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Social Science & Medicine 58 (2004) 687696

The ambivalence of error: scientic ideology in the history of the life sciences and psychosomatic medicine
Monica Greco*
Department of Sociology, Goldsmiths College, University of London, New Cross, London SE14 6NW, UK

Abstract This paper discusses the concept of scientic ideology as it appears in the work of the historian and philosopher of medicine Georges Canguilhem, whose work is becoming increasingly well known and used amongst anglophone social scientists. Whilst addressing the problematic of legitimacy and illegitimacy in the history of science, the concept of scientic ideology does something different and more complex than either the opposition between science and false science, or the one between orthodoxy and heresy, allow for. On the one hand, it enables us to preserve a crucial acknowledgment of the specicity of science in general, and of medical science in particular. On the other hand, it also allows us to challenge the sharp contrast between science and non-science by setting that contrast in a diachronic perspective. Drawing also on the work of Isabelle Stengers, the last part of the paper discusses an application of the concept of scientic ideology in relation to the eld of psychosomatic medicine and psychoneuroimmunology. r 2003 Elsevier Science Ltd. All rights reserved.
Keywords: Canguilhem; History of science; Psychosomatic medicine; Psychoneuroimmunology

Introduction The opposition of orthodoxy and heresy self-consciously differs from the distinction between science and false or pseudo-science in that it explicitly avoids ascribing a privileged status to science as a form of knowledge, suggesting in fact that it can be analyzed in the same terms as religion. At the same time, just like science and false science, orthodoxy and heresy describe forms of legitimacy and illegitimacy. This paper discusses the concept of scientic ideology as it appears in the work of the historian and philosopher of medicine Georges Canguilhem, whose work is becoming increasingly well known and used amongst anglophone social scientists (see Osborne & Rose, 1998). Whilst addressing the problematic of legitimacy and illegitimacy in the history of science, the concept of scientic ideology does something different and more complex than either the opposition between
*Corresponding author. Institut fuer Sozialforschung, Senckenberganlage 26 Frankfurt-am-Main 60325, Germany. E-mail address: m.greco@gold.ac.uk (M. Greco).

science and false science, or the one between orthodoxy and heresy, allow for. On the one hand, as I hope to illustrate, it enables us to preserve a crucial acknowledgment of the specicity of science in general, and of medical science in particular. On the other hand, it also allows us to challenge the sharp contrast between science and non-science by setting the contrast within a diachronic perspective. This is not the place to attempt a systematic introduction to the content and context of Canguilhems thought.1 For those not already familiar with his work, however, it is important to mention that Canguilhems originality as a historian and philosopher of science lies partly in his choice to focus on the life sciences biology, medicine, and psychologyand in his life-long endeavor to describe and account for their specic rationality. He argued that these sciences, which differ from physics, mathematics, or chemistry in their degree of formalization and tness for mathematisation, lead us
1 Useful starting points are Foucault (1989), Tiles (1987), Osborne and Rose (1998), Spicker (1987) and Bowker and Latour (1987).

0277-9536/03/$ - see front matter r 2003 Elsevier Science Ltd. All rights reserved. doi:10.1016/S0277-9536(03)00220-X

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to pose the problem of the status and role of knowledge in a particular way (Foucault, 1989). The concept of scientic ideology, accordingly, is a concept that Canguilhem presents as relevant specically to the historiography and epistemology of medicine and the life sciences. In what follows, I shall begin by reviewing in outline how Canguilhem denes the concept of scientic ideology, moving on to discuss how this denition relates to the contrasting philosophies of Gaston Bachelard and Thomas Kuhn. I shall then return to the concept with some illustrations from Canguilhem and with some brief suggestions for further research drawn from my own work on psychosomatic medicine. The question: What is a scientic ideology?, Canguilhem tells us, arises in the practice of the history of science and is relevant to the theory of that subject. Confronted with the problem of selecting objects of inquiry, the historian of science cannot avoid asking what the title of science designates, and when and how this title must be withdrawn. Canguilhem coins the concept of scientic ideology, as we shall see, to address instances whose locationinside or outside the history of scienceappears ambivalent or ambiguous. In outline, a scientic ideology is an explanatory system that stands in a particular relationship with science and whose main characteristics can be crystallised around three themes: (i) methodology, (ii) theoretical ambition, and (iii) scientic temporality (Canguilhem, 1988, p. 38). Focusing on these themes will help to illustrate the connections and differences that bind scientic ideology and science proper. (i) Scientic ideology arises in the same epistemological space as science itself: the realm of knowledge, as opposed, for example, to the realm of religious belief. It is not an anti-science, therefore, in the sense that it does not repudiate the function of science. It wishes, on the contrary, to be identied with it: y in a scientic ideology there is an explicit ambition to be science, in imitation of some already constituted model of what science is (1988, p. 33). Scientic ideologies do not qualify as science, however, in that they ignore the limits set upon science itself by its methodological requirements and operational possibilities. In a scientic ideology, laws or generalizations that are pertinent to very specic contexts and under specic circumstances are extrapolated from their elds of application and heterogeneously combined to yield principles whose applicability extends, for example, to the political or moral sphere. The claims such ideologies make about reality fall far beyond what the norms of scienticity to which they appeal would normally allow. Herbert Spencers evolutionism provides a useful illustration. Spencer claimed solid bases for his science: the biological work of Von Baer on the one hand, and the law of the conservation of energy on the other. He also

thought that Darwins ndings were a clear conrmation of (and parallel to) his own. His hypotheses, however, were extra-scientic, and his pseudo-scientic deductions are norms of social and political action (e.g. the advocacy of free enterprise). In the Spencerian system, de-contextualised elements of valid scientic discourse are invoked to lend scientic authority to claims which science is in no position to make. (ii) The rst methodological point is related to the theme of theoretical ambition which, in the case of a scientic ideology, is both excessive and na. ve. While science connects explanations with specic hypotheses themselves derived from scientic work, scientic ideology applies those explanations within general controversies associated with political, legal, moral, or simply practical dilemmas. In one example of medical ideology, the medical theory of John Brown (1735 1788), the practical advantages offered by the theorys over-simplication of complex phenomena led many to see it as a plausible scientic explanation, albeit for a limited period and only in particular countries. Like magic or religion, scientic ideology derives its impetus from an unconscious need for direct access to the totality of being (Canguilhem, 1988, p. 38), an unconscious and perhaps universally human yearning for a single framework with the capacity to explain any phenomenon and to resolve any problem. Its distinctive particularity is that science is chosen as the privileged point of access to that totality. (iii) One further link and difference between science and scientic ideology concerns their articulation in time. In every domain, Canguilhem (1988, p. 38) writes, scientic ideology precedes the institution of science. Similarly, every ideology is preceded by a science in an adjunct domain that falls obliquely within the ideologys eld of view. Ideology occurs between scientic episodes. But this is only visible once the title of science has been withdrawn from scientic ideology by a new science that falsies the ideologys claims. A new science is able to show, as it were, that the claims of scientic ideology were not a continuation of the old science but an illegitimate distortion and digression from it. Scientic ideology is banished, inauthentic knowledge. Crucially, it is knowledge whose location in the realm of science is initially plausible. All of these themes, but especially the second and the third one, presuppose the possibility of marking an epistemological and methodological distinction between what is properly scientic and what is not. The last theme, relating scientic ideology to a temporal dimension, also implies that episodes in the history of science are to be evaluated positively or negatively as contributions to, or digressions from, the progress of science itself. These assumptions do not stem from a na. ve endorsement of orthodox and modernist histories of science, contrary to how they might initially be read. In

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order to understand them in their proper context, it is necessary to turn to the epistemology of Gaston Bachelard, who was Canguilhems mentor and predecessor as professor of the history and philosophy of science at the Sorbonne. The concept of scientic ideology, as we shall see, represents both a continuation and a transformation of Bachelards legacy.

Gaston Bachelard: judgement and the history of science Gaston Bachelard described his epistemological project as an attempt to provide a philosophy that was adequate to the movement of contemporary science. Living and writing in the rst half of the 20th century, Bachelard witnessed what Mary Tiles describes as traumatic changes in the character of physics through the emergence of relativity theory and quantum mechanics. As Tiles explains (1987, pp. 143144): [These] were not just theories to be added to the existing stock, or to replace parts of that stock. Their acceptance entailed the disruption of the whole framework of classical physics; its concepts of space, time causality and substance, concepts denitive not only of the thought-space of physics but also, according to Kant, constitutive of our conception of the objective, physical world and thus vital to the way in which the distinction is drawn between inner and outer, subject and object. The word traumatic is therefore signicant, since these changes were experienced and interpreted as a disruption in the very order of reason, calling for a reconstruction capable of accommodating the possibility of a new disruption in the future. In Bachelards own words, a philosophy which professes to be adequate for scientic thought, which is in a constant state of evolution, must expect that scientic knowledge will [a]ffect the structure of the mind (Bachelard, 1968). The point worth noting, which gives us the key to many of the other features of Bachelards thought, is that he presents the structure of the mind as dependent on scienceit is shaped by science. This is the reason why a philosophy adequate for scientic thought cannot be a philosophy grounded in a metaphysical and unchanging faculty of reason, or in the subject understood as a given. Quite the reverse, reason is the product of sciencenot its raw material. Reason is instructed by science, in the sense that its objects and concepts are never immediate givens, but always objects and concepts that have already been produced through the work of science itself. In the most synthetic terms, Bachelard describes science as a form of work, a form of work mediated by instruments. The role of instruments is crucial; they are

not simply aids to the scientist, they are organs of intelligence (Canguilhem, 1975a, p. 191), which reorganize and transform what is given, which create the real. To quote again from Bachelard (1951, p. 84): Contemporary science has entirely broken with the prehistory of sensory data. It thinks through its instruments, not through its sense organs. This innovation does not merely mark a peculiarity of contemporary science; it throws an entirely different interpretation on what scientists in the past were doing as well. The work of science is also described as a work of verication, in the etymological sense that it is a work of making true. This is an important point for it reminds us that just as reason is the product and not the a priori condition of science, so scientic truth is the product of a reorganization of experience. In fact, for Bachelard what the work of science performs is not discovery, but rather a gesture of refusalof saying no to the immediacy of phenomena.2 Canguilhem (1975a, p. 191) coins the term antilogics in order to describe this gesture: it is the refusal to receive ready-made concepts, designated objects, an ordinary language; and correspondingly, it is the decision y to reorganize the order of syntax y to produce phenomena instead of registering them. This is the reason why, for Bachelard and Canguilhem alike, science is not entirely equivalent to other forms of culturea point to which I shall return below. Through its work of reorganization, science thus sets new norms for the use of rational categories. As an example, Bachelard offers the case of arithmetics. Arithmetics, he claims, is not founded on reason; it is reason that is founded on elementary arithmetics, since this practice has repeatedly conrmed itself to be an efcient and consistent system of organization of experienceso much so that it would be unthinkable to abandon it. What would be a function without occasions for functioning? What would be a reason without occasions for reasoning? (1988, p. 144). He cites the mathematician Destouche as saying that if arithmetics should, in a hypothetical future, reveal itself to be contradictory, reason would be reformed to erase the contradiction and arithmetics would be preserved intact. Bachelard goes further: he suggests that what might in fact happen is not that a contradiction suddenly appears within arithmetics, but that the practical need
2 For a powerful illustration of the epistemological break that science operates with respect to everyday categories, see pp. ! rationaliste de la physique contemporaine 7582 of Lactivite (1951) where Bachelard compares how the term corpuscule is understood in physics and philosophy. The commonsense and philosophical use of terms such as corpuscule, mass, or temperature bears the inherited traces, or a mixture of traces, of the concepts of outdated sciences.

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arises for a contradictory use of arithmetics, calling for a transformation of reason. To reiterate once more: reason, for Bachelard, cannot be known independently of its applications because it is generated through those applications. The inadequacies of the applications are, accordingly, the inadequacies of reason, and scientic progress is the rectication of those inadequacies. This is the sense in which Bachelard (1951, p. 27) understands scientic development to be the progress of rationalism, and the history of science to be the history of the defeats of irrationalism. This notion of rationalismfor which Bachelard coined the expression applied rationalismis therefore necessarily a form of historical reason, laden with the full implications of historicity. These implications refer, on the one hand, to the future: scientic truth, understood not as what is revealed but as what is produced, is explicitly provisional and always subject to correction. On the other hand, the past of science stands as a series of irrevocable precedents, and new science can only emerge as a function of them. On this basis, it seems clear that contemporary scienceand hence reasoncannot but look upon its past with a discriminating eye. Episodes in the history of science cluster around two opposite poles, one positive and one negative, according to whether they can be seen as contributions or obstacles towards the present state of knowledge/reason. The provisional character of the truth spoken by contemporary science means, of course, that the judgment of value it imparts on historical episodes is equally open to correction. We have, in this sense, a form of relativity. But it should be stressed that the task of pronouncing a judgment cannot be eschewed, and this profoundly distinguishes Bachelards position from a form of relativism.

Relativity not relativism It will be instructive to consider the relativist position in more detail for the benet of comparison. Kuhns account of scientic activity in terms of the conventional norms of communities was read by many in the social sciences as producing a circular denition of the distinctive character of science: science appears to be simply what we nd practiced in a scientic community and vice versa (see Lakatos & Musgrave, 1970). This, in turn, encouraged interpretations of his work as a defence of irrationalism, and as a refusal of the notion of scientic progress. Despite the fact that Kuhn explicitly attempted to counteract this reading of his work (Kuhn, 1970, postscript), it was embraced by some social scientists. The positions of Barry Barnes offer a good, if not the most recent, example of this form of relativism. The borderline between science and nonscience (and between true and false science in a historical

sense), according to Barnes (1982), is a matter of convention. This line circumscribes a nite aggregate of concrete examples of science without implying that they share a common essence or rationality. Understanding where the borderline lies, Barnes maintains, requires not the formulation of a principle of demarcation, but the empirical study of the social processes through which it is sustained and made visible. Similarly, to prefer one paradigm to another ultimately comes down to expressing a preference for one way of life over another; the emergence of paradigms is the result of a choice by their users. Accordingly, it is wrong to ever speak of truth or falsity in connection with science, since all rational elaboration is always and everywhere conventional in character, and there are no external units of measure against which the value of any particular episode can be judged. The correct employment of a concept should not be seen as a manifestation of rationality, but as a discretionary capacity of sociological interest. The latent concept of rationalism to which this form of relativism stands opposed differs from Bachelards in important respects, and is more plausibly exemplied by the propositions of thinkers like Lakatos and Popper. As Alan Chalmers synthetically put it, this version of rationalism is characterized by the fact that it presumes the universality and ahistoricity of rational criteria (Chalmers, 1976). Both these features contradict the features of what Bachelard calls applied rationalism. Rationalism, understood as both universal and ahistorical, indeed involves a reference to principles external to the linguistic community and logically prior to it, whose existence is what Kuhn and Barnes deny. But Bachelard understands history itself as the informing principle of his applied rationalism. For this reason, applied rationalism is intrinsically linked to the (scientic) practices of communities, and indeed Bachelard (1949, pp. 131132) recognizes a plurality of rationalisms that correspond to different regions of scientic activity. These regional rationalisms, as he calls them, must be considered in their own right before any attempt is made to institute, a posteriori, an integrating rationalism. The crucial point of difference between Bachelards position and the strong relativist one lies in the fact that applied rationalism, however plural and regional, is never contingent, and never available for arbitrary choice. This is at least in part because of its diachronic, temporal character. We can speak of rationalism, therefore, not because science borrows it from a platonic dimension, but because science itself is intelligibly overdetermined by its past achievements. And we can mark the particularity of science as precisely that which institutes its procedures as the rationality of a linguistic community. From the fact that concepts never correspond to unmediated objects, relativists propose that their meaning is conventional, the result of a synchronic choice by

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its users. For Bachelard, scientic work is the specic place where culture meets this choice as a productive task, and actually performs it. It is the locus where the norms of meaningfulness are creatively transformeda locus characteristically set apart from commonsense, but that inevitably feeds back into the commonsense of later generations (see Bachelard, 1951, pp. 7582). In pronouncing ourselves on the past of science, therefore, we cannot abstract from the contemporary state of scientic knowledge for two different sets of reasons. Firstly, because it is the only available point of reference we can adopt unless, like many relativists, we wish to maintain that we can and should abstain from judgment. Secondly, as a matter of intellectual honesty, it is a means of rendering explicit the elements of historical bias that are intrinsic to any form of thought. To conclude this necessary detour into the philosophy of Bachelard, let me return to its implications for the historiography of science. One of the consequences of applied rationalism is the need to distinguish between the past of a science and science in the past. The rst expression designates an order of conceptual progress, visible only after the fact, and of which the present notion of scientic truth is the provisional point of culmination (Canguilhem, 1988, p. 9; Gutting, 1989). It is the history of science, whose pertinent objects are highlighted through the projection of contemporary knowledge onto episodes of the past. All other efforts belong to the story of science, the at chronology of events which includes those once called scientic and later disqualied from that claim. For Bachelard, such events are not simply neutral sidelines of scientic development leading to a series of dead-ends. They carry a denite negative value as impediments or obstacles to scientic progress. They are mistakes, errors whose inscription in history nonetheless makes them an active presence in the language of posterity and forms part of the epistemological inheritance which must be counteracted by any effort to think scientically. Sometimes, as in the case of Newtonian mechanics, errors are such that they can be preserved in a rectied form. They are apparent errors, where the mistake lies not in the concepts themselves but in their unconditional use; the Newtonian universe is a valid conceptual subsystem, as it were, of the Einsteinian one. In these cases, Bachelard speaks of !e (sanctioned history). When errors only histoire sanctionne have a negative value, and their rectication amounts to their elimination from the map of scientic knowledge, !rimee ! (lapsed history). Bachelard speaks of histoire pe

What is the value of errors? Scientic ideologies as ambivalent obstacles We are now in a position to return to the concept of scientic ideology which, let us remember, arises in

the practice of the history of science. In particular, it arises in the practice of the history of the life sciences, and in a sense it marks the specicity of that subject. The distinction between sanctioned and lapsed knowledge, for Bachelard, is a relatively rigid one. It implies the idea that it is possible to assign an unequivocal epistemological value to different episodes in the history of science. Unless errors are rectiable and rectied that is, unless it is possible to specify conditions under which they remain valid from the perspective of contemporary sciencetheir value is entirely negative; they count simply as obstacles. Canguilhem (1989) develops these ideas to their logical consequences and, we might say, he recties them in the Bachelardian sense by specifying the limited conditions to which they apply in their original form. In particular, as Gary Gutting has suggested, through the notion of scientic ideology, Canguilhem offers an implicit correction to the concept of epistemological obstacle, by introducing the possibility that errorseven ones that cannot be rectiedmay play a positive role in the development of science. There is, of course, a sense in which the ambivalence of epistemological obstacles is simply a logical consequence of the notion that all scientic truths are provisional in character and open to revision. The value of what is incompatible with present explanations cannot be fully assessed until the limits of these explanations have been reached. What we gather from reading Canguilhem, however, is that ambivalence can be more or less signicant for the historian of science depending on his or her specic eld of inquiry. As we have seen, it was Bachelard who rst spoke of a plurality of rationalisms corresponding to different regions of !gionaux). In line with scientic practice (rationalismes re this notion, Canguilhem argues that Bachelards epistemology is particularly suited to the scientic regions in reference to which it was developed, namely the regions of mathematical physics and nuclear chemistry. Mathematics, he points out, offers a perfect illustration of Bachelards anti-metaphysical understanding of reason, since it is in that discipline that one speaks not of the normal, but of the normed (1988, p. 13). Bachelards account of rationalism, he observes, is built on a framework of mathematism. The degree of formalisation evident in sciences like mathematical physics and nuclear chemistry is such that the possibility of ambivalence appears relatively insignicant for the purpose of studying their history. It is from within this horizon that sanctioned episodes look like positive contributions to progress, while lapsed episodes look like epistemological debris that constitute a wholly negative obstacle to the development of knowledge. From the perspective of the life sciences, on the other hand, contributions and obstacles look altogether more ambivalent. The vast body of work that Canguilhem

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devoted to the concept of life and to the role of vitalism in biological thought illustrates this point. Many biologists today tend to use vitalism as a derogatory term associated with lack of intellectual rigour, anti-scientic attitudes, and superstition (e.g. Dawkins, 1988). Canguilhem would certainly agree that vitalist doctrines have, in many ways, constituted an impediment towards certain aspects of scientic development. At the same time, this impediment has contributed to the development of a science of biology in the sense of providing a corrective check, for example, on the possibility of physico-chemical reductionism. In Canguilhems own words: The need to refute vitalism, which still persists today, must mean one of two things. Either it is an implicit admission that this illusion [vitalism] y is not of the same order as those of geocentrism or the phlogiston, and that it has a vitality of its own. In which case one must account philosophically for its vitality. Or it is the implicit admission that the resistance of the illusion has obliged its critics to sharpen their arguments and their weapons. This means recognizing that the corresponding theoretical or experimental gain constitutes a benet whose importance cannot be entirely unrelated to that of the occasion from which it stems y (Canguilhem, 1975b, p. 84). In his introduction to Canguilhems most famous work, The normal and the pathological, Michel Foucault usefully suggests that at the root of this ambivalence may well lie a paradox that must be regarded as constitutive of the life sciences as such: Life and death are never in themselves problems in physics y lethal or not, for the physicist a genetic mutation is neither more nor less than the substitution of one nucleic acid base for another. But it is in this very difference that the biologist recognizes the mark of his object; and an object of a type to which he himself belongs, since he lives and manifests the nature of the living being, he exercises it, he develops it in an activity of knowledge which must be understood as a general method for the direct or indirect resolution of tensions between man and the environment (1989, p. 20). The biologist, in other words, is not indifferent to the forms of knowledge s/he produces, which s/he must regard as an expression of life and of the quest to remain alive. To deny the specicity of life, for the biologist, is #tre of science in general not only to deny the raison de but also, in reference to his or her own practice, to produce a contradictory form of science.

Between internalist and externalist accounts of science The notion of epistemological obstacle, even with the corrective of ambivalence, does not however exhaust the meaning of scientic ideology. The special interest of the concept lies in the connection it points out between scientic elements and extra-scientic concerns, and therefore in highlighting the role played by the latter in the constitution of science. Scientic ideology is ambiguously scientic from the start in the sense that it incorporates hypotheses geared to resolve extrascientic questions. Later, new science disclaims these hypotheses by conceptually reformulating an agenda which is not exclusively of its own making. The pseudoscientic concepts to which scientic work applies itself in its task of rectication do not emerge in a vacuum, but express the demands of life and action (Gutting, 1989, p. 45) in terms of a particular historical conjuncture. And the fact that, for a time, they plausibly call themselves scientic means that it is in their direction that scientic attention must turn. This is best illustrated with reference to one example of scientic ideology provided by Canguilhem and commented on in detail by Gutting (1989), namely that of the controversy over innate versus acquired traits as !nus physique. This controversy set out in Maupertuis Ve #tre in the social and political had a clear raison de context of its time and place. It was a context dominated by the problem, for example, of determining the legitimacy of aristocratic power. In the 17th century ideology of hereditary transmission, the concept of heredity designates an undifferentiated continuum ranging from the biological to the social and political. There is no epistemological break between the commonsense, everyday meanings of the term and its employment within scientic discourse. Similarly, there is a two-way line of exchange between the different epistemological levels of the term heredity, the social questions directly inform the scientic ones, and the scientic results yield political answers. The connection between science and the social is not merely analogical; it is to be found in the co-extensiveness of their concepts. The over-ambitious generalization of scientic conclusions on the part of ideology is not therefore rooted in bad faith, but in an epistemological error. It was only with Mendels transformation of the biological meaning of heredity that the efforts of his predecessors could be revealed as ideological or only pseudo-scientic. As Gutting (1989, p. 35) has put it, Mendels science is not the end point of a trail that can be traced back to the ideology it replaced, for it is the expression of a method that the ideology neglected; but the speculations of ideology are in part responsible for the choice of heredity as Mendels own eld of inquiry. Similarly, what science nds is not what ideology suggested looking for (p. 34), but the course

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of scientic development is not indifferent to these suggestions, nor is it simply slowed down by them. Scientic ideologies place fresh input into the course of scientic development. This input is derived from the demands and problems of the cultural community at large. Scientic ideology is thus a rich epistemological concept that enables us to look beyond the rigid distinction between legitimate and illegitimate science, as well as internalist and externalist accounts of scientic development. By pointing to the articulation of ethical, legal, and political dilemmas in scientic terms, it points to the notion that science should be regarded as neither entirely pure or separate from society and politics nor as entirely dened by social and political factors. In this sense, it may be read as anticipating the focus on science as a complex set of mixed practices that is the hallmark of more recent science studies (Latour, 1993, 1999).

Scientic ideology and psychosomatic medicine Canguilhem offered specic examples of scientic ideology in the history of medicine, and I believe the concept is best suited for such a specic level of analysis. I write this in contrast to a recent suggestion by Osborne that medicine may be made up of regional rationalisms that have a scientic status, but medicine itself is not a science; in its epistemological spirit, it is rather a kind of ideology (Osborne, 1998, pp. 259260). Osbornes point is not mistaken in the sense that it accurately reects and develops Canguilhems more general refutation of the possibility that medicine should ever be a positive science. And, undoubtedly, this is a point that needs to be propagated and stressed in the current political and cultural climate. But to use scientic ideology in this sense means to de-specify the concept, and to forgo some of its potential for articulating differentiation within the history of medicine itself. In the following and concluding paragraphs, I would like to offer some suggestions of where such an application might prove fruitful in relation to the eld of psychosomatic medicine. As I have argued at more length elsewhere (Greco, 1998), psychosomatic medicine is better understood as a space of problematization rather than as an organized and coherent scientic eld. This means that we cannot identify the history of psychosomatic medicine with the history of any one of the range of disciplinesfrom psychoanalysis to psychoneuroimmunologythat are pertinent to an understanding of its conguration. Indeed, psychosomatic medicine looks like a very different proposition depending on the disciplinary vantage point that is adopted in order to describe it. Yet, and this is the crux of my argument, the

concept of scientic ideology, in both its positive and its negative aspects, may facilitate commensurability between such radically different perspectives. As I hope to show, this offers a dual set of advantages: on the one hand it allows us to highlight the pertinence of many historical instances that might otherwise be dismissed as detracting detours in a linear development towards scienticity, and on the other hand it allows us to think differently about the character of that very scienticity towards which psychosomatic medicine strives. To unfold this rather ambitious proposition, it is useful to begin by considering Isabelle Stengers recent discussions of the specicity of modern medicine as a rational practice (Stengers & Nathan, 1995; Stengers, 2000). Like many other contemporary practices and forms of knowledge, modern medicine derives its claim to rationality and legitimacy from a reference to science and, in the case of medicine specically, to the theoretico-experimental model. This reference, Stengers argues, allowed historically for a transformation of the long-standing conict between doctors and charlatans, by facilitating a diagnosis of the power of the charlatan as unfounded. Stengers illustrates this transformation in her study of the inquiry led in 1784 on the magnetic practices of Mesmer, which established that Mesmers magnetic uid, to the extent that its effects might prove its existence, did not in fact exist (see Chertok & Stengers, 1992). What the Mesmer inquiry demonstrated, paradigmatically, was that a cure as such proves nothing; a popular cure-all or a few magnetic passes can have an effect, but they do not qualify as a cause. The charlatan is thereby disqualied as someone who takes this effect as proof (Stengers, 2000, p. 24). Stengers treats the scene of this inquiry as the inaugural act of denition of modern scientic medicine; the key to this modernity lies precisely in the consciousness of the fact that a cure as such proves nothing, and that rational medicine cannot be distinguished from the practice of charlatans simply by the goal it pursues or attains (that is, healing) (Stengers & Nathan, 1995). Finally, Stengers takes the relevance of this historical example to the very heart of contemporary medical research, by highlighting that the same logic is at work when it resorts to the placebo effect as a means of testing medications. The hypothetical power of a medication is disproved if the same effect can be obtained by administering a placebo; the placebo, as a clandestine effect, is thus the correlate of the charlatan. This particular framing of the way in which modern medicine establishes and understands its own rationality is interesting because it acknowledges both the gains and the losses afforded to medicine itself by its reliance on the theoretico-experimental method. In the theoreticoexperimental framework, the living bodys ability to be healed through the imagination, through hope, through

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faithin other words through bad reasonsis clearly and crucially acknowledged, as the practice of clinical trials demonstrates. Simultaneously, however, and by the logic of the experiment itself, that very ability is explained away as irrational, as a parasitic and annoying effect (Stengers, 2000, p. 24) that interferes with the pursuit of valid medicine. One might go as far as to speculate, on the basis of this argument, that scientic medicine could not acknowledge the placebo effect in a veritably positive way (that is, as a true effect, due to good reasons, worthy of investigation in themselves) without risking its claim to the ability to speak in the name of science. This last point brings me to the discussion of psychosomatic medicine in the spirit of scientic ideology. Stengers analysis enables us to see clearly the rather singular position that modern psychosomatic medicine occupies in terms of the question of how medical science relates to medical non-science. In a sense, as we shall see, this question lies at the heart of psychosomatics as a form of problematisation. One way of describing psychosomatic medicine generically might be to say that it is a form of medicine that acknowledges the placebo effect (or the effect of the imagination) as a true effect, and seeks therefore to understand and to explain it in order to incorporate it into medicine as a rational scientic practice (Harrington, 1997). This ambition, which may be articulated in a variety of locally specic ways, can indeed be regarded as a kind of minimal common denominator shared by otherwise deeply heterogeneous disciplines involved in the eld. Whether it is in terms of the materialization of infrapsychic conict as a symbolic conversion or of the neuroimmunological processes involved in coping with subjectively stressful life events, psychosomatics is characterized by the positive acknowledgment of the bodys capacity to exploit, and to succumb to, the power of ction. As we have seen, this is an acknowledgment that involves putting medicines claim to scienticity, and therefore to legitimacy, at risk. This risk is the interpretive key through which many recurrent themes in the discursive space of psychosomatics become intelligible: the fact, for example, that some gures in the history of psychosomatics described their own practice as heretical with respect to medical, scientic, and even psychoanalytic orthodoxy (Groddeck, 1970), and as likely to produce socially transgressive or . cker, 1986/1949); the fact undesirable outcomes (Weizsa that many see their work as anticipating a scientic revolution that nevertheless continues to remain elusive (Uexkull . & Pauli, 1986; Levin & Solomon, 1990; Todarello & Porcelli, 1992), and whose character is constantly in danger of being misunderstood (Weizs. cker, 1986/1949; Morelli, 1982); the fact that others still a strive to present modern psychosomatic research simply as a linear and unproblematic extension of scientic

rigour into what used to be personal convictions, anecdotes and medical folklore (Lipowski, 1986, p. 5). The risk implicit in the premise of psychosomatics, in itself, would by no means justify addressing psychosomatic medicine as a form of scientic ideology. What matters is how different historical instances of psychosomatic research and practice relate to the risk, and what may be sacriced in the name of security. On the basis of this broad interpretive framework, it is possible to construct something like a typology and a mapping of psychosomatic propositions and lines of research. I must defer the details of this typology to another occasion, but I can offer here some general orientative remarks. Among the propositions of psychosomatics, I would suggest, those that come close to Canguilhems idea of scientic ideology are those that deny the risk posed by psychosomatics to the contemporary conguration of medical science whilst retaining the ambition to account for what, in shorthand, I have referred to as the role of the imagination in health and disease. Paradoxically, but entirely in line with Canguilhems denition of the concept, it is those instances that currently enjoy the highest degree of scientic plausibilitynamely the varieties of psychosomatic research that rely on the theoretico-experimental methodthat may come to count as a form of ideology from the perspective of a medicine of the future. I have in mind, among likely candidates, the experimental practices of psychoneuroimmunology. Two notes of caution: rstly, we should not be deceived by the fact that key gures in the eld describe psychoneuroimmunology as heralding and anticipating a radical transformation in the order of medical science, or as somehow being itself already of the future (Solomon, 1999, 2000). What matters is that the eld continues to rely on the experimental method as something like a royal way towards establishing the scienticity and rationality of practice in psychosomatic medicine. When Solomon advocates the development through laboratory research, of non-linear, non-mechanistic understandings [of health and disease] based on systems, chaos, and informational theories (Solomon, 1999, p. 2), he advocates a transformation of medicine along models that are current in the practices of physics and chemistry. In the vocabulary of scientic ideology, he is extrapolating from the context of adjunct scientic elds and extending concepts that may not be relevant or pertinent in medicine in the same way as in relation to, say, atmospheric phenomena (Stengers & Nathan, 1995). At a meta-theoretical level, one might say that he is advocating a linear progression towards non-linearity. The second note of caution, which is closely related to the rst, is that what is ideological about psychoneuroimmunology in this description is not the recourse to experimental practice as such, but rather the privilege that is ascribed to it in conferring rationality (and

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respectability) to psychosomatics. As the royal way for psychosomatic medicine, psychoneuroimmunology proposes itself as an arbiter with the power to conrm or disqualify other practices theoretically, regardless of their effectiveness in the management of health and disease (Koenig & Cohen, 2002).3 In this sense, the ambition of psychoneuroimmunology can be described as ideological in terms of being both excessive and na. ve with respect to the requirements of medical rationality. To conclude, I propose to reect on how the example of psychoneuroimmunology may relate to Canguilhems (1988, p. 38) proposition that, in every domain, scientic ideology precedes the institution of science. What, if any, is the science that psychoneuroimmunology anticipates? And what, if any, is the science that might reveal the general claims of psychoneuroimmunology as ideological? As we have seen, the theme of anticipating a new science is part of the self-descriptions of practitioners in the eld. They refer to concepts and models developed in contemporary physics and chemistry in relation to complex systems as the key to imagining a scientic medicine of the future. I have argued that this illustrates a typically ideological extrapolation of concepts, and I now suggest that it may also represent a misunderstanding of the signicance of scientic developments in physics and chemistry, and of their relevance for medicine. The example of physics and chemistry, as Stengers and Nathan (1995) and Stengers (1997) have powerfully argued, is relevant not in so far as it may offer a new model that medicine should seek to imitate or import, but in so far as it reorganizes our very conception of rationality. According to Stengers, the signicance of the new science lies in its capacity to recongure the structure of our thinkingtruly in line with the spirit of Bachelards applied rationalism. The science of complex systems demonstrates that we do not need to suppose the existence of irrational entities or forces in order to recognize the reality of phenomena that may not t with the requirements of experimental methods. In other words, we cannot dismiss as irrational all that is not amenable to verication in a laboratory. The physics and chemistry of complex systems, therefore, does not suggest that we may extend the methods and concepts of those sciencesincluding the concept of a systemto the study of human bodies in health and disease. On the contrary, their relevance lies in exploding the conation of rationality with experimentation (Stengers & Nathan, 1995). For the practice of medicine in general, and psychosomatic
3 While this collection generally illustrates the view that PNI might provide a scientic rationale for religious belief, note the cautionary essay by Howard Kaye (a sociologist) on the implications of PNI for society and culture (including medical practice).

medicine in particular, this has some important implications. It means that the relevant question may not be when or how medicine will nally become scientic, but whether its claims to rationality and legitimacy must be drawn primarily or exclusively from a reference to science, as is currently the case. The answer, most evidently in the context of psychosomatics, is a resounding no. To the extent that psychoneuroimmunology presents itself as a royal way to transform medicine on account of being able to speak in the name of science, it would seem to exemplify precisely what Canguilhem described as a scientic ideology.

References
!. Paris: Presses Bachelard, G. (1949). Le rationalisme applique Universitaires de France. ! rationaliste de la physique Bachelard, G. (1951). Lactivite contemporaine. Paris: Presses Universitaires de France. Bachelard, G. (1968). The philosophy of no. New York: The Orion Press. Barnes, B. (1982). T. S. Kuhn and social science. London: Macmillan. Bowker, G., & Latour, B. (1987). A booming discipline short of discipline: (Social) studies of science in France. Social Studies of Science, 17, 715748. ! Canguilhem, G. (1975a). Etudes dhistoire et de philosophie des sciences. Paris: Vrin. Canguilhem, G. (1975b). La connaissance de la vie. Paris: Vrin. Canguilhem, G. (1988). Ideology and rationality in the history of the life sciences. Cambridge, MA: MIT Press. Canguilhem, G. (1989). The normal and the pathological. New York: Zone Books. Chalmers, A. (1976). What is this thing called science?. St. Lucia: University of Queensland Press. Chertok, L., & Stengers, I. (1992). A critique of psychoanalytic reason: Hypnosis as a scientic problem from Lavoisier to Lacan. Stanford, CA: Stanford University Press. Dawkins, R. (1988). The blind watchmaker. London: Penguin. Foucault, M. (1989). Introduction to G. Canguilhem. The normal and the pathological. New York: Zone Books. Greco, M. (1998). Illness as a work of thought: A Foucauldian perspective on psychosomatics. London: Routledge. Groddeck, G. (1970). Der mensch und sein es. Wiesbaden: Limes Verlag. Gutting, G. (1989). Michel Foucaults archaeology of scientic reason. Cambridge: Cambridge University Press. Harrington, A. (Ed.) (1997). The placebo effect: An interdisciplinary exploration. Cambridge, MA, London: Harvard University Press. Koenig, H. G., & Cohen, H. J. (Eds.) (2002). The link between religion and health. Psychoneuroimmunology and the faith factor. New York: Oxford University Press. Kuhn, T. S. (1970). The structure of scientic revolutions. Chicago: University of Chicago Press. Lakatos, I., & Musgrave, A. (Eds.) (1970). Criticism and the growth of knowledge. Cambridge: Cambridge University Press.

ARTICLE IN PRESS
696 M. Greco / Social Science & Medicine 58 (2004) 687696 Spicker, S. (1987). An introduction to the medical epistemology of Georges Canguilhem: Moving beyond Michel Foucault. Journal of Medicine and Philosophy, 12, 397411. Stengers, I. (1997). Power and invention. Minneapolis, London: University of Minnesota Press. Stengers, I. (2000). The invention of modern science. Minneapolis and London: University of Minnesota Press. !decins et sorciers. Stengers, I., & Nathan, T. (1995). Me !decin Manifeste pour une psychopathologie scientique le me et le charlatan. Paris: Les Empcheurs de penser en rond. Tiles, M. (1987). Epistemological history: The legacy of Bachelard and Canguilhem. In A. G. Phillips (Ed.), Contemporary French philosophy. Cambridge: Cambridge University Press. Todarello, O., & Porcelli, I. (1992). Psicosomatica come paradosso. Turin: Boringhieri. Uexkull, . T., & von Pauli, H. G. (1986). The mindbody problem in medicine. Advances, 3, 158164. . cker, V. (1986 [1949]). Psychosomatische Medizin. von Weizsa . cker In P. Achilles, D. Janz, M. Schrenk, & C. F. von Weizsa (Eds.), Gesammelte Schriften, Vol. 6. Frankfurt: Suhrkamp Verlag. Latour, B. (1993). We have never been modern. New York and London: Harvester. Latour, B. (1999). Pandoras hope: essays on the reality of science studies. Cambridge, MA: Harvard University Press. Levin, D. M., & Solomon, G. F. (1990). The discursive formation of the body in the history of medicine. Journal of Medicine and Philosophy, 15, 515537. Lipowski, Z. J. (1986). Psychosomatic medicinepast and present. Parts IIII. Canadian Journal of Psychiatry, 31, 221. Morelli, R. (1982). Dove va la medicina psicosomatica. Milan: Riza Libri. Osborne, T. (1998). Medicine and ideology. Economy and Society, 27, 259273. Osborne, T., & Rose, N. (Eds.) (1998). Society and the life sciences: In honour of Georges Canguilhem (Special issue). Economy and Society, 27, 154329. Solomon, G. F. (1999). Immune & nervous system interactions. The Fund for Psychoneuroimmunology. www.pnirs.org/ pages/bibliography.htlm Solomon, G. F. (2000). From psyche to soma and back. XLibris Corporation.