









Study with the several resources on Docsity
Earn points by helping other students or get them with a premium plan
Prepare for your exams
Study with the several resources on Docsity
Earn points to download
Earn points by helping other students or get them with a premium plan
Community
Ask the community for help and clear up your study doubts
Discover the best universities in your country according to Docsity users
Free resources
Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors
biomedicine with concepts and methods from the humanities – has become a visible and coherent set of interventions, with its own journals, conferences, ...
Typology: Study notes
1 / 15
This page cannot be seen from the preview
Don't miss anything!
he medical humanities are at a critical juncture. On the one hand, practitioners of this fi eld can bask in their recent successes: in the UK, at least, what was once a loose set of intuitions – broadly about animating the clinical and research spaces of biomedicine with concepts and methods from the humanities – has become a visible and coherent set of interventions, with its own journals, conferences, centres, funding streams and students.^1 On the other hand, the growth, coherence and stratification of this heterogeneous domain have raised the spectre of just what, exactly, the medical humanities is growing into. 2 In particular, scholars have begun to worry that the suc- cess of the medical humanities is tied up with being useful to biomedicine, that the medical humanities has been able to establish itself only by appearing as the domain of pleasant (but more or less inconsequential) helpmeets – lurking hopefully, poetry books in hand, at the edges of the clinical encounter’s ‘primal scene’.^3 This is, we know, a caricature; still, it is not without its truth. Some, then, have begun to ask what a more critical medical humanities would look like: how might the methodological and intellectual legacies of the humanities intervene more consequentially in the clinical research practices of biomedicine – situating accounts of illness, suffering, intervention and cure in a much thicker 4 attention to the social, human and cultural contexts in which those accounts, as well as the bodies to which they attend, become both think- able and visible?^5 Our contribution to this space is to focus on the ‘medical humanities’ as an explic- itly interdisciplinary endeavour – with a specifically integrationist intent. In what fol- lows, we explore the contours of the methodological and conceptual space that crosses the humanities and the medical sciences; in particular, we open up the relationship that the medical humanities, including its many inheritances, has to the practices and apparatuses of the biomedical sciences. We are especially interested in whether the concerns, objects, methods and preoccupations of the medical humanities, not least the figure of the human at their centre, are, in fact, neatly separable or dissociable from the concerns, objects, methods and preoccupations of the medical and life sci- ences. And if these are – as we contend – actually not very separable at all; if the figures and preoccupations of the medical humanities are, in fact, deeply and irretrievably
36 des fitzgerald and felicity callard
entangled in the vital, corporeal and physiological commitments of biomedicine; then, beyond well-rehearsed concessions to inter- and trans-disciplinarity, how might we more critically imagine what, exactly, a medical humanities practice is going to look like in the present century? This chapter is part of a wider set of interventions in which we are challenging some of the dominant ways in which interdisciplinary spaces are being conceptual- ised.^6 Our aim is to open up the topology, territory and traffic of the ‘medical humani- ties’ as it has lately emerged; in particular, we want to disrupt an intellectual economy in which all animating liveliness is accrued by the humanities, and all hard-nosed scientifi c expertise by the biomedical sciences. Our argument has four steps: firstly, we focus on how much of the conceptual and practical underpinning of the medical humanities is premised on a model of integration , and we ask whether much of the theoretically and biologically conservative stance of the medical humanities can be traced to this image; in the second and third sections, we introduce a counter-image – entanglement – drawn especially from the work of Karen Barad, and explore how this helps us to move beyond the integrationist account; finally, we focus on deployments of the ‘human’ in the medical humanities, to show how entanglement can reinscribe – and reanimate – some of the central preoccupations of this literature.
Over a decade ago, just before the 2004 annual meeting of the Association for Medical Humanities, Martyn Evans and Jane Macnaughton reflected on the field’s relationship to inter- and multi-disciplinarity_._ Arguing against a model that positions the medical humanities as a series of polite exchanges between a range of disciplines, Evans and Macnaughton called instead for a particular form of inter disciplinarity in the medical humanities – defined as ‘the engagement of disciplines one with another, and more particularly with subject matter that somehow both straddles the disciplines and falls between them’.^7 To make this case, Evans and Macnaughton distinguished between two modes in which the medical humanities are practised: in one, scholars from dif- ferent disciplines gather around a shared preoccupation, but ‘with each discipline... essentially retaining its own unique viewpoint and writing from its own literature’.^8 In the other, more ‘radical’ model, scholars instead depart from their own discipline, and:
integrate the viewpoints of whichever disciplines seem most relevant to the ques- tions they are asking.... [These scholars] will not be constrained within the view- point of historian, anthropologist or philosopher but will build a perspective that is unique to the discipline called ‘medical humanities’.^9
Evans and Macnaughton, while acknowledging the risks of this endeavour (not least to the job prospects of junior pioneers), advocated strongly for the integrationist mode: ‘medical humanities is by nature an interdisciplinary study’, they pointed out, ‘and in this way it can make its most effective contributions to knowledge and to teaching.’ 10 Rather than simply developing a series of interesting conversations across boundaries,
38 des fitzgerald and felicity callard
In this view, holistic understandings of the body, as well as its illnesses, require much richer conceptions of both doctoring and healing – the medical humanities must thus be integral to, or incorporated in, medical education and research. There are two things to pay attention to here: one is an imaginary of what the medi- cal humanities must be – integrative, holistic, rounded, ambitious and so on. The other is a metaphorical repertoire – a set of received images, terms and likenesses – that works to license this imaginary, and more precisely, to spatialise the territory between, across and/or through humanistic and clinical thought. Our interest is thus in what precisely is intended by – and what is mobilised through – an insistence that the medical humanities must proceed according to a spatial logic of integration. Because it seems to us that if this integrated, singular medical humanities is preferable to a multi-disciplinary com- mitment to polite (yet determinedly insular) exchange, still it contains its own commit- ment to a particular ‘regime of the inter-’. If the commitment to an integrated medical humanities has indeed, in recent years, been an important and even radical move for the emergence of this field, we want to claim that it none the less mobilises a very particular account (let us say: a decidedly conservative account) of what kinds of things disciplines are; about what forms of spatial arrangement position them against one another; about what relations of exchange are appropriate across them; and about what must thereby constitute the, variously, human, cultural, biological and embodied agencies to which they attend. To be blunt: we are not sure whether any serious ambition to comprehend, and to intervene in, the density, complexity, directionality and capacity of traffic across this space can be at all moved by a desire for ‘integration’ – including the very space of ‘the inter-’ in which this desire operates. We argue that a more critical conception of the medical humanities needs to bring into question the ‘inter-’ of the ‘interdisciplinary’ medical humanities. Can the intel- lectual space of the medical humanities more radically reconfigure the objects, agencies and practices of clinical attention, beyond the now rather sterile distinction between a multi- and inter-disciplinarity? Beyond the territory of the ‘inter-’, can we imagine a more risky and experimental medical humanities? Can we mobilise a medical humani- ties that is not only a novel interdiscipline, gathering up different things into an insti- tutionally signifi cant whole, but also a much more ambiguous and risky intellectual space – one willing to navigate the deep entanglements of subjectivity, experience, pathology, incorporation, and so on, which cut across the ways in which we under- stand both the human and her medicine today?
In recent years, ‘entanglement’, a term central to twentieth-century quantum phys- ics, 21 has been widely used across a host of literatures in the humanities and social sciences – often to nuance accounts of how different agencies may or may not be sepa- rable from one another. ‘Entanglement’ has been used, for example, to characterise the affective relations and discontinuities between human bodies and other entities; 22 to make sense of settler identities in colonial and postcolonial contexts; 23 and to open
entangling the medical humanities 39
up the relationships, similarities and intersections between human and non-human things. 24 But it is especially in science and technology studies (STS), and most par- ticularly in feminist STS, that ‘entanglement’ has been put to work in the last decade or so. STS scholars have invoked the term to help parse, for example, human culture in an age of ecological crisis; 25 to think the space between language and databases in science fiction 26 ; to open up the relationship between persons and species in North Atlantic societies; 27 and to make visible the rationalities and continuities between scholarly registers of science, ethics and justice. 28 Much of this prominence can be traced to the potent work of Karen Barad, and especially to the carefully wrought metaphysics that Barad names as ‘agential realism’. 29 Among the many things at stake in this coinage, for Barad, is firstly a shift from thinking relationality as process of interaction (in which more or less bounded things engage with one another) to one of ‘intra-action’ – a neologism that refuses prior wholeness as the condition of intersec- tion. Barad’s ‘agential realism’ takes the existence of discrete agencies very seriously, but it takes these forms as secondary to the intersection of those agencies – and indeed it is precisely the ‘dividual’ nature of agencies (to borrow a term from anthropolo- gist Marilyn Strathern) 30 that Barad holds to be the ‘primary ontological units’ of the world. 31 Secondly, what this means for Barad is that we cannot easily divide the prac- tices (or objects) of ‘science’ and ‘medicine’ from the practices (or objects) of social and humanistic inquiry that are interested in understanding (and maybe contributing to) scientific medical domains. We do not, as scholars from various disciplines, bring our objects and practices to another through a kind of free-trade agreement; rather we re-enter a long history of binding, tangling and cutting, within which current moves towards integration are much more weighted than they might at first seem. 32 What holds together much of the research employing ‘entanglement’ is an intuition that some set of things, commonly held to be separate from one another (indeed, that defi ne themselves precisely with reference to their separability) – science and justice, humans and non-humans, settlers and natives – not only might have something in common, but also, in fact, may be quite inseparable from one another. ‘What often appear as separate entities (and separate sets of concerns) with sharp edges’, remarks Barad, ‘does not actually entail a relation of absolute exteriority at all.’^33 In this chap- ter, we contend that working with a dynamics of entanglement – rather than a telos of integration – sets in motion a more experimental and capacious future for the medical humanities.^34 Elsewhere, we have set out our own programmatic vision for a broader sense of ‘experimental entanglements’ across the humanities, the social sciences and the life sciences.^35 There, we attempt to mobilise a different set of epistemological com- mitments vis-à-vis how the self-proclaimed humanist or interpretive social scientist might approach matters commonly considered the province of the life sciences. We have also tried to conjure a different palette of affective dispositions through which we might both characterise and live in interdisciplinary spaces. Those dispositions (eddying around ambivalence, awkwardness, frustration, failure, and so on) depart from the most common affective registers (critique, adulation, disinterested rigour) through which humanists have tended to approach the terrain of the medical, clinical
entangling the medical humanities 41
For Barad, as for Schrödinger, what is precisely at stake here is how to account for life. Confronted with the smeared cat, the fact is, says Barad, ‘life just ain’t what it used to be, if it ever was.’ 42 Life-conditions are definable only through spe- cific ‘measurement intra-actions’. 43 In this sense, the referent of measurement for Barad is not a bounded ‘object’ – ‘life’, the patient, an unfeeling doctor, a consoling poem – but what Barad calls phenomena : what we are always in pursuit of, when we measure, are ‘entangled and enfolded sets of apparatuses of bodily production of all the beings and devices relevant to this specific example’. 44 Our methodologi- cal task is thus one of ‘accountability to and for differences that matter’. 45 And our investigations, as well as the devices and apparatus that make them possible, are ‘not mere static arrangements in the world’ – rather, they are themselves ‘material- discursive configurations of the world... through which specific boundaries are enacted’. 46 Boundaries, whether between different ways of measuring things or between the act of measuring and the thing measured, do not mark differences to be overcome in the act of integration. Boundaries are instead things we produce – that we have to produce – through specific intra-active configurations and perfor- mances. Practices of making boundaries are fully implicated in the dynamics of intra-activity through which phenomena come to matter: ‘discursive practices and material phenomena do not stand in a relationship of externality to one another,’ Barad remarks: ‘rather, the material and the discursive are mutually implicated in the dynamics of intra-activity.’ 47
This is, we are aware, perhaps an obscure account of how one might disrupt the ‘inter-’ and/or ‘multi-’disciplinary nature of the medical humanities. Our theoretical- rhetorical arguments are intended to open a space for future, empirically fine-grained analyses of practices of boundary-making in the medical humanities terrain. What we want to insist on here is that when we talk about ‘entangling the medical humanities’, we are not simply introducing a new metaphor, or asking our colleagues to rearrange the disciplinary deckchairs. Instead, we are drawing attention to the fact that the pre- occupations of the medical humanities are always going to be particular kinds of, or moments in, sets of as yet undetermined material-semiotic configurations and align- ments (bodily, pathological, cultural, human, and so on) – whether this is acknowl- edged institutionally or not. This implies that we need to see the current favoured topoi of medical humanities scholarship, and the differentiations that those topoi bring into being – a quickly assembled list would surely include the suffering patient, a doctor’s practice of clinical care, the exemplary site of the clinic, and cancer – as congealed, and overly resonant configurations that constitute but one particular way of mak- ing phenomena come to matter. But what if the task of the medical humanities were to encourage the emergence of different topoi, or the limning of different topologies through which illness and care are constituted? What if illness were not imagined, for example, as co-located with or coincidental to a body? 48
42 des fitzgerald and felicity callard
Within such an imaginary, one could argue that the most pressing sites of the bio- political redistribution of bodily potencies (with all that they connote in relation to questions of medicine and health) might not include the bioethically over-invested scene of the prone figure hooked up to a life support machine; one might then explore, instead, assemblages of welfare policies, psychometric tests, affective dispositions and algorithmic predictions that are in the process of redistributing categories and mani- festations of productive labour and idleness under practices of ‘workfare’.^49 Or, to take another example, one might approach a healthcare ‘institution’ not as a conceptual and physical edifice whose histories we have become used to tracing (the National Health Service, the World Health Organisation, the hospital), but as something that gives form or order precisely by ‘cutting’ or ‘disentangling’ entities from a hetero- geneous field. Tiago Moreira, for example, has examined how the emergence of the systematic review in healthcare is an entity brought into the world by ‘disentangl[ing] data from the milieus in which they are commonly found’, and endowing these data with new qualities that are enabled by their collection and dissemination through new techno-political means.^50 We might go on. But the point here is not to introduce a new range of topics that will ‘count’ as ‘medical humanities’. The point is, rather, to break open the two halves of that term, such that the complex of human life and medical science becomes – to borrow from an analysis of interspecies health – a series of:
repeated crossings, an ongoing conversation – a repetitive material semiotics, or a working out of a new reality. Contagion, then, is more than contact and viruses don’t simply diffuse across space, or extend across a plane through simple trans- mission. They are configured in relation.^51
An integrated medical humanities, by contrast, is always going to presuppose bound- aries that obscure these differences – and, indeed, render them invisible. Thus the issue is not that illness and healing are multi-faceted phenomena that cannot be understood from a clinical perspective only, and that require a new, interdisciplinary perspective to be appreciated in their wholeness. The issue is that what get enacted, positioned and understood as moments of suffering, sickness, care, and so on are always in the process of being cut from particular sets of relations.^52 What we need methodologically, then, is a way of thinking, writing and measuring life-states that ‘stays with the trouble’ 53 of these relations and differences. The medical humanities does not need to break down boundaries, but rather to understand how practices of making, breaking and shifting boundaries constitute ill- ness and healing. Accordingly, we call for closer attention to the political as well as to the ontological consequences of installing boundaries that constitute some scenes, rather than others. By the same token, the medical humanities does not need to inte- grate different perspectives into a unified whole in order to appreciate an entity in its complexity; it needs to understand how perspectives themselves are already – and this is no shame – moments of relation, both with one another, and with what they take to be their objects. The point is that integration is layered on configurations of relations;
44 des fitzgerald and felicity callard
that would not establish at its heart those wearyingly familiar encomia – an ‘ethical life’ and a ‘good death’. In previous work, 61 we have explored such dynamics in the space of the cogni- tive neuroscientific experiment, a space whose uncanny generativity has not been fully recognised by its many, often critical, humanist onlookers. We used our own encounters with the experiment to redirect the rhythms of stale humanities-versus- sciences debates, and the familiar stagings of the subjective/objective and the human/ non-human that coagulate around them. We are interested in setting into motion rich archives of experimentation within the arts, humanities and interpretive social sciences by braiding them through the framework of laboratory science – not to ‘reduce’ the former, but to reshape and reimagine the conceptual and empirical con- tours of the latter. 62 In particular, we want to insert (at least) two humans – the experimenter and her ‘subject’ – into a complex experimental apparatus comprising other instruments and entities, and thereby to remain agnostic about the role that each part within this assemblage might play. We refuse to take for granted who or what probes whom or what in an experiment; when the human subject becomes an object and when she might remain a speaking subject; which other entities might ‘speak’ within the experimental set-up; and what the possibilities of influence and suggestion might hold for torqueing paradigms and resulting data within the cogni- tive neuroscientific experiment. Let us, in closing, propose an equivalent manœuvre for the critical medical humani- ties. What difference would it make for us to remain agnostic about what does and does not count as a medical intervention or apparatus? What would happen if we remained open about where (or what, or who) the thinking, feeling subject is within medical mise-en-scènes? What if disease were not a bodily fact that needed finer inter- pretation, but a way of describing a relation between a body, a history and an environ- ment? What if, across such interpretive labours, we could think more radically about the role that everyone (practitioners, writers, experimenters and patients of different stripes) might play? What possibilities might open up for the medical humanities, for example, if we discerned a world of awkward, lachrymose, over-involved clinicians, on the one hand, and cold, pragmatic, resolutely scalpellic poets on the other? Indeed, it is precisely in the opening up of such questions that we see the promise of the critical medical humanities.
We have tried to sketch here, in abbreviated and gestural form, an outline for what we call an entangled medical humanities. By invoking entanglement, we wish to turn the attention of medical humanities practitioners and theorists from the problematic of ‘integration’ to one of ‘differences’ – in other words, from a need to come together, to a recognition that both medicine and life itself are constituted precisely through rela- tions, and through practices of bordering, cutting and exchange through which those relations come to matter. There is thus neither an additive nor an integrative ‘human’
entangling the medical humanities 45
at the heart of the medical humanities; there are, rather, animacies,^63 vitalities and pathologies, which flow across different practices and preoccupations that then come to be ascribed to the ‘humanities’ and the ‘biosciences’. If our chapter has offered a largely theoretical account of those flows and forces, at its heart is, none the less, a significantly reanimated research programme for the medi- cal humanities. Entanglement eschews what we see as the frequently defensive appa- ratus of the field – one that has tended, despite its investment in plurality, to prescribe compelling sites of animation and analysis. An entangled medical humanities claims, in contrast, no privileged access to ‘narratives’ of illness and healing, to the ‘experi- ence’ of illness, to ‘reflections’ on doctoring, to insights on ‘care’, to normative or ‘ethical’ analysis and so on. But it also rejects any claim from a conservatively defined, narrowly bioscientific laboratory science to have unique access to the body and its ailments, to be the only interpreter and preserver of the vital capacities of that body, or to be uniquely intimate with its corporeal malfunctions. What would happen, for and to the medical humanities, if we set aside our usual allegiances and identifications to think more experimentally about the constitution and dynamics of the medical- humanistic domain? Tracing such trajectories of entanglement is what we have tried to begin in this chapter.
This research is supported by the Wellcome Trust 103817/Z/14/Z.
Karen Barad, Meeting the Universe Halfway: Quantum Physics and the Entanglement of Matter and Meaning (Durham, NC: Duke University Press, 2007). Karen Barad, ‘Living in a Posthumanist Material World: Lessons from Schrödinger’s Cat’, in Anneke Smelik and Nina Lykke (eds), Bits of Life: Feminism at the Intersections of Media, Bioscience, and Technology (Seattle: University of Washington Press, 2008), pp. 165–76. Lisa Blackman, ‘Affect and Automaticy: Towards an Analytics of Experimentation’ , Subjectivity 7 (2014), 362–84. Des Fitzgerald and Felicity Callard, ‘Social Science and Neuroscience beyond Interdisciplinarity: Experimental Entanglements’, Theory, Culture & Society 32.1 (2015), 3–32. Des Fitzgerald, Svenja Matusall, Joshua Skewes and Andreas Roepstorff, ‘What’s so Critical About Critical Neuroscience? Rethinking Experiment, Enacting Critique’, Frontiers in Human Neuroscience 8 (2014), p. 365. Monica Greco, ‘Logics of Interdisciplinarity: The Case of Medical Humanities’, in Georgina Born and Andrew Barry (eds), Interdisciplinarity: Reconfigurations of the Social and Natu- ral Sciences (London and New York: Routledge, 2013), pp. 226–46. Donna J. Haraway, Modest_Witness@Second_Millennium.FemaleMan_Meets_OncoMouse: Feminism and Technoscience (London: Routledge, 1997).
entangling the medical humanities 47
48 des fitzgerald and felicity callard