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 . . . .)