Knowledge in the Time of Cholera

by Owen Whooley

  Reason’s “entanglements with social power” (Fricker 2007, 3) is a core insight for any sociological study of epistemology, as are the ethical implications of this insight. Ultimately, the exclusionary nature of some epistemologies and the institutionalization of this exclusion in organizations can create disparities in the allocation of trust and credibility afforded to an individual’s or group’s testimony (Fricker 2007, 1). Some people are excluded from knowing either because their testimonial appeals are ignored or because the hermeneutic systems they draw upon to make claims are misunderstood or devalued (Fricker 2007). The exclusion of some from participating in knowledge production and assessment, whatever the reason, creates power inequalities between the epistemological haves and have-nots.

  This epistemic inequality has negative ramifications not only for those in positions of weakness; taken in the aggregate, it can hurt the community in general if potentially fruitful ways of thinking are closed off. Epistemic closure can result in insularity, creating inward-looking communities of knowledge producers, complete with rigid barriers to entry, which fail to transmit knowledge claims beyond a restricted sphere. The insulation of knowledge in particular epistemic communities “can be thought of as the existence of barriers to communication and experience, barriers that facilitate systemic ignorance and misunderstanding, and the coexistence of otherwise conflicting practices, understandings and expectations” (Reay 2010, 92). Epistemic closure, therefore, is not just an issue of access and participation; it becomes one of communication and knowledge production, as it produces structural incompetencies that constrain potential directions for exploration.

  In this sense, allopathy’s epistemic closure represented a failure of a kind of intellectual humility. For professional, political, and intellectual reasons, allopathic physicians, through the AMA, sought to absorb the uncertainty in medical knowledge into the promises of the laboratory. In the words of William James (1909, 9), allopathic reformers sought “to carve out order by leaving the disorderly parts out.” This endeavor had two components. Intellectually and epistemologically, the laboratory offered a controlled environment bereft of the messy uncertainty of nature. It literally carved out a purified space so as to achieve scientific certainty. By forcing all medical knowledge to conform to a single epistemological system, allopathic reformers vanquished dissenting voices. In doing so, they intentionally stifled the type of debate, dialogue, and interaction that may have borne intellectual and therapeutic fruit. This is not to dismiss the benefits achieved by the laboratory. But it is to worry about the lost opportunities—opportunities that a system more in accord with democratic values might have realized.

  TOWARD A SOCIOLOGY OF EPISTEMOLOGIES

  The main theoretical intervention of this book is to get sociologists thinking about, and engaging with, epistemology. Key to this is the observation that epistemological issues and debates are not confined to the rarefied air of academic philosophy, but rather are practical issues that people must negotiate in social life. They are ripe for sociological analysis. Whereas the conceit of philosophers investigating epistemology is to find a universal grounding for the justification of knowledge, sociologists can bring their empirical sensibility to delineate how these epistemological issues get sorted in practice.

  At root, this book serves as an exercise in the sociology of epistemologies (Abend 2006, 3), one that takes epistemologies as an object of analysis themselves and develops a conceptual toolkit that can assist in further research on the practices by which actors adjudicate true knowledge from false beliefs. It addresses a small, but burgeoning body of research that brings an empirically grounded sensibility to the study of epistemology. Research in historical epistemology challenges the misguided idea that there is a unitary timeless, universal epistemology against which all ideas must be measured by revealing how epistemological standards change over time (see Biagioli 1994; Daston 1992; Daston and Galison 2010; Davidson 2001; Dear 1992; Ginzburg 1980; Jonsen and Toulmin 1988; Poovey 1998; Schweber 2006; Shapin and Schaffer 1985). The fixed, universal standards, for which philosophers pine, are belied by the historical diversity in understandings as to what constitutes legitimate knowledge. Temporalizing the basic attributes of knowledge, historical epistemology disabuses us of the misconception that epistemological standards are timeless and that there exist epistemological rules that hold across all eras and contexts and justify all knowledge. Instead, it presents an invitation for analyses that situate epistemological claims within their historical period. This book shares a great affinity to this research. But it adds a focus on epistemological conflict within the same time period. Whereas historical epistemology focuses on comparison between eras, my work is attuned to struggles within an era of epistemological flux. Rather than focus on broad swaths of changes in knowledge, it attends to the strategies actors deploy when engaged in epistemological disputes during the same period, recognizing the importance of epistemological debates synchronically as well as diachronically.

  Within sociology, the treatment of epistemology as an object of analysis is more scattered. While one can read the entire corpus of the sociology of science in the past three decades—including laboratory studies (e.g., Knorr-Cetina 1999; Latour and Woolgar 1986) and the sociology of knowledge downstream (e.g., Gieryn 1999)—as an epistemological challenge itself to the positivistic accounts of science (Longino 2002), much of the discussion around epistemology is circumscribed to the subfield’s more reflexive moments, in metatheoretical arguments (Fuchs 1992, xvii). In other words, sociologists of science have spent so much time defending themselves against the indictment of relativism that they have not really turned to what should be their main concern: “how do people come to say they know things?” (Kurzman 1994).

  Nevertheless, sociologists in a number of different subfields (e.g., economic sociology, political sociology, sociology of science, etc.) have taken up the challenge of approaching epistemology from an empirical standpoint. Although scattered and disparate, this research suggests rich areas to be explored further. Basic mental actions—classification, perception, the reckoning of time—have social foundations, shaped by the “epistemological styles” (Mallard, Lamont, and Guetzkow 2009) or “sociomental lenses” of the communities to which we belong (Zerubavel 1999). Indeed, conceptions of truth—and in turn, particular ideas—are developed within social networks, “not in isolated brains or disembodied minds” (Collins 2000, 877). Different national contexts produce divergent understandings of what constitutes legitimate knowledge, which is reflected in the diverse organizations for knowledge production (Fourcade-Gourinchas 2001) and the rhetorical forms in which knowledge claims are presented (Abend 2006). Laboratories themselves, though generally committed to the dictates of scientific norms, have diverse internal “epistemic cultures,” which determine the nature of the knowledge they produce (Knorr-Cetina 1999). Organizational factors (e.g., task uncertainty and mutual dependence) determine the degree to which organizations allow for epistemic reflexivity (Fuchs 1992). And epistemological blind spots can produce accidents (Downer 2011) and undermine the effectiveness of political organizations (Glaeser 2011). While this body of research has yet to cohere into an organized research program, the shared sensitivity to the empirical analysis of epistemology presents many exciting opportunities for exploration.

  This book builds on this body of research by introducing and developing the concept of the epistemic contest. By acknowledging the uniqueness of such knowledge disputes, it extends our understanding of the politics of knowledge while simultaneously opening a space for the analysis of epistemological change through struggle. The concept is offered as a complement to the rich tradition of sociological research on knowledge struggle. It is not intended to supplant and absorb this past research. In the end, the sociology of epistemologies that I call for in this book is situated within the tradition of the sociology of knowledge, not the other way around. Credibility contests still abound, as do other disputes that do not inv
olve epistemic struggle. What I offer is a model for the examination of epistemic contests should the conditions of such be operative in a given case. But I want to caution those against reading every knowledge dispute as an epistemic contest. To be defined as an epistemic contest, disputes must revolve around fundamental epistemological issues. Whether these conditions hold is an empirical issue. If they do, then the insights of this book should be of great help in providing a framework and sensitizing concepts. If these conditions do not hold, then this book will offer some insights into other forms of knowledge disputes, but such use must, by necessity, be more careful and nuanced.

  Ultimately, the usefulness of concepts and theories is that they allow the researcher to remain empirically responsible to the case under examination (Reed 2011). In introducing the concept of the epistemic concept, I hope to draw attention to the diversity in types of knowledge disputes, a diversity that is often obscured by the fact that sociological models of knowledge are built mostly upon the analyses of scientific debates. But knowledge disputes are not always about the boundaries of science; they can encompass more fundamental issues. We must appreciate the unique dimensions of epistemic contests and examine the strategies by which actors try to capture epistemic authority in knowledge disputes bereft of clear standards.

  Though exceptional, epistemic contests address the most basic practical and social issue related to knowledge: how do we deem certain claims as legitimate and true, and others as illegitimate and false? Each chapter of the book elaborates on a particular facet of epistemic contests, elucidating the ways in which actors negotiate epistemological issues in practice. Epistemic contests are embedded in organizational arenas in which actors, advocating different epistemological systems, attempt to impose their vision of knowledge, gain epistemic authority, and achieve epistemic closure. The embeddedness of epistemic contests points to the importance of situated rhetoric and the mechanism of resonance in accounting for the success or failure of particular epistemological positions within a given setting. Because epistemic contests operate on a fundamental level in which standards are vague and ill-defined, they are more open than other types of knowledge disputes and, consequently, are waged with a great diversity of strategies. Indeed, perhaps the key difference between epistemic contests and other types of knowledge disputes is the extent to which actors deploy organizational strategies to gain an upper hand in what is, in its essence, a cultural dispute. The sociology of science downstream focuses on cultural practices like boundary work, but in those disputes, there is a well-defined cultural space—science—over which actors are fighting. When such a cultural space is absent, however, organizations become important arbiters in knowledge disputes, and actors thus seek to capture them to promote their epistemological visions. As this book shows, to win epistemic recognition, actors deploy diverse cultural and organizational strategies to frame epistemic authority in different ways, to construct and disseminate discoveries that validate their epistemological systems, and to win influential allies and resources.

  Although these findings are born from a strident commitment to maintaining empirical fidelity to the particular case of nineteenth-century medical disputes, certain elements of my analysis can be abstracted to help understand other cases where similar conditions may hold. Here a brief word on generalizability is in order. Ultimately, the usefulness of any theory or concept is in its ability to interpret particular empirical cases. The recognition of specificity, contextuality, and contingency does not require forgoing general theoretical claims, although it does require some humility when making these claims. The strength of a single case study is that it allows for fine-grained, process-tracing that can accommodate complex causality and a more detailed examination of context (George and Bennett 2005). This is precisely what was needed to tell this story. By attending to the historical details of this particular case, I develop the concept of the epistemic contest by identifying important strategies, processes, and factors at play. But in adopting a single case study method, I trade depth for breadth. When it comes to other cases, there is a limitation to what I can say generally. If an epistemic contest is at play, then the facets discussed herein are operative, but whether or not these conditions hold, is, at the end of the day, an empirical question. What I offer future researchers is not a general theory of epistemic contests, but an elaboration of some of the various strategies, factors, and processes involved in epistemic contests identifiable through my case study. My goal has been to identify elements that may be more or less generalizable to other epistemic contests and that can provide a springboard for beginning to analyze how these issues play out in other debates and arenas. In other words, I hope that my analytical elaboration of the concept of epistemic contests provides some grist for the sociology of epistemologies mill.

  Despite these limits, the idea of epistemic contests could prove quite fruitful for the examination of other cases. Subsequent scholars should take the concept up and manipulate it to fit the needs of their case. Here I offer only a few suggestions of the ways in which the concept might be useful.

  First, as a general rule of thumb, intractable debates with incommensurable positions are a good place to find epistemic contests. Because medical issues involve the experiential knowledge of the patient, the practical knowledge of the clinician, and the scientific knowledge of the medical expert, medicine is rife with epistemic contests. For example, the incorporation of Complementary and Alternative Medicine (CAM) into mainstream scientific medicine involves some real epistemic tensions, especially around issues of testing and evaluating treatments. CAM advocates argue that biomedical testing procedures fail to capture the essence of CAM’s efficacy. How can CAM treatments be adequately assessed if the whole of the person is not taken into account? Biomedical advocates retort that they cannot be expected to use unproven remedies. An uncertain stalemate ensues, bogged down in issues of incommensurability. Similar issues arise in cross-cultural exchanges of medical systems, particularly between Eastern and Western medical traditions. As medicine becomes globalized, these incommensurable systems interact, and often clash, in interesting ways. For example, in his analysis of the pluralities of modern Chinese medicine, Volker Scheid (2002) describes a hospital pharmacy in which one half is dedicated to modern medicines, the other to traditional herbal Chinese cures. One side is the model of modern science, the other the picture of folk wisdom. The two reside in the same space in a situation of constant tension and negotiation. Studying these separate-but-equal arrangements can shed light on epistemic contests that, unlike the case discussed in this book, do not result in one dominant epistemology or achieve epistemic closure. Andrew Lakoff (2005) has identified similar cross-cultural issues that have arisen in the importation of the biomedical model of mental illness to Argentina, a country with a long tradition of psychoanalytic psychiatry.

  Second, the concept might help shed light on the divisions between biomedical research and clinical practice that are prevalent among health professionals (see Freidson 1970; Montgomery 2006). Misconstrued as a technical problem, the tension between researchers and clinicians has deep roots. Rather than the specific exigencies of clinical practice, the salient issue is epistemological in nature. Quite simply, the divergent roles that clinicians and researchers serve in the profession lead to different orientations toward knowledge and competing models of what constitutes useful knowledge. The epistemological tensions between researchers and clinicians reflect a classic distinction, noted by Aristotle, between episteme and phronesis (Jonsen and Toulmin 1988). Episteme is what we now understand as scientific reasoning in which the goal is to illuminate universal and general rules, to uncover timeless Truth. Clinicians, in contrast, approach knowledge differently, adopting a more practical posture toward knowing (Montgomery 2006). Practical wisdom, or what Aristotle calls phronesis, addresses particular cases and specific quandaries, employing, not maxims or rules, but a network of considerations to be tested by trial and error. It operates in the r
ealm of the concrete, the temporal, and the presumptive. While phronesis and episteme are not inherently opposed, their relationship can be contentious, as the generalizing tendencies of episteme can threaten to devalue an appreciation of the idiosyncrasies of the clinical interaction. Understanding the epistemological roots in the researcher/clinician divide may prevent us from misreading issues like clinician resistance to evidence-based medicine (EBM) as merely technical problems and focus our attention on how to translate between epistemological orientations.

  Finally, the concept could prove useful in examining those marginal diseases, or “contested diseases,” like fibromyalgia, environmental illness, chronic fatigue syndrome, and sick-building syndrome (see Barker 2005; Dumit 2006; Kroll et al. 2000; Murphy 2006). Here the issue is a clash between the biomedical model and more experientially based knowledges. Unable to detect these diseases through conventional biomedical means, some medical professionals deny their existence. However, patient advocacy groups vie for recognition, and the resources (i.e., insurance coverage) that accompany recognition, by appealing to experiential knowledge. How these issues get sorted out in practice could be examined fruitfully by bringing these epistemological issues to the forefront of the analysis.

  Epistemic contests are not confined to medicine; they proliferate in other areas of social life as well. The classic cases come from the perpetual disputes between religion and science. Indeed, the Catholic Church’s censorship of Galileo and his heliocentric universe in the seventeenth century is in many ways the paradigmatic example of an epistemic contest. Galileo’s insight was rooted in his telescope, the Church’s in the Bible. Galileo drew his insight from his own eyes, the Church from its clerical tradition. The modern incarnation of this, the debates over evolution, repeats this age-old epistemic contest in many ways.10 Other examples of contemporary epistemic contests are the debates over postmodernism in academia, local environmental disputes like controversies over fisheries that pit local experiential knowledge against environmental science (see Marlor 2010), conflicts between the collective memory of communities and the historical knowledge produced by historians (Whooley 2008), the various cross-cultural confusions that proliferate under globalization, and even talent evaluation in baseball front offices, where new, advanced statistical analyses clash with the traditional wisdom of the baseball scout (see Lewis 2004).