In 1982/3 I spent the academic year in Paris. There I lived in the Cité Universitaire—student housing that was built in the aftermath of the 1914–1918 war as a contribution to global peace. The hope was that if young people, the elites of the near future, would immerse themselves in higher learning and live together in attractive surroundings, this would prevent further wars. For they would learn to think rationally and to talk with each other rather than to run after divided self-interests. Various countries had asked eminent architects to make designs. In one way or another, these represented the various participating nations. The buildings were mostly finished in the course of the nineteen thirties. Just a few years before another ravaging war divided the world.
Another hope that was broken. But I don’t want to talk about that war now, but about Hajime. He, too, lived that academic year in the Pavillon Néerlandais. His room was a few doors away from mine on the same corridor. Hajime came from Japan. He was the first person from that country with whom I had a chance to talk. He studied French literature and it became quickly clear that he knew a lot more about Europe than I knew about East Asia. My schooling of almost twenty years, I realised with a shock, had been strikingly provincial. (No, I hadn’t yet gone to anthropology classes at the time. I started doing so in Paris, lucky to find a seminar of Marc Augé.) In my secondary school I had learned Latin, the language of the Romans of two thousand years ago that these days is no longer actively spoken. In medical school I had been presented with knowledge about ‘the human body’ as if this was a universal phenomenon, to be known in a univocal way. But that a body might, for instance, have meridians or be energized by yoga was never considered. In philosophy classes I had been presented with the history of Western thought, but other traditions, not just those Japanese, but also those from China, Ghana, Mexico, what have you, had not been mentioned. The social theorists I had been introduced to were frantically disagreeing over ‘society’, but the ‘society’ they disagreed about fitted at most with social life in France, Britain or Germany, or—I read texts in Dutch as well—the Netherlands. Just a few provinces in the North West of Europe.
So I was glad to learn from Hajime as we drank the green tea he made and I got to eat my first red bean cakes. One of the more striking lessons that he taught me came wrapped up in a story about his grandfather. It may not surprise you, but it did surprise me. Hajime told me that each morning his grandfather would pray in front of a Buddhist shrine and that each evening he would worship in a Shintoist temple. Hence, he moved between two quite different spiritual traditions. And while taken as systems of belief these traditions variously clash, his grandfather was not at all torn between them. Contradictions didn’t bother him in the least. Instead, the possibility to engage in Buddhist prayers as well as in Shintoist worship greatly enriched his life.
Up until that moment, I had only seriously been confronted with the ‘religions of the Book’, Judaism, Christianity and Islam. All three are monotheist and exclusive. There are many differences between them, but they share the convictions that there is just a single God and that praying to other gods (that they necessarily call ‘false gods’) is sinful and scandalous. Later I would learn how in spreading Christianity missionaries had often been adaptable and absorbed a few of the locally revered deities by allowing them to be transformed into saints. But at the time the idea that one might juxtapose practices related to different spiritual traditions was a revelation to me.
It didn’t just defy the monotheist religious stance, but also Western philosophy. Here, contradictions were taken very seriously. They were not accepted at face value, but formed occasions to seek univocality. Surely, if A is right, non-A, its opposite, cannot be right as well? This conviction formed the base of propositional logic on which the entire argumentative philosophical tradition was built. I had just started reading Michel Serres and would attend his lectures that year. This heretic philosopher was undermining the binary A versus non-A logic. And when Hajime told me about his grandfather I listened eagerly. I liked this! An elegant departure of the idea that one has to adhere either to this belief or that other. And an equally elegant departure of seriously stable identities that invite one to say I am Buddhist or rather I am Shintoist. Being is supposed to endure but doing allows for more variety. The morning and the evening are different moments in time. Why would what you practice one moment clash with, or contradict, what you do some time later?
Practice was a crucial term here. Or so I came to think as I followed another formative seminar that year. Michel Callon and Bruno Latour explored the sciences through the lens of technology. They did not pursue scientific representations, but rather science-inspired practices. Hence, they explored the tools and techniques that made scientific research possible and the interventions that such research helped to orchestrate. Callon was writing about scallop fishing and the engineering of electric cars. Latour wrote about the modest but far-reaching technique of pasteurisation. In both cases what mattered most were not systems of belief about reality that might contradict each other but rather practices of dealing with reality that might either be crafted into existence or fail to materialize. While for philosophers there could only be a single truth, for technologists, much like for Hajime’s grandfather, contradiction was not an issue.
Once back in the Netherlands I lost contact with Hajime. But I kept playing with the idea that different understandings of reality do not necessarily clash in practice. They may as well coexist. In fact, they do coexist. For in theory Western science might be mono-realist, but it wasn’t so in practice. My first case was ‘woman’.
(I wrote a text about this in Dutch that was recently translated into English.) Genetics, anatomy, endocrinology, psychoanalysis, geography, and so on, I argued, do not talk about the same ‘thing’ when they talk about this figure that they all call ‘woman’. Instead, they worked with remarkably different definitions and orchestrated different interventions. The relations between these were complex. Disagreements in one site did not preclude collaborations elsewhere. This messiness bore the promise of escape. For if the sciences disagreed between them about ‘woman’, why, then, should ‘we feminists’ submit to any one of them? That the sciences did not always and everywhere accord with each other, but appeared to be full of tensions and contradictions, opened up a space for alternatives.
The Body Multiple follows on from there. It is grounded in an ethnography of a university hospital in the Netherlands. It argues … well, you are about to read what it argues. But the short story is that the different departments of the hospital stage reality differently—and hence enact different realities. In the outpatient clinic a doctor talks with patients about what exactly troubles them in their daily life. In the operation theatre, by contrast, anesthetists silence patients with drugs and surgeons use knives to cut open their bodies. In one location the patient is treated as a person to talk with, in the other the patient is enacted as a body to intervene in, either physiologically (with drugs) or anatomically (with knives). Hence, in the Western tradition it may well be said (over and over again) that there is only a single reality and that we should strive after telling the singular, univocal truth about it. But that is not in accordance with how reality is treated in Western practices. There, reality comes in different versions. Which is fine. The outpatient clinic and the operation theatre are different places. Why would what happens in one of them be made to fit the same terms than what happens in the other?
My problem was, and is, with the fact that this multiplicity tends to be hidden. If it were recognized, we might ask upfront which version of reality to live with when and where. As it is, this question is not dealt with overtly and in so many words. Instead, it is all too often answered by stealth. And we end up with practices because they happen to be the oldest, the most profitable, the cheapest, the easiest to publish about, the most routinized—and so on. And not necessarily with the practices that are most agreeable to patients and that best help them to live their daily lives.
That is the argument of this book. It says that diseases, bodies, realities, come in versions. But beware, it doesn’t preach pluralism. That contrasting version of reality are practiced, doesn’t mean that the hospital falls apart into isolated sections. Another Western obsession deserves to be reiterated here. Which is the idea that reality is composed of separable entities that may be added together (as the stones in a wall), but that do not mix (as the ingredients in a dish). Critiquing pluralism and the individualism that comes with it, Donna Haraway had pointed out that pregnant mammals harbour a creature inside their wombs that is both other to and dependent on them. Marilyn Strathern had added that a person may be both an anthropologist and a feminist. These figures speak to different concerns and hence they may say different things, while they still fold together in the same person. In line with that, here, too I sketch a reality that is not plural but multiple. In the first few chapters I illustrate the multiplicity of the disease ‘atherosclerosis’. The rest of the book explores how in hospital practice the versions of this disease are co-ordinated together.
The book itself is multiple too. It is composed of two texts that run in parallel. The first tells stories about the hospital, the second relates to the literature that informed my writing. But these two texts are not separate: they pursue the same argument and seek to develop the same intervention in theory.
In the period in which I was writing, many other colleagues were working along similar lines. They also dug up the complexities of a non-unified medical world. They wrote about the readily transforming subjectivity of pregnant women; about different modes of giving birth that stage mother, child and birth differently; about lung diseases or blood pressure or dementia done in varied ways; and about techniques, such as patient-files, that hold contrasting versions of reality together. Others were exploring co-existence elsewhere, in other sites and situations. There is for instance Aircraft Stories—a book in which John Law explores themes that are quite similar to mine in the quite different context of designing and testing a military aircraft. And since the present book got published the ‘multiples’ have boomed. A striking amount of them (to my surprise and pleasure) have been variously explored. See the literature.
The authors of all that work had different backgrounds. It is unlikely that they were all inspired by stories about Japanese spiritual practices. Our concerns were more immediately informed by obdurate problems in the fields that we studied. And yet our work has striking resonances with what Hajime told me about his grandfather. He, too, said different prayers depending on the time of the day and the temple in which he found himself. But for all that he was not two people. This analogy might help us to avoid simplistic differentiations between ‘Japan’ and ‘the Netherlands’ (or Euro-America, or however you want to delineate the place that this book emerged from). Between such entities, too, there are differences as well as commonalities. There are lessons that may travel and shared imaginations. And there are clashes. There is ‘Western medicine’ in Japan—does that makes Japan Western, or said medicine (also) Japanese? It holds no answer to such questions, but if you want to, you may read this book as one that addresses them. For the stories that it tells are about patients, doctors, technologies and a single hospital in the Netherlands, but its concern is with co-existence-in-difference. This may as well be co-existence-in-difference between countries, languages, cultural traditions. I hope to break out of the provincialism that has different cultural traditions each retreat in their own corner of the globe.
And yet as I wrote this book, I did not imagine that readers from so many corners of the globe might be interested in it. The reader whom I imagined while writing did not live in, say, Rio de Janeiro, Johannesburg or Tokyo. I thought that at best and with lots of luck I might be locally relevant. Plus, I had not travelled to any of those places, nor had I a read a great deal from authors who were located there. So I apologize for the provincialism that lingers on in this text. I wrote it in English, which is not my mother tongue, but I did not think of readers in places where that language doesn’t travel all that easily. I hope you can read around that. And I consider this as a challenge for present day academia: that we find good ways of engaging in long distance conversations. Conversations in which concepts and concerns from a wide range of languages enter, even if all the translations implied will inevitably transform them.
For the translation of The body multiple into Japanese I am deeply grateful to Yoko Taguchi and Akinori Hamada. What a lot of work have they done! How many words did they turn inside out to sense out which Japanese term might best convey the English words of the original. I am deeply impressed by their dedication. Thank you. And I hope that in Japan this book may find new readers, new meanings and new urgencies—and enter into locally relevant, spirited conversations. The best outcome would be that it would inspire some of its readers to explore in their turn, in their own way, surprising juxtapositions of diverse and yet intertwined realities. Or maybe, by contrast, that some of its readers would take the occasion to explain to the rest of us why sometimes seeking logical coherence may be a good thing. I hope for intriguing explorations of shrines, temples, deities, hospital, bodies, factories, cell lines, patents, freshness, rocks, nuclear energy, metro stations. And, if you please, could someone, as a turn in this conversation, introduce a few intricate Japanese concepts or daily life practices into English while telling stories (for I would love to read more about those) about green tea and red bean cakes?
Annemarie Mol is Professor of Anthropology at Universiteit van Amsterdam. She is widely published in anthropology, culture, and critical theory on topics such as the multiplicity and complexity of objects, medical anthropology, the culture of food and eating, and the philosophy of care.