue’s editors, Boris Jardine and Matthew Drage, discuss the origins of the project and some of their ideas about the image and pragmatics of universal knowledge.

Matthew Drage (MD): Boris, tell me a bit about how the idea for this special issue came about?

Boris Jardine (BJ): I was visiting the Max Planck Institute (MPI) for the History of Science (Berlin) in 2014, as part of the working group ‘Historicizing Big Data’ – but I was only at the MPI briefly, and when I was back in Cambridge I wanted to do something that drew on what I’d learnt there, involving some of the fantastic scholars I’d met. It seemed to me that the idea/reality of ‘The Archive/archives’ supervened on notions of ‘data’, and that there were philosophical, ethical and historical issues around classification, privacy and knowledge that became pressing when the concept of ‘totality’ came into play. I was also talking to historians in different fields – economic history, history of bio-medicine, art history/aesthetics – and wanted to do something that connected those. With some colleagues I proposed a conference at CRASSH (Centre for Research in Arts, Social Sciences and Humanities) in Cambridge, which happened in March 2015. So this has been a while germinating!

MD: I know might be is a slightly strange side of the story , but my recollection is that it was also connected to an art project that we were both involved in.

BJ: Yes, ‘UA’, or ‘Elements of Religion’ as it was originally known. That was how I/we got to the idea of the aesthetics of totality, as a (quasi) religious idea. I wrote about that in the special issue of LIMN that came out soon after the conference. But you’re better placed to explain what that project was…

MD: I’ll do my best! So at the same time that Boris was thinking about the historical questions surrounding the emergence of the first really huge data projects of the 21st century – we were both part of an Arts Council project which aimed to consider totality from a rather different perspective. We were thinking and talking about the ways in which religions sought to encompass totalities, and how the productive modes that religions often house (text-writing, ritual, song, architecture, healing practices, contemplation) are arranged to create all-encompassing institutional wholes. And we were trying to produce our own productive systems styled on religion, as a way of making and viewing artworks. John Tresch, a historian of science who influenced mine and Boris’s introduction to the special issue, writes at length how the Auguste Comte sought to create a ‘religion of positivism’ – a religion built entirely on the ideal of total human knowledge. Our work on the aesthetics of total knowledge as parts of ‘Elements of Religion’ gave us a perspective on the emergent debates about big data that we then went on to explore in the conference in 2015, and then the special issue.

BJ: So a large part of what we were/are thinking about is to do with ‘images’ of totality – that can indicate literal images, but it also has a broader meaning. Perhaps you could say something about that, and how the contributors addressed it?

MD: I think this was what I found most exciting about the contributions – the range of ways in which the authors dealt with and understood ‘images’ of totality. In the case of Judith Kaplan’s work, for example, sometimes this took the form of poetic images. Her article examines (in part) the work of a group of Russian historical linguistic scholars, who collaborated with Americans in the 1990s to attempt to uncover the deep pre-history of human language. One of the field’s founding fathers, V. M. Illich-Svitych, Kaplan tells us, pieced together a projected ‘Nostratic’ language, which, he claimed, gave birth to eight major world language groups. In the language he had devised, he composed poems. In one, he wrote,

Language is a ford through the river of Time, 

It leads us to the dwelling place of those gone ahead; 

But he does not arrive there

Who is afraid of deep water. 

I think this typifies the kind of visionary, sometimes even mystical perspective that, as the authors in this issue show, seem to emerge when people take the image of the total archive very seriously as a model for human knowledge. It seem to draw those who are involved into (and perhaps sometimes past) the limits of human subjectivity, and then to confront them, sometimes violently, with the political, moral, aesthetic and spiritual consequences. 

BJ: I love that this example is also about pragmatics. Kaplan explains how Illich-Svitych was trying to resolve quite a difficult technical issue in historical linguistics when he came up with this hypothesis about a single overarching language family. That seems to be a typical move – or one of two kinds of move: sometimes people start with a problem they want to solve and realise that they’ve come up with a procedure before coming up with a classification, at which point they end up with problems of scale, manageability, even moral issues to do with representation and ownership. This is striking in the case of Alan Lomax, as described by Whitney Laemmli. That’s also what I found with Mass-Observation. And it’s obviously a very contemporary concern in the age of social media, genetic data etc. The other direction is also interesting though: the ‘Casaubon method’, where you have a ‘key to all mythologies’ and collect or order everything within that system, or find a way to order everything in such a way that nothing can be added or taken away. Just thinking of Edward Casaubon from Middlemarch though, do you think there are important issues of gender and gendered knowledge in this collection?

MD: Something that comes through very strongly in a lot of the articles in this issue is the relationship between ambitious, utopian institution-building and patriarchal power. This is something that Jacques Derrida talks a lot about in his long essay, Archive Fever, which has a lot to say about how psychoanalysis – one of the 20th century’s defining knowledge projects – was very strongly structured by a Jewish patriarchal logic that valorises ritualised transmissions from father to son. Many of his conclusions there could, I think, be justly extended to cover the cases covered in this special issue. The dream of universal knowledge was often also a dream of extending the agency of individual men, institutions, nations, to encompass totalities which would then be pressed into their service, and a the same time used as a means of by which to draw in ever-greater quantities of data. Rebecca Lemov’s article, which describes the data-gathering practices of the American military in the South Pacific, is particularly good at showing how this masculinist, almost “conquestadorial” urge plays out in practice in the human sciences.

BJ: Another way to think about it – though maybe it raises more questions than it provides answers – is in terms of subjectivity: the archival subject, as (on the one hand) an organizer, possibly even a heroic or all-knowing organizer, then (on the other) an invisible labourer, cleaning up, sorting the data, enlisting subjects, becoming a subject (as in Mass-Observation), and finally (on the third hand?) the knowing subject – but I think this is where we kept hitting up against this idea of ‘pathology’ in totalizing projects. There is often ‘too much to know’, too much to organize, no place to start. I use the term ‘bathos’ to describe this for Mass-Observation but it’s definitely also present in Lemov’s piece in the figure of Tarev (a Micronesian person who displays behavior that baffles the measurement systems of the Americans sent to study him) and how he can’t quite find his place in the social data project run by Melford Spiro. The thing that links these is the critique of universality, which is there in our introduction and in some of the essays, but is probably best articulated in Cadence Kinsey’s piece on Camille Henrot and her work Grosse Fatigue.

MD: Maybe this brings us to an important point: there has been a lot of discussion recently, following electoral scandals in the US and in Britain, of the power of enormous data-gathering projects like those of Google and Facebook, of the political dangers of the dream of total knowledge. Shoshana Zuboff has written about this in a particularly provocative and urgent way in her recent book, Surveillance Capitalism. What do you think this special issue has to contribute to that debate? 


Bullock’s Museum, (Egyptian Hall or London Museum), Piccadilly: the interior. Coloured aquatint, 1810. Thomas Hosmer Shepherd, 1793-1864. Credit: Wellcome Collection – CC-BY.

BJ: Probably the most obvious point is that the collection of huge amounts of data is also an issue of subjectivity, so that like it or not there is a fundamental connection between the self and its ‘data doubles’, and this isn’t something that can easily be ignored or avoided. Sometimes this is because there is a direct relationship between data and possibility, like in Daniel Wilson’s article about the kinds of information insurance companies offer and the attitude towards mortality that they engendered. In that case there’s a very clear connection between self-conception, financial possibility and particular ideologies of data. In other cases the connection is less clear cut but still decisive, and this seems to hinge on that idea of ‘totality’. One thing that Zuboff brings out really well I think is the way that Surveillance Capitalism is indiscriminate in a certain sense: these companies don’t really care exactly what kind of data they can accumulate. This gives a scary sense of randomness to the kind of (radically multiple) data doubles that we are all already accumulating. It’s also a kind of positivism in reverse: the data constitute the reality, but not because there is any kind of empiricist system, rather because there are massively accumulative technologies that just happen to latch on and then re-present different parts of the world.

MD: The way you put it just there suggests that maybe what the special issue adds to the debate is an important element of reflexivity. It’s not a new idea that those who are measured are changed by the process of measurement – it’s a point that Michel Foucault has made very thoroughly. Perhaps what the authors in this issue show is that there are some marked patterns in the way large-scale knowledge projects affect the human subject when those projects aim to include absolutely everything – an ambition which has never been so nearly reached as it has been by Google. 

BJ: Definitely. There are clearly issues of the limits of these projects, what they exclude, who gets left out and so on, that are common whenever the idea of totality is brought into play. But I also think the strength of the issue is in the historical specificity of the case studies. The point in each case (I take it) is that something as seemingly universal as universality has its own complex history. So there are useful points of continuity and also discontinuity – it has to be ‘both/and’ I think.

Matthew Drage is an artist, writer and postdoctoral researcher. He lately completed his PhD at the Department of History and Philosophy of Science at Cambridge, and is now Post-Doctoral Research Fellow in the History of Art, Science and Folk Practice, at the Warburg Institue, in the School of Advanced study, University of London. 

Boris Jardine is a Leverhulme Trust Early Career Research Fellow, supported by the Isaac Newton Trust, at the Department of the History and Philosophy of Science at the University of Cambridge. His project is titled, “The Lost Museums of Cambridge Science, 1865–1936.”

The Buddhistic Milieu


Matthew Drage is an artist, writer and postdoctoral researcher. He lately completed his PhD at the Department of History and Philosophy of Science at Cambridge, and is now Post-Doctoral Research Fellow in the History of Art, Science and Folk Practice, at the Warburg Institue, in the School of Advanced study, University of London. His first article from his PhD, Of mountains, lakes and essences: John Teasdale and the transmission of mindfulness, appeared in December 2018, as part of the HHS special issue, ‘Psychotherapy in Europe,’ edited by Sarah Marks. Here Matthew talks to Steven Stanley – Senior Lecturer in the School of Social Sciences at Cardiff University, and Director of the Leverhulme-funded project, Beyond Personal Wellbeing: Mapping the Social Production of Mindfulness in England and Wales – about the article, and his wider research agenda on mindfulness in Britain and America.  

Steven Stanley (SS): This article is your first publication based on your PhD research project, which you recently completed. Congratulations! Can you tell us a bit about your PhD project?

Matthew Drage (MD): Thank you! So yes, my PhD project was a combined historical and ethnographic project which focused on the emergence of “mindfulness” as a healthcare intervention in Britain and America since the 1970s. My main question was: why was mindfulness seen by its proponents as such an important thing to do? Why did they seek to promote it so actively and vigorously? I focused on a key centre for the propagation of mindfulness-based healthcare approaches in the West: the Center for Mindfulness in Health, Care and Society at the University of Massachuestts Medical Center. I also looked at the transmission of mindfulness from Massachusetts to Britain in the 1990s – this is an episode I narrate in the article.

I had a real sense, when I did my fieldwork, archival research and oral history interviews, that for people who practice and teach it as their main livelihood, mindfulness was something like what the early 20th century sociologist Max Weber called a vocation. I had a strong impression that this devotion to mindfulness as a way of relieving suffering was what helped mindfulness to find so much traction in popular culture. While my PhD thesis doesn’t offer empirical support for this instinct, it does focus very closely on why mindfulness seemed so important to the people who propagated it. I argued that this was because mindfulness combined some of the most powerful features of religion – offering institutionalised answers to deep existential questions about the nature of human suffering and the purpose of life – while at the same time successfully distancing itself from religious practice, and building strong alliances with established biomedical institutions and discourses.

Maybe the real discovery – which is something I only mention briefly in this article – is that religious or quasi-religious ideas, practices and institutions, especially Buddhist retreat centres – were crucial for making this separation possible. Mindfulness relied heavily on Buddhist groups and institutions (or, at least, groups and institutions heavily influenced by Buddhism) for training, institutional support and legitimacy, whilst at the same deploying a complex array of strategies for distancing itself from anything seen as as potentially identifiable (to themselves and to outsiders) as religious.

Matthew Drage

More specifically, most mindfulness professionals I met sought to distance themselves from the rituals, images, and cosmological ideas associated with the Buddhist tradition (for example chanting, Buddha statues or the doctrine of rebirth). But at the same time, many “secular” mindfulness practitioners shared some fundamental views with contemporaneous Buddhist movements. Many held the view that the ultimate goal of teaching mindfulness in secular contexts was to help people to entirely transcend the suffering caused by human greed, hatred and delusion: that is, reach Nirvana, or Enlightenment, the central goal of Buddhist practice. And the sharing of these views between Buddhist practitioners and secular mindfulness teachers was helped by the fact that the latter frequently attended retreats with local Buddhist groups – indeed, often helped lead those groups! In my project I try to show how blurry the lines were, and that this blurriness was really at the heart of what the secular mindfulness project – at least in its early stages – was about: trying to keep the transcendental goal of Buddhism intact whilst shedding aspects of it that were seen as mere cultural accretions, deliberately blurring the boundaries between the religious and the secular. 

SS:How did this project come about?

MD: I came across secular mindfulness in 2011 through my own personal involvement with religious Buddhism. It was clearly on the rise, and while I wasn’t that interested in practising meditation in a secular context, I could see it was probably going to get big. Mindfulness seemed part of a more general cultural trend towards using science and technology to reshape the way the individual experiences and engages with the world around them. Technological developments like personal analytics for health (tracking your own fitness with wearable devices, say), and increasingly personalised user-experiences online, also seemed to exemplify. When I decided to do a PhD in 2013, I was interested in a very general way in questions of subjectivity and technology in contemporary Western culture, and I picked the one that seemed to fit best with my existing interests.

SS: Your article makes an important contribution to the historiography of recent developments in clinical psychology in Britain, especially the development of so-called ‘third-wave’ of psychotherapy (that is, approaches that include mindfulness and meditation). In particular you highlight the perhaps unexpected influence of alternative religious and spiritual ideas and practices on the emergence of British mindfulness in the form of Williams, Teasdale and Segal’s volume, Mindfulness-Based Cognitive Therapy, in the 1990s. You have also unearthed some fascinating biographical details regarding living pioneers of British mindfulness. Did you know what you were looking for before doing your study? Were you surprised by what you found?

MD: The simple answer is sort of, and yes! I kind of found what I was looking for, and (yet) I was surprised by what I found. 

When I began my research I was convinced that mindfulness was just another form of Buddhism, slightly reshaped and repackaged to make it more palatable. My supervisor, the late historian of psychoanalysis Professor John Forrester, warned me about taking this approach. I remember him telling me, “If you keep pulling the Buddhism thread, the whole garment will unravel!” And unravel it did. After about three years, I realised that the most central metaphysical commitments of the mindfulness movement were not especially Buddhist, but owed as much, if not more, to Western esotericist traditions. By this I mean the 19th century tradition that includes the spiritualist theologian Emmanuel Swedenborg, the American Transcendentalists (e.g. David Henry Thoreau and Ralph Waldo Emerson) and, in the 20th century, people like the countercultural novelist and philosopher Aldous Huxley. These thinkers shared, amongst other things, the idea that there is a perennial, universal truth at the heart of all the major religions. The influence of this view was often, I found, invisible to mindfulness practitioners themselves. Indeed, it was invisible to me for a long time. They, like me, had often encountered Buddhism through the lens of these very Western, esotericist religious or spiritual ideas, so they just appeared as if they’d come from the Buddhist tradition. So while I wasn’t surprised by the influence of spiritual ideas on mindfulness, I was surprised by their source.

I was also surprised by the conclusions I reached about its relationship with late 20th century “neoliberal” capitalism. I’m not quite ready to go public with these conclusions yet, but watch this space. I’ll have a lot to say about it in the book I’m working on about the mindfulness movement.

SS: As you say in your article, mindfulness has become a very popular global phenomenon, which in simple terms is about being more aware of the present moment. When we think of mindfulness, we tend to think of ‘being here now’. What was it like studying mindfulness as a topic of historical scholarship? And, vice versa, mindfulness is sometimes understood as referring to, as you say, a ‘realm beyond historical time’. What lessons are there for historians from the world of mindfulness?

MD: A really great question. There is a fundamental conflict between my training as an historian and the views I was encountering amidst mindfulness practitioners. They tended to use history in very specific ways to legitimise their views. Mindfulness was taken as both about a universal human capacity (and thus beyond any specific historical or cultural contingency) and primordially ancient, a kind of composite of the extremely old and the timeless. If mindfulness had a history at all, so the story within the mindfulness movement tended to go, it was coextensive with the history of human consciousness. 

I spent a lot of time thinking and writing about the history of this view of the history of mindfulness. This was challenging because it often left me feeling as though I was being somehow disloyal to my interlocutors within the mindfulness movement; as though I was – in a way that was very hard to explain to them – undermining a key but implicit pretext for their work. In the end I tried to present a view of mindfulness which takes seriously its claims to universality by examining the historicity of those claims. I do not want to assume that there are no universals available to human knowledge; and if there are, then – as feminist science and technology studies scholar Donna Haraway argues in her incredible 1988 essay, “Situated Knowledges,” universals are always situated, emerging under very specific historical conditions. My main theoretical concern came to be understanding and describing the conditions for the emergence of universalising claims about humans.

To answer the other part of your question: I think mindfulness teaches historians that time is itself a movable feast; that we should take seriously the possibility of a history of alternative or non-standard ways of thinking about time. Mindfulness practitioners often talk a lot about remaining in the “present moment,” a practice which you could think of in this way: it takes the practitioner out of the usual orientation to time, to past and future, and creates quite a different sense of the way time passes. I found that institutionalised forms of mindfulness practice, to some extent, organised to support this change in one’s approach to time. I suspect this is also linked to an idea that I talk about in my article, the idea that mindfulness is somehow “perennial” or “universal.” There is a sense in which by practising mindfulness, and especially by practising on retreat, one is removing oneself from the usual run of historical time.  I think that it would be extremely interesting to think about how to do a history of this phenomenon; a history of the way people, especially within contemplative traditions, have sought to exit historical time.

Steven Stanley

SS: Many researchers of mindfulness also practice mindfulness themselves. Did you practice mindfulness as you were studying it? If you did, how did this work in relation to your fieldwork?

MD: Yes, I did. I was reluctant to do so initially, mainly because I had my own Buddhist meditation practice, and didn’t want to add another 40 minutes to my morning meditation routine. However, when I started meeting people in the mindfulness movement, they were very insistent that mindfulness could not really be understood without being experienced. While carrying out my PhD research I went to a lot of different teacher training retreats, workshops and events, and even taught an 8-week mindfulness-based stress reduction (MBSR) course to students at Cambridge. I think that this was an indispensable part of my research, to experience first hand what people were talking about when they spoke about mindfulness. Participating in a shared sense of vocation that I encountered amongst many mindfulness professionals showed me just how emotionally compelling  mindfulness was.

SS: Mindfulness is often presented as a secular therapeutic technique which has a scientific evidence based – and that it has completely moved away from its religious roots. Does your work challenge this idea and if so, how? And, related to this, what do you mean in your article by the ‘Buddhistic milieu’?

MD: As I say above, I do mean to complicate this idea that mindfulness is a straight-up medical intervention, moving ever-further from its religious roots. I think perhaps the development of mindfulness as a mass-cultural phenomenon roughly follows this trajectory. But this trajectory is also in itself complex: the parts of the mindfulness movement that I studied were also an attempt at making society more sacred, using the secular biomedical discourse, institutionality and rationality as a means of doing so – although most people wouldn’t have talked about it in this way. Secular biomedicine, at least for the earliest proponents of mindfulness, was seen as a route through which a what we might think of (though they didn’t think of it like this) a special kind of spiritual force (a force which, in my view, has very much to do with what we normally call religion), could be transmitted.

I mean by the ‘Buddhistic milieu’ to refer to something fairly loose – the constellation of communities, institutions, texts and practices which are strongly influenced by the Buddhist tradition, but which do not – or do not always – self-identify as Buddhist. It’s a coinage inspired by sociologist of religion Colin Campbell’s idea of a “cultic milieu,” a term he used to describe the emergent New Age movement in the 1970s. For Campbell, the cultic milieu is a community of spiritual practitioners characterised by individualism, loose structure, low levels of demand on members, tolerance, inclusivity, transience, and ephemerality. When I talk about a Buddhistic milieu here, I mean something like this, but with Buddhism (very broadly construed) as a focus. Some traditions, such as the Insight meditation tradition, which did much to give rise to the secular mindfulness movement, especially encourage this type of relationship to Buddhist practice, emphasising their own secularity, and insisting on its openness to practitioners from any faith tradition.

SS: You suggest that the transmission of mindfulness follows a ‘patrilineal’ lineage which is captured by terms like dissemination, essence, seminal and birth. Your focus is very much on the male ‘founding fathers’ of Mindfulness-based stress reduction (MBSR) and Mindfulness-based cognitive therapy (MBCT) rather than the women pioneers of the movement. Given that such stories of male founders have been troubled by feminist and revisionist historians of science and psychology since the 1980s especially, can you tell us more about the gender politics of the mindfulness movement and give us a sense of the role female leaders have played in the movement?

MD: An excellent but difficult line of questioning! When I first wrote this paper – and when I started my PhD – I took a much more explicitly feminist perspective. But as I started to write, I was confronted by how incredibly sensitive a topic this is, and I’m still not quite ready to say anything very definite. Mindfulness was not, nor do I think we should expect it to have been, impervious to the tendency towards patriarchal domination that permeates society in general. And, as you suggest here, we might fruitfully read some of the key symbols of male power I identify in my article as a sign of this tendency. I can’t say much more for now by way of analysis, but I’m aiming to tackle this issue more directly in the book.

I can give a couple of cases, though, which I plan e to explore in more detail in the future. The first is the role of meditator and palliative care worker called Peggie Gillespie who worked with Jon Kabat-Zinn in the very earliest days of his Clinic in Worcester, Massachusetts (where he first developed Mindfulness-Based Stress Reduction). Gillespie joined Kabat-Zinn as co-teacher in 1979, either in the very first mindfulness course he taught to patients at the University of Massachusetts Medical, or not long afterwards. She then acted as his second-in-command for the first couple of years of the Stress Reduction Clinic’s existence. She was certainly involved in developing MBSR (which was called SP&RP – the Stress Reduction and Relaxation Program, for the first decade of its life), and even wrote the first ever book about MBSR, her 1986 work Less Stress in Thirty Days. To my knowledge, however, Gillespie only gets a single mention in any writing anywhere about the history of MBSR – in the foreword to Jon Kabat-Zinn’s Full Catastrophe Living. The second example is the relative neglect of Christina Feldman. It wasn’t until the very end of my research period that I realised just how influential a figure Feldman has been – she had led the retreat on which Kabat-Zinn had his idea for MBSR, and went on to be the primary meditation teacher of one of the main early proponents of British mindfulness, cognitive psychologist John Teasdale. Although again she’s rarely mentioned, in a sense she oversaw the birth of secular mindfulness both in Britain and in America. I’m hoping that she’ll grant me an interview, so that I can write her into the book!

SS: If a teacher or practitioner of mindfulness is interested in your research, and wants to know more about the history of mindfulness, what texts would be in your History of Mindfulness 101?

So, when it comes to straightforward history, I’d go for Jeff Wilson’s (2014) Mindful America, Anne Harrington’s (2008) Cure Within, Mark Jackson’s (2013) The Age of Stress, and David McMahan’s (2018) The Making of Buddhist Modernism. These books all do important work in both narrating episodes the history of mindfulness since the 1970s, and in situating those episodes amidst broader currents in the history of science, medicine, and religion. Finally, Wakoh Shannon Hickey’s forthcoming book Mind Cure: How Meditation Became Medicine, was published a couple of weeks ago in March 2019. I haven’t read it yet, but I know something of her doctoral research into the history of MBSR, and suspect it will provide a much more in-depth and focused exploration than has yet been seen.

Matthew Drage is a Post-Doctoral Research Fellow in the History of Art, Science and Folk Practice, at the Warburg Institue, in the School of Advanced study, University of London.

Steven Stanley is Senior Lecturer atthe School of Social Sciences, Cardiff University.

Kinds of Uncertainty: Speaking in the Name of Doubt.

This is the second part of a two-part interview, between Vanessa Rampton, Branco Weiss Fellow at the Chair of Practical Philosophy, ETH Zurich, and the anthropologist Tobias Rees, Director of the ‘Transformations of the Human Program’ at the Berggruen Institute in Los Angeles, and author of the new monograph, After Ethnos (Duke). The discussion took place following a workshop on Rees’s work at the Zurich Center for the History of Knowledge in 2017. You can read the first part of the interview here.

4. Uncertainty and/as Political Practice

Vanessa Rampton (VR): I want to continue our conversation by asking you about the implications of foregrounding uncertainty and the ‘radical openness’ you mentioned earlier for aspects of life that are explicitly normative. Take politics, for example. Have you thought about the political implications of embracing uncertainty, and what could be necessary to facilitate communication, or participation, or what it is you think is important?

Tobias Rees (TR): For me, the reconstitution of uncertainty or ignorance is principally a philosophical and poetic practice. These concepts are not reducible to the political. But they can assume the form of a radical politics of freedom.

VR: How so?

TR: For a long time, in my thinking, I observed the classical distinction between the political as the sphere of values and the intellectual as the sphere of reason. And as such I could find politics important, a matter of passion, but I also found it difficult to relate my interest in philosophical and anthropological questions to politics. And I still think the effort to subsume all Wissenschaft, all philosophy, all art under the political is vulgar and destructive. However, over the years, largely through conversations with the anthropologist, Miriam Ticktin, I have learned to distinguish between a concept of politics rooted in values and a concept of politics rooted in the primacy of the intellectual or the artistic. I think that today we often encounter a concept of politics that is all about values, inside and outside of the academy. People are ready to subject the intellectual –– the capacity to question one’s values –– to their beliefs and values.

VR: For example?

Tobias Rees: This is much more delicate than it may seem. If I point out the intellectual implausibility of a well held value … trouble is certain. Maybe the easiest way to point what I mean is to take society as an example again. We know well that the concepts (not the words) of society and the social emerged only in the aftermath of the French Revolution, under conditions of industrialization. We also know perfectly well that the emergence of the concepts of society and the social amounted to a radical reconfiguration of what politics is. I think there is broad agreement that society is not just a concept but a whole infrastructure on which our notions of justice and political participation are contingent. If I point out though that society is not an ontological truth but a mere concept – a concept indeed that is somewhat anachronistic in the world we live in, people become uncomfortable. Many have strong emotional reactions insofar as they are vetted to the social as the good, and as the only form politics takes. When I then insist, as I usually do, the conversation usually ends by my interlocutors telling me that this is not an intellectual but a political issue. That is, they exempt politics as a value domain from the intellectual. I thoroughly disagree with this differentiation.

In fact, I find this value-based concept of politics unfortunate and the readiness to subject the intellectual to values disastrous. Values are a matter of doxa, that is, of unexamined opinions, and as long as we stay on the level of doxa the constitution of a democratic public is impossible. Kant saw that clearly and made the still very useful suggestion that values are a private matter. In private you may hold whatever values you prefer, Kant roughly says, but a public can only be constituted through what is accessible to everyone in terms of critical reflection. He called this the public exercise of reason. So the question for me is how, in this moment, we might allow for a politics that is grounded in the intellectual, in reason even, rather than in values. The anti-intellectual concept of politics that dominates public and especially academic discussions is, I think, a sure recipe for disaster. Obviously this is linked, for me, to the production of uncertainty and to the question of grounding practice in uncertainty.

VR: I am very sympathetic to your desire to avoid confusing the tasks of, say, philosophy with political activism, but how does this go together with uncertainty and ignorance?

TR: Yes, it may seem that my work on the instability of knowledge or on uncertainty amounts to a critique of reason. But in fact the contrary is the case: for me, the reconstitution of ignorance, the transformation of certainty into uncertainty is an intellectual practice. Or better, an intellectual exercise. It is accomplished by way of research and reflection; it is accomplished by thinking about thinking. Another way of making this point is to say that uncertainty –– or the admission of ignorance –– is the outcome of rigorous research, it is the outcome of a practice committed, in principle, to searching for truth. If I am at my most provocative I say that uncertainty implies an open horizon –– it opens up the possibility that things could be different and this possibility of difference, of openness, is what I am after. So one big challenge that emerges from this is how can one reconcile the intellectual and the political, and I do think that’s possible. That would lead back to what I called epistemic activism.

VR:  How would that work in practice?


Michel Foucault portrait (1926-1984) french philosopher. Ink and watercolor. By Nemomain. CC-BY-SA. Source: Wikimedia Commons

TR: My personal response unfolds along two lines. The first one amounts to a gesture to Michel Foucault: with Foucault one could describe my work as a refusal to be known or to be reducible to the known. Hence, my interest in that which escapes, which cannot be subsumed, etc. A second way of responding to your question, with equal gratitude to Foucault, is to say that the political is for me first of all a matter of ethics, that is, of conduct: how do you wish to live your life? And here I advocate the primacy of the intellectual –– katalepsis –– over values. Based on these two replies one can approach the political on a more programmatic scale: whenever someone speaks in the name of unexamined values or claims to speak in the name of truth and thereby closes the horizon and undermines the primacy of the intellectual, I can make myself heard and ask questions and express doubt. And when I say doubt I don’t mean a hermeneutics of suspicion. I also don’t mean social critique. I mean radical epistemic doubt that tries to reconstitute irreducible uncertainty.

VR: So this would involve calling out the truth-claims of other actors?

TR:  I am not fond of the term calling out. The phrase tends to hide the fact that what is at stake is not only to confront the truth claims someone is making, but also to avoid the very mistakes one problematizes: to speak in the name of truth. I am more interested in speaking in the name of doubt: not a doubt that would do away with the possibility of truth and that would leave us with the merely arbitrary, but a doubt that transforms the certain into the uncertain, while maintaining the possibility of truth as measure or as guiding horizon.

5.Uncertainty as Virtue

VR: Let’s talk about the normative implications of uncertainty beyond politics. I was interested in a review of your work by Nicolas Langlitz in which he accused you of wanting to radically cultivate uncertainty, and he had arguments for why this wouldn’t work. Actually this reminds me of a passage in Dostoevsky’s The Brothers Karamazov where the Grand Inquisitor condemns Christ for having burdened humanity with free choice, and claims that actually human beings cannot cope with freedom, nor do they really desire it. Rather they prefer security or happiness: having food, clothes, a house and so on. And one question would be, how do we acknowledge uncertainty, acknowledge its importance, but not cultivate it in a way that could potentially be destructive?

TR: I have several different reactions at once. Here is reply one: I am deeply troubled by the idea of decoupling happiness from freedom. As I see it now, uncertainty is a condition of the possibility of freedom –– and of happiness. Why? Because the impossibility to know provides an irreducibly open horizon. This is one important reason for my interest in cultivating uncertainty.

Immanuel Kant (1724-1804). This work is in the public domain in its country of origin and other countries and areas where the copyright term is the author’s life plus 70 years or less. Source: Wikimedia Commons.

My second reply amounts to a series of differentiations that seem to me necessary or at the very least helpful. For example, I think it makes sense to differentiate between the epistemic and the existential as two different genres. To make my point, let me go to the beginning of the preface to the first edition of the Critique of Pure Reason, where Kant says that human reason (for reasons that are not its fault) finds itself confronted with questions it cannot answer. I am thoroughly interested in this absence of foundational answers that Kant points out here. What answers does Kant have in mind? He doesn’t actually provide examples and most modern readers tend to conclude he meant the big existential questions of the twentieth century: why am I here? What is the meaning of life? Stuff like that. However, I think that is not at all what Kant had in mind. He simply shared an epistemological observation: whenever we try to provide true foundations for knowledge, we fail. In every situation –– whether in science or in everyday life –– we cannot help but rely on conceptual presuppositions we are not aware of. What is more, there are always too many presuppositions to possibly clear the ground. The consequence, pace Kant, is that knowledge is intrinsically unstable and fragile. I am interested in precisely this instability and fragility of knowledge. Of all knowledge. Let’s say for me this instability is the condition of the possibility of freedom.

Up until this point I simply have made an epistemological observation. Now Langlitz, whose work I admire, asks if my epistemic cultivation of uncertainty is productive in the face of, say, climate change deniers. To me, he implicitly confuses here the epistemic –– which remains oriented towards truth and is an intellectual practice –– with the doxa driven rejection of the epistemic and the intellectual that is characteristic of the climate change deniers. What you are asking about though is of a different quality, right? You are asking about a more existential uncertainty.

6.Uncertainty and Medicine

VR: My question is motivated by thinking about cases such as medicine. For example, does the epistemic uncertainty you are concerned with require special measures in the clinical encounter? After all, physicians’ perceived ability to cope with uncertainty has a well-documented placebo effect. So for example physician and writer Atul Gawande – I’m thinking of his books Complications (2002) and Better (2007) – writes about all the things modern medicine doesn’t know in addition to what it does know. But he emphasizes that this self-doubt cannot become paralyzing, that physicians must act, and that action is – in many cases – in patients’ interests. So this doesn’t contradict per se what you were saying before, but it does show how epistemic uncertainty is seen as something that has to be managed in this particular professional setting, and that a kind of simulacrum of certainty may also give patients hope in a difficult situation.

TR: I think that perhaps the best way to address the questions you are raising is a research project that attempts to catalogue the multiple kinds of uncertainties that flourish in a hospital. If I stress that there are different kinds of uncertainties then this is partly because I think that different kinds of uncertainties have different kinds of causes –– and partly because I think that there is no obvious link between the epistemic uncertainty I have been cultivating and the kinds of uncertainties that plague the doctor-patient relation in medicine.

VR: I am surprised to hear you say that, because I understood the relation between technical progress and the skill of living a life in intrinsically uncertain circumstances as a central feature of your work. In Plastic Reason, for example, you quote Max Weber who says: ‘What’s the meaning of science? It has no meaning because it cannot answer the only question of importance, how shall we live and what shall we do?’ And as you know Weber came to that idea via Tolstoy, who basically says: ‘the idea that experimental science must satisfy the spiritual demands of mankind is deeply flawed’. And Tolstoy goes on to say: ‘the defenders of science exclaim – but medical science! You’re forgetting the beneficent progress made by medicine, and bacteriological inoculations, and recent surgical operations’. And that’s exactly where Weber answers: ‘well, medicine is a technical art. And there is progress in a technical art. But medicine itself cannot address questions of life and how to live, and what life you want to live.’

TR: But why does Weber answer that way? You are surely right that he arrives at the question concerning life and science via Tolstoy. However, it also seems to me that he thoroughly disagrees with Tolstoy. In my reading, Tolstoy makes an existential or even spiritual point. He places the human on the side of existential and spiritual questions and calls this life –– and then criticizes science as irrelevant in the face of these questions. Weber’s observation is, I think, a radically different one. Tolstoy is right, he says, there are questions that science cannot answer. However, if you want to live a life of reason –– or of science –– then this absence of answers is precisely what you must endure. Or, perhaps, enjoy. In other words, Weber upholds science or reason vis-à-vis its enemies.

One can refine this reading of Weber. He answers that science is meaningless. And I think the reason for this is that, as he sees it, science isn’t concerned with meaning. Indeed, from a scientific perspective human life is entirely meaningless. However, Weber nowhere argues that science is irrelevant for the challenge of living a life. On the contrary, he lists a rather large series of tools that precisely help here –– from conceptual clarity to the experience of thinking, to technical criticism. His whole methodological work can be read as an ethical treatise for how to live a life as a Wissenschaftler. According to Weber, the Tolstoy argument requires a leap of faith that those of us concerned with reason –– and with human self-assertion in the face of metaphysical claims –– cannot take.


A female figure representing science trimming the lamp of life. Engraving by A. R. Freebairn, 1849, after W. Wyon. This image is available
CC BY. Credit: Wellcome Collection

It is easy, of course, to claim that life is so much bigger than science. But then, upon inspection, there is no aspect of life that isn’t grounded in conceptual presuppositions –– and these presuppositions have little histories. That is, they didn’t always exist. They emerge, they re-organize entire domains of life, and then we take them for granted, as if they had always existed. Which they didn’t. This includes the concept of life, I hasten to add. Weber opts for the primacy of the intellectual as opposed to the primacy of the existential. And for Weber the only honest option is to accept the primacy of the intellectual. That may mean that some questions are never to be answered. But all answers he examined are little more than a harmony of illusions.

You see, I think that this is easily related back to my distinction between epistemic uncertainty and existential uncertainty. In Plastic Reason I quoted Weber not least because my fieldwork observations seemed to me a kind of empirical evidence that proves the dominant, anti-science reading of Weber wrong. If you are thinking that it is your brain that makes you human and if you are conducting experiments to figure out how a brain works, well, then you are at stake in your research. Science doesn’t occur outside of life. None of this is to say that the uncertainties that plague medicine aren’t real. But it is to say that I think it is worthwhile differentiating between kinds of uncertainty.

Tobias Rees is Reid Hoffman Professor of Humanities at the New School of Social Research in New York, Director of the Transformations of the Human Program at the Berggruen Institute in Los Angeles, and Fellow of the Canadian Institute for Advanced Research. His new book, After Ethnos is published by Duke in October 2018.

Vanessa Rampton is Branco Weiss Fellow at the Chair of Philosophy with Particular Emphasis on Practical Philosophy, ETH Zurich, and at the Institute for Health and Social Policy, McGill University. Her current research is on ideas of progress in contemporary medicine.


Kinds of Uncertainty: On Doubt as Practice

In his recent books, Plastic Reason: An Anthropology of Brain Science in Embryogenetic Terms (University of California Press, 2016) and After Ethnos (Duke University Press, 2018), the anthropologist Tobias Rees explores the curiosity required to escape established ways of knowing, and to open up what he calls “new spaces for thinking + doing.” Rees argues that acknowledging – and even embracing – the ignorance and uncertainty that underpin all forms of knowledge production is a crucial methodological part of that process of escape. In his account, doubt and instability are bound up with a radical openness that is necessary for breaking apart existing gaps and allowing the new/different to emerge – in the natural but also in the human sciences. But are there limits to such an embrace of epistemic uncertainty? How does this particular uncertainty interact with other forms of uncertainty, including existential uncertainties that we experience as vulnerable human beings? And how does irreducible epistemic uncertainty relate to ethical claims about how to live a good life? What is the relation of a radical political practice of freedom with art? After a workshop on his work at the Zurich Center for the History of Knowledge in 2017, Vanessa Rampton, Branco Weiss Fellow at the Chair of Practical Philosophy, ETH Zurich, explored these themes with Rees.

 

1. The Human

Vanessa Rampton (VR): Tobias, your recent work aims to destabilize and question common understandings of the human. I wonder how you would place your work in relation to other engagements with ‘selfhood’ within the history of philosophy, and the history of the human sciences more widely. Because there are so many ways of thinking of the self – for example the empirical, bodily self, or the rational self, or the self as relational, a social construct – that you could presumably draw on. But I also know that you want to move beyond previous attempts to capture the nature and meaning of ‘the human self’. What are the stakes of this destabilization of the human? What do you hope to achieve with it?

Tobias Rees (TR): In a way, it isn’t me who destabilizes the human. It is events in the world. As far as I can tell, we find ourselves living in a world that has outgrown the human, that fails it. If I am interested in the historicity of the figure of the human –– a figure that has been institutionalized in the human sciences –– then insofar as I am interested in rendering visible the stakes of this failure. And in exploring possibilities of being human after the human. Even of a human science after the human.

VR: When you say the human, what do you mean?

Vanessa Rampton, Branco Weiss Fellow, ETH Zurich

TR: I mean at least three different things. First, I mean a concept. We moderns usually take the human for granted. We take it for granted, that is, that there is something like the human. That there is something that we –– we humans –– all share. Something that is independent from where we are born. Or when. Independent of whether we are rich or poor, old or young, woman or man. Independent of the color of our skin. Something that constitutes our humanity. In short, something that is truly universal: the human. However, such a universal of the human is of rather recent origin. This is to say, someone had to have the idea to begin articulating an abstract, in its validity universal and thus time and place independent, concept of the human. And it turns out that this wasn’t something people wondered about or aspired to formulate before the 17th century.

Second, I mean a whole ontology – that the invention of the human between the 17th and the 19th century amounted to the invention of a whole understanding of how the real is organized. The easiest way to make this more concrete is to point out that almost all authors of the human, from Descartes to Kant, stabilized this new figure by way of two differentiations. On the one hand, humans were said to be more than mere nature; on the other hand, it was claimed that humans are qualitatively different from mere machines. Here the human, thinking thing in a world of mere things, subject in a world of objects, endowed with reason, and there the vast and multitudinous field of nature and machines, reducible –– in sharp contrast to humans –– to math and mechanics. The whole vocabulary we have available to describe ourselves as human silently implies that the truly human opens up beyond the merely nature. And whenever we use the term ‘human,’ we ultimately rely on and reproduce this ontology.

Third, I mean a whole infrastructure. The easiest way to explain what I mean by this is to gesture to the university: the distinction between humans on the one hand and nature and machines on the other quite simply mirrors the concept of the human, insofar as it implies two different kinds of realities, as it emerged between the 17th and 19th century. Now, it may sound odd, even provocative, but I think there can be little doubt that today the two differentiations that stabilized the human –– more than mere nature, other than mere machines ––fail. From research in artificial intelligence to research in animal intelligence, en passant microbiome research or climate change. One consequence of these failures is that the vocabulary we have available to think of ourselves as human fails us. And I am curious about the effects of these failures: what are their effects on what it means to be human? What are their effects on the human sciences –– insofar as those sciences are contingent on the idea that there is a separate, set apart human reality and insofar as their explanations, their sense making concepts are somewhat contingent on the idea of a universal figure of the human, that is, on the ‘the’ in ‘the human’? Can the human sciences, given that they are the institutionalized version of the figure of the human, even be the venue through which we can understand the failures of the human? Let me add that I am much less interested in answering these questions than in producing them: making visible the uncertainty of the human is one way of explaining what I think of as the philosophical stakes of the present. And I think these stakes are huge: for each one of us qua human, for the humanities and human sciences, for the universities. The department I am building at the Berggruen Institute in Los Angeles revolves around just these questions.

‘Human embryonic stem cells’ by Jenny Nichols. Credit: Jenny Nichols. CC BY

VR: What led you to doubt the concept of the human and the human sciences?

TR: My first book, Plastic Reason, was concerned with a rather sweeping event that occurred around the late 1990s: the chance discovery that some basic embryonic processes continue in adult brains. Let me put this discovery in perspective: it had been known since the 1880s that humans are born with a definite number of nerve cells, and it was common wisdom since the 1890s that the connections between neurons are fully developed by age twenty or so. The big question everyone was asking at the beginning of the twentieth century was: how does a fixed and immutable brain allow for memory, for learning, for behavioral changes? And the answer that eventually emerged was the changing intensity of synaptic communication. Consequently, most of twentieth-century neuroscience was focused on understanding the molecular basis of how synapses communicate with one another –– first in electrophysiological and then in genetic terms.

When adult cerebral plasticity was discovered in the late 1990s the focus on the synapse –– which had basically organized scientific attention for a century –– was suddenly called into question. The discovery that new neurons continue to be born in the adult human brain, that these new neurons migrate and differentiate, that axons continue to sprout, that dendritic spines continuously appear and disappear not only suggested that the brain was perhaps not the fixed and immutable machine previously imagined; it also suggested that synaptic communication was hardly the only dynamic element of the brain and hence not the only possible way to understand how we form memory or learn. What is more, it suggested that chemistry was not the only language for understanding the brain.

The effect was enormous. Within a rather short period of time, less than ten years, the brain ceased to be the neurochemical machine it had been for most of the twentieth century, but without – and this I found so intriguing – without immediately becoming something else. The beauty of the situation was that no one knew yet how to think the brain. It was a wild, an untamed, an in-between state, a no longer not-yet, a moment of incredibly intense, unruly openness that no one could tame. The whole goal of my research was to capture something of this irreducible openness and its intensity.

Anyway, when trying to capture something of the radical openness in which my fieldwork was unfolding, I began to wonder about my own field of research: if the taken for granted key concepts of brain science, that is, the concepts that constituted and stabilized the brain as an object, could become historical in a rather short period of time, then what about the terms and concepts of the human sciences? Which terms might constitute the human in such a situation? These questions led me to the obsession of trying to write brief, historicizing accounts of the key terms of the human sciences, first and foremost the human itself: when did the time and place independent concept of the human, of the human sciences we operate with emerge? And this then led me to the terms that stabilize the human: culture, society, politics, civilization, history, etc. When were these concepts invented –– concepts that silently transport definitions of who and what we are and of how the real is organized? When were they first used to describe and define humans, to set them apart as something in themselves? Where? Who articulated them? What concepts –– or ways of thinking –– existed before they emerged? And are there instances in the here and now that escape the human?

Somewhere along the way, while doing fieldwork at the Gates Foundation actually, I recognized that the vocabulary the human sciences operate with didn’t really exist before the time around 1800, plus or minus a few decades, and that their sense-making, explanatory quality relies on a figure of the human –– on an understanding of the real –– that has become untenable. I began to think that the human, just like the brain, had begun to outgrow the histories that had framed it. You said earlier, Vanessa, that I am interested in destabilizing common understandings of the human. Another way of describing my work, one I would perhaps prefer, would be to say that through the chance combination of fieldwork and historical research I discovered the instability –– and the insufficiency –– of the concept of the human we moderns take for granted and rely on. I want to make this insufficiency visible and available. The human is perhaps more uncertain than it has ever been.

VR: Listening to you, I cannot help but think that there are strong parallels between your work and the history of concepts as formulated by, say, Reinhart Koselleck or Raymond Williams. I can nevertheless sense that there is a difference –– and I wonder how you would articulate this difference?

TR: First, I am not a historian of concepts. I am primarily a fieldworker and hence operate in the here and now. What arouses my curiosity is when, in the course of my field research a ‘given,’ something we simply take for granted, is suddenly transformed into a question: an instance in which something that was obvious becomes insufficient, in which the world or some part thereof escapes it and thereby renders it visible as what it is, a mere concept. From the perspective of this insufficiency I then turn to its historicity: I show where this concept came from, when it was articulated, why, under what circumstances, and also how it never stood still and constantly mutated. But in my work this history of a concept, if one wants to call it that, is not end in itself. It is a tool to make visible some openness in the present that my fieldwork has alerted me to. In other words, the historicity is specific: the specific product of an event in the here and now, a specificity produced by way of fieldwork.

Reid Hoffman Professor of Humanities at the New School of Social Research in New York, Director of the Transformations of the Human Program at the Berggruen Institute in Los Angeles.

Second, my interest in the historicity –– rather than the history –– of concepts runs somewhat diagonal to presuppositions on which the history of concepts has been built. Koselleck, for example, was concerned with meaning or semantics and with society as the context in which changes in meaning occur. That is to say, Koselleck –– and as much is true for Williams –– operated entirely within the formation of the human. They both took it for granted that there is a distinctive human reality that is ultimately constituted by the meaning humans produce and that unfolds in society. Arguably, the human marked the condition of the possibility of their work. It is interesting to note that neither Koselleck nor Williams, nor even Quentin Skinner, ever sought to write the history of the condition of possibility of their work: they never historicized the figure of the human on which they relied. On the contrary, they simply took it for granted as the breakthrough to the truth. If I am interested in concepts and their historicity, then it is only because I am interested in the historicity of the concept of the human as a condition of possibility. How to invent the possibility of a human science beyond this condition of possibility is a question I find as intriguing as it is urgent: how to break with the ontology implied by the human? How to depart from the infrastructure of the human, while not giving up a curiosity about things human, whatever human then actually means?

 

2. Epistemic Uncertainty

VR: I am wondering if all concepts can outgrow their histories. Isn’t this more difficult in the case of, say, ‘the body’ or ‘language,’ than for our more doctrinal concepts – liberalism and socialism, for example?

TR: Your question implies, I think, a shift in register. Up until now we talked about the human and its concepts and institutions but now we are moving to a more general epistemic question: are all concepts subject to their historicity? And if so, what does this imply? Seeing as you mentioned the body, let’s take the idea –– so obvious to us today –– that we are bodies, that it is through our warm, sentient, haptic bodies that we are at home in the world. Over the last fifty years or so, really since the 1970s, a large social science literature has emerged around the body and around how we embody certain practices and so on. Much of this literature, of course, relies on Mauss on the one hand and on Merleau-Ponty on the other. And if one works through the anthropology or history of the body, one notes that most authors take the body simply as a given. It is as if they were saying, ‘Of course humans are, were, and always will be bodies.’

But were humans always bodies? At the very least one could ask when, historically speaking, did the concept of the body first emerge? When did humans first come up with a concept of the body and thus experience themselves as bodies? What work was necessary –– from physiology to philosophy –– for this emergence? To ask this question requires the readiness to expose oneself to the possibility that the category of the body and the analytical vocabulary that is contingent on this category is not obvious. There might have been times before the body –– and there might be times after it. For example, if one reads books about ancient Greece, say Bruno Snell’s The Discovery of the Mind, one learns that archaic Greek didn’t have a word for what we call the body. The Greeks had a word for torso. They had two words for skin, the skin that protects and the skin that is injured. They had terms for limbs. But the body, understood as a thing in itself, as having a logic of its own, as an integrated unit, didn’t exist.

‘Carved stone relief of Greek physician and patient’ . Credit: Wellcome Collection. CC BY

One version of taking up Snell’s observation is to say: the Greeks maybe did not have a word for body –– but of course they were bodies and therefor the social or cultural study of the body is valid even for archaic Greece. What I find problematic about such a position is that it implies that the Greeks were ignorant and that our concepts –– the body –– mark a breakthrough to the truth: we have universalized the body, even though it is a highly contingent category. Perhaps a better alternative is to systematically study how the ‘realism of the body’ on which the social and cultural study of the body is contingent became possible. A history of this possibility would have to point out that the concept of a universal body –– understood as an integrated system or organism that has a dynamic and logic of its own and that is the same all over the world –– is of rather recent origin. It doesn’t really exist before the 19th century. In any case, there are no accounts of the body –– or the experience of the body –– before that time and philosophies of the body seem to be almost exclusively a thing of the first half, plus or minus, of the twentieth century. Sure, anatomy is much older, and there were corpses, but a corpse is not a body. The alternative to the realism of the body that I briefly sketched here would imply that one can no longer naively –– by which I mean in an unexamined way –– subscribe to the body as a given. The body then has become uncertain. I am interested in fostering precisely this kind of epistemic uncertainty. To me, epistemic uncertainty is an escape from truth and thus a matter of freedom.

VR: Perhaps a kind of taken-for-granted approach to the body is so bound up with what you call ‘the human’ that questioning it is necessary for your work.

TR: Indeed, although my work led me to assume that what is true for the human or the body is true for all concepts. Every concept we have is time and place specific and thus irreducible, instable and uncertain.  But to return to the human: we live in a moment in time that produces the uncertainty of the human all by itself. I render this uncertainty visible by evoking the historicity of the human, and this in turn leads me to wonder if one could say that the human was a kind of intermezzo – a transient figure that was stable for a good 350 years but that can no longer be maintained.

VR: I wonder what you would reply if I were to say: but isn’t that obvious? Concepts are historically contingent, so what else is new?

TR: In my experience, most people grant contingency within a broader framework that they silently exempt from contingency itself. For example, if contingency means that different societies have different kinds of concepts, then society is the framework within which contingency is allowed: but society itself is exempt from contingency. One could make similar arguments with respect to culture. If we say that things are culturally specific, that some cultures have meanings that others don’t have, or entirely different ways of ordering the world, then we exempt culture from contingency.

All of this is to say, sure, you are right, social and cultural contingency are obviously not new. But what if you would venture to be a bit more radical. What if you would not exempt society and culture from contingency? Talk to a social scientist about society being contingent, and they become uncomfortable. Or they reply that maybe the concept of society didn’t exist but that people were of course always social beings, living in social relations. This is a half movement in thought. It assumes that the word has merely captured the real as it is –– but misses that the configuration of the real they refer to has been contingent on the epistemic configuration on which the concept of society has depended. We could say that the one thing a social scientist cannot afford is the contingency of the category of the social.

What I am interested in is the contingency of the very categories that make knowledge production possible. To some degree, I am conducting fieldwork to discover such contingencies, to generate an irreducible uncertainty: as an end in itself and also as a tool to bring into view in which precise sense the present is outgrowing –– escaping –– our understanding and experience of the world.

 

3. Knowledge Production Under Conditions of Uncertainty/Ignorance

VR: I imagine there is a kind of parallel here with how natural scientists would react to the fact that their concepts no longer fit, for example by developing a more up-to-date way of thinking the brain to replace the synaptic model. But it strikes me that, if done properly, this task is much more radical for practitioners of the human sciences. This is because all of our concepts – including such fundamental ones as the human and the body – are historically contingent, that we have to do away with universal categories. Our task is to fundamentally destabilize ourselves as historical subjects, as academics, as knowers. And I guess a key question is how this destabilization, this rendering visible of uncertainties, can nevertheless be linked to the kinds of knowledge production we have come to expect from the human sciences.

TR:  The question, perhaps, is what one means by knowledge production in the human sciences. I think that the human sciences have been primarily practiced as a decoding sciences. That is to say, researchers in the human sciences usually don’t ask ‘What is the human?’ No, they already knew what the human is: a social and cultural being, endowed with language. Equipped with this knowledge they then make visible all kinds of things in terms of society and culture. In addition, perhaps, one could argue that the human sciences have established themselves as guardians of the human – that is, they have been practiced in defensive terms. For example, whenever an engineer argues that machines can think and that humans are just another kind of machine, the human sciences react by defending the human against the machine. The most famous example here would maybe be Hubert Dreyfus against Seymour Papert. A similar argument though could be made with respect to genetics and genetic reductionism.

Now, if one destabilizes the figure of the human neither one of these two forms of knowledge production can be maintained. I think that this is why many in the human sciences experience the destabilization of the human as outrageous provocation. If one gets over this provocation one is left with two questions. The first is: what modes of knowledge production become possible through this destabilization of the human? Especially when this destabilization means that the entire ontological setup of the human sciences fail. Can the human sciences entertain, let alone address this question, given that they are the material infrastructure of the figure of the human that fails? Or does one need new venues of research? I often think here of the relation between modern art and the nineteenth century academy.

VR: That reminds me of Foucault.

TR: Foucault was an anti-humanist –– but he remained uniquely concerned with human reality. I think the stakes here – I say this as an admirer of Foucault – are more radical. So my second question is: what happens to the human? I am acutely interested in maintaining the possibility of the universality of the human after the human. Letting go of the idea seems disastrous. So how can one think things human without relying on a substantive or positive concept of what the human is? My tentative answer is research in the form of exposure: the task is to expose the normative concept of the human in the present, by way of fieldwork, to identify instances that escape the human and break open new spaces of possibility, each time different ones, ones that presumably don’t add up. The goal of this kind of research-as-exposure is not to arrive at some other, better conception of the human, but to render uncertain established ways of thinking the human or of being human and to thereby render the human visible and available as a question.

VR:  So if you don’t want to talk about what the human is, I’m wondering if the appropriate question would be about what the human is not.

‘Human microbial ecosystem, artistic representation’ by Rebecca D Harris. Credit: Rebecca D Harris. CC BY

TR: I think such an inversion doesn’t get us very far. I would rather say that I am interested in operating along two lines. One line revolves around the effort to produce ignorance. That is, I conduct research not so much in order to produce knowledge but the uncertainty of knowledge. The other line wonders how one could conduct research under conditions of irreducible ignorance or uncertainty, or how to begin one’s research without relying on universals. A comparative history of this or that always presupposes something stable. As does any social or cultural study. In both cases I am interested in a productive or restless uncertainty –– or second-order ignorance –– not only with respect to the human. In a way, what I am after is the reconstitution of uncertainty, of not knowing, by way of a concept of research that maintains throughout the possibility of truth.

If you were to press me to offer a systematic answer I would say, as a philosophically inclined anthropologist, that I conduct fieldwork/research because I am simultaneously interested in where our concepts of the human come from, in whether there are instances in the here and now that escape these concepts, and in rendering available the instability –– the restlessness –– of the category or the categories of the human, both as an end in itself and as a means to bring the specificity of the present into view. It strikes me as particularly important to note that what I am after is not post-humanism. As far as I can tell most post-humanists hold on to the 18th-century ontology produced by the human but then delete the human from this ontology. What interests me is to break with the whole ontology. Not once and for all but again and again. Nor am I interested in the correction of some error à la Bruno Latour – as if behind the human we can discover some essential truth –– call it Actor Network Theory –– that the moderns have forgotten and that the non-moderns have preserved and that we now all can re-instantiate to save the world.

I am not so much interested in a replacement approach –– what comes after the human? –– than in rendering visible a multiplicity of failures, each one of which opens up onto new spaces of possibility. After all, how Artificial Intelligence derails the human is rather different from how microbiome research derails it or climate change. These derailments don’t add up to something coherent. As I see it, it is precisely this not-adding-up –– this uncertainty –– that makes freedom possible. Perhaps this form of research is closer to contemporary art than to social science research, that could well be. Anyhow, the department I try to build at the Berggruen Institute revolves around the production of precisely such instances of failure and freedom.

 

Tobias Rees is Reid Hoffman Professor of Humanities at the New School of Social Research in New York, Director of the Transformations of the Human Program at the Berggruen Institute in Los Angeles, and Fellow of the Canadian Institute for Advanced Research. His new book, After Ethnos is published by Duke in October 2018.

Vanessa Rampton is Branco Weiss Fellow at the Chair of Philosophy with Particular Emphasis on Practical Philosophy, ETH Zurich, and at the Institute for Health and Social Policy, McGill University. Her current research is on ideas of progress in contemporary medicine.

History and trauma across the disciplines: psychoanalytic narratives in the mid twentieth century

In the new issue of History of the Human Sciences, Matt ffytche analyses the exclusion of traumatic histories from psychoanalytic accounts of the mid-twentieth century, through a detailed engagement with the figure of the father (and of family authority) in different forms of psychoanalytic theory. Focusing especially on the work of the German psychoanalyst, Alexander Mitscherlich, ffytche traces the filtering out of the historical experiences of Nazism and the war from psychoanalytic narratives of the social – but then their return in texts of the 1980s and 1990s, under the banner of a new interest in historical trauma.  Here, HHS Editor in Chief, Felicity Callard, interviews Matt about his article

Felicity Callard (FC): Maybe we can start off with the institutional context in which you work. You have recently transitioned from being the director of a Centre for Psychoanalytic Studies to becoming the head of a new Department of Psychosocial and Psychoanalytic Studies. Can you tell us more about this new department, and what its emergence tells us about the history and sociology of psychoanalysis in the present?

Matt ffytche (Mf): It’s a very exciting moment for us, and a fascinating, transitional moment for the discipline. In many UK institutions, programmes connected to psychoanalysis have been in long-term decline, I think mainly because of the way in which Centres or Units which were once set up in relationship with schools of psychology or health, have found the disciplinary ground being whittled away from under their feet as the institutions which housed them have gone more and more quantitative. In the humanities, I think interest in psychoanalysis has remained steady (usually in its Lacanian form) but just as part of the general critical mix – it has rarely dealt in full-scale psychoanalytic programmes. The University of Essex, along with Birkbeck and a few other institutions, have bucked this trend and found a real impetus to growth around such topics as psychoanalysis and the psychosocial – and this may have something to do with social science, which allows forms of research and enquiry connected to psychoanalytic viewpoints to stay in touch with mental health, without being limited by the specific positivist agendas of the natural science disciplines. At the same time, the social science platform does allow the critical dimensions of psychoanalysis, and the psychosocial, to be explored and extended, and paired up to contemporary feminist and postcolonial agendas, amongst other things. The Centre at Essex did originally emerge out of the Sociology department during the 1990s, I think out of a small research group interested in psychoanalysis and mental health. But it has grown so much, particularly over the last decade, that it was impossible to reabsorb it back into Sociology – so the change this year was really about recognising that we were a fully-functioning department of our own, with two BAs and a new BA Childhood Studies coming in, and various Masters programmes and a large body of PhD students. Where exactly this all goes remains to be seen – but credit has to go to Essex for recognising the potential of new kinds of disciplines in the current climate, or at least the need to respond flexibly to the kinds of topics school leavers are wanting to work on. And many of them do want topics connected to mental health, or a more narrative psychology, or one with critical dimensions. I think the future of psychoanalysis in the academy (which is different from its future as a clinical, professional practise) has a lot to do with whether it can continue to be rethought, in conjunction with the rethinking that has been going on in other disciplines for a while.

 FC: Your article focuses on the father and on fatherhood. There has been, recently, a fair amount of writing in and around the history of the human sciences, on the mother and motherhood (two comprise Rebecca Plant’s Mom and Ann Harrington’s essay ‘Mother love and mental illness: an emotional history’).There has arguably been less on the father and fatherhood. Would you agree? And what are you hoping to encourage in terms of future research on the father? 

Mf: That’s a difficult one for me to answer mainly because I was driven less by an involvement in the stakes of fathers per se, than ‘the father’ as this vanishing or dwindling moment in mid-century psychoanalytic social psychology, in which nearly all the authors are registering the same thing: fathers no longer have the status they once had; and people’s subjective formation, and social formation, is increasingly bypassing what for psychoanalysis had been thought of as a foundational ‘confrontation’ with the father. That was the perception. The issue for me was less about whether any of these approaches were accurately responding to the experience of families, and more to do with the way the family – and gender – had been inscribed in theories of socialisation, and how aspects of this seemed to be imploding in the 1960s. Which was surely a necessary thing, given the sweeping reassessment of patriarchy which (in the time frame of my article) was about to be made in the 1970s. So I’m less able to comment in relation to representations of motherhood and fatherhood now. What I can add as a side-note is the way in which, in psychoanalysis of the 1940s and 50s – especially in the UK – a shift had already been made, by figures such as Melanie Klein, Donald Winnicott, and John Bowlby, to accord far more status to the mother. They near enough reversed Freud’s emphasis on sons and fathers – which Freud had speculatively extended back through cultural time, beyond the epoch of Oedipus and into deep, Darwinian primeval history – into one of mothers and babies, as foundational for the future of emotional life. But this shift didn’t seem to make its way into the more mainstream social psychological authors inflected by psychoanalysis, who were still evidently reading the Freud of the 1920s into the social experience of the 1950s and 1960s.

FC: Your essay is one of a number of recent reconsiderations of how to think the (socio)political in relation to psychoanalysis. I’m thinking, for example, of Michal Shapira’s The War Inside, Dagmar Herzog’s Cold War Freud and Daniel Pick’s The Pursuit of the Nazi Mind. How would you account for the blossoming of such an interest, now, and how would you distinguish your own approach to this question? 

Mf: It’s been an interesting development, and one I feel closely associated with – Dagmar Herzog has now joined me as Editor of Psychoanalysis and History, and Daniel Pick and I collaborated on an edited volume – Psychoanalysis in the Age of Totalitarianism (Routledge, 2016) – for which Dagmar and Michal Shapira both contributed chapters. One way of looking at it is that these are all attempts to move the history of psychoanalysis forwards from a concentration on the ‘Freud era’ to what came after. Some of this is simply about extending the history of psychoanalysis forward through the century, and responding to the opening up of more recent archives. But it was also a way of getting beyond the idea that the history of psychoanalysis necessarily has to do with the history of Freud. It’s in the 1920s to 40s in particular, that you start to get a much broader involvement of the second wave of psychoanalysts in other disciplinary fields (pedagogy, criminology, child psychology, sociology, etc). In the totalitarian book I was intrigued by the ways in which Frankfurt school sociologists had responded to the rise of fascism and anti-semitism with a wave of psychoanalytically-informed research and critical theory [. The article for HHS was in some ways an attempt to keep tracking that alliance onwards in subsequent history.

As to why this and similar initiatives amongst historians might be happening now? I think there’s also a recognition that there is a huge postwar history of psychoanalysis that remains to be told – too much for any single volume because of the degree to which psychoanalytic ideas implicated themselves so successfully in many different cultures in the middle decades of the twentieth century. And it’s always a fascinating history, because of the ways in which psychoanalysis delves into people’s fears and fantasies, or makes unusual social interventions, challenges existing assumptions, etc. It’s hard to characterise my own input here, but if anything I’d say that I pursue the history of psychoanalysis because of the complex ways in which it poses questions about the nature of identity and subjectivity that are relevant far beyond the practise of psychotherapy. For this reason, psychoanalysis is always renewing its engagements with philosophy, sociology and critical theory – an alliance very present within current psychosocial studies.

FC: Your were trained in literature as well as in history, and your article made clear to me how we much we need to move with agility between the social sciences and the humanities — including, in particular, literary studies — if we are properly to analyse the history of psychoanalysis. How would you describe your approach to interdisciplinarity in relation to the history of the human sciences?

Mf: I’ve never felt myself committed to any discipline exactly, and have generally simply pursued questions that I have felt to be crucial, about the way subjectivity is understood in the modern era, particularly in relation to individualism. And that’s true for thinkers that have influenced me as well – which REF panel would you submit Franz Fanon to, or Julia Kristeva, or Walter Benjamin, or Freud for that matter? It’s a huge problem at the moment – despite all the lip-service paid to interdisciplinarity, most elements of the way academic research and teaching are set up conspire to make liaison across fields difficult. My own tendency is to choose interdisciplinary ground not just in order to put fragments of a bigger social picture together, but in order to materialise entirely new domains. For instance, one of the areas that is intriguing me going forwards is the role of ‘fantasy’ in the social sciences. There’s obviously a psychoanalytic link here, because fantasy is an object of enquiry for psychoanalysis. But it goes wider than this. We tend to think of fantasy as something inaccessible, or illusory, or private, or without social agency. But how could you study the history of modern racism, for instance, without putting together materials from literature and culture, with other discourses circulating in the historical and social science archives, and further data from psychosocial work with the dreams and fantasies that regularly feature in relation to racial hatred? Ideally one needs to be housed in an institution that allows for that capacity, to bring these kinds of materials together across various disciplinary divides, because the logic of the material itself demands it. And one also has to work with others to find ways of arbitrating across different criteria of knowledge-formation, different theoretical frameworks.

FC: Whatever else your essay does, I read it as a fascinating contribution to the history of the emotions — in the way that you narrate a complex history whereby empathy and coolness are, variously, objects of analysis and epistemic virtues upheld by those doing the analysing. Can you say more about how this element of your argument reorients how we might think about the histories of disciplines? 

Mf: Interestingly, that point about empathy was the one that occurred to me last of all, in this article that went through several iterations in the last couple of years. Or it’s the furthest point I reached in my thinking. What really struck me was the way in which psychoanalysts drawn to social science, in the 1950s and 1960s, ended up in some instances detaching themselves from the kind of empathic relation to their subjects that psychotherapy might foster. Instead, they became more abstract ‘diagnosticians’ of societies. With Alexander Mitscherlich and Margarete Mitscherlich in particular (the German psychoanalysts who are my focus in the latter half of the article) there was the added factor that this was postwar Germany, and – for them – empathy with their subjects was not an option; or they willingly exchanged empathy for moral critique. For them, Germans had been unable to acknowledge their emotions, and their past, and what had resulted was a kind of postwar social pathology, despite the apparent economic successes. This shift in the Mitscherlichs was something I could pull out by comparing certain texts, and in particular looking at the side effects of certain disciplinary lenses on the way human subjects were rendered. More recently I participated in a workshop on ‘Denial’ at the Pears Institute in London, which brought together historians, literary scholars social scientists, and psychoanalysts, and for me it raised related sets of questions about the ways in which historical subjects (in this case the agents of certain forms of violence and genocide) are rendered differently by different disciplines. One of the things that shifts is whether the observer is called upon to empathise with the object of enquiry, called to empathise by the discipline itself. What assumptions do disciplines build in about a common ‘human’ or moral viewpoint? To what extent do they use empathy to ‘flesh out’ the minds and motives of perpetrators; and by contrast, to what extent – by abandoning subjective levels of description – do other attitudes create ‘impersonal’ subjects, who then appear to act in incomprehensible, unjustifiable ways? It’s certainly an area for further work.

Matt ffytche is head of the Department of  Psychosocial and Psychoanalytic Studies at the University of Essex, and the author of The Foundation of the Unconscious (Cambridge)

Felicity Callard is Editor-in-Chief of History of the Human Sciences and director of the Institute for Social Research at Birkbeck, University of London.

 

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.