Our January 2024 LMCC meeting took place on Wednesday, January 31 at 5:30pm in UNC’s HHIVE Lab (Greenlaw 524) and via Zoom. 
We discussed The Body Multiple: Ontology in Medical Practice by Annemarie Mol (Duke UP, 2002). Specifically, we discussed:
- Preface (pp. vii-xii)
- Chapter 1: “Doing Disease” (pp. 1-27)
- Optional but suggested reading: Chapter 2: “Different Atheroscleroses” (pp. 29-51)
If you missed the meeting, you can still access the text on the Readings page of this site!
You can also access the recording of our meeting here.
This was our first meeting of the semester! Our next meeting will take place on Wednesday, February 28 at 5:30pm in UNC’s HHIVE Lab, Greenlaw 524. If you can’t attend in person, you can attend in real-time via our usual Zoom link. We will send out an announcement soon with more information for that meeting.
A few reminders and announcements:
- Be sure to follow LMCC on Twitter and Instagram to show your support and receive regular updates!
- If you want to get more involved with LMCC, please send us other resources we should post to the site or suggestions for improvements, additions, future readings, etc. We’d love to hear your ideas and input! (See our email addresses on the Home page of this site.)
- Also, please feel free to spread the word about LMCC to other interested graduate or professional students at UNC.
Mol, Annemarie. The Body Multiple: Ontology in Medical Practice. Duke UP, 2002, https://doi-org.libproxy.lib.unc.edu/10.1215/9780822384151.
Some key concepts:
- Mol is a science and technology studies scholar, everything is relational
- Mol lays out the way different aspects of life have been separated along binary lines, often in a well-intended way; she uses these as analogies for “disease” and “illness,” ultimately revealing that this separation is potentially problematic in terms of political strength or activism.
- Critical of the social scientist approach
- The medical act is what brings disease into being
- Admits limitations as an ethnographer, as a scholar integrating outside literature
- How is the object constructed?
- Enacted practices: how do they come into being?
- The text is not prescriptive but lays out an alternative philosophy
- The form of the text: two texts run alongside each other
Some key passages:
Preface (pp. vii-xii)
“This is a book about the way in which (Western, cosmopolitan, allopathic) medicine deals with the body and its diseases. The questions it raises do not concern the ways in which medicine knows its objects. Instead, what the book explores is the ways in which medicine attunes to, interacts with, and shapes its objects in its various and varied practices. Or, to use the technical term: this is a book about the way medicine enacts the objects of its concern and treatment” (Mol vii).
“Thus, unlike many other books on medicine and its processes, this one does not speak of different perspectives on the body and its diseases. Instead it tells how they are done. This means that the book comes to talk about a series of different practices. These are practices in which some entity is being sliced, colored, probed, talked about, measured, counted, cut out, countered by walking, or prevented…. Attending to enactment rather than knowledge has an important effect: what we think of as a single object may appear to be more than one” (Mol vii).
“Since enactments come in the plural the crucial question to ask about them is how they are coordinated. In practice the body and its diseases are more than one, but this does not mean that they are fragmented into being many” (Mol vii-viii).
“I don’t delve into the question of how the appropriateness of the various enactments presented are, or might be, judged. Instead I try to take part in creating a theoretical repertoire for thinking about this. I contribute to theorizing medicine’s ontological politics: a politics that has to do with the way in which problems are framed, bodies are shaped, and lives are pushed and pulled into one shape or another” (Mol viii).
“I have framed this book not only as a debate with the epistemological approach to knowledge, but also as a debate with the way in which the social sciences have studied the body and its diseases in the past” (Mol viii).
“It [this book] says that a study of the enactment of reality in practice makes it possible to ethnographically explore the body multiple and its diseases in all their fleshiness. How? Outlining an answer to that question is precisely what all these pages are for” (Mol ix).
Ch. 1: “Doing Disease” (pp. 1-27)
“This is a study in empirical philosophy. Let’s begin with the empirical. The stories I will tell you in this book are mostly situated in a university hospital in a medium-sized town in the center of the Netherlands, Hospital Z. For four years I went there once or twice weekly” (Mol 1).
“…my purpose: to investigate the way the tensions between sources of knowledge and styles of knowing are handled inside present-day allopathic medicine—or at least one of its exemplars” (Mol 1).
“In the ethnographic stories that I tell throughout this book, I do not try to sum things up. I do not describe Western medicine, but particular events in a single Dutch university hospital” (Mol 2).
“I wanted my observations to be a means to get to know their standards, rather than an occasion to apply my own” (Mol 2-3).
“I have tried—will try—both to relate to the literature and deal with the question as to how one might do so. To do this properly, I have separated out the question about relating to the literature from the core text of this book. I deal with the literature in a series of separate texts that resonate, run along, interfere with, alienate from, and give an extra dimension to the main text. In a subtext, so to speak” (Mol 3).
“For even if there are a lot of empirical materials in this book, this is not a field report: it is an exercise in empirical philosophy” (Mol 4).
“It is possible to refrain from understanding objects as the central points of focus of different people’s perspectives. It is possible to understand them instead as things manipulated in practices. If we do this—if instead of bracketing the practices in which objects are handled we foreground them—this has far-reaching effects. Reality multiplies” (Mol 4-5).
“If practices are foregrounded there is no longer a single passive object in the middle, waiting to be seen from the point of view of seemingly endless series of perspectives. Instead, objects come into being—and disappear—with the practices in which they are manipulated. And since the object of manipulation tends to differ from one practice to another, reality multiplies. The body, the patient, the disease, the doctor, the technician, the technology: all of these are more than one. More than singular. This begs the question of how they are related. For even if objects differ from one practice to another, there are relations between these practices. Thus, far from necessarily falling into fragments, multiple objects tend to hang together somehow. Attending to the multiplicity of reality opens up the possibility of studying this remarkable achievement” (Mol 5).
“This book tells that no object, no body, no disease, is singular. If it is not removed from the practices that sustain it, reality is multiple. This may be read as a description that beautifully fits the facts. But attending to the multiplicity of reality is also an act. It is something that may be done—or left undone. It is an intervention. It intervenes in the various available styles for describing practices. Epistemological normativity is prescriptive: it tells how to know properly. The normativity of ethnographic descriptions is of a different kind. It suggests what must be taken into account when it comes to appreciating practices. If reality doesn’t precede practices but is a part of them, it cannot itself be the standard by which practices are assessed. But ‘mere pragmatism’ is no longer a good enough legitimization either, because each event, however pragmatically inspired, turns some ‘body’ (some disease, some patient) into a lived reality—and thereby evacuates the reality of another” (Mol 6).
“If I take so much trouble to point out the multiplicity of medicine while I refer to sociology, anthropology, history, or philosophy in general terms, this might suggest that they possess the unity that medicine does not. But they don’t. Just as it is possible to write about the multiplicity of the objects of medicine, this could be done about other disciplines. I won’t attempt to do so here. But I will try to do justice to the variety of concerns, materialities, styles, and object framings in the various knowledges mobilized here by seeking not to suppress or hide these while relating to the literature” (Mol 6).
“If reality is multiple, it is also political. The question this study provokes is how the body multiple and its diseases might be done well. This question will not be answered here. Instead, I’ll map out the space in which it may be posed” (Mol 7).
“Instead, they [social scientists] had something to tell in addition to existing medical knowledge. They pointed out that the reality of living with a disease isn’t exhausted by listing physicalities. There is more to it. Apart from being a physical reality, having a disease has a meaning for the patient in question. A meaning that is open to investigation” (Mol 7-8).
Describing a biomedical approach: “Mr. Trevers [a pseudonymized patient] became frightened when his wound didn’t heal. To the vascular surgeon who has operated on him, this fear is hardly relevant. It is relevant that Mr. Trevers finally decided to go and see a doctor. But once he did, well, fear, this is ‘one of the things people feel,’ as is an aversion of wounds that stay ‘gaping holes.’ If there is time, Mr. Trevers may be allowed to talk about his feelings. But they need not be written down in his surgical files. As ‘a good doctor’ the surgeon may explain some facts in an attempt to reassure his patient. But ‘fear’ is not a part of Mr. Trevers’s vascular disease, nor of his diabetes” (Mol 8).
“As a complement to this [biomedical approach], social scientists have made it their trade to listen for feelings when they interview patients. And they have persistently and severely criticized doctors for neglecting psychosocial matters, for being ever so concerned about keeping wounds clean while they hardly ever ask their patients what being wounded means to them. In addition to attending to blood sugar levels, bad arteries, wounds, and other physicalities, or so social scientists have been arguing in all kinds of ways, physicians should attend to what patients experience. This is how they have come to phrase it: in addition to disease, the object of biomedicine, something else is of importance too, a patient’s illness. Illness here stands for a patient’s interpretation of his or her disease, the feelings that accompany it, the life events it turns into” (Mol 9).
Talcott Parsons: “Parsons invented medical sociology. The crystallization of both of the objects of this discipline can be traced in his work. They are: illness and health care” (Mol 9).
“Then, social scientists gradually began to stress that reality isn’t responsible all by itself for what doctors say about it. ‘Disease’ may be inside the body, but what is said about it isn’t. Bodies only speak if and when they are made heavy with meaning” (Mol 9-10).
“Perspectivalism turns doctors and patients into equals, for both interpret the world they live in. But to say this is also to reinforce their division, because the interpretations doctors and patients give must differ, linked as they are to the specific history, interests, roles, and horizons of each group” (Mol 10).
Talcott Parsons, The Social System: “Illness, Parsons writes, ‘is a state of disturbance in the “normal” functioning of the total human individual, including both the state of the organism as a biological system and of his personal and social adjustments. It is thus partly biological and partly socially defined’ (431). A whole tradition of sociological thought can be traced back to this single sentence. Thus, Parsons’s work is crucial. I must relate to it. Doing so may help me to escape from the coordinates in which it has been set” (Mol 10).
“It may seem that studying ‘perspectives’ is a way of finally attending to ‘disease itself’—but it isn’t. For by entering the realm of meaning, the body’s physical reality is still left out; it is yet again an unmarked category. But the problem has grown: this time the body isn’t only unmarked in the social sciences, but in the entire world they evoke. The power to mark physical reality, after all, is no longer granted to medical doctors, it is granted to nobody. In a world of meaning, nobody is in touch with the reality of diseases, everybody ‘merely’ interprets them. There are different interpretations around, and ‘the disease’—forever unknown—is nowhere to be found. The disease recedes behind the interpretations. In a world of meaning alone, words are related to the places from where they are spoken. Whatever it is they are spoken about fades away” (Mol 11-12).
“For if Parsons talks about ‘the sick role’ as a sociologist, then sociologists apparently have the technical competence to talk about the socially defined part of illness. This means that sociology isn’t simply outside health care, taking this as its object. Sociology also has the ability to acquire knowledge that may be useful to physicians” (Mol 11-12).
“The first step of the social sciences in the field of medicine was to delineate illness as an important object to be added to a disease’s physicalities. The second step was to stress that whatever doctors say about ‘disease’ is talk, that it is part of a realm of meaning, something relative to the specific perspective of the person talking. And here is the third step. It consists of foregrounding practicalities, materialities, events. If we take this step, ‘disease’ becomes a part of what is done in practice” (Mol 12-13).
“They [social scientists] turned the domain of the social into what they were competent to speak about. In this way the social sciences delineated an object of their own and granted biomedicine the exclusive right to talk about the body and its diseases. So if I relate to Parsons’s outdated work here, it is because, at the very moment of medical sociology’s invention, he articulated so clearly the outlines of the place subsequently occupied by medical sociology for a long time. The place from which this book (like various others that appear these days) tries to escape” (Mol 13).
“This story reveals something about Mr. Gerritsen [a pseudonymized patient], all right. About his feelings, his sense making, and his self-irony. But in telling about the way he lives with his painful legs, Mr. Gerritsen also presents us with insights into the events that happen to someone with an impaired body. He tells about adapting his habits to his inability to walk without pain” (Mol 14).
“When they talk, sick people do not necessarily refer to an internal state, but may instead attempt to reach some goal. They tend to not be in an operational mode, but in a preoperational one. This means that their own experiences are more important to them than any theory that might explain these experiences, that the words they use may have an array of diverging meanings instead of a single one, and that their reasoning is not linear” (Mol 14).
“We can listen to Mr. Gerritsen as if he were his own ethnographer. Not an ethnographer of feelings, meanings, or perspectives. But someone who tells how living with an impaired body is done in practice” (Mol 15).
Referring to Allan Young, “When Rational Men Fall Sick: An Inquiry Into Some Assumptions Made By Medical Anthropologists (1981): “The stories people tell do not just present grids of meaning. They also convey a lot about legs, shopping trolleys, or staircases. What people say in an interview doesn’t only reveal their perspective, but also tells about events they have lived through. If you agree to go along with this possibility for a while, and listen to patient interviews in a realist mode, the question becomes ‘what are the events people report on?’” (Mol 15).
“At one point Young mentions that while people’s talk isn’t only cognitive, neither is cognition confined to talk. There is such a thing as embedded knowledge. This knowledge cannot be deduced from people’s talk. It is incorporated in nonverbal schemes, in clinical procedures, in apparatuses. The precise formulations suggest that Young takes the existence of embedded knowledge to indicate a lack: a lack in the ability or willingness of those involved to be more articulate” (Mol 15).
“In the interviews we held with them, patients gave us detailed descriptions of the way they reorganize their households, their work, their family life. They told about how to get into the car or when to take a taxi. About steps and stairs, bicycles, and dogs on a lead. About the trials and tribulations of dealing with an impaired body in daily life” (Mol 16).
“I investigate what Young calls ‘embedded knowledge’ even if I use a different terminology…. There is a problem in making relations to the literature explicit: it takes so much space to outline a single, simple link such as this. And there are so many of them, so many more. They are embedded, indeed, in the questions asked, the topics raised, the words used throughout this study” (Mol 16).
“But there are so many other fields places, literatures to relate to. Crucial among these are the dispersed studies about the framing of boundaries between biology and the social sciences. After the Second World War it became important to draw these boundaries and to draw them sharply. Talk about biological difference between humans had become suspect. In an attempt to make a sharp contrast with the murderous eugenic practices of the Nazis, the biological equality of humankind was stressed. Talking about differences between humans became a privilege of the social sciences, even if this privilege had to be reconquered over and over again (see, e.g., Rose 1982). In various forms and variants the social sciences delineated their own objects alongside those of biology. One of the arguments for doing so was that this helped to ward off racism” (Mol 17-18).
Mr. Jonas, a pseudonymized patient, recalling his surgery: “He adds that he remembers images, and vividly too, but he can’t tell anything much about them. How should he? The terms with which one might articulate the specificities of an operation do not belong to his vocabulary” (Mol 19).
“It is possible to listen to people’s stories as if they tell about events. Through such listening an illness takes shape that is both material and active. It is an illness that consists of lying on a sloping table. Of arguing with your anesthesiologist about the cloth in front of your eyes. It is an illness made up of scars on your legs that do not stop you from becoming a new person. This illness is something being done to you, the patient. And something that, as a patient, you do” (Mol 20).
“The patient stories quoted above do not expel physical reality. Instead, they talk about it, for it is everywhere…. Patients may interpret bodies, but they also live them. And so do doctors. Doctors figure prominently in the patient stories” (Mol 20).
“Perspectivalism puts doctors and patients on a par, with a great divide between them, because they cast their views from different angles. The traffic across the doctor-patient divide attracts much public attention…. But both the difficulties and the possibilities of crossing the gap point toward the existence of that gap. So there it is. A cleavage. A perspective from one point of view differs from that of the other” (Mol 20-21).
“In stories that tell about events-in-practice this is different. However shared or solitary perspectives may be, the practice of diagnosing and treating diseases inevitably requires cooperation” (Mol 21).
“And yet these texts are worth relating to when I want to argue that we should no longer leave the study of ‘disease’ to biomedicine. There are analogies. Differentiations between race and culture, biological parenthood and kinship systems, sex and gender, or disease and illness have a lot in common. Each of these distinctions was crafted in the 1950s in order to create a space for the social sciences alongside biology. Alongside: the metaphor may be taken seriously. The social domain was regionally separated from the biological domain. This both solved and created problems. Problems that were comparable” (Mol 21).
“…one might conjecture that it isn’t only knowledge of ‘disease’ that holds power over patients these days. Knowing ‘illness’ also does; for example, the ‘quality of life’ so important in framing present-day health care is defined in sociological terms. Strathern [Marily Strathern, After Nature: English Kinship in the Late Twentieth Century, 1992] tells that the nature/culture divide is subordinate to its latter element: it is the invention of a quite specific culture. Where this very culture is changing its procreative possibilities, new schemes will (have to) emerge. Translating this analysis, it is possible to say that one of the dominant ways Western cultures live their ‘illnesses’ is by taking them to be ‘diseases.’ Things doctors know about. But recent transformations in health care, like those that make patients into the guardians of their own therapies, are in the process of undoing the former divisions” (Mol 21-22).
“Thinking along with this, in an activist mode, one might say that leaving ‘disease’ in the hands of physicians alone is a political weakness. For whatever one may say about the social shaping of the former sick role, whatever one may say about ‘illness,’ as long as ‘disease’ is accepted as a natural category, and left unanalyzed, those who talk in its name will always have the last word. It would be better to mix with them, move among them, study them, engage with them in serious discussion” (Mol 22).
“In order for ‘intermittent claudication’ to be practiced, two people are required. A doctor and a patient. The patient must worry or wonder about something and the doctor be willing and able to attend to it. The doctor must ask questions and the patient be willing and able to answer them” (Mol 23).
Robert Pool, “Gesprekken over ziekte in een Kameroenees dorp: Een kritische reflectie op medischantropologisch onderzoek” (1989): “Pool makes it clear that if an anthropologist goes out to study ‘illness’ as if it were the lay theory of a ‘disease’ that doctors talk about in medical terms, he is trapped from the beginning. He is trapped in ‘disease’ language. Why would laypeople, let alone in Cameroon, delineate entities in their own talk that nicely parallel the categories of Western medicine? To presume this is to presume that the disease categories of Western medicine are ‘natural.’ That they reflect a reality out there for everyone to stumble over before interpreting it in diverse ways. But people’s categories, or so Pool argues, do not reflect a nature accessible, if in various ways, for all. Instead, they are part of a specific practice for dealing with life, suffering, and death” (Mol 23-4).
“But what is needed, indeed indispensable for clinical diagnosis, is that there be a patient-body. This must be present. And it must cooperate” (Mol 24).
“Who does the doing? Events are made to happen by several people and lots of things. Words participate, too. Paperwork. Rooms, buildings. The insurance system. An endless list of heterogeneous elements that can either be highlighted or left in the background, depending on the character and purpose of the description. The descriptions given here are mine, not those of Mrs. Tilstra, Mr. Romer, or any other patient. And even if my descriptions are informed by what patients tell about events, I only rarely follow patients in this book. This ethnography (that is its force but also constitutes its limits) concentrates on medicine: it is made to unravel medical knowledge, medical technology, medical diagnosis, and medical interventions. It is informed by my own observations and by attending primarily to the words of another group of lay ethnographers: medical professionals” (Mol 25-26).
Barbara Duden, The Women Beneath the Skin (1991): “…even the lived experience of one’s own body is mediated. It is not that just any form can be plastered into it. But neither is it the case that the modern Western body preceded medicine—subsequently to be objectified by it. They both have a history. These histories may well be intertwined” (Mol 26).
“In this unbounded territory, the disease/illness distinction is no longer helpful. When doctor and patient act together in the consultation room, they jointly give a shape to the reality of the patients’ hurting legs. How to call what they thus shape? If I use the word disease here, this is not to locate my text on the disease side of the disease/illness distinction, but to breach it. To make it plain that I will attend to physicalities even if I am not a medical doctor. To underline that it can be done. That there are ways of ethnographically talking bodies. There are good reasons to try, if only this one: that the humane does not reside exclusively in psychosocial matters. However important feelings and interpretations may be, they are not alone in making up what life is all about. Day-to-day reality, the life we live, is also a fleshy affair. A matter of chairs and tables, food and air, machines and blood. Of bodies. That is a good reason not to leave these issues in the hands of medical professionals alone but to seek ways, lay ways so to speak, to freely talk about them” (Mol 27).