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Social Science & Medicine 58 (2004) 687696

The ambivalence of error: scientific ideology in the history of

the life sciences and psychosomatic medicine

Monica Greco*

Department of Sociology, Goldsmiths College, University of London, New Cross, London SE14 6NW, UK

Abstract

This paper discusses the concept of scientific ideology as it appears in the work of the historian and philosopher ofmedicine Georges Canguilhem, whose work is becoming increasingly well known and used amongst anglophone social

scientists. Whilst addressing the problematic of legitimacy and illegitimacy in the history of science, the concept of

scientific ideology does something different and more complex than either the opposition between science and false

science, or the one between orthodoxy and heresy, allow for. On the one hand, it enables us to preserve a crucial

acknowledgment of the specificity of science in general, and of medical science in particular. On the other hand, it also

allows us to challenge the sharp contrast between science and non-science by setting that contrast in a diachronic

perspective. Drawing also on the work of Isabelle Stengers, the last part of the paper discusses an application of the

concept of scientific ideology in relation to the field of psychosomatic medicine and psychoneuroimmunology.

r 2003 Elsevier Science Ltd. All rights reserved.

Keywords: Canguilhem; History of science; Psychosomatic medicine; Psychoneuroimmunology

Introduction

The opposition of orthodoxy and heresy self-con-

sciously differs from the distinction between science and

false or pseudo-science in that it explicitly avoids

ascribing a privileged status to science as a form of

knowledge, suggesting in fact that it can be analyzed in

the same terms as religion. At the same time, just like

science and false science, orthodoxy and heresy describe

forms of legitimacy and illegitimacy.

This paper discusses the concept of scientificideology as it appears in the work of the historian

and philosopher of medicine Georges Canguilhem,

whose work is becoming increasingly well known and

used amongst anglophone social scientists (see Osborne

& Rose, 1998). Whilst addressing the problematic of

legitimacy and illegitimacy in the history of science, the

concept of scientific ideology does something different

and more complex than either the opposition between

science and false science, or the one between orthodoxy

and heresy, allow for. On the one hand, as I hope to

illustrate, it enables us to preserve a crucial acknowl-

edgment of the specificity of science in general, and of

medical science in particular. On the other hand, it also

allows us to challenge the sharp contrast between science

and non-science by setting the contrast within a

diachronic perspective.

This is not the place to attempt a systematic

introduction to the content and context of Canguilhems

thought.1

For those not already familiar with his work,however, it is important to mention that Canguilhems

originality as a historian and philosopher of science lies

partly in his choice to focus on the life sciences

biology, medicine, and psychologyand in his life-long

endeavor to describe and account for their specific

rationality. He argued that these sciences, which differ

from physics, mathematics, or chemistry in their degree

of formalization and fitness for mathematisation, lead us

ARTICLE IN PRESS

*Corresponding author. Institut fuer Sozialforschung, Senck-

enberganlage 26 Frankfurt-am-Main 60325, Germany.

E-mail address:[email protected] (M. Greco).

1Useful starting points are Foucault (1989), Tiles (1987),

Osborne and Rose (1998), Spicker (1987) and Bowker and

Latour (1987).

0277-9536/03/$ - see front matter r 2003 Elsevier Science Ltd. All rights reserved.

doi:10.1016/S0277-9536(03)00220-X


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order to understand them in their proper context, it is

necessary to turn to the epistemology of Gaston

Bachelard, who was Canguilhems mentor and prede-

cessor as professor of the history and philosophy of

science at the Sorbonne. The concept of scientific

ideology, as we shall see, represents both a continuation

and a transformation of Bachelards legacy.

Gaston Bachelard: judgement and the history of science

Gaston Bachelard described his epistemological pro-

ject as an attempt to provide a philosophy that was

adequate to the movement of contemporary science.

Living and writing in the first half of the 20th century,

Bachelard witnessed what Mary Tiles describes as

traumatic changes in the character of physics through

the emergence of relativity theory and quantum

mechanics. As Tiles explains (1987, pp. 143144):

[These] were not just theories to be added to the

existing stock, or to replace parts of that stock. Their

acceptance entailed the disruption of the whole

framework of classical physics; its concepts of space,

time causality and substance, concepts definitive not

only of the thought-space of physics but also,

according to Kant, constitutive of our conception

of the objective, physical world and thus vital to the

way in which the distinction is drawn between inner

and outer, subject and object.

The word traumatic is therefore significant, since these

changes were experienced and interpreted as a disrup-

tion in the very order of reason, calling for a

reconstruction capable of accommodating the possibility

of a new disruption in the future. In Bachelards own

words, a philosophy which professes to be adequate for

scientific thought, which is in a constant state of

evolution, must expect that scientific knowledge will

[a]ffect the structure of the mind (Bachelard, 1968).

The point worth noting, which gives us the key to

many of the other features of Bachelards thought, is

that he presents the structure of the mind as

dependent on scienceit is shaped by science. This isthe reason why a philosophy adequate for scientific

thought cannot be a philosophy grounded in a

metaphysical and unchanging faculty of reason, or in

the subject understood as a given. Quite the reverse,

reason is the product of sciencenot its raw material.

Reason is instructed by science, in the sense that its

objects and concepts are never immediate givens, but

always objects and concepts that have already been

produced through the work of science itself.

In the most synthetic terms, Bachelard describes

science as a form of work, a form of work mediated by

instruments. The role of instruments is crucial; they are

not simply aids to the scientist, they are organs of

intelligence (Canguilhem, 1975a, p. 191), which reor-

ganize and transform what is given, which create the

real. To quote again from Bachelard (1951, p. 84):

Contemporary science has entirely broken with the

prehistory of sensory data. It thinks through its

instruments, not through its sense organs. Thisinnovation does not merely mark a peculiarity of

contemporary science; it throws an entirely different

interpretation on what scientists in the past were doing

as well.

The work of science is also described as a work of

verification, in the etymological sense that it is a work of

making true. This is an important point for it reminds us

that just as reason is the product and not the a priori

condition of science, so scientific truth is the product of

a reorganization of experience. In fact, for Bachelard

what the work of science performs is not discovery, but

rather a gesture of refusalof saying no to theimmediacy of phenomena.2 Canguilhem (1975a, p. 191)

coins the term antilogics in order to describe this

gesture: it is the refusal to receive ready-made concepts,

designated objects, an ordinary language; and corre-

spondingly, it is the decision y to reorganize the order

of syntaxy to produce phenomena instead of register-

ing them. This is the reason why, for Bachelard and

Canguilhem alike, science is not entirely equivalent to

other forms of culturea point to which I shall return

below.

Through its work of reorganization, science thus sets

new norms for the use of rational categories. As an

example, Bachelard offers the case of arithmetics.

Arithmetics, he claims, is not founded on reason; it is

reason that is founded on elementary arithmetics, since

this practice has repeatedly confirmed itself to be an

efficient and consistent system of organization of

experienceso much so that it would be unthinkable

to abandon it. What would be a function without

occasions for functioning? What would be a reason

without occasions for reasoning? (1988, p. 144). He

cites the mathematician Destouche as saying that if

arithmetics should, in a hypothetical future, reveal itself

to be contradictory, reason would be reformed to erase

the contradiction and arithmetics would be preservedintact. Bachelard goes further: he suggests that what

might in fact happen is not that a contradiction suddenly

appears within arithmetics, but that the practical need

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2For a powerful illustration of the epistemological break

that science operates with respect to everyday categories, see pp.

7582 of Lactivit!e rationaliste de la physique contemporaine

(1951) where Bachelard compares how the term corpuscule is

understood in physics and philosophy. The commonsense and

philosophical use of terms such as corpuscule, mass, or

temperature bears the inherited traces, or a mixture of traces,

of the concepts of outdated sciences.

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arises for a contradictory use of arithmetics, calling for a

transformation of reason.

To reiterate once more: reason, for Bachelard, cannot

be known independently of its applications because it is

generated through those applications. The inadequacies

of the applications are, accordingly, the inadequacies of

reason, and scientific progress is the rectification of thoseinadequacies. This is the sense in which Bachelard (1951,

p. 27) understands scientific development to be the

progress of rationalism, and the history of science to be

the history of the defeats of irrationalism. This notion

of rationalismfor which Bachelard coined the expres-

sion applied rationalismis therefore necessarily a

form ofhistorical reason, laden with the full implications

of historicity. These implications refer, on the one hand,

to the future: scientific truth, understood not as what is

revealed but as what is produced, is explicitly provi-

sional and always subject to correction. On the other

hand, the past of science stands as a series of irrevocableprecedents, and new science can only emerge as a

function of them.

On this basis, it seems clear that contemporary

scienceand hence reasoncannot but look upon its

past with a discriminating eye. Episodes in the history of

science cluster around two opposite poles, one positive

and one negative, according to whether they can be seen

as contributions or obstacles towards the present state of

knowledge/reason. The provisional character of the

truth spoken by contemporary science means, of course,

that the judgment of value it imparts on historical

episodes is equally open to correction. We have, in this

sense, a form of relativity. But it should be stressed that

the task of pronouncing a judgment cannot be eschewed,

and this profoundly distinguishes Bachelards position

from a form of relativism.

Relativity not relativism

It will be instructive to consider the relativist position

in more detail for the benefit of comparison. Kuhns

account of scientific activity in terms of the conventional

norms of communities was read by many in the social

sciences as producing a circular definition of thedistinctive character of science: science appears to be

simply what we find practiced in a scientific community

and vice versa (see Lakatos & Musgrave, 1970). This, in

turn, encouraged interpretations of his work as a

defence of irrationalism, and as a refusal of the notion

of scientific progress. Despite the fact that Kuhn

explicitly attempted to counteract this reading of his

work (Kuhn, 1970, postscript), it was embraced by some

social scientists. The positions of Barry Barnes offer a

good, if not the most recent, example of this form of

relativism. The borderline between science and non-

science (and between true and false science in a historical

sense), according to Barnes (1982), is a matter of

convention. This line circumscribes a finite aggregate

of concrete examples of science without implying that

they share a common essence or rationality. Under-

standing where the borderline lies, Barnes maintains,

requires not the formulation of a principle of demarca-

tion, but the empirical study of the social processesthrough which it is sustained and made visible.

Similarly, to prefer one paradigm to another ultimately

comes down to expressing a preference for one way of

life over another; the emergence of paradigms is the

result of a choice by their users. Accordingly, it is wrong

to ever speak of truth or falsity in connection with

science, since all rational elaboration is always and

everywhere conventional in character, and there are no

external units of measure against which the value of any

particular episode can be judged. The correct employ-

ment of a concept should not be seen as a manifestation

of rationality, but as a discretionary capacity of socio-logical interest.

The latent concept of rationalism to which this form

of relativism stands opposed differs from Bachelards in

important respects, and is more plausibly exemplified by

the propositions of thinkers like Lakatos and Popper.

As Alan Chalmers synthetically put it, this version of

rationalism is characterized by the fact that it presumes

the universality and ahistoricity of rational criteria

(Chalmers, 1976). Both these features contradict the

features of what Bachelard calls applied rationalism.

Rationalism, understood as both universal and ahisto-

rical, indeed involves a reference to principles external to

the linguistic community and logically prior to it, whose

existence is what Kuhn and Barnes deny. But Bachelard

understands history itself as the informing principle of

his applied rationalism. For this reason, applied

rationalism is intrinsically linked to the (scientific)

practices of communities, and indeed Bachelard (1949,

pp. 131132) recognizes a plurality of rationalisms that

correspond to different regions of scientific activity.

These regional rationalisms, as he calls them, must be

considered in their own right before any attempt is made

to institute, a posteriori, an integrating rationalism. The

crucial point of difference between Bachelards position

and the strong relativist one lies in the fact that appliedrationalism, however plural and regional, is never

contingent, and never available for arbitrary choice. This

is at least in part because of its diachronic, temporal

character. We can speak of rationalism, therefore, not

because science borrows it from a platonic dimension, but

because science itself is intelligibly overdetermined by its

past achievements. And we can mark the particularity of

science as precisely that which institutes its procedures as

the rationality of a linguistic community.

From the fact that concepts never correspond to

unmediated objects, relativists propose that their mean-

ing is conventional, the result of a synchronic choice by

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its users. For Bachelard, scientific work is the specific

place where culture meets this choice as a productive

task, and actually performs it. It is the locus where the

norms of meaningfulness are creatively transformeda

locus characteristically set apart from commonsense, but

that inevitably feeds back into the commonsense of later

generations (see Bachelard, 1951, pp. 7582). Inpronouncing ourselves on the past of science, therefore,

we cannot abstract from the contemporary state of

scientific knowledge for two different sets of reasons.

Firstly, because it is the only available point of reference

we can adopt unless, like many relativists, we wish to

maintain that we can and should abstain from judgment.

Secondly, as a matter of intellectual honesty, it is a

means of rendering explicit the elements of historical

bias that are intrinsic to any form of thought.

To conclude this necessary detour into the philosophy

of Bachelard, let me return to its implications for the

historiography of science. One of the consequences ofapplied rationalism is the need to distinguish between

the past of a science and science in the past. The first

expression designates an order of conceptual progress,

visible only after the fact, and of which the present

notion of scientific truth is the provisional point of

culmination (Canguilhem, 1988, p. 9; Gutting, 1989). It

is the history of science, whose pertinent objects are

highlighted through the projection of contemporary

knowledge onto episodes of the past. All other efforts

belong to the story of science, the flat chronology of

events which includes those once called scientific and

later disqualified from that claim. For Bachelard, such

events are not simply neutral sidelines of scientific

development leading to a series of dead-ends. They carry

a definite negative value as impediments or obstacles to

scientific progress. They are mistakes, errors whose

inscription in history nonetheless makes them an active

presence in the language of posterity and forms part of

the epistemological inheritance which must be counter-

acted by any effort to think scientifically. Sometimes, as

in the case of Newtonian mechanics, errors are such that

they can be preserved in a rectified form. They are

apparent errors, where the mistake lies not in the concepts

themselves but in their unconditional use; the Newtonian

universe is a valid conceptual subsystem, as it were, of theEinsteinian one. In these cases, Bachelard speaks of

histoire sanctionn!ee (sanctioned history). When errors only

have a negative value, and their rectification amounts to

their elimination from the map of scientific knowledge,

Bachelard speaks of histoire p!erim!ee (lapsed history).

What is the value of errors? Scientific ideologies as

ambivalent obstacles

We are now in a position to return to the concept of

scientific ideology which, let us remember, arises in

the practice of the history of science. In particular, it

arises in the practice of the history of the life sciences,

and in a sense it marks the specificity of that subject.

The distinction between sanctioned and lapsed knowl-

edge, for Bachelard, is a relatively rigid one. It implies

the idea that it is possible to assign an unequivocal

epistemological value to different episodes in the historyof science. Unless errors are rectifiable and rectified

that is, unless it is possible to specify conditions under

which they remain valid from the perspective of

contemporary sciencetheir value is entirely negative;

they count simply as obstacles. Canguilhem (1989)

develops these ideas to their logical consequences and,

we might say, he rectifies them in the Bachelardian sense

by specifying the limited conditions to which they apply

in their original form. In particular, as Gary Gutting has

suggested, through the notion of scientific ideology,

Canguilhem offers an implicit correction to the concept

of epistemological obstacle, by introducing thepossibility that errorseven ones that cannot be

rectifiedmay play a positive role in the development

of science.

There is, of course, a sense in which the ambivalence

of epistemological obstacles is simply a logical conse-

quence of the notion that all scientific truths are

provisional in character and open to revision. The value

of what is incompatible with present explanations

cannot be fully assessed until the limits of these

explanations have been reached. What we gather from

reading Canguilhem, however, is that ambivalence can

be more or less significant for the historian of science

depending on his or her specific field of inquiry. As we

have seen, it was Bachelard who first spoke of a plurality

of rationalisms corresponding to different regions of

scientific practice (rationalismes r!egionaux). In line with

this notion, Canguilhem argues that Bachelards episte-

mology is particularly suited to the scientific regions in

reference to which it was developed, namely the regions

of mathematical physics and nuclear chemistry. Mathe-

matics, he points out, offers a perfect illustration of

Bachelards anti-metaphysical understanding of reason,

since it is in that discipline that one speaks not of the

normal, but of the normed (1988, p. 13). Bachelards

account of rationalism, he observes, is built on aframework of mathematism. The degree of formalisa-

tion evident in sciences like mathematical physics and

nuclear chemistry is such that the possibility of

ambivalence appears relatively insignificant for the

purpose of studying their history. It is from within this

horizon that sanctioned episodes look like positive

contributions to progress, while lapsed episodes look

like epistemological debris that constitute a wholly

negative obstacle to the development of knowledge.

From the perspective of the life sciences, on the other

hand, contributions and obstacles look altogether more

ambivalent. The vast body of work that Canguilhem

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devoted to the concept of life and to the role of

vitalism in biological thought illustrates this point.

Many biologists today tend to use vitalism as a

derogatory term associated with lack of intellectual

rigour, anti-scientific attitudes, and superstition (e.g.

Dawkins, 1988). Canguilhem would certainly agree that

vitalist doctrines have, in many ways, constituted animpediment towards certain aspects of scientific devel-

opment. At the same time, this impediment has

contributed to the development of a science of biology

in the sense of providing a corrective check, for example,

on the possibility of physico-chemical reductionism. In

Canguilhems own words:

The need to refute vitalism, which still persists today,

must mean one of two things. Either it is an implicit

admission that this illusion [vitalism]y is not of the

same order as those of geocentrism or the phlogiston,

and that it has a vitality of its own. In which case onemust account philosophically for its vitality. Or it is

the implicit admission that the resistance of the

illusion has obliged its critics to sharpen their

arguments and their weapons. This means re-

cognizing that the corresponding theoretical or

experimental gain constitutes a benefit whose im-

portance cannot be entirely unrelated to that of the

occasion from which it stemsy (Canguilhem, 1975b,

p. 84).

In his introduction to Canguilhems most famous

work, The normal and the pathological, Michel Foucaultusefully suggests that at the root of this ambivalence

may well lie a paradox that must be regarded as

constitutive of the life sciences as such:

Life and death are never in themselves problems in

physics y lethal or not, for the physicist a genetic

mutation is neither more nor less than the substitu-

tion of one nucleic acid base for another. But it is in

this very difference that the biologist recognizes the

mark of his object; and an object of a type to which

he himself belongs, since he lives and manifests the

nature of the living being, he exercises it, he developsit in an activity of knowledge which must be

understood as a general method for the direct or

indirect resolution of tensions between man and the

environment (1989, p. 20).

The biologist, in other words, is not indifferent to the

forms of knowledge s/he produces, which s/he must

regard as an expression of life and of the quest to remain

alive. To deny the specificity of life, for the biologist, is

not only to deny the raison d#etre of science in general

but also, in reference to his or her own practice, to

produce a contradictory form of science.

Between internalist and externalist accounts of science

The notion of epistemological obstacle, even with the

corrective of ambivalence, does not however exhaust the

meaning of scientific ideology. The special interest of

the concept lies in the connection it points out between

scientific elements and extra-scientific concerns, andtherefore in highlighting the role played by the latter in

the constitution of science. Scientific ideology is

ambiguously scientific from the start in the sense that

it incorporates hypotheses geared to resolve extra-

scientific questions. Later, new science disclaims these

hypotheses by conceptually reformulating an agenda

which is not exclusively of its own making. The pseudo-

scientific concepts to which scientific work applies itself

in its task of rectification do not emerge in a vacuum,

but express the demands of life and action (Gutting,

1989, p. 45) in terms of a particular historical

conjuncture. And the fact that, for a time, they plausiblycall themselves scientific means that it is in their

direction that scientific attention must turn.

This is best illustrated with reference to one example

of scientific ideology provided by Canguilhem and

commented on in detail by Gutting (1989), namely that

of the controversy over innate versus acquired traits as

set out in Maupertuis V!enus physique. This controversy

had a clear raison d#etre in the social and political

context of its time and place. It was a context dominated

by the problem, for example, of determining the

legitimacy of aristocratic power. In the 17th century

ideology of hereditary transmission, the concept of

heredity designates an undifferentiated continuum

ranging from the biological to the social and political.

There is no epistemological break between the com-

monsense, everyday meanings of the term and its

employment within scientific discourse. Similarly, there

is a two-way line of exchange between the different

epistemological levels of the term heredity, the social

questions directly inform the scientific ones, and the

scientific results yield political answers. The connection

between science and the social is not merely analogical;

it is to be found in the co-extensiveness of their concepts.

The over-ambitious generalization of scientific con-

clusions on the part of ideology is not therefore rootedin bad faith, but in an epistemological error.

It was only with Mendels transformation of the

biological meaning of heredity that the efforts of his

predecessors could be revealed as ideological or only

pseudo-scientific. As Gutting (1989, p. 35) has put it,

Mendels science is not the end point of a trail that can

be traced back to the ideology it replaced, for it is the

expression of a method that the ideology neglected; but

the speculations of ideology are in part responsible for

the choice of heredity as Mendels own field of

inquiry. Similarly, what science finds is not what

ideology suggested looking for (p. 34), but the course

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of scientific development is not indifferent to these

suggestions, nor is it simply slowed down by them.

Scientific ideologies place fresh input into the course of

scientific development. This input is derived from the

demands and problems of the cultural community at

large.

Scientific ideology is thus a rich epistemologicalconcept that enables us to look beyond the rigid

distinction between legitimate and illegitimate science,

as well as internalist and externalist accounts of scientific

development. By pointing to the articulation of ethical,

legal, and political dilemmas in scientific terms, it points

to the notion that science should be regarded as neither

entirely pure or separate from society and politics nor as

entirely defined by social and political factors. In this

sense, it may be read as anticipating the focus on science

as a complex set of mixed practices that is the

hallmark of more recent science studies (Latour, 1993,

1999).

Scientific ideology and psychosomatic medicine

Canguilhem offered specific examples of scientific

ideology in the history of medicine, and I believe the

concept is best suited for such a specific level of analysis.

I write this in contrast to a recent suggestion by Osborne

that medicine may be made up of regional rationalisms

that have a scientific status, but medicine itself is not a

science; in its epistemological spirit, it is rather a kind of

ideology (Osborne, 1998, pp. 259260). Osbornes

point is not mistaken in the sense that it accurately

reflects and develops Canguilhems more general refuta-

tion of the possibility that medicine should ever be a

positive science. And, undoubtedly, this is a point that

needs to be propagated and stressed in the current

political and cultural climate. But to use scientific

ideology in this sense means to de-specify the concept,

and to forgo some of its potential for articulating

differentiation within the history of medicine itself. In

the following and concluding paragraphs, I would like

to offer some suggestions of where such an application

might prove fruitful in relation to the field of psychoso-

matic medicine.As I have argued at more length elsewhere (Greco,

1998), psychosomatic medicine is better understood

as a space of problematization rather than as an

organized and coherent scientific field. This means that

we cannot identify the history of psychosomatic

medicine with the history of any one of the range of

disciplinesfrom psychoanalysis to psychoneuroimmu-

nologythat are pertinent to an understanding of its

configuration. Indeed, psychosomatic medicine looks

like a very different proposition depending on the

disciplinary vantage point that is adopted in order to

describe it. Yet, and this is the crux of my argument, the

concept of scientific ideology, in both its positive and its

negative aspects, may facilitate commensurability be-

tween such radically different perspectives. As I hope to

show, this offers a dual set of advantages: on the one

hand it allows us to highlight the pertinence of many

historical instances that might otherwise be dismissed as

detracting detours in a linear development towardsscientificity, and on the other hand it allows us to think

differently about the character of that very scientificity

towards which psychosomatic medicine strives.

To unfold this rather ambitious proposition, it is

useful to begin by considering Isabelle Stengers recent

discussions of the specificity of modern medicine as a

rational practice (Stengers & Nathan, 1995; Stengers,

2000). Like many other contemporary practices and

forms of knowledge, modern medicine derives its claim

to rationality and legitimacy from a reference to science

and, in the case of medicine specifically, to the

theoretico-experimental model. This reference, Stengersargues, allowed historically for a transformation of the

long-standing conflict between doctors and charla-

tans, by facilitating a diagnosis of the power of the

charlatan as unfounded. Stengers illustrates this trans-

formation in her study of the inquiry led in 1784 on the

magnetic practices of Mesmer, which established that

Mesmers magnetic fluid, to the extent that its effects

might prove its existence, did not in fact exist (see

Chertok & Stengers, 1992). What the Mesmer inquiry

demonstrated, paradigmatically, was that a cure as

such proves nothing; a popular cure-all or a few

magnetic passes can have an effect, but they do not

qualify as a cause. The charlatan is thereby disqualified

as someone who takes this effect as proof (Stengers,

2000, p. 24). Stengers treats the scene of this inquiry as

the inaugural act of definition of modern scientific

medicine; the key to this modernity lies precisely in the

consciousness of the fact that a cure as such proves

nothing, and that rational medicine cannot be distin-

guished from the practice of charlatans simply by the

goal it pursues or attains (that is, healing) (Stengers &

Nathan, 1995). Finally, Stengers takes the relevance of

this historical example to the very heart of contempor-

ary medical research, by highlighting that the same logic

is at work when it resorts to the placebo effect as ameans of testing medications. The hypothetical power of

a medication is disproved if the same effect can be

obtained by administering a placebo; the placebo, as a

clandestine effect, is thus the correlate of the

charlatan.

This particular framing of the way in which modern

medicine establishes and understands its own rationality

is interesting because it acknowledges both the gains and

the losses afforded to medicine itself by its reliance on

the theoretico-experimental method. In the theoretico-

experimental framework, the living bodys ability to be

healed through the imagination, through hope, through

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faithin other words through bad reasonsis clearly

and crucially acknowledged, as the practice of clinical

trials demonstrates. Simultaneously, however, and by

the logic of the experiment itself, that very ability is

explained away as irrational, as a parasitic and

annoying effect (Stengers, 2000, p. 24) that interferes

with the pursuit of valid medicine. One might go as faras to speculate, on the basis of this argument, that

scientific medicine could not acknowledge the placebo

effect in a veritably positive way (that is, as a true

effect, due to good reasons, worthy of investigation in

themselves) without risking its claim to the ability to

speak in the name of science.

This last point brings me to the discussion of

psychosomatic medicine in the spirit of scientific

ideology. Stengers analysis enables us to see clearly

the rather singular position that modern psychosomatic

medicine occupies in terms of the question of how

medical science relates to medical non-science. In asense, as we shall see, this question lies at the heart of

psychosomatics as a form of problematisation. One way

of describing psychosomatic medicine generically might

be to say that it is a form of medicine that acknowledges

the placebo effect (or the effect of the imagination) as a

true effect, and seeks therefore to understand and to

explain it in order to incorporate it into medicine as a

rational scientific practice (Harrington, 1997). This

ambition, which may be articulated in a variety of

locally specific ways, can indeed be regarded as a kind of

minimal common denominator shared by otherwise

deeply heterogeneous disciplines involved in the field.

Whether it is in terms of the materialization of

infrapsychic conflict as a symbolic conversion or of

the neuroimmunological processes involved in coping

with subjectively stressful life events, psychosomatics

is characterized by the positive acknowledgment of the

bodys capacity to exploit, and to succumb to, the power

of fiction. As we have seen, this is an acknowledgment

that involves putting medicines claim to scientificity,

and therefore to legitimacy, at risk. This risk is the

interpretive key through which many recurrent themes

in the discursive space of psychosomatics become

intelligible: the fact, for example, that some figures in

the history of psychosomatics described their ownpractice as heretical with respect to medical, scientific,

and even psychoanalytic orthodoxy (Groddeck, 1970),

and as likely to produce socially transgressive or

undesirable outcomes (Weizs.acker, 1986/1949); the fact

that many see their work as anticipating a scientific

revolution that nevertheless continues to remain elusive

(Uexk .ull & Pauli, 1986; Levin & Solomon, 1990;

Todarello & Porcelli, 1992), and whose character is

constantly in danger of being misunderstood (Weizs-

.acker, 1986/1949; Morelli, 1982); the fact that others still

strive to present modern psychosomatic research simply

as a linear and unproblematic extension of scientific

rigour into what used to be personal convictions,

anecdotes and medical folklore (Lipowski, 1986, p. 5).

The risk implicit in the premise of psychosomatics, in

itself, would by no means justify addressing psychoso-

matic medicine as a form of scientific ideology. What

matters is how different historical instances of psycho-

somatic research and practice relate to the risk, andwhat may be sacrificed in the name of security. On the

basis of this broad interpretive framework, it is possible

to construct something like a typology and a mapping of

psychosomatic propositions and lines of research. I must

defer the details of this typology to another occasion,

but I can offer here some general orientative remarks.

Among the propositions of psychosomatics, I would

suggest, those that come close to Canguilhems idea of

scientific ideology are those that deny the risk posed by

psychosomatics to the contemporary configuration of

medical science whilst retaining the ambition to account

for what, in shorthand, I have referred to as the role ofthe imagination in health and disease. Paradoxically,

but entirely in line with Canguilhems definition of

the concept, it is those instances that currently enjoy

the highest degree of scientific plausibilitynamely the

varieties of psychosomatic research that rely on the

theoretico-experimental methodthat may come to

count as a form of ideology from the perspective of a

medicine of the future.

I have in mind, among likely candidates, the experi-

mental practices of psychoneuroimmunology. Two

notes of caution: firstly, we should not be deceived by

the fact that key figures in the field describe psychoneur-

oimmunology as heralding and anticipating a radical

transformation in the order of medical science, or as

somehow being itself already of the future (Solomon,

1999, 2000). What matters is that the field continues to

rely on the experimental method as something like a

royal way towards establishing the scientificity and

rationality of practice in psychosomatic medicine. When

Solomon advocates the development through laboratory

research, of non-linear, non-mechanistic understand-

ings [of health and disease] based on systems, chaos, and

informational theories (Solomon, 1999, p. 2), he

advocates a transformation of medicine along models

that are current in the practices of physics andchemistry. In the vocabulary of scientific ideology, he

is extrapolating from the context of adjunct scientific

fields and extending concepts that may not be relevant

or pertinent in medicine in the same way as in relation

to, say, atmospheric phenomena (Stengers & Nathan,

1995). At a meta-theoretical level, one might say that he

is advocating a linear progression towards non-linearity.

The second note of caution, which is closely related to

the first, is that what is ideological about psychoneur-

oimmunology in this description is not the recourse to

experimental practice as such, but rather the privilege

that is ascribed to it in conferring rationality (and

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respectability) to psychosomatics. As the royal way

for psychosomatic medicine, psychoneuroimmunology

proposes itself as an arbiter with the power to confirm or

disqualify other practices theoretically, regardless of

their effectiveness in the management of health and

disease (Koenig & Cohen, 2002).3 In this sense, the

ambition of psychoneuroimmunology can be describedas ideological in terms of being both excessive and

na.ve with respect to the requirements of medical

rationality.

To conclude, I propose to reflect on how the example

of psychoneuroimmunology may relate to Canguilhems

(1988, p. 38) proposition that, in every domain,

scientific ideology precedes the institution of science.

What, if any, is the science that psychoneuroimmunol-

ogy anticipates? And what, if any, is the science that

might reveal the general claims of psychoneuroimmu-

nology as ideological? As we have seen, the theme of

anticipating a new science is part of the self-descriptionsof practitioners in the field. They refer to concepts and

models developed in contemporary physics and chem-

istry in relation to complex systems as the key to

imagining a scientific medicine of the future. I have

argued that this illustrates a typically ideological

extrapolation of concepts, and I now suggest that it may

also represent a misunderstanding of the significance of

scientific developments in physics and chemistry, and of

their relevance for medicine. The example of physics and

chemistry, as Stengers and Nathan (1995) and Stengers

(1997) have powerfully argued, is relevant not in so far

as it may offer a new model that medicine should seek to

imitate or import, but in so far as it reorganizes our very

conception of rationality. According to Stengers, the

significance of the new science lies in its capacity to

reconfigure the structure of our thinkingtruly in line

with the spirit of Bachelards applied rationalism.

The science of complex systems demonstrates that we

do not need to suppose the existence of irrational entities

or forces in order to recognize the reality of phenomena

that may not fit with the requirements of experimental

methods. In other words, we cannot dismiss as irra-

tional all that is not amenable to verification in a

laboratory. The physics and chemistry of complex

systems, therefore, does not suggest that we may extendthe methods and concepts of those sciencesincluding

the concept of a systemto the study of human

bodies in health and disease. On the contrary, their

relevance lies in exploding the conflation of rationality

with experimentation (Stengers & Nathan, 1995). For

the practice of medicine in general, and psychosomatic

medicine in particular, this has some important implica-

tions. It means that the relevant question may not be

when or how medicine will finally become scientific,

but whether its claims to rationality and legitimacy must

be drawn primarily or exclusively from a reference to

science, as is currently the case. The answer, most

evidently in the context of psychosomatics, is aresounding no. To the extent that psychoneuroimmu-

nology presents itself as a royal way to transform

medicine on account of being able to speak in the name

of science, it would seem to exemplify precisely what

Canguilhem described as a scientific ideology.

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3While this collection generally illustrates the view that PNI

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implications of PNI for society and culture (including medical

practice).



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