Originally posted: Fri, 17 Oct 2003 11:17:06
The Body Multiple: Ontology in Medical Practice
Annemarie Mol, a Dutch ethnographer, has written and worked with John Law and has helped to develop the brand of post-ANT amodernism that we see in his later work. The hordes of people who read this blog undoubtedly are thinking of the review I wrote of Law's Aircraft Stories, which I think tried a bit too hard and lost its grip on the materialist pragmatism (if I can characterize it that way) of ANT. As I began reading this book, I was worried it would turn out the same way. After all, she spends a lot of time in the first chapter being rather introspective -- talking about her positioning as a Dutch researcher who must write in English if she is to be read by a large number of colleagues; examining her own pre-med background; talking about disease as being "more than one, less than many." (When I mentioned that phrase a few days ago, someone shot back: "That would be ... two?") Most bothersome was Mol's choice to have two running sets of texts, meaning that on nearly every page, the top half and the bottom half constitute different takes on the chapter. That probably seems clever and dialogic to most people, but I found it to be annoying and discouraging: I'd finish a chapter, then go back to the beginning to read the same pages over again.
Yet the book, as a whole, is tremendously interesting. Either it makes John Law's point from Aircraft Stories far, far better than he did, or I'm going to have to read Law's book over again. Because what Mol does here is to persuasively argue that the things we take as settled, scientifically quantifiable and observable phenomena are not really just objects-in-the-world; rather, they always multiple. Reality, she says, multiplies when we focus on artifacts or practices.
How could that be? Mol manages to take a very mystical-sounding concept and -- unlike Law -- ground it through material, pragmatically gathered and analyzed data. She asks: What is the disease called atherosclerosis? And the best illustration comes from one of her informants, who shows her a slide under the microscope and demonstrates how the veins have calcified and narrowed, restricting blood flow and causing great pain in the legs of the person who had the disease. This calcification, he tells her, is atherosclerosis. And after a pause, he qualifies: under the microscope.
It's an important qualification. The pathologist can only make these slides after the leg has been amputated (since the veins are otherwise occupied until that point, you see), so his version of atherosclerosis comes rather late in the game. Other people's versions of atherosclerosis are enacted differently (and Mol selects the term enacted carefully, to indicate the complex practices in which they are embedded). To the patient, atherosclerosis is great pain in the legs; to the general practicioner, one possible explanation for that pain and for the weak pulse in the legs; to the radiologist, a cloudy smear in the X-rays after a radioactive dye has been injected; to a surgeon, "pipes" that have to be cleaned; to an occupational therapist, a malady that can be abated with exercise. Mol points out that usually these multiple enactments of the disease cohere -- that is, there's enough correspondence among them that people can be said to be talking about the same object, the same disease. But, interestingly, sometimes these enactments don't cohere. Mol spends much time trying to figure out when that happens and why.
The book is in general engagingly written (although, like Law, Mol can sometimes be too self-indulgent) and thought-provoking. What interests me is how this line of research impacts activity theory. In amodernist, ANT and post-ANT approaches, we always operate at the level of lived experience and we use tools such as representations to change the scale of things to fit that lived activity. To examine calcified veins, for instance, we use a microscope to make the veins "larger"; to examine galaxies, we map them in photos; and we don't marvel that we can place photos of microscopic veins and macroscopic galaxies next to each other. Sociologically speaking, there is no macroscopic or microscopic, there is only the lived experience with its many tools for expanding or shrinking phenomena appropriately. But in AT, there is a definite belief in different scales of sociocultural phenomena. We look for the elements of an activity system, including the actions that sustain it and the operations with which those actions are enacted. And at the macro level, activity theorists look for contradictions among or within activities. Engestrom, for instance -- following Marx a bit too closely -- argues that the primary contradiction in capitalist society is the one between use value and exchange value. For a materialist theory, AT sounds very abstract sometimes! What Mol's work does is to clearly call into question these sorts of macro-level abstractions, pulling us back from dialectic and into a more dialogic understanding of activity that is always grounded at the level of the individual. Yes, I'm still processing this notion.
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