Medical Humanities Blog

On Dehumanization & the Humanities: Part II of II

See here for Part I.

Continuing on with Slouka's analysis, we left off by explaining that even those at the vanguard of pushing for greater attention and resources for education frame their case in economic terms.  Says Slouka, "[i]t can be touching to watch supporters of the arts contorting themselves to fit."

It would be bad enough on its own terms to reduce the value of education to the production of capital, but what makes it far worse is that it is a total corruption of the studia humanitatis itself, the entire point of this was to teach us how to be better human beings, to cultivate virtuous practice.  To say this is not to imply that the humanists and those fortunate enough to receive a humanist education were unconcerned with the practical world.  Quite the contrary; the measure of virtue was the way in which it produced betterment in the actual, daily interactions of community and society.  I have remarked on several occasions that if I were to attribute an ethos to the studia humanitatis, it would be "practical engagement."  But such engagement, in the service of virtue, is a galaxy far far away from viewing the primary role of education as increasing capital.

Yet, the able reader wants to know, how can I claim with a straight face that the humanities are characterized by a focus on practical engagement? Examining the state of the humanities in undergraduate and graduate education does not inspire confidence that due attention to practical engagement is the norm.  Slouka is well aware of these concerns, and reserves some of his sharpest criticism for his fellow humanities scholars and teachers:

No assessment of the marginalized role of the humanities today is possible without first admitting the complicity of those in the fold.

[ . . . ]

[University humanities scholars], in a pathetic attempt to ape their more successful colleagues in the sciences, have developed over time their own faux-scientific, isolating jargon, robbing themselves of their greatest virtue, their ability to influence (or infect) the general population. Verily, self-erasure is rarely this effective, or ironic.

Though I have both a background and facility in the kinds of critical theory that I believe Slouka is targeting, I have intentionally chosen not to frame my own scholarship in such style.  The reason, again, is my commitment to the Aristotelian question, to what I perceive as the ethos of the humanists themselves.  If the point of the humanities, historically understood, is to cultivate virtuous practice through practical engagement with the world, adopting a style of thinking and writing that is basically dense with impenetrable jargon virtually ensures that nothing I say or do as a scholar will have any meaning to all but a few hundred people (at most) around the world.

Again, the question looms: what kind of a person do I want to be? I have no delusions of grandeur, I hope.  But I cannot knowingly and intentionally choose a life as a scholar which makes even more likely the notion that little I say, teach, or write about will accomplish much in terms of practical engagement.  Perhaps in some fields of inquiry or disciplines in the humanities, the choice of style and discourse is more acceptable, but I honestly feel that when one's concern is health and illness in society, such a luxury, if it is indeed a luxury, is gone.

We humanities scholars either want to help, or we do not.  And it is hard for me to understand how much help we can be if we choose to communicate in ways that can barely be understood by those whom we should most want to reach (whether scholars and educations from other disciplines and traditions, or illness sufferers, caregivers, etc.).

All that said, why study the humanities? Why should we care that they are marginalized from both within and without? Defunded, declined, denied?

Answers Slouka:

The case for the humanities is not hard to make, though it can be difficult—to such an extent have we been marginalized, so long have we acceded to that marginalization—not to sound either defensive or naive. The humanities, done right, are the crucible within which our evolving notions of what it means to be fully human are put to the test; they teach us, incrementally, endlessly, not what to do but how to be.

Note, of course, that this is simply Aristotle's question recast in Plato's terms: how shall we live? IMO, Slouka is absolutely correct that assessing how we shall live is and has been the raison d'etre for the humanities for thousands of years; it is unquestionably the central theme of the studia humanitatis.  Note also the implication that such a task is perforce value-laden and political.  I have little patience for the frequent calls to avoid politicizing health policy, nor for the same calls with regards to teaching and scholarship.  There are, to be sure, some very real concerns that I imagine opponents are referencing in such a call, but the resolution is to act on those concerns (i.e., closed-mindedness, exclusion of viewpoints) rather than launch a quixotic and absurd quest to strip from an inherently, intentionally political, value-laden activity politics and values. 

Anyone with the slightest awareness of who Socrates was and what happened to him cannot possibly believe the legitimacy of the notion that practitioners of the humanities should strive to remove politics and values from their work (as if they can be eliminated or even minimized to any great extent).  Slouka explains it thusly:

They are thus, inescapably, political. Why? Because they complicate our vision, pull our most cherished notions out by the roots, flay our pieties. Because they grow uncertainty. Because they expand the reach of our understanding (and therefore our compassion), even as they force us to draw and redraw the borders of tolerance. Because out of all this work of self-building might emerge an individual capable of humility in the face of complexity; an individual formed through questioning and therefore unlikely to cede that right; an individual resistant to coercion, to manipulation and demagoguery in all their forms.

Slouka moves on to conclude that the humanities are critical to forming vibrant democracy, and to building democratic values.  There is likely some truth to this, but I generally do not share many theorists' enthusiasm on such grounds, mostly because I concur with Churchill that democracy is absolutely the worst form of government imaginable except for all the other ones that have ever been tried.  Nor do I agree for one moment with Slouka's contention that the practice of science is politically neutral.  This is both conceptually and empirically untenable, neither the human enterprise of scientific practice is apolitical, nor are the uses to which it is put.

Nevertheless, these are relatively minor quibbles.  So there, gentle readers, you have it.  A masterful essay, truly.  I am not remotely hopeful that the low cultural value we assign to the humanities will be staunched or reversed any time in the near future.  The reasons why I am pessimistic have much to do with the reasons why science and medicine enjoy such dominance, why they are the great social legitimizers of contemporary American and Western society. 

That scientific perspectives enjoy such dominance is, as Slouka reminds, only a problem because there are some things a scientific perspective simply is not designed to illuminate.  Engaging the deep questions -- how shall we live? what kind of people do we wish to be? -- is primary among them.  Which is not to say a scientific perspective is irrelevant to these questions, but merely that our capacity to reflect deeply and meaningfully on how best to live, and then to do so, is in large part a function of our recourse to a peculiarly humanities-based point of view.

Thoughts?

On Dehumanization & the Humanities: Part I of II

Mark Slouka has a stunningly good essay on our culture's general disdain for the humanities in favor of all things numerative and scientific.  The entire article must be read in full, and is so good, it will take me two separate posts to highlight his discussion full.

Slouka's perspective cuts to the very heart of the medical humanities, of this blog, and of my own professional and personal identity.

As I move through both this post, and/or as the good readers of MH Blog read Slouka's thoughts, it is worth disclosing that in an entirely literal sense, I am driven by Aristotle's foundational question: what kind of a person do I want to be? I am particularly interested in the social version of this question: what kind of people do we want to be? 

Slouka opens his essay:

Many years ago, my fiancée attempted to lend me a bit of respectability by introducing me to my would-be mother-in-law as a future Ph.D. in literature. From Columbia, I added, polishing the apple of my prospects. She wasn’t buying it. “A doctor of philosophy,” she said. “What’re you going to do, open a philosophy store?”

[ . . . ]

It’s a play I’ve been following for some time now. It’s about the increasing dominance—scratch that, the unqualified triumph—of a certain way of seeing, of reckoning value. It’s about the victory of whatever can be quantified over everything that can’t. It’s about the quiet retooling of American education into an adjunct of business, an instrument of production.

Indeed.  To reduce such eloquence to a soundbite, Einstein will do: not everything that can be counted counts, and not everything that counts can be counted.  For a more scholarly take on the undeniable dominance of quantification in American culture, see the work of Theodore M. Porter.

During graduate school I took a course on aging in context of the medical humanities.  In that course, I read a number of works which began to convince me that Western society's turn to using productivity as a paramount criterion of value is unfortunate at best and pernicious at worst.  And here, let me emphasize that I use the term value in its proper, classical, humanistic sense.  Value, not measured and quantified, but value in the Aristotelian spirit, read as an account of our social lives, our polis, our living and dying.  The immensely powerful trope in which productivity defines one's social identity has devastating consequences for elderly persons in our society, because retirement, sickness, or injury result not just in the need for a radical transformation of self, but suggest that the economically unproductive life is not worth living.

This is not what Socrates had in mind.

More from Slouka:

What is taught, at any given time, in any culture, is an expression of what that culture considers important.

[ . . . ]

In our time, orthodoxy is economic. Popular culture fetishizes it, our entertainments salaam to it (how many millions for sinking that putt, accepting that trade?), our artists are ranked by and revered for it. There is no institution wholly apart. Everything submits; everything must, sooner or later, pay fealty to the market; thus cost-benefit analyses on raising children, on cancer medications, on clean water, on the survival of species, including—in the last, last analysis—our own. If humanity has suffered under a more impoverishing delusion, I’m not aware of it.

Quite so.  I have tried, in my own feeble way, to echo Slouka's concerns in my consistent warnings of the error of reducing discussions of health policy to cost-benefit analyses (or any other descriptive program).  It is, of course, important and relevant to understand how patterns of health, illness, and human suffering are shaped by costs and benefit.  But never can the collective decisions we do and do not make -- our answers to the beacon of Aristotle's question -- be reduced to such programs, for they cannot absolve us of the awful responsibility to decide which pathways and practices are virtuous.  And efficiency is not a cipher for virtue, which means sometimes virtue would require us to act inefficiently.  Yet in my own little sphere, the conversations so frequently end once the calculations have been performed, and the costs and benefits have been lined up, when in fact, this is simply the beginning of the conversation.  Or at least, it should be.

Slouka:

The questions are straightforward enough: What do we teach, and why?

[ . . . ]

Our primary function, in other words, is to teach people, not tasks; to participate in the complex and infinitely worthwhile labor of forming citizens, men and women capable of furthering what’s best about us and forestalling what’s worst. It is only secondarily—one might say incidentally—about producing workers.

I would not even put the task of producing workers as worthy of second order status, or if I would, I would require an extremely large chasm between the normative importance of the first-order goal Slouka articulates and the need for producing workers.  Even the discourse on the crisis of education is accounted for in terms of labor and productivity:

From the local PTA meeting to the latest Presidential Commission on Education, the only subject under discussion, the only real criterion for investment—in short, the alpha and omega of educational policy—is jobs. Is it any wonder, then, that our educational priorities should be determined by business leaders, or that the relationship between industry and education should increasingly resemble the relationship between a company and its suppliers, or that the “suppliers” across the land, in order to make payroll, should seek to please management in any way possible, to demonstrate the viability of their product?

Thus concludes Part I.  In Part II, I will address the case Slouka makes for the humanities.  Needless to say, please don't wait for my bare attempts at exposition.  Read Slouka.

(h/t Leiter Reports)

On Disease Causality

I have the great honor of having a guest-post up at Felice Aull's marvelous Literature, and Medicine Blog.  The subject of the post is disease causality, and discusses stigma, fatness, the SDOH, and public health ethics/policy.  Mosey on over if the mood strikes you.

On the WHO, the CSDH, and "Closing the Gap"

It has been one year since the World Health Organization's ("WHO") Commission on the Social Determinants of Health released its Final Report, entitled Closing the Gap in a Generation.  To mark the occasion, the current issue of the outstanding open-text electronic journal Social Medicine has several pieces devoted to the Report.  I am still reading through them, but have finished Anne-Emmanuelle Birn's provocative piece entitled Making it Politic(al): closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health (PDF).  Here is the Abstract, after which I'll offer some comments:

The anniversary of the publication of Closing the Gap in a Generation (CGG) offers a moment to reflect on the report’s contributions and shortcomings, as well as to consider the political waters ahead. The issuance of CGG was not the first time the World Health Organization (WHO) raised the problem of global inequalities in health. Numerous analysts and advocates have compared CGG to the 1978 Declaration of Alma-Ata. Some see CGG as a continuation of Alma-Ata; others malign it for paying insufficient attention to the principles, background documents, and lines of action proposed in the Alma-Ata declaration. 

We might understand the two reports as bookends to 30 years of brutal global capitalism, punctuated by the “lost decade” of the 1980s, the end of the Cold War, and, more recently, the implosion of global finance. This period saw the publication of two seminal neoliberal health manifestos –the World Bank’s 1993 World Development Report and the WHO’s 2002 Commission on Macroeconomics and Health report. Both feature the term “investing in health” in their title, conveying “a double meaning—investing [through “cost-effective,” narrow, technical interventions] to improve health, economic productivity, and poverty; and investing capital, especially private capital, as a route to private profit in the health sector.”

For anyone interested in the social determinants of health -- which, frankly, should be everyone with an interest in health and illness in society -- Birn's essay is a must-read.  Birn, of course, is a preeminent SDOH scholar, and details a number of strengths and weaknesses in CGG.  

(An aside on terminology: She argues that the term "societal determinants of health" is more accurate than "social determinants of health" because the former refers to the "broader array of historical, political, and other structural influences" in comparison to the latter, which refers "to those factors related to interactions among people and communities."  (Birn, at 167).  I have heard this argument before, and remain frankly unconvinced.  Social is social.  Sociopolitical structures are in no ways I can tell less "social" than community level interactions).

Substantively, Birn tracks a recent and equally provocative piece (PDF) on the SDOH by Vicente Navarro, in arguing that assigning causation for the preventable deaths and suffering to inequities is not equivalent to assigning culpability to moral agents who benefit from inequities.  This is, to the best of my knowledge, an overtly Marxist argument, an interpretation buttressed by Birn's discussion of Engels's concept of social murder.

This leads into what I take to be Birn's central point; that CGG is "profoundly apolitical" (Birn, 172, quoting Navarro, at 15).  "The report says almost nothing about the causes of the "'causes of the causes," viz., what creates inequity in the first place" (Birn, 172) (footnote omitted).  Essentially, CGG fails to document how the distribution of raw political power is the primary determinant of inequitable social, political, and economic structures.  Hence, CGG is relatively silent on how political action is needed to ameliorate these structures.  Birn observes 

This criticism seems to imply that radicalization is needed to address the SDOH, and Birn confirms this, arguing that what is needed to ameliorate the SDOH is the disempowerment of moneyed "private-sector" interests who wield that power "block the passage or enforcement of laws and regulations aimed at protecting the public good" (Birn, 174).

As I said, provocative.  I personally have neo-Marxist tendencies, so I am somewhat disposed to agree with her, but I am also a pragmatist and a public health policy scholar, and at least in the U.S., am quite confident that the state of the political culture is exceedingly unlikely to support radical redistribution of wealth, which I agree could only proceed by upsetting dominant power structures.  I think such action is similarly unlikely to occur on the global scale as well.

Of course, what can happen and what ought to happen are not equivalent.  This is what I have referred to as the ethics of health policy paradox: what we can do may not be what we ought to do, and what we ought to do may not be what we can do.  At one point in her article, Birn acknowledges that the practical realties of global health politics may impede the activity Birn is recommending: "Surely CGG cannot be as incendiary as Engels!" (Birn, 174).  Indeed, they cannot.  CGG would never have gotten off the ground had it advocated radicalization, which (again), does not mean that it ought not have done so, but does present a practical policy problem.

Once again, the Aristotelian concept of phronesis matters here; we are looking for practical wisdom, what some have referred to as the least worst solution.  Note also that parallel processing is tenable; there is no rule which says one cannot attend to some of the intermediate "causes" CGG identifies while at the same time pushing for more radical alteration of power structures.

Thoughts?

On Interdisciplinarity & "Academic Gangs"

In the course of a fascinating discussion on the Interdisciplinary Studies listserv, sponsored by the Association for Integrative Studies (the closest thing to a professional association for interdisciplinarians that exists), Thomas Scheff, Professor Emeritus of Sociology at UCSB, directed the list to a provocative article he had published in 1995.  The title of the article is "Academic Gangs," and he has posted the text on his website.  Here is an excerpt:

Criminologists have proposed that patterns of behavior in youthful gangs can be understood in terms of what they call "the code of the streets," as in Anderson (1994). The code is a set of understandings between gang members which help them meet both their material and emotional needs. In this essay I describe the codes of academe, the understandings between professors in gang-like groups that function to fulfill their needs.

Most academics belong to one or another group called "a school of thought" or a specialty. For example, a large group of academic psychologists consider themselves to be behaviorists. These academics are loyal to the strict code of behaviorism which bands them together in thought, feeling and behavior. In addition to membership in a specialty, all academics are also members of a super-gang or clan, the discipline.

[ . . . ]

Just as members of street gangs earn most of their livelihood from theft, academics gain most of theirs from careers. Being a member in good standing of a gang and a supergang is crucially important for advancement of one's career. There is little chance of advancement in the academy without hard work, but flaunting membership in gang and clan can certainly supplement or even substitute for talent and intelligence.

[ . . . ]

The emotional function of the gang and clan is to remove the crushing burden of isolation created by esoteric knowledge . . .  In essence, academic gangs and clans create an artificial but highly involving round of problems and practices that provide a sense of unity among members . . . 

Given the emotional and material needs of professors, much of what goes on in teaching and research becomes a ritual whose main focus is on maintaining gang and clan identity. Given this mesmerizing focus, gang and discipline rather than real world issues take pride of place.  This idea explains most of the more obvious scandals in the academy, and some that are not so obvious. It completely explains the shocking distance that most professors maintain from their students, especially undergraduates. The center of the lecturer's interest is in problems of his or her specialty and clan, which mean nothing to undergraduates.

I have already excerpted more of the article than I should, so I am going to stop here.  I don't necessarily endorse all of Scheff's perspectives, but there is enough of a ring of accuracy to pay serious attention to what he is suggesting, not least because it may go some way to explaining the liminality of the interdisciplinary scholar.  This is not simply my opinion, although it is that, but there is excellent evidence that the overt pursuit of truly interdisciplinary work, as opposed to cross-disciplinary work, is not a likely path to professional success.  As another commentator in the listserv discussion put it, the political economy of American universities is not constructed to encourage interdisciplinary studies.

I was also drawn to Scheff's essay because of a series of articles that appeared in a recent issue of Academic Medicine.  The lead article was a plea to have more non-physician medical educators ("NPMEs") involved in medical education (full-text access).  As a NPME myself, I was intrigued by both the article, and by a commentary prepared by Frederic Hafferty and Janet Hefler (full-text access).  Hafferty is the principal figure responsible for bringing the concept of the hidden curriculum into medical education (Good lord -- there's the topic for the next Lexicon entry), which is simply critical, and one I address at some length in my dissertation.

Hafferty, who is a sociologist, and Hefler, who is an educationist, near as I can tell, applaud the effort to include more NPMEs in medical education, but express concern for a variety of reasons.  Moreover, they include a warning in terms that I have been unable to forget for some weeks now:

As we look toward the horizon, one major problem we continue to face is medicine's own tribal nature. We are a culture dominated by specialists, a culture in which generalists are devalued and in which outsiders (including educationalists) are routinely (if invisibly to insiders) treated as second-class citizens.

Indeed.  One of the most basic tenets of socialization is that key aspects of our beliefs, attitudes, and practices are often invisible to group insiders.  Thus, in response to the perspective, one I frequently encounter, that suggests something akin to 'You don't know, because you have not practiced X yourself,' where X can be any one of a number of things health care providers do, I often want to say something akin to 'You don't know, because you have practiced X yourself.'  The idea is not that practical experience is irrelevant or unimportant, but simply that there are important aspects of our own practices which are best seen and interpreted by learned outsiders by virtue of their outsider status.

My own perspective is that the legitimacy of this viewpoint is very poorly recognized in medical culture, but perhaps I am mistaken.

Thoughts?

On Ghostwriting

PLoS Medicine has generally impressed me with the amount of attention, as well as the validity of its substantive ethical positions, on the disgraceful prevalence of ghostwriting in biomedical scholarship. 

Today they publish an editorial (forthcoming in the September 2009 issue, available now on the PLoS Medicine Blog) announcing the creation of a public database of over 1500 documents acquired through the discovery process in various lawsuits filed against pharmaceutical companies that detail the nature and extent of ghostwriting.  Some choice excerpts from the editorial:

If you are an editor, author, reviewer, or reader of medical journals, or if you depend on your doctor or health care provider getting unbiased information from medical journals, then the 1,500 documents now hosted  on the PLoS Medicine Web site should make you very concerned and angry. Because, quite simply, the story told in these documents amounts to one of the most compelling expositions ever seen of the systematic manipulation and abuse of scholarly publishing by the pharmaceutical industry and its commercial partners in their attempt to influence the health care decisions of physicians and the general public.

[ . . . ]

What’s clear is that ghostwriting can no longer be considered one of the “dirty little secrets” of medical publishing that nothing can be done about. While editors, medical schools, and universities have turned a blind eye to, or at the least failed to tackle head-on the pervasive presence of ghostwriting, drug companies and medical education and communication companies have built a vast and profitable ghostwriting industry.

And consider the authors almost plaintive query, "How did we get to the point that falsifying the medical literature is acceptable?"

How indeed.

There is too much I want to say to really begin the task of blogging about it, although the inimitable Margaret Soltan is, as usual, worth reading.  I hope to wade through the database if I can stomach it, and may post further thoughts subsequent to the review.

On Fatness & Health

Perhaps because I read Gary Schwitzer's blog and quality assessment project so avidly, I am somewhat down on the quality of much health journalism, in the West, at least.  But every now and then, I read a terrific article that renews my faith.  One such article, authored by Margaret Wente, appeared in the Globe and Mail, a Toronto-based publication.  The article takes an unusually (for media, I think) critical look at the epistemology of the fatness-health connections.  It is quite well-written, and while I do not endorse the entire article, I absolutely appreciate the critical tone of the writing and the arguments adduced therein.  The article models, in many ways, some of the best and most persuasive academic writings in the critical obesity scholarship.

Some excerpts:

Thin was always in. But now, the social and public-health message is that fat is not simply a sign of sloth. It kills. The obesity epidemic is the greatest health crisis of the age. According to various health statistics (which are never consistent), between 17 per cent and 25 per cent of Canadian adults are obese. Thirty-six per cent of the adult population is overweight, or maybe two-thirds. Whatever. It's a catastrophe.

But is it? A new study based on Statistics Canada population data reaches an exceedingly awkward conclusion: People who are overweight live longer than people who are classified as “normal” weight. Not only that, people who are classified as significantly overweight also live longer.

(For the record, thin was most assuredly not always "in."  Quite the contrary, in fact.  But it has been so for much of the 20th century, at least in the U.S.)

[ . . . ]

“Overweight may not be the problem we thought it was,” said David Feeny, a senior investigator at Kaiser Permanente Center for Health Research in Oregon, almost apologetically. “Overweight was protective.” He added that agencies such as Health Canada might want to rethink the way they classify people's weight.

It is remarkable to see an academic investigator working on obesity research publicly allow as such.  Perhaps there is hope.  Indeed, as Wente notes,

Is this study just a fluke? On the contrary. It confirms the findings of dozens of other large population studies that rarely get publicity. They all conclude that being overweight is not a problem, except at the extreme. In fact, a little extra padding is good for you.

Many of these studies are documented in Gard and Wright's fine book on the subject.  Last excerpt:

In 2005, another researcher, Katherine Flegel, of the U.S. Centers for Disease Control and Prevention, published another large study with similar findings. Prominent health experts were outraged, calling the research flawed. “There's not a lot of money in trying to debunk obesity, but a huge amount in making sure it stays a big problem,” Patrick Basham, a professor of health-care policy at Johns Hopkins University, told The Associated Press.

Indeed.  

Go read the whole thing.  Thoughts?

(h/t SDOH Listserv) 

On Renaissance Networks

Ann Moyer (History -- Univ. of Pennsylvania) has a wonderful review up on H-Net of Paul McLean's recent book, The Art of the Network: Strategic Interaction and Patronage in Renaissance Florence.  Many aspects of this review should be of interest to a medical humanities audience.

Moyer notes:

To get things done, then, required knowing whom to ask; it also required that the petitioner have something to offer, whether now or later, tangible or intangible, to repay the favor. And of course these urban citizens lived their lives embedded in a number of relationships of different sorts: family, profession, neighborhood, political party, and so on, to a very long list of social groupings and obligations, any or all of whose members might hope to make claims on one another over the course of a career or a lifetime.

These matters are exactly what the studia humanitatis were targeted towards: a practical engagement with the world.  But not simply any practical engagement will suffice; virtuous engagement is needed, and the studia humanitatis was intended to facilitate.  This is in part why the apparent belief that the humanities are impractical vexes me no end.  If this belief is actually accurate -- if the humanities as currently practiced are in fact disengaged and impractical, then those of us responsible for such practices are abandoning the hopes, lessons, and programs of our forefathers.

Thus, Moyer notes that

McLean’s specific focus on Florentine letters of recommendation and request then leads him to look at the role of the humanist educators who set a high standard for quality of writing and dispensed rules about the specifics. These men helped establish formal norms for such letters, and the literary skills they imparted aided Florentines in both composing and reading such letters strategically.

It is no accident that so many humanists and humanistically-educated personages were active participants in social and political life as diplomats, jurists, couriers, advisors, officials, attorneys, professors, etc.

More from Moyer:

[McLean] argues that good letter writers were able to give a shape in their letters to the ongoing relationship between author and recipient, such that the request and its granting would, it was hoped, ring true with the recipient and inspire him to undertake the desired action. The rhetorical tools of the humanists, along with their goals of shaping people’s understanding of their world and bringing them to appropriate action within it, thus had a major role to play in the lives of scholars and of middle-class Florentines. As McLean notes, in Florence these tools served not only social ends, but political ones as well; indeed, political and social goals often overlapped.

These considerations are why I continue to believe that those of us interested in the medical humanities should ground our work in an historically and philologically informed understanding of those who mediated antiquity into the educational program we continue to call the humanities.  There is, if not an essence to the humanities, at least a set of family resemblances that can shed a great deal of specific light on the nature and potential goals of the interdiscipline.  And those resemblances emerge in important part from examination of the humanists, the studia humanitatis, and the local social worlds in which these conversations took place.

Thoughts?

(H/T H-SCI-MED-TECH) 

On Eugenics and History (II)

I have the privilege of corresponding, from time to time, with historian of eugenics Gie van den Berghe, a professor at the University of Ghent.  I reprint below his comments on my recent post on eugenics and history:

You call Oliver Wendell Holmes' line 'Three generations of imbeciles are enough' "infamous", but that is how we judge it here and now. In fact it was, seen in its time, a courageous and logical standpoint (and of course not only the decision of Holmes but of the almost unanimous Supreme Court). So his/their decision shouldn't, in my opinion, so much be admired ('Holmes was nevertheless ready, willing, and able to utter the infamous line') then understood.

"We have seen more than once that the public welfare may call upon the best citizens for their lives. It would be strange if it could not call upon those who already sap the strength of the State for these lesser sacrifices, often not felt to be such by those concer­ned, in order to prevent our being swamped with incompetence. It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are mani­festly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Jacobson v. Massachusetts, 197 U.S. 11. Three generations of imbeciles are enough".

 Generally one cites only this part of 'The Supreme Court Opinion in Buck v. Bell' (or some extract of it), but the Opinion continues and ends by the following line:

 "But, it is said, however it might be if this reasoning were applied generally, it fails when it is confined to the small number who are in the institutions named and is not applied to the ultitudes outside. It is the usual last resort of constitutional arguments to point out shortcomings of this sort. But the answer is that the law does all that is needed when it does all that it can, indicates a policy, applies it to all within the lines, and seeks to bring within the lines all similarly situated so far and so fast as its means allow. Of course so far as the operations enable those who otherwise must be kept confined to be returned to the world, and thus open the asylum to others, the equality aimed at will be more nearly reached."

This kind of argumentation had been employed in the 1920s by several eminent American and European men, frequently with a reference to the many thousands young, vigorous men who had died or ho were mutilated during the devastating Great War. In 1920, in Weimar Germany, the reknowned jurist Karl Binding and doctor Alfred Hoch pleaded wit this and other arguments for the 'euthanasia' for so-called lifes unworthy of life (Die Freigabe der Vernichtung lebensunwerten Lebens), and Adolf Hitler did the same in 1924 in the first part of his Mein Kampf.

his is not to claim that Nazism was founded on Darwinism. There is no direct link, but indirectly one can trace a kind of reasoning about asocial, marginal 'elements' in one's community, a community that was seen as of much greater importance than the individual. The people (Volk), the nation, the body of the nation (Volkskörper in German) had to be saved of the contaminated, rotten cells/individuals it contained. This kind of thinking generated in Great-Britain, shortly before Darwin wrote his 'On the origin of species' (1859) - think for instance of Herbert Spencer. And after the publication of Darwins masterpiece, more and more thinkers, such as Francis Galton, adopted it. Now that the motor of evolution, natural selection, was discovered, one was afraid that the biological evolution, this progress of the human species, was countered or even stopped by Civilisation. A civilisation who not only kept in live marginals that Nature normally would have eleminated (poor laws, medicine, hospitals, asiles), but even made possible that these unfit breed and multiply themselves at a faster rate then the fittest specimens of the nation.

On Eugenics & History (I)

H-Law published a review by Lynne Curry of two recent books on eugenics, including Paul Lombardo's account of Carrie Buck, and her experiences before, during, and after the notorious case of Buck v. Bell. 

Here is an excerpt from the Review:

Eugenicists, many of whom were associated with the Eugenics Record Office in Cold Springs Harbor, New York, exercised a profound and disturbing influence on law and social policy, including drafting a model compulsory sterilization law and then vigorously campaigning to have it replicated in the states.  While much of this material will not be new to historians, Carrie Buck’s story becomes even more compelling steeped in the rich detail that Lombardo provides.  Buck was an extremely poor, barely educated, seventeen-year-old rape victim, who in 1920s Virginia became a pawn of a blatantly self-serving cast of incredibly shady characters.  Mandatory sterilization laws had met with mixed success in state courts, and therefore in Virginia a small circle of eugenicist lawmakers, doctors, and institutional directors conspired to write and enact a statute and then manufacture a test case to gain a judicial stamp of approval for their own project.  Lombardo vividly presents the patently absurd case concocted purporting to show that Buck was both “feeble-minded” herself and the daughter and mother of feeble-minded females, rendering her a genetic threat to the population and a fit subject for the operation. (Her younger sister was also sterilized.)  Buck’s lawyer, himself a major crusader in Virginia’s sterilization campaign, “violated every norm of legal ethics” in deliberately failing his client at each step in the case, leaving Buck quite literally defenseless (p. 155).

I had the opportunity to meet Dr. Lombardo at the AAHM Meeting in April, and it was wonderful to get the chance to chat with him a bit about the history of eugenics.

Dr. Lombardo has compiled a wonderful web site in support of his book and his work, which features a rich digital supplement chock-a-block with downloadable primary sources from the public domain.  I cannot recommend either the book or the website enough.

As notorious as Buck v. Bell is, I think it is actually underemphasized in terms of its importance, mostly because the case aptly demonstrates how powerful was the hold eugenics exercised on American society during the 1920s.  Lombardo's book, which I am currently in the middle of, does an excellent job of separating the scholarly and religious debate over eugenics from the widespread acceptance it enjoyed among wide swaths of the lay public.  This last point is an important methodological aspect of any social history, which both Fairburn and Jenner warn against (presuming that the attitudes, beliefs, and practices of an elite subsume those of various less privileged communities and subgroups).

Having legal training as to Buck v. Bell helps, not so much because the case is difficult to interpret, but more because knowing anything at all about American legal history suggests just how visionary and singular a mind was Oliver Wendell Holmes.  Arguably the most important jurist in that history, and one of the most influential in Anglo-American jurisprudence itself over the last 100 years, Holmes was nevertheless ready, willing, and able to utter the infamous line: Three generations of imbeciles are enough.  This is a critical example of the reach and power of eugenics ideas, and it is absurd, as so many do, to see this history as a curio, an artifact. 

Roughly 90% of pregnant women informed that their fetus has trisomy 21 (Down Syndrome) choose to terminate the pregnancy.  I do not judge this decision, but do want to note that there is no way to interpret this as anything other than an example of the persistence of eugenics tropes.  Disability studies scholars have repeatedly pointed out that prenatal testing itself is founded on eugenics, whether we endorse or reject the practice.

The history of eugenics demonstrates the importance of understanding history dialectically, as events, ideas, and conditions continue to shape the world we inhabit in profound ways.  There are, in my view, fewer short-sighted approaches to the study of history then to perceive it as a linear "that-was-then-this-is-now" phenomenon.  History has much more to offer than that.  Despite the frequency with which people bandy about Santayana's quote, my suspicion is that a much lower percentage of those who quote him approvingly actually understand why it is that history repeats itself.  It does so, in short, because it never really leaves us.

Thoughts?