The prevalent disease picture of medical sciences, premised on causal mechanisms, presumes a nation’s ability to finance the massive research effort required (laboratory work, development of vaccines, endless tests etc.) to win the battle, or else a global cooperative society that transcends national and regional boundaries is necessary. Is the current geo-political structure facilitating the combat of COVID-19?
(updated 25 May 2020)
如果「病因」溯源是「疾病因果機制」下戰勝疾病的重心，那麼便只有那些能夠承受維繫「因果機制」所帶來的龐大開資（如研究、實驗、疫苗的開發、測試）的社會才能「打勝仗」，又或各地區社群能夠慷慨的交換知識和數據，以團結無私為原則。目前的地緣政治情勢，尤其以國家為本的公共衛生策略，並不有利於這樣的團結。羅海德明示現行這個話語論述體系的漏洞。如果疾病、傳染病是「文化形態」，有個人、群體、社會機制、地緣政治、經濟能力各個多種的面向的話，為何我們每天聽到和針對的，都僅是處理個人和病毒之間的操守？除了這個層次的團結無私（隔離為了眾人的好）之外，如何回應「在與冠狀病毒的鬥爭中，人類缺乏領導能力」這個光景？個人衛生作底線防守可以走多遠？（中文大綱撮譯／黎肖嫻）
/… to continue from “Framing Diseases 02”
/… feature image: An influenza camp, where patients were given “fresh air treatment,” in 1918.
COVID-19 and the cooperative society
Edson’s work has become a referent point for progressive authors who argue that socialized universal health care is the only effective response to the pandemic. These authors often argue against the commodification of healthcare, and take the failure of privatised medicine in the face of the pandemic as an argument for socialised medicine. [1] [2]
The underlying idea is that the pandemic is at once biological and social. The two aspects cannot be cleanly disentangled from one another. This line of thought stresses the role of economic (and other forms of) inequality in the form that a disease takes in our world. Activist Dennis Kosuth, for instance, has called attention to the role of racial inequality: “African Americans make up about 30 percent of Chicago’s population, but 72 percent of deaths from COVID-19.” [3]
Other frequently mentioned facts that are at once social and biological include… Over-crowding, for instance, in prisons and poor neighborhoods contributes to the spread of the disease. Short staffing in prisons means that if there are not enough nurses and doctors, patients might fail to get their medicine. The expense of (for example) hand sanitizer and surgical masks put them beyond the reach of the poor. And there are more.
Other writers stress the need of cooperation and sharing as the only appropriate response to the pandemic, given our current scientific knowledge of infectious disease. Best-selling historian Yuval Noah Harari is an example. In describing the pandemic, he uses a war metaphor. There is a war between pathogens and scientists. In this war, “pathogens rely on blind mutations while doctors rely on the scientific analysis of information.” [4] Victory in this war is accomplished, according to this picture, once the causal mechanisms are understood. Harari thus endorses a key idea in the modern concept of disease. The notion that the identification and understanding of the essence of a disease involves knowing its causal sources is at the heart of this framework. Successful intervention is always driven by aetiological knowledge. Identifying the causal mechanisms requires a massive research effort, the success of which depends on the possibility of sharing information. “History indicates that real protection comes from the sharing of reliable scientific information, and from global solidarity.” [4]
I will not here elaborate on Harari’s war metaphor, although I will return to this topic in subsequent posts. I want to highlight that his analysis points to two critical factors in the effort to promote public health: (1) identifying and sharing reliable information, and (2) enhancing global solidarity and cooperation. In this context, isolation is futile. For instance, consider a country contemplating the possibility of lockdown: “Locking down your own cities could lead to economic collapse. If you think that other countries will then come to your help – you will be more likely to adopt this drastic measure. But if you think that other countries will abandon you, you would probably hesitate until it is too late.”
The spread of epidemic in one nation or region endangers everyone. The good of one person or one country is bound up with the good of all others. The argument strongly resembles Edson’s thesis concerning the role of disease as a social leveller. “We are used to thinking about health in national terms, but providing better healthcare for Iranians and Chinese helps protect Israelis and Americans too from epidemics.” Unfortunately, Harari accurately notes, the geopolitical system at the present moment lacks the orientation towards the public good that our predicament demands: “Xenophobia, isolationism and distrust now characterize most of the international system.”
These various arguments, although diverse, suggest that the struggle against disease cannot be won by means of purely pharmaceutical interventions, but also demand a wide-ranging social transformation at the national and international level.
In lieu of a tentative conclusion
I do not wish either to endorse or to criticize the framework that I have outlined. I am only presenting it because I believe it is important to start a conversation about its basic presuppositions. I take it to be a promising line of investigation.
Crucially, it is important to remind ourselves that this discursive field is rooted, explicitly or implicitly, in the practice of hygiene. This practice is a fundamental constituent of the cultural horizon in which the notion of a cooperative society was linked to the science of epidemics. The role of hygiene is essential, because it is a meeting point between scientific and practical knowledge, and so involves an inexorably ethical or normative aspect: it aims for the good, the preservation of health, and it involves a state of war against pathogens. It is insofar as health is understood to be a fundamental good that scientific knowledge can take on a normative role, i.e., one that founds social values. But hygiene itself is a cultural concept, one that is at least partly expressive of values. It has its own cultural morphology.
The question then arises: Does our scientific knowledge, insofar as it is connected to a therapeutic practice oriented towards a specific good, that of health, in any sense demand, or at least justify, any calls for social transformation along progressive lines? Have similar arguments not been used, in authoritarian contexts, to justify anti-democratic measures in the name of public hygiene? Should we argue that, in these authoritarian contexts, the arguments have in some sense been distorted in line with the demands of the relevant regime? On what basis can we justify this argument?
One possible line of response is the following: Many of the authors cited here, specially Sigerist, insisted on the social character of disease. Certain totalitarian tendencies in public hygiene, notably the eugenics movement in modern Germany, under-emphasized this social character and focused instead on the internal bodily “constitution” of the individual patient. The turn towards Constitutionspathologie or Constitutionslehre among late 19th century German pathologists was, according to Sigerist, an important foundation for the subsequent rise of eugenics. [5] One could perhaps argue that authoritarian or totalitarian visions of public hygiene tend, in a certain sense, to neglect the social. Thus the placement of disease in social context, the approach I have broadly characterized as cultural morphology, is essential to the emancipatory framework I have reconstructed.
I am not sure whether this response is right, or whether it suffices to answer the questions raised here. There could exist perfectly coherent visions of public hygiene that regard disease as partly or even largely social rather than merely individual, but nonetheless treat it as a phenomenon that requires authoritarian intervention and control. In any case, I hope to explore other aspects of the modern disease picture in subsequent posts. The critical situation faced by the world today demands not only clarity of action but also clarity of thought. In this context, exploration of the conceptual coherence and justification of our programs of action, and the value of the metaphors on which we rely, remains particularly urgent.
(12 May 2020, Hong Kong)
CITATIONS
[1] “Covid-19 unmasks dangers of commodified healthcare,” New Frame; Saturday, 16 May 2020. https://www.newframe.com/covid-19-unmasks-dangers-of-commodified-healthcare/
[2] “Coronavirus and the Crisis of Captialism,” New Frame; Saturday, 16 May 2020. https://www.newframe.com/coronavirus-and-the-crisis-of-capitalism/
[3] Dennis Kosuth, “When COVID-19 Meets Health Inequality,” Jacobin, 5 May 2020: https://www.jacobinmag.com/2020/05/covid-coronavirus-cook-county-jail-chicago-provident-hospital
[4] Yuval Noah Harari, “In the Battle Against Coronavirus, Humanity Lacks Leadership,” Time, 15 March 2020: https://time.com/5803225/yuval-noah-harari-coronavirus-humanity-leadership/
[5] Sheila Faith Weiss, Race Hygiene and National Efficiency, pp. 170-1.
RELATED READINGS 相關閱讀：
Rodriguez, “Framing Diseases 01: Disease Pictures”
Rodriguez, “Framing Diseases 02: Disease and the Cooperative Society”
