Canguilhem, "Diseases" and "Health" from Writings on Medicine

The group began with questions.

[1] What is the thesis in these pieces? PP. 48: health becoming an object of calculation. The body as given. What should we make of this?

[2] PP. 39: “We would nevertheless….social facts”. In what sense are patients not social facts? Is there a distinction between social factors in medicine and psycho-somatic qualities that he discusses below?

[3] PP. 38: “Should the introduction….” Discussion of the “in vogue” paradigm. What other sources (other than immunology) are there for thinking about disease? Where else does GC look for an account of disease?

Is the reading of health and the history of philosophy performing an account of disease and human experience?

[4] PP. 37-8 How is the discussion for living conditions integrated into an understanding of disease? How does this relate to inequality?

PP. 50 does GC contrast his own account with the phenomenological account?

[5] Could we apply Delaporte’s ‘epistemographic’ framework to make sense of the disease chapter? What does GC mean in claiming that health is the truth of the body?

 Discussion ensued.

The Normal and the Pathological : is disease merely a quantitative variation of the normal state? GC: no.

Do sciences of the normal and the pathological exist? Are these discrete? CG: 228. only a science of what is called normal. He is critical of the idea that physiology comes before pathology. We actually start with pathology (the way that knowledge actually develops): ‘the patient calls the doctor’. Eventually that gives rise to questions about normality.

GC is criticizing the ideas that there is no self-standing “ontology” of disease. It is always a quantitative distance from the health.

Three problems with this view: (i) rationalist optimism: evil has no reality. (ii) the view is too deterministic (Laplace). (iii) the reduction of quality to quantity.

CG is doing historical epistemology. But is he also doing epistemocritical work too? He is not only charting the discursive shift, but wants to make a positive argument for why conception of health is better than another.

At the end, GC seems to suggest that Merleau-Ponty was paving the way for his own view. On pp. 48, he refers to the body as having different qualities—then this is taken up in relation to health. He also does not want to embrace a kind of anti-medicine.

CG wants to see the body as both given and constructed. But does not seem to want to take the phenomenological route to make this point. He seems to want to preserve a space for experience viz a viz the body (or health and disease?).

Perhaps what CG is rejecting is a kind of reductionism of health to either the first or third personal perspective.

37-8: The treatment of disease in the hospitals systematically erase or decontextualize them from their social conditions. There is an interesting connection between production and medicine.

GC seems like he is interested in different registers: social, biological, etc.. and wants to leave room for a kind of phenomenological point of view within each.

Is GC just rejecting the idea that ophthalmology patients are purely social facts?

He wants to affirm both the sociological and the medical.

Delaporte, "Foucault, Epistemology, and History"

 We began with questions:

p.288 - Delaporte mentions the idea of an “internally normative project”.

p. 291 - Delaporte distinguishes the current and the present and says that for Foucault the present was bracketed.

p. 287 - Delaporte describes Broussais as inventing a whole series of relations among disparate entites (287).  To what extent does archaeology require looking outside of a discipline.  Is Delaporte claiming that this is essential to (important for) archaeology?

p. 287 – Delaporte defines history of science in terms of history of veridical discourse.  Would this definition apply to different kinds of history?  Or is this definition specific just for history of science?  Is the focus on “the true and the false” central to science specifically

p. 290 – Delaporte discusses the status of the concept of rupture (p. 292) and origin  in Foucault and uses it in unexpected ways, or potentially unexpected ways.

p. 285 – Delaporte sketches four different levels of epistemography. What are the relations among these levels? How would we apply these levels to Delaporte’s own works?

Why is Delaporte focusing this analysis more on the early Foucault rather than the later Foucault?  Why is there no discussion here of HSv1?  How would we extend the analysis to later Foucault?

 

 Some items in discussion:

Four levels of epistemography

The epistemonomic – The identification of “internal epistemological controls”, which are standards and rules for saying, seeing, inquiring based on accepted epistemological foundations.  The identification of  internal structure.  Are these rules presumed to be explicit?

The epistemocritical - An analysis that “would put” to a historical figure “the question of the truth of his assertions”.  (Rorty’s “rational reconstruction”.)

The epistemological – Analysis of “theoretical structures” and “concepts” and “rules governing their use” (p. 286).  Delaporte is here referring to Canguilhem.  This differs from epistemonomic in that the epistemological is focused on the history of our epistemological concepts today.

The archaeological – The identification of transformations, or “historicity”.

 All three levels make use of the epistemonomic but establish different relations  to it.  [Image on board]

Delaporte, The History of Yellow Fever Chs. 6 and 7

We began with questions.  

[1] To what extent is Delaporte engaged in genealogy? What is the relationship of the book to more traditional forms of history?

[2] What should we make of Delaporte’s claim that the mosquito is constituted as an object? What about his distinction between ‘words’ versus ‘concepts’?

[3] On page 144, Delaporte claims to be laying the groundwork for a true archaeology of science. Is this book supposed to be an instance of archaeology? Or is it just laying the groundwork? Presumably this is supposed to differ from a history of science. In DaC didn’t Delaporte make a claim about taking claims in their positivity? Not with the truth or falsity of claims per se. What is the broader context for this book? What makes this argument important? Is it just correcting other historians?

[4] What does Delaporte mean by ‘history’ and ‘historical epistemology’? Is the latter supposed to serve as a corrective to the former? What is the epistemological shift that Delaporte is drawing attention to in the book?

[5] What is does the axiom of historical epistemology involve? (pp. 127, 131).

[6] Is Delaporte successful in setting aside questions of truth and falsity? Or is he ultimately concerned with correcting myths? pp. 106: political practice did not alter the shape of theory (i.e., it was not political indifference). Pp. 136: “psychology has nothing to do with hypothesis formation and verification”. How is this consistent with Delaporte’s broader project? Perhaps this section is an example of Delaporte focusing on figures.

[7] On page 103-5. What should we make of the notions of linearity and (dis)continuity?

[8] Continuity and discontinuity both seem to play an important role in scientific discovery.

 Discussion ensued.

What does FD mean when he says that there is an epistemological transformation on pp. 122? Manson and Finlay are both trying to explain how the Yellow Fever is transferred from one circulatory system to another. Vehicle model: a mechanistic conception of transfer (Finlay). Host model: pays attention to the life cycle as well.

Classical epidemiology as the intersection between parasitology and microbiology. It has both ‘Hippocratic’ and ‘Newtonian’ assumptions built into it.

Can we read this section as an attempt to account for the historical conditions of possibility for epidemiology of the vector?  

On page 108: “no research objects to which… compare”. What is the notion of the ‘research object’ doing?

How would FD characterize the interesting thing about his own account? He is not interested in an analysis that starts with present scientific truth and then assesses past views in relation to it. If it is archaeological, then what are the depth transformations in knowledge?

Perhaps the archaeology component differs from Foucault’s account, insofar as it is internal to science. Foucault looks more broadly. Perhaps the archaeology gives FD a new way of talking about historical contributions. We can hold the opening up of ideas and their wrongness in tension. Archaeology is a domain specific analysis. Genealogy can be read as not domain specific. So DaC could be considered more genealogical in so far as it puts political and economic discourse into conversation with medical knowledge.

 

Traditional historiography (legendary history):

·         FD contrasts two paintings he in his introduction. Master of ceremonies (pp. 4). Focus on these great individuals.

·         Discovery of the truth.

·         Fadedness versus accidental structure.

·         Assumes that there is a single valid point of view and that we can analyze the past in terms of truth and error (does not respect the historical epistemological axiom).

·         Repetition and extension (not fine detail).

Delaporte’s work:

·         Documenting a transformation.

·         Historical epistemological axiom.

·         Privileges fine detail over (simplified) continuity and discontinuity.

·         Perhaps there is a kind of realism/happy positivism about FD’s writing. Pp. 106: appeal to historical accuracy.

·         Reversal: the facts and the conditions of possibility for those facts (i.e., “structure of the visible” and “surface effects”).

Delaporte, The History of Yellow Fever, Chs. 4 and 5

 (Meeting Date: April 8th)

We began with questions:

1. Page 67. “[T]he structure of the visible” is discussed that which grounds the principle of analogy. What does Delaporte mean by this?

2. Page 91. Delaporte makes the claim that the mosquito theory constituted an interpretive scheme for thinking about disease. The movement is from theory to observation and not the reverse. Can we talk a bit about the role of theory here?  

3. On page 89, he refers to history as chronological and as having a logic. What does he mean by this? 

4. What is the point of a chapter that is basically saying “and this is why they did not find the solution for 20 years.” Why write a 20 pages on this and not just a paragraph or 2 pages?

5. Page 79 [“The divergence of interpretations and … in reality the controversy took place because...”]. Addresses the distinction between something observed as a fact versus the reality of the thing. This links up with a notion in Foucault of mythmaking and storytelling.

6. Page 93 [“in order clarify the history, let us first set down the facts”]. Recall discussion last week about historians versus historical epistemologists. Shall we revisit some of this theme?

7. Page 65 [end of the first paragraph]. Delaporte talks about the transformation of scientific theory as a matter of salvation. What is behind this terminology? Can we relate some form of Christian theological understanding to his study of science? He also talks at some point about missionaries. Does he talk more about this connection elsewhere?

8. This may be a situation where he is moving away from early Foucault focusing on discourse etc. and looking instead at individual human beings…Or perhaps he is holding both individuals and discourse in relation to each other?

Then we discussed:

- People described the discovery as “fated” (89), but Delaporte says “history is not a story dictated by fate.” Everything did in fact come together in a rather remarkable way. It’s like he is telling a story of accidents. A bumbling detective story where the silly detective turns out to be right by chance/accident.

- In showing failure and error Delaporte undermines a teleological conception of history.

- Delaporte's history has a performative element, and this is something worth thinking about. Foucault’s and Nietzsche's genealogical writings are also performative. The latter two aim to take the reader to a new place. To change the reader, to bring them to a new place via literary style. But Delaporte’s story is not super impressive in this way…one’s consciousness is not revolutionized by it.

- Page 95 [“these are the facts”]. We see the return of this notion of history as having a chronology and logic. He refers to logic again on page 89.  

- In order to discuss the history we first have to get down the facts. But the ordering of facts on their own does not constitute or make a history. What matters is how we line them up?

- In his foreward Canguilhem mentions political context [“This history is the political history of the exploitation of the globe of international trade”], but we are now almost done reading the book and there is no clear political analysis from Delaporte.

- What function is Canguilhem’s intro supposed to have? What is the function of naming the text as a political tract when it doesn’t actually read that way? Is there some political element in Delaporte we are missing? Will it emerge in the last chapters of the book?

 

Delaporte, The History of Yellow Fever, Chs. 2 and 3

 (Meeting Date: April 1st)

Questions

1. “…Now we had an object of which it remained to form a concept” (31). What does he mean by concept here? Is “the mosquito” a concept?

2. He is quite keen on the language of analogy. Can we track some of his analogies? What is the methodological function of analogy here?

3. At the end of Chapter 3 he says, “It was necessary to adopt the standpoint of…” Why did he think historical epistemology was necessary to refute "the legend” in question? How to connect his historical epistemology point with the larger context about the importance of Manson, the context of Cuban medicine versus American medicine, etc.?

4.  Is doing historical epistemology like writing a mystery novel? (remembering the publisher's description of this text as mystery and Deleuze’s description of reading philosophy like a mystery novel)

5. What is Delaporte trying to teach us about scientific discovery? If we had to come up with a description of scientific discovery, what would that look like according to him?

6. He uses the word problematic in a really specific way. How does it connect or not with Foucault’s use of the word? 

 

Discussion (and more questions!)

- What is happening such that there is something about the object which allows it to not be a concept prior to it showing up? What is involved in the transformation from object to conceptualization?  

- What is a research object and how does it differ from discipline to discipline?  How do research objects change across scholarly contexts? 

- Page 33. Delaporte makes a claim about the work of historians and then spends the next 10 pages reflecting on how, despite what the literature says, Finlay was actually familiar with Manson’s work. This whole section is kind of odd. Why did Finlay hide his familiarity with Manson’s work? This familiarity might have led him to make the claims that he did, but that doesn’t even seem to be Delaporte’s claim...

- Further on the point of hiding his familiarity with Manson’s work: According to a naïve view of the history of science, no reasonable scientist would have any reason to conceal their indebtedness to another thinker. One reason to make so much about this point might be that it teaches us something about the psychology of science. Perhaps we get a snapshot of scientists as not just driven by the pursuit of truth as some shared goal but as concerned with things like social prestige.

- Delaporte aims to describe the conditions of possibility of Finlay thinking what he was able to think. He is tracking an epistemic problem and the epistemic conditions which make sense of certain kinds of theories. In a way, the historical work is deeper than tracking who cited who.

- In Chapter 2, his methodological approach is to focus on the problems Finlay is trying to solve. But he also considers the problems Finlay isn’t trying to solve…Delaporte reads the inconsistencies in Finlay’s memoir to tease out the problem Finlay didn’t want to go to.

- Some context: Delaporte was a student of Foucault. He was also close to Canguilhem. He went to the US for a while, and there are references to  Kuhn and some other American philosophers in another one of his pieces.