This is the plot of my philosophical tale: that ontology is not given in the order of things, but that, instead, ontologies are brought into being, sustained, or allowed to wither away in common, day-to-day, sociomaterial practices. Medi-cal practices among them
Ontologies are, instead, highly topical matters. They inform and are informed by our bodies, the organization of our health care systems, the rhythms and pains of our diseases, and the shape of our technologies. All of these, all at once, all intertwined, all in tension.
For a long time, "disease" was the unmarked category of anthropology and sociology of medicine. As the state of a physical body it was an object of biomedicine. Doctors told the truth about disease, or at least they were the only ones able to correct each other in so far as they didn't. Social scientists were careful not to get mixed up in this body-talk.
Instead, they 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.
All along social scientists left the study of disease "itself" to their colleagues, the physicians, until they started to worry about the power a strong alliance with physical reality grants to doctors. Then, social scientists gradually began to stress that reality isn't responsible all by itself for what doctors say about it.
Like patients, professionals may be supposed to have perspectives of their own. However, these are not what I'll be telling about. There are, or so I want to argue, some problems with this line of work. 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.
Is it possible to tackle these problems? Here's the task I've set myself. That is why I will not tell about the perspectives of medical doctors, nurses, technicians, patients, or whoever else is concerned. Instead I'll try to find a way out of perspectivalism and into disease "itself." How might this be done? By taking a third step.
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.
order of things, but that, instead, ontologies are brought into being, sustained, or allowed to wither away in common, day-to-day, sociomaterial practices. Medi-cal practices among them