Tuesday, July 05, 2005

Reading :: The Parasite

Originally posted: Tue, 05 Jul 2005 22:46:46

The Parasite

by Michel Serres

What makes these Parisian philosophers write in such heavily metaphorical language? Maybe it's in the Perrier. Whatever it is, Latour seems to have sipped a bit, while Callon is almost wholly a tetotaler. Deleuze imbibed deeply. And Serres, he swims in it.

Serres is known as a master stylist in French and his works are sometimes described as almost untranslatable because of it. And I see glimmers of that, especially when the translator includes the original wording in parentheses so that we can understand and admire particularly clever wordplay. Some of this I found quite worthwhile. But throughout, I longed for the clarity that comes from Latour's and Callon's empirical cases. In those works, we are treated to laboratories and the hospitality industry. In Serres' work, we get Aesop's fables.

These fables can be nicely illustrative, of course, but it's hard to figure out how they apply to other cases. Nevertheless, we get some idea of why Latour and Callon turned to Serres' work.

What is a parasite? The translator helpfully explains that the French term has three meanings: a biological parasite, a social parasite, and static (p.vii). Serres uses all three meanings, switching from one to the other and trying to pull in all three at once, in his illustrations. The parasite, in brief, is a figure meant to illustrate intermediaries in a network. In a chain, the parasite intercepts material meant for the host and transforms it; the parasite turns material into information, like a guest who pays for his supper with stories (p.11 and many other places). But the parasite, like a rat, may find its meal interrupted by a noise -- the rat is parasited by the noise, which comes between it and its meal (p.19). A parasite always comes between. and we are all parasites: "We parasite each other and live among parasites. Which is more or less a way of saying that they constitute our environment. We live in that black box called the collective; we live by it, on it, and in it" (p.10).

Notice the language of symmetry here. In his metaphorical fashion, Serres seems to be saying what actor-network theorists have later said, citing him for support: The world is full of mediators, or intermediaries, each of which comes between other things, each of which plays a transformative role. These things include people and animals, but also "the telephone, the telegraph, television, the highway system, maritime pathways and shipping lanes, the orbits of satellites, the circulation of messages and of raw materials, of language and foodstuffs, money and philosophical theory" (p.11). This list closely parallels Callon's lists of intermediaries. And Serres does not see these things atomistically; rather, he defines them relationally, in a way that recalls Bateson's definition of information as a difference that makes a difference: "The difference is part of the thing itself, and perhaps it even produces the thing. Maybe the radical origin of things is really that difference, even though classical rationalism damned it to hell" (p.13). Serres finds it necessary to begin with a theory of relations (p.130).

In such a theory of relations, doubles and oppositions become unsuitable: " the doubles and oppositions would disappear in favor of the plural and transformations" (p.21). The implications for dialectic (Hegelian dialectic, at least) are obvious. "A text in three parts -- a dialectic -- has a forked tongue and the head of a viper. The twin thesis and antithesis divinely produce the athletic synthesis: the synthesis waits for its adversary or its double in the wrestling match" (p.29). And elsewhere: "dialectic is the logic of phenomenology, that is to say, appearance" (p.76; cf. p.222). But that appearance does us no good. "What is the good of opposing word to word, article to article and antithesis to thesis, sound to sound or idea to meaning, if by slipping into the channel, one can perturb the sound, meaning, thesis, and system at will? ... The old kind of combat and the two fighters disappear in this fog" (p.195).

Let's leave the two fighters there, then, and get back to the parasite. Serres recalls the story of the passer-by who finds a snake frozen stiff in the snow. The passer-by takes the snake into his home, places it by the fire to warm up -- then kills it when it tries to attack him (p.22). The snake has turned traitor, refusing its new and unasked-for role of a guest in debt. The host tried to speak for it; the snake refused to accept the host's attempted role. Plug this story back into the definition of the parasite as intermediary and you get the notion of translation-betrayal of which Callon and Latour write so frequently. Who is the host and who is the guest? Who decides? According to Serres, the question can be asked "not of the whole network, but at a local division, a single point of the system" (p.27).

Speaking of betrayal, the longer you fend it off and the more elements you can add without betrayal, the stronger the network is: "The stronger the voice the longer the relation" (p.84).

Serres' discussions eventually lead to the notion of a quasi-object, which Latour later picks up in We Have Never Been Modern. He argues that a parasite is an intermediary in the network, in fact, the "elementary relation" of the network (p.224). In the network, a quasi-object helps to define those relations by marking the one who holds it (p.225). Think of a ball game: "A ball is not an ordinary object, for it is what it is only if a subject holds it" (p.225). If the object of the game is to possess the ball, the game's knot (or focus) is the ball's possessor. The subjects serve the object rather than making it their slave. And when the ball is passed, the knot is undone and the focus shifts. "What was supposed to be decided isn't; the knot comes undone. History and attention bifurcate" (p.226). The game is a graph of substitutions. "The quasi-object that is the marker of the subject is an astonishing constructor of intersubjectivity" (p.227).

What's a quasi-object? Money, for one (p.229). And again we see the connection to Callon's intermediaries.

The Parasite might be a joy to read in French or for someone of a different temperament, but I found it to be frustrating. I got a lot out of it, as I hope the review demonstrates, but without the frame of actor-network theory I would have had a much harder time. Read Latour and Callon first before tackling this one.

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Monday, July 04, 2005

Reading :: Rationalizing Medical Work

Originally posted: Mon, 04 Jul 2005 19:32:13

Rationalizing Medical Work: Decision Support Techniques and Medical Practices

by Marc Berg

Marc Berg's dissertation work was supervised in part by Annemarie Mol, and her influence is quite evident in this book based on the dissertation. Berg uses actor-network theory to examine medical work, particularly the trend of rationalization that is exemplified by decision support systems -- information systems that are meant to help doctors make consistent, accurate decisions about medical care. Such systems look good on paper, but begin to provide wildly inaccurate diagnoses when applied to problems outside their specialty area. Berg wants to know: Why is this so? How do medical personnel deal with the problem? What does all of this tell us about knowledge work?

As I've discussed elsewhere on this blog, Berg has done some very smart work in relating ANT to computerized information systems, and in doing so he has brought it onto "turf" that has been occupied by information processing cognitive psychology and (more recently) situated cognition, distributed cognition, and activity theory. ANT has some methodological and theoretical relations with the latter three, but it is ultimately a rather different enterprise because it represents a relationist sociology hooked up to a particular type of ontology. So although it deals with some of the same problems that an AT or DC study might, it sometimes diverges in interesting ways, especially as it treats history, multiplicity, and development.

Berg discusses how medicine has been framed over the last couple of centuries, noting that it has involved a struggle between two concepts of medicine: as a situated practice grounded in tacit knowledge and as a set of general principles grounded in formal research. The latter view has gained the upper hand lately, resulting in attempts to flatten and univeralize concepts and vocabularies (e.g., p.24). This view has led to developing automated decision systems that can compile general knowledge about various conditions, based on the research paradigm. Such systems not only draw from normative concepts and vocabularies, it enforces them: the practice of its users is "disciplined to this formalism" (p.92, his emphasis).

Unfortunately, this approach simply doesn't work well. Like Mol, Berg identifies the problem as multiplicity: different disciplines simply don't and can't agree on the "same" object (p.96). As one informant complains: "But nobody agrees on what they are talking about. What should the result of the test be. A figure? The angle the leg makes with the table?" The informant goes on to describe ever more specific variations of decisions physicians must make in order to reach the degree of specificity necessary for agreement. Berg's point is that such negotiations could go on in remarkable detail for each case, with more negotiations necessary whenever a new medical specialty is brought in, and no guarantee of agreement -- because the different specialties are looking at different objects and mobilizing them in different ways. The approach necessitated by a decision support system involves building these negotiations into the tool itself, flattening them into a single discipline with a single body of knowledge and object. The task is problematic to say the least:

... formal medical tools cannot be conceived ass inert carriers of some "good medical practice." Delegating tasks to a formal tool transforms the nature of those tasks. The introduction of a decision-support tool generates a propensity to refocus medical criteria on the elements that behave in predictable and easily traceable ways. Formal tools contain a predisposition to build simple, robust worlds, without too many interdependencies or weak spots where contingencies can leak back in. In doing so, in selecting the measurements and indications that best fit its prerequisites, the breast cancer protocol redefines what eligibility for bone-marrow transplantation treatment denotes -- and, thus, what "potentially curable disseminated breast cancer" is. (p.99)

Hard data, Berg says, is data whose production has been disciplined (p.101).

So on the one hand a decision-support system redefines that which it describes, but on the other hand the system cannot contain too many negotiations with too many disciplines. That quickly becomes too complex a task -- unless the system is sharply bounded. "Constructing a feasible, working decision-support tool, then, always implies building specific contexts into the technique" (p.108). The decision-support system appears to embody some sort of universal medical knowledge, but it can only do so in a sharply limited space, and even then, "idiosyncratic, unique features of the specific sites involved become embedded in a tool's script" and thus "a tool's radius of action is reduced" (p.108). "The contingent nature of the protracted process of negotiations, I argue, is incorporated into the core of the tool. Trying to get a protocol to work is a process of making ad hoc compromises, going back to the tool, and tinkering to get the medical practice's elements in line" (p.115). The traces of these struggles and compromises are left in the tool (p.116).

Ultimately, "Instead of the transparent, optimal, unified Clinical Rationality hoped for, we end up with opaque, impure, additional rationalities" (p.116).

In the latter part of the book, Berg brings the principle of symmetry to bear on the issue. He points out how chains of events are consistently rewritten to attribute decisions to individual physicians rather than to the tools and practices on which they draw, and in doing so, he calls into question the notion of uniquely human agency (p.136; cf. Hutchins, Suchman). Berg also follows ANT by arguing that history and future are continually reconstructed in medical records (p.137).

Ultimately, Berg argues, "the only way the network can persist is through its looseness, its openness, and its unresolved tensions" (p.168). I agree, of course, having made a similar argument in my own book.

Overall, Berg makes a strong case for applying ANT insights to information systems. Those of us coming from an activity theory standpoint can extrapolate a critique of our own work as well as ways in which the two approaches complement each other.

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