Beyond the Limits: Conversation, Part III

of 2 10 "The body multiple: ontology in medical practice (2002)" is a reflective ethnographic study which presents the ways in which 'enactment of a disease' occurs in medicine. It is a 200 pages book, 1 2 divided into 6 chapters with a preface and bibliography section. Originally published by Duke University Press in 2002. Written by a Dutch ethnographer and philosopher Annemarie Mol, this book is an interesting read for anyone trying to tread beyond the boundaries and follow the trail of practices. By analysing the enactments of a single disease-'Atherosclerosis' in a large university hospital (anonymised as hospital 'Z') in the medium sized Dutch town, Mol has focused the debates in medical practice on the 'politics of what' ? This 'politics of what' is essential to understand 3 "..that different enactments of a disease (in this case Atherosclerosis) entails different ontologies" (Mol, 2002, pg.176). There is a shift from an epistemological to a 'praxiographic inquiry' situated in the specificities of the field. This approach is undertaken by the author to neither suggest any hierarchy among the various enactments of a single disease nor to engage in criticism of medical practice, but rather it is to "…resist the idea that rationalization is the ultimate way of 4 improving the quality of health care" (Ibid, pg.182). The term 'body multiple' is explained by referring to various manipulations in medical practices entailing multiple realities. It is not just about the difference in perspectives, but related to the actual appearance of different objects in the process of manipulations in practice. Consequently, there are more than a singular patient, doctor, pain, disease, technicians, fluids vessels, techniques and technologies involved in practicing medicine. Despite the appearance of multiple objects in medical practice at hospital Z, all these objects are related to each other. They are multiple, but not fragmented or plural. Thus the question is no more about, "..how to find truth? but "how are objects The word 'enact' is carefully chosen by the author to describe how a disease is practiced/done by the 1 practitioner. She refrains from using the term-performance because it may have a connotation of a backstage reality which needs to be unveiled. In fact by using the word 'enact', the author is able to describe the activities that take place 'then and there' without having a definitive claim about it's actors. The author is conscious of the distinction between 'disease and illness' in medical anthropology and 2 medical sociology, therefore, she clarifies that her object of study is 'disease'. However, as she proceeds with her ethnography, the objective is to dismantle the boundaries between 'illness and disease'. As she remarks that, "There are good reasons to try, if only this one: that the humane does not reside exclusively in the psychosocial matter. However important feelings and interpretations may be, they are not alone unmaking up the what life is all about. Day-today reality, the life we live, is also a fleshy affair" (Mol, 2002, pg.27). Mol has clearly stated that, in this book the 'politics of what' is not merely about the difference between the 3 doctors and patients. The idea of rationalization has often been used in medicine to tame the complexities of practice and 4 indicate certain improvement in health care.

Medical pluralism plays a role in many people's lives. In the existing body of literature, it is described as the «co-existence of ideas and practitioners from several traditions occupying the same therapeutic space in society» (Janzen 2002: 234). And although anthropologists have long written about the influence of distance on the assumed efficacy of therapeutic traditions, as well as the crossing of cultural/ linguistic borders and the movement of patients/practitioners (Parkin forthcoming), the conceptualisation of medical pluralism has suffered from what scholars have called " methodological nationalism " (Wimmer & Glick Schiller 2003; Beck 1997): namely, that medical pluralism has been primarily envisioned as occurring within one nationally bound space. The travel of patients in search of affordable and appropriate treatment, the circulation of pharmaceuticals within personal networks, the spread of technologies and knowledge to different contexts and the institutionalisation of international legal frameworks to regulate issues of health and healing are not new phenomena. But their technologically-driven intensification and expansion in tandem with increased opportunities for travel has lead anthropologists to study these occurrences as examples of globalisation and transnationalism. We do not attempt to exhaustively cover these research areas in this chapter; rather, we want to explore how we can rethink classical concepts of medical pluralism via a critical reading of transnationalism and spatial theorisation.

2018

Ramah McKay’s Medicine in the Meantime: The Work of Care in Mozambique (2018) is concerned with the tensions embedded in Mozambique’s health system across governmental institutions, non-governmental organizations, transnational clinicians, local volunteers, and patients with chronic illness. McKay’s ethnography traces the competing visions of care for patients in Mozambique within a health system marked by institutional multiplicity, complicated political legacies, and economic uncertainty. Medicine in the Meantime explores the in-between spaces elicited by the co-existence of public health frameworks and humanitarian medical models, helping critical medical anthropology elucidate the complicated support networks contemporary citizens and patients must navigate.

Medical anthropology, 2017

When Foucault spiraled into the historical depths of the rise of the modern clinic and the doubleedged sword of biopower, he foregrounded the primacy of the medical gaze (Foucault 1973). With each successive advance in the technologies of visual and auditory perception came dominance over and subjugation of the body and its diseases, the biopower complex began. First, advancing technologies of auscultation then visualization permitted an increased penetration into the body; feeling and hearing from without, then seeing organs, then cells, and then the tiniest of microprocesses that power the cells. Along with the increased capacity to perceive came the capacity to name, to classify, to manipulate, and ultimately to control and to cure. That process of striving to visualize, understand, and control continues. Taking inspiration from this trajectory of Foucault's conception of the gaze, the authors in this special issue dissect images, their content, the processes that created them, and their ability to display, distort, and preserve minute slices of our lived moments. Images, both moving and still, used in these articles bring with them insights into the multimodal environment where we live and work (Collins, Durrington, and Gill 2017). They show how we interact with other people and objects in our environment, they include information on the places and spaces where research took place, and they preserve metadata that demonstrate the timing of events and of the interactions of the researchers. We emphasize the trust, timing, and tempo of the processes that surround making meaning of the images both by participants and researchers. By engaging these images as data, as actors themselves, we can tweak our theoretical notions about how they play an expanded role in the work of medical anthropology. Central to our theme of considering images (and more broadly multimodality) for use in medical anthropology is our recognition that images (and other modes) are representations of the world filtered by the positionalities of the makers themselves, influenced by unique experiences that brought them to that point in time. Their conscious effort to use a camera to capture something of interest reflects their intent, or motivation, to do more than simply document and describe for an audience. Images become an extension of a way of thinking, visually connecting maker with participant along lines of thought. In this special issue, we share six examples of how images inform and enhance our approaches to the body and its well-being, encouraging logophiles to consider making images in a multimodal sense for more than illustration in film or print production. Rather, we encourage people to include the dynamic process of the production of knowledge, in which researcher, participant, and audience are each present and contribute to the work. Vision There is increasing evidence for the extraordinarily rich interconnectedness and interactions of the sensory areas of the brain, and the difficulty, therefore, of saying that anything is purely visual or purely auditory, or purely anything. The world of the blind can be especially rich in such in-between states-the intersensory, the metamodal-states for which we have no common language.

Pastoral Psychology, 2008

This paper considers the relationship of unconscious fantasy to theory, with the focus on the issue of unity and multiplicity. The purpose of the paper is to explore the deep structure of unconscious fantasy, which is understood as that which promotes and organizes our experiences of the “one” and the “many” and serves as a driving force in the formation of the self. Using Thomas Ogden’s reformulation of Melanie Klein’s theory of fantasy (phantasy) and his vision of the Kleinian subject, alongside Christian Trinitarian theology, the paper argues that unity and multiplicity persist in a generative and interpenetrating dialectic that unfolds within/toward a transcendent unity-in-process, an eternal “becoming one.”

Drawing from Annemarie Mol's conceptulisation of multiplicity, we explore how health care practices enact their object(s), using physiotherapy as our example. Our concern is particularly to mobilise ways of practicing or doing physiotherapy that are largely under-theorised, unexamined or marginalised. This approach explores those actions that reside in the interstitial spaces around, beneath and beyond the limits of established practices. Using Mol's understanding of multiplicity as a theoretical and methodological driver, we argue that physiotherapy in practice often subverts the ubiquitous reductive discourses of biomedicine. Physiotherapy thus enacts multiple objects that it then works to suppress. We argue that highlighting multiplicities opens up physiotherapy as a space which can broaden the objects of practice and resist the kinds of closure that have become emblematic of contemporary physiotherapy practice. Using an exemplar from a rehabilitation setting, we explore how physiotherapists construct their object(s) and consider how multiplicity informs an otherwise physiotherapy that has broader implications for health care and rehabilitation.

Romancing Theory, Riding Interpretation: (In)fusion Approach, Salman Rushdie, ed. by Ranjan Ghosh. New York: Peter Lang, 2012

In this commentary, I focus on Albert Newen’s multiplicity view (MV) and aim to provide an alternative framework in which it can be embedded. Newen claims that social understanding draws on at least four different epistemic mechanisms, thus rejecting the idea that there is a default mechanism for social cognition. I claim that MV runs the risk of combining elements that have been described in metaphysically incompatible theories. I will argue that multiplicity needs coherence, which can be achieved by applying the theoretical framework of first-, second-, and third-order embodiment (1-3E; Metzinger 2014) to the study of social cognition. The modified version of this theory, 1-3sE (first-, second-, and third-order social embodiment), can serve as a unifying framework for a pluralistic account of social understanding

Journal of Clinical Psychology, 2007

The view that the self has multiple parts and that these appear in people seeking psychotherapy-and people conducting psychotherapy-is shared by clinicians of various orientations and supported by psychological research. It is useful for clinicians to think of patients as multifaceted and pay attention to the changes between facets that occur during therapy. They can thus help hidden parts to surface, facilitate dialogue between parts not in contact with each other, and convince excessively dominant or oppressive parts to make room for other adaptive facets. The authors contributing to this issue of Journal of Clinical Psychology: In Session describe, from their different theoretical perspectives, how they deal with patients' and therapists' inner multiplicity in clinical practice.