U.S. Intellectual History Blog

History of Medicine and Intellectual History

The following is a guest post by Daniel Goldberg.

As I was contemplating my guest post for USIH Blog, I have been following the vibrant blog debates on “the usable past” with considerable interest, in part because of my chosen subfield and approach: the history of medicine and intellectual history, respectively.  There is almost no dispute among card-carrying historians of medicine and public health that deep understanding of the latter can shed a very bright light indeed on pressing contemporary matters of public health policy.  This has most fruitfully and extensively been demonstrated in context of infectious disease management – witness the aphorism that quarantine is the oldest public health policy – but historiographic techniques are increasingly being applied to study the past, present, and future of chronic illnesses such as type II diabetes and coronary artery disease, and of course, of the particular trajectories of health systems in their national and global contexts.

In reading and rereading the debate over the usable post, I was struck by my sense that, so well-settled is the utility of an historical lens for clear thinking about health and medicine, when presenting historical scholarship I often have to dial down instrumental applications.  There is a Scylla and a Charybdis here, because the value of studying history is not in any way contingent on the insight it provides on contemporary experience nor the guidance it offers for the future.  Even if a particular historical inquiry told us nothing at all that could illuminate the present, it would still be worth studying.  History has intrinsic value, and Clio would be justly furious if I implied that she was barred from the kingdom of ends.

But, as I often remark, the only problem with reductionism is that it is reductionist.  That is, the danger comes in reducing the history of medicine and public health to purely instrumental pursuits.  If we properly regard the intrinsic value of historical inquiry, we can and should embrace the illumination of present and future matters of health, policy, illness, and suffering.

So if history in general is highly usable at least in context of medicine & public health (about which I have argued there are important distinctions to be drawn), how does this apply to intellectual history? The history of medicine in particular has in my view wholeheartedly embraced the New Social History, and for good reason.  In its origins as a professional field of study, it was dominated by studies of Great Men and their Discoveries, and the voices of patients and non-elites were relegated to the background.  The social turn helped center the illness experiences of lay and non-elite, as well as situating the healers themselves in more rich and complex sociocultural contexts.  So it has been all to the good, and the vast majority of historians of medicine and public health gravitate to social and cultural historiography.  Self-identifying intellectual historians are relatively rare among historians of medicine and public health, and are of course much more likely to end up studying the history and philosophy of science.  (I leave aside the interesting albeit hopelessly internecine debate over the existence of meaningful distinctions between the history of medicine and the history of science).

Yet, I believe that intellectual history has a vital role to play in unpacking a great many topics of import within the history of medicine itself.  The example I work with most closely is that of the history of pain without lesion.  We would call it chronic pain today, but that term did not arise until the 1960s, so in the 19th c. contexts in which I study it, the preferred umbrella term is “pain without lesion.”  I and several other pain scholars insist that if we wish to understand our present difficulties in treating pain equitably and effectively, we have to understand some of the historical roots of those difficulties.  And one of the key knots on those roots relates to ideas about pain that occurs in the absence of material, discrete pathologies that can be clinically correlated with the illness complaint.  In 1995, one of my mentors, retired pain physician C. Stratton Hill argued in a commentary entitled “When Will Adequate Pain Management be the Norm?” that attitudes about pain and pain relief are systematically transferred from one generation of physicians to the next.  If he is at all right in this surmise – and from an historiographic vantage point I am committed to proving that he is in an important sense correct – I want to insist that a central part of the transfer relates to ideas about health, illness, mind, body, truth, and doubt.

More on that, and on some of the other 19th c. ideas that I believe are critical to making sense of contemporary public health policy, in future posts! (Assuming their existence . . . .)

14 Thoughts on this Post

  1. Welcome to this discussion space, Daniel! Since I advise medical students for my day/subsistence job, I too have occasion to think about the intersections of medicine, education, intellectual history, and usability (though less about public policy). I’ve been sorting out directions to take since I started this job last September, with my only concrete conclusion being that I needed to construct a history of medical advising (which I have a plan to work toward).

    But, on the esoteric discussions about a usable past that have taken place here recently, they have little place in other professions where history is *mostly* a catalog of errors to be avoided and successes to be built upon. The practices of the past are most certainly usable in medicine, law, engineering, etc. Those same advocates for a usable past dislike ambiguity; it feels like lost efficiency to them. Anyway, I digress. – TL

    • Thanks, Tim!

      (Long-time lurker, first-time caller, though at least some of that has to do with the fact that my expertise, such as it is, is obviously focused on very different topics and issues than much of the excellent material here on USIH blog . . . so I’ve mostly been trying to shut up and learn, which is a good habit for me to be working on).

      On the use of history in so-called applied professions (for lack of a better terms), you are so right re tolerance for ambiguity. Though the new social turn’s influence in HoM is well-settled by this point, I should not imply it was bought cheaply. There are still many who think that the “complexification” (gah) of health, illness, healing, and medicine has come at the expense of true applicability and relevance for the professional practice of health care delivery.

      I’m thinking about this a lot today because I am scheduled to give a Pain Grand Rounds in the hospital in a few weeks, and I am expressly attempting to bring historical clinical cases to bear on present difficulties in treating pain. “Clio in the Clinic,” as a well-known anthology title indicates . . . but there’s a very serious limit on how far into the ideas that I deem important I am able to go if I wish to be truly useful.

      Thanks again for the kind welcome!

  2. This is a really fascinating post and I look forward to its elaboration. I am working on a project, parallel to my diss, on the way that productivity and output restriction by workers was talked about in the twentieth century, and so there is plenty of overlap with your research area: I wonder if you could say a bit about the role of ideas like “malingering” and other terms often used re: workers who called in sick in the history of chronic pain? Given that so much chronic pain stems, I would think, from repetitive work or injuries sustained on the job (or in hobbies meant to counteract the bodily atrophy that goes with white collar work), it seems that there is a strong labor-historical and policy-historical dimension to this project, too. Would love to hear more about that, too.

    Also thought it would be worth noting that the hardcore anti-psychiatry critiques of the 1960s blasted the profession for their theory of illness in the absence of visible lesions (I”m thinking of Ivan Illich, but I recall this line in other anti-medicalization texts, as well). That points to some interesting ideological twists and turns of “pain in the absence of a lesion” as a rhetorical figure.

    Thanks again for this!

    • Kurt (if I may),

      Thanks for the kinds words, and talk about setting them up and knocking them down . . . although there are several other closely related aspects of pain within my research, the history of malingering in context of lesionless pain is one of the main subjects on which I am working.

      Although there’s some work on the history of malingering, there remains a great deal to be said, and IMO there’s virtually nothing that examines the role played by key ideas about medicine, illness, the body, and the epistemic valence attached to these constellations of ideas in shaping issues of truth, doubt, authenticity, and deception.

      What ideas about health and the body animate malingering? And why do we see a significant spark in the growth of such concerns in the latter half of the 19th c. and the early 20th c. West? And what does it have to do with ideas of medical seeing (a la Foucault)?

      See, now I am getting excited. More on this in future posts!

  3. Daniel, a most interesting post. Glad to know that we had at least two readers (you and Tom Cutterham, who blogs at The Junto) who weren’t bored witless by “Usable Past Week.”

    I’m intrigued by where your essay ends:

    “…one of my mentors…argued…that attitudes about pain and pain relief are systematically transferred from one generation of physicians to the next.”

    His argument shifts the focus from the texts or the studies or the standard authorities to the chain of custody of those texts and authorities. It is this “living tradition” of physicians passing on the lore of their craft that gives weight to the particular axioms upon which they rely. The pedagogical tradition underwrites the canons of the discipline, not vice versa. (This is a way of framing Guillory’s Cultural Capital, which Tim has been writing about here.)

    In a sense, your very commitment to demonstrating the historical validity of your mentor’s idea about the “chain of transmission” involved in physicians’ ideas of pain is itself a demonstration of the effectiveness of the pedagogic process.

    I am looking forward to future posts.

    And Kurt — thanks for your comment. Here I thought I was the only one who takes on side projects while also working on dissertation stuff. You have inspired me to answer that CFP I had been planning to ignore!

  4. L.D.,

    Thanks for the kind words and the incisive comments. I’m fascinated by the notion that the pedagogical ideas drive the texts themselves, which seems absolutely right to me.

    More to the point, it kind of makes sense of one of my principal methods, which is to dive deeply into the medical journals, treatises, case studies, and professional correspondence to excavate the ideas that animate attitudes, practices, and beliefs towards pain.

    It’s strange; although Foucault’s The Birth of the Clinic is unquestionably canonical in the history of medicine, there is serious lack of historiography overtly applying and synthesizing his framework (and I’ve even said as much in print!). And the subtitle of the book hints at its significance: “An Archaeology of Medical Perception.” He is unearthing a new way of seeing the body, health, illness, etc.

    It’s almost as if the book is a victim of its own success. It’s so essential that it is universally read, but IMO neglected given its signal importance for explaining key features of 19th c. changes in Western medicine and science.

    And although it is many things, the book is also nothing if not intellectual history. And means everything for clear thinking about the history of pain, too.

    So, canonical texts then and now, ideas traveling through and apart from them, etc.

    Much to do!

  5. Daniel, Would you agree that this comparative neglect or devaluation “pain without lesion” or chronic pain in the recent history of Western medicine compelled individuals to seek out forms of (what we call today) complementary and alternative medicine? Indeed, I think this is a clear case where EBM gives way to so-called traditional and Asian forms of healing and therapeutic regimens associated with “mind-body” medicine (which often more explicitly involve the mind, the emotions, or the ‘heart-mind’ of the individual as implicated in what it means to be embodied) as discussed, say, in works by Roberta Bivins and Anne Harrington.

    • Patrick,

      Interesting question. Here I think the history might point us to a different answer than the present situation, the latter of which likely features pain sufferers turning to CAM.

      But professional healing through most of the 19th c. U.S. is much more varied and eclectic than we see today. Where healing was less limited to allopaths in general, and especially for middle and lower class illness sufferers, I’m not sure our idea of a turn to CAM and away from orthodox medicine really fits very well in a 19th c. context.

      Of course, as historians have documented for decades, orthodox physicians waged largely successful professional battles to either stamp out or assimilate competing healing traditions, but that does not say much about the kinds of remedies and healers that pain sufferers sought in the 19th c.

      Does that make any sense?

      • Yes, but that’s why I made the reference to “recent” history, by which I meant, perhaps not clearly enough (‘recent’ history for historians and a layperson like myself may be two different things!), beginning in the twentieth century (and roughly the last quarter thereof).

      • Hi Patrick,

        Sorry for the misunderstanding. I think you are right to observe that in the recent past (say post 1960s), pain sufferers’ difficulties in obtaining adequate pain management have prompted more recourse to CAM.

        However, I suppose I might question what the baseline is . . . health cultures involve multiple overlapping and shifting healing traditions, and many people who desire allopathic medical interventions rely on other healing traditions as well, IMO.

        But now we’re more into medanthro than histmed, and I’m certainly no expert on the former!

  6. Thanks so much for your kind response.
    Would love to see even a provisional malingering in history biblio… I have assembled some interesting primary sources from the world of “industrial medicine” between 1900-1930. A lot of it is now online in google books. Often a wild confluence of biopolitics, race pseudo-science, and Tayloraist productivism.

    I am a huge fan of Anson Rabinbach’s The Human Motor. If you haven’t had a look at it, I strongly recommend it. Very Foucauldian project, and “fatigue” and chronic pain are quite closely connected. Rabinbach’s book is so under-read, in fact, that I would be interested in organizing a roundtable on The Human Motor as a kind of “second look at an underacknowledged major work” sort of thing.

  7. Kurt,

    It must be under-read, for I admit I have not read Rabinbach, although after my holiday this week I will hightail it to the library to procure it!

    Since Andrew was kind enough to invite me back for some future posts, you can be darn sure the history of malingering in context of intellectual history is forthcoming, with some suggestions for sources!

  8. One of the things that interests me about the (19th c. American) history of medicine is that it seems to exemplify modernity. The transition from relying on a set of canonical texts toward empiricism and the embrace of the scientific method seem to be the main elements of the story as usually told. But there’s a contrasting story of the building of a profession, which in many ways pushed in the opposite direction (for example, mid-19th c. doctors called some of their competitors “empirics”). Reminds me of Thomas Kuhn’s comments about how institutions form around new paradigms.

    • Hello Dan,
      I think caution is warranted, because while the traditional narrative from within older traditions of HoM and in popular history is to emphasize the scientific turn, subsequent generations of historians of medicine have complicated and problematized the telos implied in the march towards somaticist allopathic medicine.

      This is not to suggest that no such process occurred, but I think the social and professional processes you allude to above are generally thought to be at least as if not more important than the epistemic significance of changing scientific models in the dominance and legitimation of allopathic medicine in the U.S.

      Does that make any sense?

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