Hello from Canada! This has very little to do with the topic of today’s post. I’m just taking advantage of this moment to announce my recent arrival in Vancouver, BC. For those of you who don’t know—and I don’t know who that would be since I tweet constantly about my newfound Canadian residency—I’ve just started a new position as an Assistant Professor of Rhetorical Theory and History at the University of British Columbia. And I’m super-excited about it!
Ok enough of that. So, recently I’ve been reading monographs on (medico-)scientific controversy. Rather than review each individually, I thought it might be more useful and more fun to review the three latest at one go. The works that I’ll address in this post span nearly two decades and three disciplines. The first, rhetorician Lisa Keränen’s Scientific Characters, explores “Datagate”—a very public discovery of data fabrication in breast cancer research trials. The second comes from across the pond and was authored by French sociologists of science Michel Callon, Pierre Lascoumes, and Yannick Barthe. Acting in an Uncertain World interrogates several public scientific controversies including the storage of nuclear waste, Mad Cow, and AIDS as part of a large effort to argue for a new vision for technical democracies. The last, despite the title (The Selling of the DSM: The Rhetoric of Science in Psychiatry, which one might expect to have been authored by rhetoricians—I did actually…because honestly, who reads the back cover thoroughly when purchasing on Amazon)–(this epic run-on sentence has clearly gotten the better of me, but I’m going to go with it all the same)—was penned by a pair of social work/social welfare scholars, Stuart A. Kirk and Herb Kutchins. Kirk and Kutchins provide a thoroughly engaging exploration of the development and promulgation of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and the manifold political debates which surrounded including the exclusion of homosexuality, the inclusion of post-traumatic stress disorder, and the relationships among psychiatrists and other mental health professionals (psychologists, social workers, therapists, etc).
Keränen, L. (2010). Scientific characters: Rhetoric, politics, and trust in breast cancer research. Tuscaloosa: The University of Alabama Press.
Scientific Characters uses the analytic lenses provided by ethos, persona, and voice to interrogate the nature of scientific controversy. This interrogation focuses on a once renown case of fraud in Breast Cancer clinical trials. In 1994, it was reported that Dr. Roger Poisson (then of Montreal’s Saint-Luc Hospital) had falsified patient records and data reports in a large series of lumpectomy studies. Keränen traces the fallout from this report through various venues and fora including the popular presses of the US and Canada, congressional hearings, and the journal literature. Along the way, she uses her investigation to refine the aforementioned rhetorical notions through studying the public discourse surrounding our chief offender Dr. Poisson and the ultimate study supervisor American physician/researcher Dr. Bernard Fisher.
First a note on Keränen’s analytic categories: Scientific Characters seeks to provide greater clarity to the often muddled and overlapping categories of ethos, persona, and voice. In so doing, Keränen identifies ethos as creditability or character derived from a pattern of behavior, persona as the symbolic construction of the author for the audience, and voice as the embodied stylistic and lexical choices of the rhetor. Nothing is controversial in this taxonomy. I think most rhetors would accept it readily. And I laud Keränen for providing clear taxonomic distinctions between each therm. As Keränen readily notes, this clarity is not always the case. Quoting Robert Allen Brookey, she argues that “rhetorical scholars ‘have seldom kept ethos well located, mixing terms, sometimes using ethos, persona, and voice as if they were identical” (p. 28). I agree, and as I mentioned I find Keränen’s taxonomy clear and effective. I do not, however, entirely agree with her theoretical rational for the taxonomy. Keränen locates her definition of ethos in Aristotle’s Rhetoric. However, I don’t think Aristotle was quite so clear as Keränen wishes he were. My reading of that classic would suggest that ethos is something constructed in the text (and is really rather akin to persona) rather than derived from a life of good behavior. Certainly, not everyone agrees with that reading, but many do. Personally, I think Keränen would’ve been better served if she had located her conception of ethos in Quintilian’s vir bonus bene dicendi (good man [sic] speaking well). But this truly is a minor quibble.
I really enjoyed Scientific Characters and found it to be great narrative and a solid example of detailed scholarship. That being said, I don’t have that much to say about it other than to suggest that you read it. I could retell the Datagate narrative, but honestly, Keränen does a better job. So, there you go.
Callon, M., Lascoumes, P., & Barthe, Y. (2001). Acting in an uncertain world: An essay on technical democracy. (G. Burchell, trans.). Cambridge, MA: The MIT Press.
Compared to Scientific Characters, Acting in an Uncertain World is a completely different experience. Maybe that’s a truism of French sociology. I’ll have to read more of it to find out. In any event, Acting is thoroughly grounded in the European STS tradition with frequent citation to the likes of Latour, Callon, and Woolgar, among others. The text artfully integrates descriptive passages from ethnographic notebooks , keen theoretical analyses, and normative suggestions for the future to technical democracy.
Invoking Latour’s concept of a parliament of things, Callon, Lascoumes, and Barthe argue that the technical controversies of contemporary democracy need to be addressed by recourse to dialogic rather than delgative democracy. Obviously, that needs some clarification. The idea is built on a series of normative propositions, the first interestingly enough is that controversy is good. Yep, you read that right; controversy is good. Why? Because if there’s a public controversy about a scientific and/or technical issue/object, that means more than just the elite scientists or politicians are involved in the discussion and maybe even the decision. Without controversy, so the argument goes, we don’t have democracy, we have technocracy. That’s smart stuff. I wish I’d thought of it.
More to the point, however, the authors argue that to be truly democratic, minority and disenfranchised stakeholders need to be participants in technical decision making. If not, we have a delgative democracy; that is, the discussion and decision-making authority has been delegated to scientists and politicians. (Of course, this is the norm.) But every once in a while people get angry, non-elite/non-technical stakeholders get involved. This is dialogic democracy and requires what Callon, Lascoumes, and Barthe dub “hybrid fora” to function. (Actually, the authors and/or translator dubs them “hybrid forums,” but I’m too damn pedantic to use that pluralization.)
Hybrid fora are those that explicitly invite the participation both of non-credentialed experts and of nonhuman actants (animals, ecosystems, rocks, scalpels, whatever). (Here is the direct link to Latour’s parliament of things.) Borrowing from Phil Brown, Acting introduced me to a fantastic term for one form of non-credentialed participation—“popular epidemiology.” Popular epidemiology is what happens when there’s a community health crisis, and no one in the medical establishment, environmental agencies, etc can or will address it. For example, when a large group of children in a given community suddenly turn up with leukemia, parents, local officials, and community leaders start to do their own research investigating power lines near playgrounds or illegal chemical dumping from the local factory. It’s not credentialed, legitimate laboratory science, but it’s a critical part of a scientific controversy.
There’s so much going on in Acting in an Uncertain World, that’d it be impossible to cover it all if I devoted an entire post to it. So, I’m not even going to try here. I will say that it’s one of the best books I’ve read in a long time. Almost as exciting as reading Haraway or Latour for the first time. I highly recommend it.
Kirk, S.A., & Kutchins, H. (1992). The selling of the DSM: The rhetoric of science in psychiatry. New Brunswick: Transaction Publishers.
Last, but certainly not least, I turn to Kirk and Kutchins’ The Selling of the DSM. An absolutely fantastic book, which would explain why it’s endured through multiple printings since 1992. (My edition was printed in 2008.) The Selling of the DSM is a product of its time—and I don’t mean that in a bad way. Despite being put together by a couple of social work/social welfare professors, it reads like many other STS/RSTEM monographs from the early 1990s. It’s supreme goal seems to be to demonstrate the politicization of an area of science. What differentiates this book from others by more familiar authors like Latour, Galison, Pickering, or Haraway, is that more mainstream STS/RSTEM from that era hope to demonstrate the political elements of all science, while this book seems to suggest that the development and promulgation of the DSM-III was somehow more rhetorical or more political than other scientific endeavors. One of the reasons for this difference is the fact that the authors have a very different stake in the issues at hand than a sociologists or rhetorician has while studying physicists or evolutionary biologists. Kirk and Kutchins’ students (and perhaps even themselves) are mental health providers. The DSM-III had a profound impact in their professional lives—and that impact clearly affected their analysis.
The Selling of the DSM is a thoughtful exploration of the rhetorical dimensions which lead to the development and promulgation of the DSM-III. The authors explored the kairos and exigencies for which revision of the DSM-II was deemed necessary, the negotiations of various committees and organizational bodies, and the proselytization of the new manual after its publication. While little of the manuscript invokes specific rhetorical terminology—other than popularly known constructs such as “argument claim,” it does, at times, reference the work of prominent STS/RSTEM researchers such as Kuhn, Latour, Woolgar, and Bazerman. The only issue, as I have suggested, is that the analysis is not parallel. They do not embrace the symmetry principle. In their criticism of the DSM-III, Kirk and Kutchins seem to suggest that a more scientific—less rhetorical—approach to the manual’s development was possible. Obviously, I don’t agree. But I also don’t want to get bogged down by this critique since it really only applies to the last few chapters. The Selling of the DSM is divided into nine chapters and the first four and much of the seventh read just like any other STS/RSTEM work. It’s only the more normative sections, the ones that will directly impact their students’ (or perhaps their own) work that are more problematic.
While there are many great moments in this book, one of my favorites involves a story about the major protagonist—Robert Spitzer, a psychiatrist who exercised considerably oversight over the development of both the DSM-II and DSM-III. In response to some of the criticisms that Spitzer had received for the politicization of the DSM-III, he jokingly identified a new psychiatric condition—PSDS (Politics-Science Dichotomy Disorder) (p. 195). For Spitzer, this diagnosis is to be applied to those who allow political decisions to trump their scientific integrity. He, of course, excludes himself from this diagnosis because, while some of his decisions regarding the DSM-III were political, the pursuit of objective science was his root goal. While this approach to PSDS will never be particularly interesting and useful, I still think we should revive the term and that Spitzer was an acute sufferer. In fact, I aim to start using PSDS to refer to those poor scientists who have had such a break with reality that they actually believe that science is an objective apolitical thing.
Another wonderful piece of The Selling of the DSM was Kirk and Kutchins’ reconstruction of the debates over the exclusion of homosexuality form the DSM-III. Much of the text is devoted to charting the arguments—generally conducted through the press, but also through protest actions between gay rights organizations, the gay psychiatric caucus and the rest of the American Psychiatric Association. As most of my readers likely know, homosexuality was indeed left out of the DSM-III. However, the decision to do so was made through some fascinating political maneuvering which involved interrogating the very meaning of mental illness. During the revision third revision of the DSM, the definition of mental illness was a moving target, and it had more to do with deviation from the norm, than the more contemporary approach which involves a deviation from the norm which causes social or cognitive distress. Actually, it was the move from the former to the latter which allowed for the removal of homosexuality form the list of possible diagnosis. Spitzer, who was apparently not a big fan of homosexuality, was at least able to recognizing that being gay does not necessarily cause distress.