November 22, 2002

On a Winters Night, Epistemology

Category: Anthropology — Biella @ 10:10 pm

It gets dark early, even in “sunny”California at least Northern California. I am amazed nearly every day when I look out my window to see the silent dusk settle in, my heart usually sinking with the disappearance of light.

But today, I was reanimated, by words, books, and reading and was reminded why winter can be a great time of year. Unlike summer, which for me tends to be a very social time punctuated by long periods spent outside, I have come to reacquaint with the pleasures of alternating between sitting and lying on my bed, for the *entire day* just to read. My inward turn was first inspired to read up on “hacker ethics” for a grant proposal I am “supposedly” working on as well as for a paper that I want to write but then I sort of went nutso and after looking over like 5 books that deal in some fashion with the hacker ethic, I hit all these other books and articles that I have been dying to read but there never seemed an opportune moment till today.

The day started off with reading Seth’s Blog where midway in his long entry he mused as at to whether “computers have given us a new kind of understanding of the problems of epistemology, much as they’ve given us new ways of thinking about psychology. This is not to say that the metaphors we take from computing are more accurate or ultimately more faithful to reality. But they’re undeniably present.” He goes on to note that humans like software have no means for independent verification for “internal processes:”

In that sense, we are in the position of software: we can try to look at ourselves, but we can’t have independent confirmation that what we see is really there. There is always a philosophical possibility that we are implemented somewhere or in some way we don’t know about, that we have a particular feature we can’t anticipate, and in general that any part of our experience, not just our senses, could be unreliable

Indeed, a very sophisticated analogy although it made me wonder, which I have wondered often, why is it that western epistemology is so concerned with dissecting and knowing *the* (and I will return to the “the”) underlying nuts and bolts of human thought and emotions and for that matter, the nuts and bolts of everything on the face of this earth and beyond. On the one hand, there is the sheer drive to know for the sake of knowing, which can be worthy in its own right and has also produced many technological wonders that I adore. But it still strikes me on the other hand as a strangely creepy drive if only for the potential regiments of control and exclusion that can take shape if and when we feel that only absolute and underlying Truths can be “found.”

I then went on to read an interesting review of a book, I will be sure not to read The Human Denial of Human Nature which addresses at some level those very same questions that were first raised in Seth’s blog in terms of what can we know and how we can know in this case relating to human beings. More of a naturalist, he argues that evolutionary psychology and genetics can explain it nearly all, and the reviewer does a wonderful job at poking very humorous holes in what seem to be inflated arguments and an ego to match. One of the more humorous ones follows:

He argues for example, that democracy, the rule of the law, and women’s reproductive freedom are all products of evolution. The Founding Fathers understood that the ideas of power sharing and individual rights are grounded in human nature….. Now, democarcy, individual rights, and women’s sexual autonomy are concepts almost nowhere to be found, even in the West, before the eighteenth century. Either human beings psent ten thousand years denying their own nature by slavishly obeying the whims of the rich and powerful, cheerfully burning heretics at stake, and arranging their daughters ‘s marriages, or modern liberal society is largely a social construction. Which hypothesis seems more plausible?

Nothing quite like having a biological theory to legitimate a mode of governing.

Anyway, I then I stumbled on this wonderful piece by what has to be one of my favorite historians of science Peter Galison who has such a way with words. He captures complexity using really clear and strong language, which makes reading his work almost addicting. It is dense yet clear which is a good thing considering he likes to write really long long books like Image and Logic where he looks at the rise of “Big Science” in physics, a restructuring that occurred by and through the scientific needs of WWII. Shifts that had implications for everything from scientists own self-understandings to aesthetic means (that also have ethical implications) of apprehending and reading data. He spends a good chunk of the 800 + page book contrasting an image based mode of objectifying knowledge with a more logic tradition of number crunching.

Even while never denying the reality of the material, he so elegantly (and maybe his elegance as to do with the fact that he has some training in physics) argues that categories and practices that seem so asocial, so ahistorical, are in fact through-and-though historical. It is never an either/or game but a sophisticated rendering of the ways in which these seemingly asocial dimensions of science have a social life. So tonight, I read in one of his edited books Picturing Science, Producing Art his account of the subtle historical shifts within the very practice of objectivity in terms of the scientific reading of images from the 19th to 20th centuries in a piece called “Judgment Against Objectivity.” Along with the transformation of the practice of reading images are corollaries in terms of the moral role of the scientist in making and doing science. He, thus, is able to beautifully weave the technological, aesthetic, and moral considerations of science. The piece is worth reading but here is nice summary excerpt for those who [just] can’t wait:

Images–even images as apparently similar as those found in the atlases of science and medicine–turn out to be radically different entities under three regimes that roughly covered three periods of pre-mid-nineteenth centuries to the early twentieth century and the last two thirds of or of the twentieth century. The metaphysical image revealing the essence behind the appearance, mediates between the Genius and an audience that learns from the metaphysical images but will never become the genial author himself. By contrast, the objective, mechanical image is produced by scientists committed to the role of a stoic, and in this resolve, determined to become transparent to nature, a copying mechanism with the affective disengagement of the technical manufacturer. Third and finally, the interpreted image is produced not by a moral culture of towering Geniuses” or neutral, self-abnegating bureaucrats, but by self-confident experts, who trust the trained eye more than master philosophical systems or the automatic conveyance of pictures”

I have thought about this question of aesthetics, objectivity, and morality, thinking about these issues in a very similar fashion but less through academic musings and more from the perspective of being a patient for over 10 months a couple of years ago. While doctors poked and prodded me unable to figure out what was wrong, I was amazed (although I knew this about our medical establishment, but one can’t really KNOW until one’s body actually goes through the torture that can be “diagnosis”) that the “medical doctor” really used so very little of his or her own Judgment allowing the test to speak the truth instead. It was like every time the test came out negative, the doctor was like:
“no, no, looks like nothing is wrong… you must just be stressed.”
And I would reply:

“But, but anthropology is so not stressful. We like talk to people, it is not the hell you go through in medical school”

and he of course was thinking:

“talk to the hand…. I mean the test, this girl is crazyolaaaaaaaa. Anthropology is HARD, I mean all the tests, the memorization, the long hours at the hospital, the demanding pateints” [get my point, projection..]

That is, in a world where medical tests are ubiquitous (and let me tell you there are tests for everything), my experience has been (and read any Usenet Medical Illness support group for corroboration) that authority lies in the test itself while the doctors role is scarcely to interpret them but more more of lifeless mouthpiece for the information already and really inscribed in the MRI, in the blood specimen, in the spinal fluid etc. They have and are becoming more than ever thanks to the pressures of managed care and other factors, mere technicians in which the “Art of Medicine” is being lost in the conventional tunnels of American medicine. This lacuna of Judgment is not hegemonic as the art of judgment has been readily picked up by more alternative minded doctors and health practitioners who keep alive the ethos and practice that diagnosis can be a complex and messy affair that requires clinical history as much as it does tests.

The epistemological turn that glorifies the test above all else has very real material consequences not simply for the role of the doctor but the experience of the patient. You see, what happens is that when and if the “test” becomes the sole bastion for rendering illness visible, this also significantly shapes how and who can play a role in diagnosis. As noted, I think the doctor acts a mere technician (and you know this is not an easy shift for doctors. I think they are in their worst position ever losing autonomy at all different fronts), interpreting data that is inscribed supposedly unambiguously while a patient’s experience of the illness is rendered obsolete. Why might it matter when and how symptoms manifest as told by the patient if and when the test can give a MORE objective, and reliable picture of inner bodily practices? What happens is that when there is a certain authority structure built into the practice of diagnosis that privileges one way of knowing over and REALLY above another, the patient’s role is fundamentally altered to one of epiphenomenon (and one gets the feeling of nuisance) even when there are many doctors with good and honest intentions. It is a structural problem whose basis lies at the very root of the question “how we know.” It is not just a problem of the arrogant doctor (though there are a sure many of those and well, one just has to look at their socialization in medical school and the residency for the answer to that riddle) but one of epistemology.

And though the question as to why the test reigns supreme is an interesting one in its own right that I should write a blog entry about later (and it will provide a nice example of how an ideological commitment in science is fueled as a brush fire by wind by the economics of health care), I think for now and for the sake of finishing the entry, it is important to ask what are the tangible, material effects and consequences of a certain epistemological regime? What might be the consequences of having one epistemology that favors one mode of explanation to the complete exclusion of others (lets say nature over culture, or medical test over clinical information)? Is it even possible to keep in play more than one system of knowing within one social field? I do personally think that it is possible to simultaneously have more than one system in use although I think as a society (and that happens to be more than anything in the realm of science but it has such a strong grip in the popular imaginary) we have to let go of the idea then that there is one ultimate truth as that becomes an epistemological barbed wire that basically renders the multiple existence of modes of knowing impossible. And ending again with the perspective of a patient, where knowing means not just “wow, I want to know because it is a fun and cool thing to do” but “I want to know so that I can get better and get on with my life” (intention can matter in epistemology) a patient can and does want recourse to the clarity and authority of the test (it is so nice to know, to really know), yet in the face of ambiguity as well as the fact that illness is still experienced though bodies in life, a patient’s experience should never be treated as null, void or even secondary. What is needed is a more well formed and explicit aesthetic and an ethic in science and medicine that fundamentally values other ways of knowing aside from that which is easily visible and quantifiable.

How to do this is a whole other topic but a how that I do have some ideas for, ironically (or maybe not so ironic) from the the world of free software and hackers, a site and a group of people that I consider way, and I mean WAY more ethically dense than that of the medical profession. How about that for an epistemological shock?

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