While COVID-19 has invoked many discursive battles fuelling global power disputes, anxiety for likely economic tsunamis and aggravations of basic human rights, Hector Rodriguez focuses on the discursive practices of disease research, which de-mystifies lay assumptions that scientific knowledge is absolute and objective. Concepts of disease are constructed and premised on assumptions such as aetiology, operating on mechanisms of legitimization. COVID-19 過去幾個月的震盪掀起了全球的話語論述戰,隨之爆發的是國際權力圈的比併,「預言家」們提醒全球經濟海嘯將至的同時,民間泛起失去行動的自由自主的恐慌。羅海德博士的「建構疾病」系列針對疾病醫理研究如何建基於特定的前提上,例如「病因學」的假設,打破了坊間以為科學知識絕對、結論終極而不可改的一廂情願的看法。由科學地假設的「疾病的圖像」到成為普遍知識的「世界的圖像」塵埃落定,中間所經過的,是疾病定義和合法化的爭議,各層次的規管活動與科技和工具發明的配合。(引言及中譯撮要/黎肖嫻)

(updated 18 May 2020)

Disease pictures

Historian Charles E. Rosenberg has reminded us that concepts are not found readymade in nature. In the context of the history of medicine, he has emphasized that we construct our concepts of disease, and this construction is a processes that involves the proposal, negotiation, stabilisation, and acceptance of specific disease objects. This work of conceptual construction sometimes involves the question of whether a proposed disease, for instance bipolar disorder or Gulf War Syndrome, is indeed a disease. (Rosenberg 2003: 498)  The “process of disease definition” evolves around the “contested legitimacy” of proposed definitions of a disease. Struggles for legitimacy sometimes culminate in the formation and stabilization of “accepted disease pictures”. (Rosenberg 1989: 3-4)  These pictures render disease intelligible. (Rosenberg 2003: 496) The disease is then accepted into our shared ontology, our world-picture. It becomes part of our frame of reference.

The social history of medicine calls attention to the relation between medical profession and the state.

Quarantine Scarlet Fever. Ca. 1910. Credit: U.S. National Library of Medicine  https://www.nlm.nih.gov/exhibition/visualculture/introduction04.html The social history of medicine calls attention to the relation between medical profession and the state. 

Typhoid Fever ca1905. This item is in the public domain. Found on NIH website. “…two key elements remain fundamental; one is a faith in medicine’s existing or potential insights, another, personal accountability.” — Hector Rodriguez

The modern conception of disease is not a single monolithic picture, but there is one assumption that pervades many of its strands: the assumption that to understand a disease is to understad its aetiology. To understand the disease, to know the criteria for its identity and the justification for its reality, is at least in part to know the causal mechanism that underpins it. In the modern frame of reference, the aetiology of a disease belongs to its essential nature. To understand what a disease is, is to know the explanatory frameworks that properly belong to it. Rosenberg notes, for instance: “For many Americans the meaning of disease is the mechanism that defines it; even in cancer the meaning is often that we do not yet know the mechanism.” (Rosenberg 1986: 50) This picture involves a fundamental faith in the explanatory power of medical science, either its existing knowledge or its potential for securing knowledge concerning the mechanism that accounts for the disease being instantiated in any given patient.

Consider, for instance, diseases like the flu of 1918 or COVID-19, which are widely categorized as “infectious.” A “disease” is, according to one scholar, “the sum total of abnormal reactions of the organism or its parts to abnormal stimuli”. (Sigerist, p. 1) An “infectious disease” is one that is caused by certain pathogens, many of which are micro-organisms, for instance viruses or bacteria. The establishment of this “germ theory of disease” in the 1870s was the conclusion of a complicated historical process that terminated in the acceptance of micro-organisms as real, i.e., their inclusion in what could be called the scientific ontology, and the recognition of their causal role in the production of disease. This process involved, for instance, the invention and acceptance of equipment like the microscope as epistemologically reliable, and the establishment of standards of proof for any claim that a particular micro-organism caused a certain disease. (For a historical account, see Lederberg, 287-93.) Once this framework was established, it constituted our understanding of the nature of infectious diseases. The identity of the disease lies, at least in part, in the agent that causes it. Essence is welded to aetiology.

Modern pictures of disease, however, are complex and multi-layered. They often also express and articulate cultural and social values. “To some…, the meaning of cancer may transcend the mechanism and the ultimate ability of medicine to understand it. For such individuals the meaning of cancer may lie in the evils of capitalism, of unhindered technical progress, or perhaps in failures of individual will. We live in a complex and fragmented world and create a variety of frameworks for our several ailments. But two key elements remain fundamental; one is a faith in medicine’s existing or potential insights, another, personal accountability.” (Rosenberg 1986: 50) An extreme version is the tendency to explain the vulnerability of certain people to disease on the basis of their own actions, for instance: AIDS is a result of promiscuity or heroin addiction, obesity results from overeating, etc. So the discourse of disease involves questions of personal accountability. In many cases, the meaning of a disease lies in the actions of the diseased and of the healthy. It is brought about by “behavior uncontrolled” or “guilt and deserved punishment”. (Rosenberg 1986: 52) So “diseases can be seen as occupying points along a spectrum, ranging from those most firmly based in a verifiable pathological mechanism to those, like hysteria or alcoholism, with no well-understood mechanism, but with a highly charged social profile…” (Rosenberg 1986: 51). But disease pictures can also serve to legitimize the suffering of persons by specifying their identities: “someone is diseased” is sometimes also a way of saying that the person is exempt from blame, for instance, that someone is not a lazy student but rather one that suffers from ADHD. Disease is closely connected to the assignment of and absolution from responsibility.

Disease pictures are also connected to “the bureaucratisation of disease”. [Rosenberg, “What Is Disease?: In Memory of Owsei Temkin”, Bulletin of the History of Medicine, Volume 77, Number 3, Fall 2003, p. 500] An important feature is the institutional importance of disease pictures “in their relationship to the administration and management of health care,” (Rosenberg 2003: 499) for instance, the imposition of conventional names and uniform protocols, including experimental methods, and methods for observing, recording, and processing data. Frameworks render the experience of the sick into “administratively readable units” within a bureaucratic system. 499) Moreover, disease pictures serve to legitimize institutional arrangements: “relations between the medical profession and society are structured around interactions legitimated by the presumed existence of disease.” (Rosenberg 1986: 34) In this way, disease concepts serve as social integration mechanisms, “facilitating countless micro-decisions and thus linking different parts of the health-care system in a way that seems both necessary and proper.” (Rosenberg 2003: 499)

/…end of Framing Diseases #01

(12 May 2020, Hong Kong)

 

 

REFERENCE:

Lederberg, Joshua 2000: “Infectious History,” Science April 14, pp. 287-93.

Rosenberg, Charles E. 2003:  “What Is Disease?: In Memory of Owsei Temkin,” Bulletin of the History of Medicine, Volume 77, Number 3, Fall. p. 498.

Rosenberg, Charles E. 1989:  “Disease in History: Frames and Framers,” The Milbank Quarterly Vol. 67, Supplement 1. Framing Disease: The Creation and Negotiation of Explanatory Schemes (1989), pp. 1-15.

Rosenberg, Charles E. 1986: “Disease and Social Order in America: Perceptions and Expectations,” The Milbank Quarterly Vol. 64, Supplement 1. AIDS: The Public Context of an Epidemic, pp. 34-55.

Sigerist, Henry E. 1943: Civilization and Disease. Cornell University Press.

 

/… to be continued: “Framing Diseases 02: Disease and the Cooperative Society,” 2020.05.17

 

About the author | Dr. Hector Rodriguez is a digital art theorist and computational artist, currently Associate Professor at the School of Creative Media, City University of Hong Kong, teaching Generative Art, New Media Art and Theory, Critical Theory, Software Art, and Interdisciplinary Practices in Art, Science and the Humanities.