Über die Autorin bzw. den Autor

Annemarie Mol is Socrates Professor of Political Theory at the University of Twente in the Netherlands. She is coeditor of Differences in Medicine: Unraveling Practices, Techniques, and Bodies and Complexities: Social Studies of Knowledge Practices, both published by Duke University Press.

Von der hinteren Coverseite

""The Body Multiple" is compelling, wonderfully and sometimes slyly well-written, and full of innovative insights into 'actually existing medical practice.' Mol's parallel text is well-placed intellectually in relation to her primary research text on atherosclerosis, and it provides a powerful teaching tool on how to think through and with science studies literatures when conducting an empirical project."--Rayna Rapp, New York University

Auszug. © Genehmigter Nachdruck. Alle Rechte vorbehalten.

The Body Multiple-CL

Duke University Press

Chapter One

A Movement between Fields

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. I had an identity card that allowed me to leave my bicycle behind a fence and drink free coffee from the omnipresent vending machines. I had a library card and the use of a desk in a succession of crowded rooms. I had a white coat. And I observed.

I would go to the professor who headed a department and explain 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. I would explain what made "atherosclerosis in the lower limbs" a suitable case for my purpose and what I hoped to learn in their department. I presented myself as both insider and outsider, having received basic training in medical school as well as extensive training in philosophy. And I gave the name of the professor of internal medicine supporting my study. Each of the professors thus approached reacted in a friendly way. They all emphasized that academic hospitals must encourage research. My particular research plans made some interested and some skeptical. Others simply were indifferent. But after some further questions I would invariably be sent to someone one or more steps down the hierarchy to talk about and practically arrange my observation.

So I sat for many mornings behind vascular surgeons and internists doing their outpatient clinics, observing some three hundred consultations. (All surgeons and internists I observed for this study were men, and I will not hide that fact, so I use the generic "he" whenever I write about "the doctor," even though one of the pathologists whom I observed was a woman. Yes, this is a fading historical moment. The profession is undergoing a rapid gender change. But that is another story. One more complication left out here.) In university hospitals, both physicians and patients are used to observers: there are always students and junior doctors around who need to learn something. Yet I was surprised by the calm with which my presence was accepted-for I found these observations rather intimate. Patients tell about so much and undress so often. Although that is difficult for some and a relief to others, my presence behind the attending doctor hardly seemed to make a difference. When it risked to do so, I skipped a visit (once when a patient asked for it, several times when a doctor did, and once when I recognized someone I knew vaguely and left of my own initiative). The other transgression was into the privacy of the doctors. I was in a position to observe all kinds of details about the way they work. Some of them were visibly uneasy about the fact that I might judge the degree to which they were humane and kind in their interactions with patients. But (though that was sometimes difficult to resist) I wasn't out to make such judgments. Nor did I want to judge the so-called technicalities of their diagnosis and treatment. I wanted my observations to be a means to get to know their standards, rather than an occasion to apply my own.

This made me shift sites and move around in the hospital. I observed technicians handling diagnostic tools in the vascular laboratory. I followed the tracks of radiologists and pathologists in their dealings with leg arteries. I went for months to the weekly meetings where the treatment options for patients with complicated cases of vascular disease were discussed. I witnessed several operations. Spent some days in the research laboratory of the hematologists. Held interviews or had conversations with epidemiologists, physiologists, internists, surgeons, and general practitioners. A couple of them read my articles and we talked about their reactions. I also went to the library and studied the textbooks and journal articles written, or mobilized as a resource, by "my doctors" and, when the references and my curiosity took me there, compared them with other publications. For two years I followed the monthly research colloquium on atherosclerosis. I coauthored with a junior doctor an article about the introduction of a diagnostic protocol. I supervised a medical student who interviewed vascular surgeons in several smaller hospitals and another one who analyzed discussions about the intake of cholesterol. And, finally, I had the temporary luxury of a research assistant-Jeannette Pols, a philosopher like myself, moreover trained as a psychologist-who held long patient interviews, transcribed them, talked them over with me, and coauthored publications about this material. She also was a good sparring partner with whom to discuss my work.

Discussion was also what I sought in other worlds, outside the hospital. I could seldom go to those places by bicycle, for they were a lot farther away-and yet they were less alien to my writing and talking self. They were departments of philosophy, anthropology, sociology, or science and technology studies. I attended conferences and listened bored or fascinated to speakers presenting papers to five or fifty listeners. I read journal articles, wrote them, reviewed them. I went for talk-walks on lakesides or chatted over dinners. I was cross-examined about my field, my method, my purpose, my theoretical ancestors. Often such exchanges took place in an odd version of the English language, a transportation device that poses some difficulties to those who have not grown up with it, but reaches far. So though my stories come from the hospital in the town where I live, they went with me to many other places. To my intellectual friends and enemies in places like Maastricht, Bielefeld, Lancaster, Paris, Montreal, San Francisco. They managed to travel, my stories about leg vessels and pain. Immersed in theoretical arguments about the multiplication of reality.

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. Let's shift to the philosophy. The plot of my stories about vessels and fluids, pain and technicians, patients and doctors, techniques and technologies in hospital Z is part of a philosophical narrative. In conformity with the dominant habit of that genre, I'll give away the plot right here, at the beginning. It is this. 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.

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...