Tag Archives: history of medicine

So, Just What is the Point of the History of Medicine?

ing0ea9e4f5ccabaafef2ce05512e9a0599I remember reading Roger Cooter’s Writing History in the Age of Biomedicine around the start of my PhD. And I thought it was a strange book — not, I should stress, because there is anything untoward about its writing-style (in fact, the opposite: it reads brilliantly). Neither is there anything objectionable about its structure: though eight of the book’s ten chapters have been published before, Cooter has provided a neat little preamble to each, allowing him, now at the end of his career, to expose the intellectual/epistemic conditions that previously informed each essay (as he explains here). I thought this was very nicely done. Indeed, I thought that Writing History in the Age of Biomedicine expertly consolidates a number of issues on the purpose of the history of medicine in wider academia, and Cooter does well to imbue his argument with vigour and force. But I found Writing History in the Age of Biomedicine strange because of how I responded to it, for precisely what I admired about the book I also puzzled over. And as my reading has deepened over the past couple of years, and my range of influences grown, I’ve become more critical of Cooter — specifically, what he identifies as the purpose of the history of medicine.

I have to admit something at the outset, though. Even on a third reading, it is hard not to be seduced by Writing History in the Age of Biomedicine. Cooter forcefully impresses upon the reader the importance of and need for academic history. Yet his position goes beyond a simple call for more and more research (or research for it’s own sake). Rather, he advocates for a particular focus to academic history, for the discipline, according to Cooter, faces unparalleled threats from neoliberalism and the growing rise of neuroscience. The former imposes not only greater levels of scrutiny and exposure to ‘audit culture’ within higher education, Cooter claims, but also insists on ‘never-ending growth and “economic progress”’. In so doing, it denigrates the study of the past (for why examine history if it has nothing to offer the ‘present-centric economist thinking about the future’?)[1]

Cooter’s criticism of neoliberalism is coupled with warnings of the threat posed by the turn to neuroscience in various disciplines, and which is regarded by Cooter as both an extension of, and coinciding with, neoliberal dogma. This, in part, helps to explain Cooter’s objection to the growing role of neuro-disciplines in the present century. But his aversion to neuroscience is also animated by what he identifies as the threat it poses to academic history. Cooter chides the arrogance of the ‘neuro enthusiasts’, their absolutism and tendency to absorb academic history into their own neuroscientific paradigms. History, in such accounts, is only seen as useful when seeking to further neuroscientific insight; it has no role in explaining how the neurosciences came to dominate in the 21st century nor otherwise challenge their existing orthodoxy.[2] This pivots to the third of Cooter’s concerns — that many academics blindly acquiesce in the rise of neuro (e.g., through the study of affect or the emotions).[3] This, he argues, amounts to a presentification of the past, an overloading of it with our present-day penchant for neuroscientific explanation.

Cooter contends that a two-fold strategy is needed to extricate history from the ghetto it now finds itself in. Firstly, the humanities have to be sundered from the hard sciences if they are to offer necessary but critical interrogation of the latter. Wishy-washy interdisciplinarity (e.g., the medical humanities) will not do.[4] Instead, medical historians must vigorously agitate against the ‘reductive’ forces of the natural sciences and the narrative of unbroken progress that they are wedded to.[5] With recourse to the study of the past, medical historians must take up the mantle of social critique — ‘critical history’ — to challenge the current dominance of biomedicine in the 21st century.

Yet Cooter also argues that historians, at the same time as they place a check on the neurosciences, must also reflect on the values that inform their own discipline. In other words, they must engage in rigorous self-policing — the turning, that is, of the critical gaze (normally reserved for the object of study) back onto the historian and her methodologies, concepts, frameworks, etc.[6] The historian’s ignorance of her own position, Cooter warns, leaves the discipline vulnerable to being side-lined or de-funded altogether in the face of wider influences — without a firm location within history, the historian is in danger of misunderstanding her role and the relevance of her discipline.[7] And without a critical understanding of historical epistemology (‘the constructedness of [historical] thought’), historians are in danger of losing themselves in engaging with the more powerful neuro-disciplines, of becoming swallowed up by the ‘new biological regime of truth’.[8] Hence why the ten chapters that compose Writing History in the Age of Biomedicine are prefaced with commentaries on the context on which they were produced: they are part of Cooter’s attempt to demonstrate how self-critique should look, how we should reflect upon (and thereby check) the various forces operating on our writings. Indeed, in language that is notably more open-ended, Cooter suggests that a greater engagement with one’s own position in history, and the impact of this vis-a-vis on history-writing, may bring with it a greater degree of ‘honesty and credibility’ to a form of research that still (within some quarters) seeks to perpetuate the ruse that history can be written ‘objectively’ and value-free.[9]

This call for self-reflection is to be lauded; in my opinion, it remains one of the most memorable points made in Writing History in the Age of Biomedicine. Historians do need to better reflect on the forces operating upon their research. They do need to jettison the notion that they can access the past unmediated by present-day concerns, values, technologies, etc (as I’ve already argued here). And on the subject of neoliberalism’s threat to academic history, I am also in deep agreement with Cooter. Whilst some of his rhetoric may be overblown — explained, perhaps, by his wish to provoke and startle historians out of their established ways of writing — his fundamental point about neoliberalism’s threat is sound.

But where I depart from Writing History in the Age of Biomedicine is in both the solution Cooter proposes and the purpose he assigns to the history of medicine. There are a number of inconsistencies in Cooter’s position. For example, it is unclear, as one reviewer has noted, how history can be both alive to contemporary threats whilst eschewing the use of present-day systems-of-value to study the past.[10] Equally, I am at a loss to understand how, according to Cooter, reducing human subjectivity to neuroscience is bad, but reducing everything to historical explanation, as advocated also by Cooter, is better (are not both equally reductive?).[11]

More worryingly, Writing History in the Age of Biomedicine is cut through with three unresolved contradictions. The first concerns historians, and their aversion to ‘theory’. Cooter insists on the need for historians to self-reflect on their position and the cultures that they are embedded in. He warns that the future of history-writing is in ‘the hands of historians themselves’, that ‘prayers for survival simply will not suffice’ and that ‘the time for procrastination and pious hope is past’[12]. Elsewhere, however, Cooter has written of the sluggishness with which social historians of medicine took to developments in Foucauldian scholarship (and, even then, implied that this was more a case of cherry-picking than critical engagement).[13] His comments on historians in general are more caustic, lampooning them for not ‘getting an ethical grip on themselves’ and for casually taking more and more ‘turns’ in history without deeper thinking of what this actually entails.[14] To be clear, I agree with Cooter — historians do neglect critical theory, and are frequently late to the party in engaging with new theoretical developments. But it remains a mystery how or why historical scholars will turn to self-critique, having eschewed all engagement with critical theory thus far.

In a similar vein, further questions are posed by Cooter’s animosity towards academics and their inability to mobilise against threats to their profession (at least within the British context). For instance, he complains about the willingness of historians to engage in competition over income-generation, and chides British academics for not being better unionised (in contrast to continental Europe). Cooter does concede that the ‘neoliberal forest […] has been difficult to penetrate’ by even those who wanted to, their efforts limited by a lack of time and opportunity.[15] But combined with his repeated complaints against the acquiescence of academics to the neuro-turn the result is another quandary — if academics have thus far failed to resist the effects of neoliberalism (or, for that matter, see it as much of a problem), then how and why will they want to do so now?

Fundamentally, I think, there is something unsatisfying about Cooter’s call for self-critique. It is animated by a belief that historians have to reflect on the systems-of-value that they bring to the study of the past, that, unless they are careful, historians might confirm rather than challenge existing power-relations. Yet Cooter also acknowledges that objectivity is not possible in historical research, and that ‘objectivity’ is itself a political category. What he proposes, however, is a system where historians should work tirelessly to expunge all present-day values from their research, as if, even though research is never objective, we should have a go anyway, that the past is some virginal territory which historians must not contaminate. Cooter’s logic is puzzling — if objectivity is not possible, and is itself a social construct, then why bother with it at all? Why persist with existential hand-wringing over presentism when we will never, ever be able to read the past without present-day values? Why expend energy spinning around in a never-ending cycle of self-critique?

But I think my beef with Writing History in the Age of Biomedicine stems from the role that Cooter assigns to historians in policing new instantiations of biomedical power. In my opinion, it comes across as a reactionary — that is, it reads like an attempt to lock others out of debate, to colonise an object of research so as to bolster the ontological foundations of academic history.

And we’ve heard it before, for there is now a typical narrative-structure employed in many historical studies (indeed, I have found it handy to utilise myself). It proceeds by arguing that there is a particular object that is regarded by non-historians as timeless or culturally-universal and/or entirely new to human thought and with no even half-related precedent. The historian then intervenes to demonstrate that said object is not transhistorical, universal and/or novel but is instead shaped by socio-historical forces. This is history in a reactive mode, directed towards a perceived challenge — useful for justifying academic research and the historian’s place in wider debate, but limited by its perception of other disciplinary paradigms as threatening. Thus, though Cooter suggests that the response of academic history to the neuro-disciplines should be one of attempting to critique, and thereby disrupt, the latter’s centrality in academia, this sounds like history in the reactive mode again, now directed to a new threat that ostensibly requires taming.  My point is that it’s a very narrow way of conceiving the historian’s role. And although I think Cooter is on to something with his talk of self-critique,  Writing History in the Age of Biomedicine feels like a missed opportunity to reflect on the narratives and arguments that we use in history to bolster our discipline. Cooter falls into auto-pilot, only furthers the idea that all contemporary developments are opportunities for historians to historicise. And it is this lack of imagination – more than anything else, I think – that will sideline academic history yet further.



[1] Roger Cooter with Claudia Stein, Writing History in the Age of Biomedicine (New Haven and London: Yale University Press, 2013), p. 33 and 4.
[2] Ibid., pp. 9-10.
[3] Roger Cooter, ‘Neural Veils and the Will to Historical Critique: Why Historians of Science Need to Take the Neuro-Turn Seriously’, Isis, vol. 105, no. 1 (2014), p. 147.; Cooter, Writing History in the Age of Biomedicine, p. 206.
[4] Cooter claims that interdisciplinarity often places humanities scholars under the thumb of scientists and is usually advanced by penny-pinching bureaucrats in HE. See Cooter, Writing History in the Age of Biomedicine, pp. 37-39. Relate this to his criticisms of neoliberalism and ‘audit culture’ above.
[5] Ibid., pp. 10-11.
[6] By way of background reading, consider Cooter’s comments on the loss of political relevancy amongst social historians of medicine in Roger Cooter, ‘After Death/After-‘Life’: The Social History of Medicine in Post-Postmodernity’, Social History of Medicine, vol. 20, no. 3 (2007), pp. 441-464.; and Roger Cooter, ‘Re-Presenting the Future of Medicine’s Past: Towards a Politics of Survival’, Medical History, vol. 55, no. 3 (2011), pp. 289-294. On the explicit influences on Cooter’s thought, see the respective arguments by Scott and Butler on the need for, and inventiveness of, self-critique in Joan W. Scott, ‘History-Writing as Critique’ in Keith Jenkins, Sue Morgan and Alan Munslow (eds), Manifestos for History (London and New York: Routledge, 2007), pp. 19-38.; and Judith Butler, ‘Critique, Dissent, Disciplinarity’, Critical Inquiry, vol. 35, no. 4 (2009), pp. 773-795.
[7] Cooter, ‘After Death/After-‘Life’, p. 442.
[8] Cooter, Writing History in the Age of Biomedicine, 12-13 and p. 16.
[9] Ibid., p. 7.; Cooter, ‘Neural Veils and the Will to Historical Critique’, p. 154.
[10] See Jouni-Matti Kuukkanen, ‘A Craving for Critical History’, History and Theory, vol. 53, no. 3 (2014), p. 432. We might also ask whether self-critique is easier to achieve in retrospect, when looking back on your work from a distance. Self-critiquing in situ, and then making that explicit in such a way as to satisfy a peer-review process, might be more of a challenge.
[11] As argued in Jonathan Toms, ‘So What? A Reply to Roger Cooter’s ‘After Death/After-“Life”: The Social History of Medicine in Post-Postmodernity’, Social History of Medicine, vol. 22, no. 3 (2009), p. 615.
[12] Cooter, ‘Re-Presenting the Future of Medicine’s Past’, p. 294.; Cooter, Writing History in the Age of Biomedicine, p. 40.
[13] Cooter, ‘After Death/After-‘Life’’, pp. 449-450.
[14] Cooter, Writing History in the Age of Biomedicine, pp. 207-208. Also see the comments on historians’ ‘resistance’ to their own self-interrogation in ibid., pp. 11-12.
[15] Cooter, ‘Re-Presenting the Future of Medicine’s Past’, p. 290.