A collection of ten essays paired with substantial prefaces, this book chronicles and contextualizes Roger Cooter’s contributions to the history of medicine. Through an analysis of his own work, Cooter critically examines the politics of conceptual and methodological shifts in historiography. In particular, he examines the “double bind” of postmodernism and biological or neurological modeling that, together, threaten academic history. To counteract this trend, suggests Cooter, historians must begin actively locating themselves in the problems they consider.
The essays and commentaries constitute a kind of contour map of history’s recent trends and trajectories—its points of passage to the present—and lead both to a critical account of the discipline’s historiography and to an examination of the role of intellectual frameworks and epistemic virtues in the writing of history.
|Publisher:||Yale University Press|
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About the Author
Roger Cooter is a professor at the Centre for the History of Medicine at the University College London, where he specializes in the social history of ideas in science and medicine. Claudia Stein is an associate professor of history at the University of Warwick.
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Writing History in the Age of Biomedicine
By Roger Cooter, Claudia Stein
Yale UNIVERSITY PRESSCopyright © 2013 Yale University
All rights reserved.
History-Writing in the Age of Biomedicine (and Before)
Some of the most important watersheds in human history have been associated with new applications of technology in everyday life: the shift from stone to metal tools, the transition from hunting and gathering to settled agriculture, the substitution of steam power for human and animal energy. Today we are in the early stages of an epochal shift that will prove as momentous as those other great transformations. This time around, however, the new techniques and technologies are not being applied to reinventing our tools, our methods of food production, our means of manufacturing. Rather, it is we ourselves who are being refashioned. —Michael Bess, "Icarus 2.0"
There is now a substantial and rapidly expanding literature depicting the transformation of our times through biomedicine, biotechnology, and neurobiology. Written mainly by scholars in sociology, anthropology, and science studies, it reveals how the new life sciences have come fundamentally to challenge our understanding of being human. "Biocitizenship" and "neurological identity," it claims, have replaced social citizenship in the course of molecular biology and neurobiology's reduction of human life entirely to its biology. A "neuromolecular gaze" is said to have come to reconfigure our moods, desires, and personalities. And through visualizations made possible by molecular diagnostic technologies such as DNA sampling, functional magnetic resonance imaging (fMRI), microarrays, microfluidics, "lab-on-a-chip," and protein staining, the human body has been reconstituted "at the critical interval between perception and knowledge," or between how we see it and how we think it. This reconstitution, linked to biometrics and other information technology, is held to have produced a new anatomical body for what many scholars now refer to as "posthuman medicine." No longer are we simply the potential victims of applications of biology to society (sociobiology). In a world in which humanness is flattened to the biological, the salience of the social disappears altogether, while humanness becomes, as one social scientist has put it, a folk category in a neo-Darwinian world. Such are some of the alleged features of our "posthuman age" and some of the ways in which our "neuroculture futures" are coming to be imagined.
Illuminating much of it, Nikolas Rose, author of The Politics of Life Itself (2007) and "The Human Sciences in a Biological Age" (2012), has pointed to how peoples' conception of themselves has been transformed from hardly even half a century ago. No longer do we conceive of ourselves largely in terms of a "deep interior psychological space" but rather, increasingly, in terms of a self-evident biology. Other social scientists have expanded on this, elaborating, for example, how today's hugely profitable sale of products for "erectile dysfunction" rests on an understanding of "impotence" not as a psychological problem, but a physiological one—a comprehension powerfully solidified through "the problem's" instant pharmacological solution. This example is also but one of how the ideal of the perfect body armored against all the corruptions to which flesh is heir has come substantially to redefine the practice of Western medicine away from the treatment of illness toward the supposed greater enhancement of physical and mental well-being. Further, it points to how the human body down to its molecular level has come to be exploited and sold as a valuable commodity. Newly "materialized" in this sense, bodies and brains have become shimmering objects not just for research, explication, and sensational popular exhibition, but for vast capital accumulation. Ethics themselves have been "somaticized," or made to support the commoditization and commercialization of body parts in their global exchange. Little wonder, then, that the medical profession's "selfless humanity"—its stamping of medicine as "the greatest benefit to mankind"—has been all but consigned to the dustbin of history along with the literature that lent it support.
Yet—and here's the rub—through the very act of observing this professed new "biological age," its ethnographers also market it. In their determinist claims for the new bio-knowledges and practices, they unwittingly perform for the professional, commercial, and political interests invested in the claims. This includes (less wittingly perhaps) their own academic investments. At the very least, their observations may be said to be more than what they seem; as a character in Richard Powers's novel Galatea 2.2 wryly observes, "You think observation doesn't have an ideological component?" Nor, of course, are these scholars today's only "observers"; the new age of biology is also substantiated by the many popularizers of neurobiology, including those who use it to buttress claims for social justice and other liberal values, and those who enhance its cultural valance by stressing how human nature is now to be understood in terms of this or that neurochemical marker.
I do not mean to suggest that the image of a new biological and neurobiological order is a fiction, or that the economic and political power attributed to the new life sciences is but a fabrication of the self-interested and/or deluded. It is far from it, in my opinion, even if a neurobiological "revolution" remains yet to be proved, and even if the general public and most scholars in the humanities may yet have little awareness of the claim that perception, cognition, identity construction, "the social," and "life itself" have all undergone a refashioning as a result of the new life sciences. That a new generation of scholarship is "coalescing around the assertion that the very grounds of life itself are changing" is only right; the new biomedical theories and practices clearly do demand careful exploration and analysis. But is not such attention at the same time an elaborate representation of our times, in the sense of something that both helps to make up a regime of truth and performs for it, culturally and existentially? "Truth," as Nietzsche said, "is a power that renders itself true by prevailing," and the representation of our times as neurobiological surely does just that. Instructively, the particular game of truth that Nietzsche observed in the nationalistic context of the newly unified German state was that of an excessive valorization of the past. Through "a consuming historical fever," he observed, the dead were burying the lives of the living. Today, in stark contrast, the living might be said to be burying the dead (the past) through a consuming ahistorical preoccupation with the biopresent as all there is and biology as all we are. One of the many consequences of this is an obliviousness to, or denial of, the practice of history as a means to understand the present and guide the future. Instead, the past is trivialized; packaged into a sellable media commodity, and in this way, by no coincidence, effectively fitted to today's entrepreneurial prizing of innovation, or the "sloughing off of yesterday," and starting over. Academic history, beyond its use in political propaganda, is dismissed as having no practical (that is, market) value, let alone intrinsic value. What's "old" is unwanted, like last week's iPod or mobile phone. Instead, we are encouraged to the new, to a future of never-ending growth and "economic progress"—an ideology now all the more forcefully preached after being caught (yet again) with its pants down. At best, the study of the past can only contribute to an understanding of decay, the stuff perceived as holding back the present and the future. In the English-speaking world, and perhaps in the Westernized world as a whole, the prevailing view is that present-centric economistic thinking about the future is all that matters.
Thus, to cut to the chase, it is not the accuracy, extent, or otherwise of the representation of our times as neurobiological and posthuman that should immediately draw our attention, but rather how this truth or how this whole field of observation with all its ahistoricity and disdain of academic history has come into being. How, in temporally specific terms, did it get constituted and naturalized? What legal, moral, ethical, philosophic, economic, political, and other institutional strategies or technologies of power, as Foucault called them, were involved in enabling this to happen, so as to permit a new governance of the self and others? And how (to the extent they have) did older values, technologies, practices, political and economic ideas and ideologies, notions of rights, and so on get retooled for this truth to become so shiny, believable, and powerful? What has been closed off, or is being closed off and tarnished, by this truth coming to prevail?
Such questions are historical, although not conventionally so, and not just because they query the present. They reflect a distinct kind of historical practice, sometimes called postmodern, constructivist, or representationalist. Honed over the past thirty years or so by critical theorists exploring the constitution of modernity, representations theory encompasses a multitude of different means and methods, but at its core suggests that there is no reality beyond what is represented through language, which is shaped historically. Its scholars, including now many historians, have elaborated the socio-political and historical epistemology of concepts and categories as basic to modern science and modern thought as "objectivity," "empiricism," and "experiment." They have exposed and contested the idea of would-be universal, historically transcendent concepts and essentialist categories, such as "consciousness," "biology," "the body," "the social," and even "history" itself (as a universalizing and homogenizing metanarrative). They have challenged the naïve acceptance of facts as nothing more than facts. (Hence, as here, the frequent intrusion of scare-quotes around words and concepts to indicate that they can no longer be taken for granted.) And they have called into question and de-privileged, if not wholly inverted, the exalted valuation of science and its method as the standard for all other social and cultural enterprises. In short, they have demonstrated that everything is historically contingent, including the reasoning and rationality involved in representations of "the present," "the past," and "the future."
Representations theory and practice owes much to Foucault, whose "genealogical method" directed attention to the conditions of possibility for the emergence and unfolding of any kind of knowledge and power. Impelled by a desire to comprehend the evaluative frameworks of the present (as well as the past within what he referred to as the "history of the present"), Foucault's genealogical method encourages the de-centering of any object of investigation. It urges resisting the temptation to follow well-established modes of investigation, such as the compulsion in academic history to the linear tracing of causesandeffects,"forerunners,"origins,"culminations,"inevitableoutcomes," and so on. As far as possible, the approach permits standing on the outside of any object of inquiry and investigative practice to explore the nature and exercise of the theories, concepts, and categories that sustain it. What, it asks, are the multiple sources of power that make things seem the way they seem? What are the practices and theories, and the combined conceptual and epistemological, juridical, and institutional strategies that create a particular field of truth in which the object of any investigation is to be perceived? Basic to Foucault's genealogical method, and that of representations theory in general, is the understanding held by Marx in his early writings that nothing is ever outside of history, including our conception of ourselves and our most abstract categories, not absenting the very historical knowledge on which the modernist or Enlightenment project to demystify the past was based. But in representations theory, Marx's view of history is to be seen as it self are presentation—one heavily reliant on Hegel and with a particular understanding of itself as a conscious process that consciously supersedes itself. Thus, from the perspective of representations theory, Marx's view of history constitutes a technology of power, or a means by which a particular representation of the world is sustained.
A representations approach to the would-be neurobiological present encourages directing attention to features that do not come into focus through its ethnography, anthropology, and sociology. It incites us to read outside or against such texts—above all, to see them as ahistorical in denying any relation to the past of their objects of investigation. Among other things, it raises for question the insistence in these texts that the refashioning of the understanding of "life" necessitates the radical overhaul of long-held conceptual distinctions and divisions of labor between academic disciplines (especially between the natural and human sciences)—the politics of which I will come back to in the third and final part of this chapter. It also encourages questioning the epistemological implications of returning to biological essentialist explanations and conceptualizations for what it is to be human. Further, it invites exploring how an emphasis on the would-be vital importance of the (represented) biologized and biotechnologized present devalues the worth of trying to historicize it, even though, paradoxically, the alleged grounds for both the devaluation and the historicization are inherently historical: after all, as Rose and others insist, the present is far more "complex" than anything that has preceded it. Perhaps most importantly, the representations approach permits exposing what might be depicted as the nasty fly in the ointment for the representationalist understanding of our biologized times, the fact that that biologization closes off that very means to its investigation.
Most evidently, this closure is manifested in what is now proudly proclaimed as "non-representational theory," the aspiration of which is to elaborate "multisensual worlds" that are "more-than-human and more-than-textual." Although the genealogy of non-representational theory and its modes of thinking and expression are entirely postmodern, it also embraces "affect theory," which, though similarly postmodern in its origins, draws directly on the neurosciences to make claims about human cognition and identity. Both non-representational and affect theory routinely encourage the intertwining of biology and culture and explicitly call for the "biological understanding of semiconscious cognition." Both convey the belief that there really is a reality beyond representations, which can now be located in the brain. Explicitly, they claim that the days of representations and postmodern theory are gone. "Constructivism" is passé, reports Rose, "no longer are social theories thought progressive by virtue of their distance from the biological." Thus, no less than the analysts and ethnographers of our biological times, the theorists of non-representationalism and affect provide technologies of power for the new game of truth. Moreover, in doing so they endorse neoliberal economics and its faith in modern managerialism. This is clear in their devotion to concepts such as fluidity, exchange, interchangeability, logics of propensity, and "susceptible situations which can be ridden rather than rigidly controlled"—notions all culled from contemporary business management. In this respect they manifest, uncritically, one of the tenets of critical theory as elaborated in the New Historicism of the 1980s and 1990s where representations theory was born—namely, that no critical method or language adequate to describe culture under capitalism can do so without participating in the economy described.
Admittedly, representations has not been every historian's cup of tea. Far from it. Above all, this is because it inhibits historians from assuming "objective" detachment from the contexts in which their objects of investigation appear. Indeed, it renders them incapable of acting as analysts of pasts "out there" or "over there," separated from the contexts in which their own questions are framed. The present in which the historian operates, it insists, provides no neutral shelter in which to stand objectively observing. Rather, like all spaces, that of the present is to be seen as historically constituted and hence impossible for the historian to extricate him- or herself from. As some historiographers and critical theorists have suggested, therefore, the only solution for the historian is continually to interrogate him- or herself as the analyzing subject, constantly self-monitoring and destabilizing the historical self. Understandably, many practitioners find this is a frightful prospect. But it need not be; far from marking an end to academic history, it might be regarded as a means to restore a degree of honesty and credibility to a practice now often criticized by insiders and outsiders alike for its pretentions to scientificity or objective truth recovery. At a time when academic history-writing has never been more under threat (at root, ironically, precisely because of the adoption of ahistorical modes of thought), any opportunity for enhancing its credibility should be seized upon. It does mean, though, the abandonment of the idea that the historian stands as if on Mars. And it involves understanding the need for this abandonment on grounds beyond those merely acknowledging that history-writing is always conducted in the present.
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Table of Contents
1 The End? History-Writing in the Age of Biomedicine (and Before) 1
2 Anticontagionism and History's Medical Record 41
3 "Framing" the End of the Social History of Medicine 64
4 The Turn of the Body 91
5 Coming into Focus Posters, Power, and Visual Culture in the History of Medicine 112
6 Visual Objects and Universal Meanings AIDS Posters, "Globalization" and History 138
7 The Biography of Disease 160
8 Inside the Whale Bio ethics in History and Discourse 170
9 Cracking Biopower 183
10 The New Poverty of Theory Material Turns in a Latourian World 205
What People are Saying About This
I can think of no really comparable recent book…Writing History in the Age of Biomedicine may turn out to be quite significant as a touchstone for the internal critique of historical scholarship in the first decade of the current century.—William Summers, Yale University
....an intellectual tour de force wresting with Marc Bloch’s original quest to interrogate the purpose, meaning, and methodology of the historian’s craft....this will be a ‘must have’ book for introducing students to the study of history, especially at the graduate level.—Dorothy Porter, Professor in the History of Health Sciences, University of California, San Francisco