"He says lie down, shut up, take your clothes off... you do."
James Burke's description of the authority of doctors provides an example of why I enjoy his perspective on history: it's a blunt, humourous and--for all intents and purposes--accurate representation of our trust in the medical system, and by extension (I'm sure Burke would add) an indication of our faith in science itself.
The description is provided in "What the Doctor Ordered", episode six of Burke's series The Day the Universe Changed. In this episode, Burke discusses the establishment of a doctor-centered medical expertise via the military surgeons of the French Revolution, and the development of systems of bureaucratic efficiency that are echoed in today's managerialist institutional governance.
Burke's "connectivist" approach is what I enjoy about his series, and I've come to realise that it's a quality I enjoy in a number of theorists who have informed my own way of thinking--particularly Harold Innis and Michel Foucault. Innis and Foucault might seem like an odd couple to put in a room together. While questions of knowledge--not just epistemology, but also about economies of knowledge--are at the heart of the matter for both authors, their views on the subject differ theoretically. Yet as intellectuals they seem to share a fascination with the processes and mechanisms of societal and civilisational change and, not coincidentally, with communication and media--from Foucault's fascination with language and its "formations" to Innis' sweeping historical accounts of communication technologies. Both authors betray a concern with the organisation of power, and they both combine this with the investigation of ways of knowing and the (possible, and historically contingent) instrumentalities of knowledge. This encompassing interest is what leads them to politics, to culture, to economics and to the rituals and problems of social organisation and social life over time.
For Burke, there is the same concern with knowledge and its use. The "connections" made are between the grand abstractions of theory and the one-off solutions to pressing demands of everyday life, with an emphasis on the complex and quirky effects of circumstance, politics, greed, curiosity, religion, objects and technologies, and the new social relations engendered by (and engendering) everything else. In other words, historical messiness: not as a deviation from the kind of theorising provided by the "grand narratives", but rather an attempt to theorise the messiness as is, to trace historical developments as emergent and interconnected in multiple, multidimensional ways, and from which patterns develop in any case--just not always predictably or in ways that seem to "fit".
Take Burke's narrative of medicine: theory and practice, another persistent divide, had to be brought into a working relationship in order for medicine to take on the shape it has today. In other words, surgeons who practiced in the field became doctors who taught what they'd learned to others, and they taught it in institutional environments. Additionally, the doctor had to become an expert, with control over the patient based not on coercive power but on knowledge. Knowledge was generated in new environments and in new ways--the hospitals, built to house large numbers of sick people according to their ailments, provided the evidential input (in the form of patients) for observation, description and classification--all of which was recorded. Statistical analysis, a new mathematical tool, was brought to bear on this data as medical experts sought numerical patterns that could describe and explain (and predict!) the physical world. And for the first time, the patient became just that--an object, or even a collection of symptoms, to be acted upon by medical technologies.
The nineteenth-century concern for numbers was influenced by other developments--an example of which is the one Burke points to, the overpopulation of English cities during the (second) industrial revolution. In other words, a "mass" urban society was confronted with the epidemic of cholera, which required a radical solution. The answer they found involved the use of numbers to track human activity and correlate it with disease (early epidemiology, and the famous London water-pump).
This development, which ultimately pointed to the mobilisation of numbers to make change (including to the landscape of London), was relevant in multiple fields of activity in the nineteenth century including education. Numbers became more important because there was simply more of everything: more people living in crowded cities, more patients collected together in larger hospitals, more students in the schools. It was hard to get a grip on all those people, never mind finding a way of getting them to act in the right ways at the right times--and the more people there were, the more you needed to get them to act the right way, if anything was going to work at all. The connection between nations and numbers is exemplified by the roots of the word "statistics".
Thus Burke argues, "the transition by medicine from bedside to hospital to chemistry is complete. And with it, the disappearance of the patient from our story. His complaint, once voiced personally and authoritatively, is now reduced to a string of numbers on a computer terminal." Burke views the developing medical profession as the beginning of expansive influence for forms of numeric governance. The latter took on an authority that was to extend to numerous areas of our lives--articulated through the use of statistics, correlations, causes and effects. The expertise of doctors is what preserves life, our lives, hence our acceptance of its authority. The (manageable) "population" is born, and here there is a strong connection to Foucault's theories of governance (bio-politics in particular) and his discussions of "medicalisation".
In the final episode of Connections (series 1), James Burke gestures at a linear wall chart of the "History of Agriculture" and articulates his central thesis: "This makes you think in straight lines. And if today doesn't happen in straight lines [...] why should the past have?" Burke's question has implications for the pursuit of (instrumental) knowledge--implications that are clearest in the context of the contemporary university and its shifting position in a network of knowledge "production". What assumptions might be undermined by this view of innovation, in a socio-political landscape so littered with both past accounts and future plans for "strategic" discovery? In what ways might national governments, for example--ever-more dependent upon marketable "innovation" and the development of policy that leads to this profitable result--come to implement/reiterate linear narratives of "progress"?
The search for a successful template for development, or for a proven path to prosperity in uncertain economic times, is constrained by risk. This reminds me of one last point from James Burke (Connections, series 1, episode 1): knowledge of the future tends to bring power over the present. But what role might there be for a re-assessment of the messy, non-linear past?
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Some references for the above topic: James Burke "Re-Connections", a series of recent interviews; The Day the Universe Changed; The Birth of the Clinic and The Order of Things by Michel Foucault; Empire and Communications and The Bias of Communication by Harold Innis; various by Marshall McLuhan (James Burke indirectly quotes McLuhan on a regular basis).
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