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Science and Cultural Theory
The Body Multiple: Ontology in Medical Practice
The Body Multiple is an extraordinary ethnography of an ordinary disease. Drawing on fieldwork in a Dutch university hospital, Annemarie Mol looks at the day-to-day diagnosis and treatment of atherosclerosis. A patient information leaflet might describe atherosclerosis as the gradual obstruction of the arteries, but in hospital practice this one medical condition appears to be many other things. From one moment, place, apparatus, specialty, or treatment, to the next, a slightly different “atherosclerosis” is being discussed, measured, observed, or stripped away. This multiplicity does not imply fragmentation; instead, the disease is made to cohere through a range of tactics including transporting forms and files, making images, holding case conferences, and conducting doctor-patient conversations. The Body Multiple juxtaposes two distinct texts. Alongside Mol’s analysis of her ethnographic material—interviews with doctors and patients and observations of medical examinations, consultations, and operations—runs a parallel text in which she reflects on the relevant literature. Mol draws on medical anthropology, sociology, feminist theory, philosophy, and science and technology studies to reframe such issues as the disease-illness distinction, subject-object relations, boundaries, difference, situatedness, and ontology. In dialogue with one another, Mol’s two texts meditate on the multiplicity of reality-in-practice. Presenting philosophical reflections on the body and medical practice through vivid storytelling, The Body Multiple will be important to those in medical anthropology, philosophy, and the social study of science, technology, and medicine.
216 pages, Paperback
First published January 1, 2002
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Displaying 1 - 27 of 27 reviews
January 17, 2013
Perhaps a foreign concept to many (as it certainly was to me), Mol's aim is for an ethnography of disease, specifically as it is enacted through various modes of interactions among various agents, with the subsequent result being a multiplicity of different (potential) realities to this singular object we have come to call "atherosclerosis." However, rather than being a trivial exercise in semantics, her argument builds up to an activist tone toward the end, posing questions that can perhaps guide us toward a view of health and disease with a reintroduction of the subject, and shifting toward an (re)inclusion of one's knowledge of their own body, distinct from the structures of knowledge opposed from the power-structures overhead. Although some may feel compelled to shy away from the subtext that runs throughout the entire length of the book, I really found her arguments to be more coherent by trading off section by section from subtext to main narrative.
December 13, 2021
This book was not primarily an enjoyable read - I found the format of the main ethnographic text presented along a separate and literal subtext to be challenging and frustrating, like attempting to read 2 books at once (and I don’t know if that’s an ADHD-specific difficulty or a common one, lol). However, I think what Mol was able to do using this format was fascinating and impressive. I did find myself wishing that the references to “the literature” (which were entirely in the subtext) were integrated narratively into the main ethnographic text, but separating them out allowed Mol to delve much more deeply and substantively into relevant literature, allowing the space to both substantively explore concepts in the literature and to do a sort of historiographical survey of it. As well, keeping the ethnographic text on its own allowed an impressive level of detail, specificity, and focus on the ethnographic material itself, which greatly strengthened her arguments and illustrations of them. The result was a very concrete, evidence-based, clearly grounded-in-practice series of arguments.
I did find myself often wondering what the point of Mol’s illustrations and sub-arguments were throughout the book; and once I got to the final chapter, I was almost relieved to see everything tied together there. My critique is that this overarching argument could’ve been more clearly and persistently present throughout the book - the granularity and detail of Mol’s ethnography is at once a strength and a weakness, as it provides a very strong and clear evidence/explanatory base, but also left me wanting for a more global or meaningful expression of relevance. (Which, again, she does beautifully in the last chapter, but it would have been nice and more convincing as a reader to see that a little bit sooner and more persistently).
I also appreciate that Mol is very careful and bounded about her claims. She also preempts critiques of this work, such as that it’s not universal enough to be proper philosophy - but then demonstrates and argues why universality is not her goal, for example. This care, attention, and clarity to what the work is actually doing is something I find very valuable and that strengthens her arguments: and what she does claim to do, which is provide a philosophical account clearly grounded in practice (a praxiography of sorts), is done well. The reasons for doing this are also laid out clearly and clearly tied to conversations happening in the literature, which I think is impressive. I am convinced by her case for a situated and localized theoretical investigation, even though I admit I often itched for more universality in this book. Following her own theoretical frame, though, I’m able to appreciate the choices she made in that regard.
I also want to comment on the idea of the body multiple, and multiplicity- and ontology-in-practice. Mol’s demonstration of how these exist and are enacted, by investigating and explaining their material manifestations in detail, is excellent, clear, and convincing. I would have never myself thought about, for example, a body and veins existing alongside each other rather than one within the other, but Mol’s sketch of how these are conceptualized ontologically as separate, next-to-each-other within the hospital is novel (to me at least), interesting, and convincing. The ontological construction of a thing (atherosclerosis in this case) being more than one and less than many is shown extremely well. I yearned for a clear application for this concept - why should we care, what does it mean for practice, what does it tell us exactly? And I think this is another thing that Mol actively and intentionally resists, in a way I find both frustrating and admirable. I think the general call to further investigate and attend to multiplicity-in-practice is sensical and clearly flows from this particular exploration, but even as I keep thinking about it, it still feels a bit wishy-washy. There’s no clear takeaway beyond the multiplicity and perhaps messiness of medical practice. I suppose it provides a new frame(work) for thinking about medicine and disease and illness, which I think is exactly the goal with this text, but I struggle to see how this framework is broadly useful or can be applied concretely. I grapple with this because it’s perhaps not necessary for it to be broadly useful or concretely applicable; this may not diminish its usefulness. This may just be my personal preference or desire for a clear(er) takeaway as a reader. Similarly, I wished the text was more clearly political, and simultaneously I recognize that this was not an ostensibly political text and instead is really about a philosophical concept in practice. This may again be my personal preference for political framing (mind you, philosophy is and can be political as well...so the philosophical nature of the text shouldn’t preclude politicism...but I acknowledge the politicism is just the frame I like and not necessarily a weakness of the book). But I will say that I think all of these gripes culminate to my opinion that while this text is very strong at explanation and demonstration, it is not as argumentatively strong, both in the clarity and nature of arguments being made. I think the book successfully does what it sets out to do, so it’s difficult to make this critique, but I’m still left with a sense that it could have had more of a tangible takeaway. Perhaps this text just needs to be viewed as a novel sketching-out of a specific concept that, as Mol notes, deserves further investigation, and perhaps it is just these further investigations that should provide the more tangible takeaways.
Another aside: the fleeting attention to gender in medical practice is really interesting, and also not as sophisticated in its critiques or analyses of gender as I would have hoped. Gender is binarized and biologically essentialized here, which was disappointing to see and a bit surprising considering Mol touches on performativity (although not explicitly in relation to gender - but I believe Butler is still cited there). I think there’s a lot of rich and interesting and important analysis to be done with respect to gender in medical practice, especially with gender uncoupled from biological essentialism and from the binary, that I wish I would’ve seen here. Of course, the gender stuff is not central to this book or its arguments and so is not a critique I can substantively level at the entire book, but as an aside this little portion of it left me wanting!
As I said to a friend (S/O when you read this): I would probably recommend this book to someone for its interesting, novel, fresh (as much as it could be for a book published in 2002, lol) approach, but with the caveat that it’s a bit of a frustrating read and that the arguments really come together at the very end. My opinions of the book in the middle of reading it and having finished it are very different: that last chapter does a lot of work to make everything come together and kind of has the book redeem itself. It’s a detailed, granular account of ontology and multiplicity in medical practice through the disease atherosclerosis, and so to anyone who wants to understand or think about ontological multiplicity in a medical context, I would recommend this.
I did find myself often wondering what the point of Mol’s illustrations and sub-arguments were throughout the book; and once I got to the final chapter, I was almost relieved to see everything tied together there. My critique is that this overarching argument could’ve been more clearly and persistently present throughout the book - the granularity and detail of Mol’s ethnography is at once a strength and a weakness, as it provides a very strong and clear evidence/explanatory base, but also left me wanting for a more global or meaningful expression of relevance. (Which, again, she does beautifully in the last chapter, but it would have been nice and more convincing as a reader to see that a little bit sooner and more persistently).
I also appreciate that Mol is very careful and bounded about her claims. She also preempts critiques of this work, such as that it’s not universal enough to be proper philosophy - but then demonstrates and argues why universality is not her goal, for example. This care, attention, and clarity to what the work is actually doing is something I find very valuable and that strengthens her arguments: and what she does claim to do, which is provide a philosophical account clearly grounded in practice (a praxiography of sorts), is done well. The reasons for doing this are also laid out clearly and clearly tied to conversations happening in the literature, which I think is impressive. I am convinced by her case for a situated and localized theoretical investigation, even though I admit I often itched for more universality in this book. Following her own theoretical frame, though, I’m able to appreciate the choices she made in that regard.
I also want to comment on the idea of the body multiple, and multiplicity- and ontology-in-practice. Mol’s demonstration of how these exist and are enacted, by investigating and explaining their material manifestations in detail, is excellent, clear, and convincing. I would have never myself thought about, for example, a body and veins existing alongside each other rather than one within the other, but Mol’s sketch of how these are conceptualized ontologically as separate, next-to-each-other within the hospital is novel (to me at least), interesting, and convincing. The ontological construction of a thing (atherosclerosis in this case) being more than one and less than many is shown extremely well. I yearned for a clear application for this concept - why should we care, what does it mean for practice, what does it tell us exactly? And I think this is another thing that Mol actively and intentionally resists, in a way I find both frustrating and admirable. I think the general call to further investigate and attend to multiplicity-in-practice is sensical and clearly flows from this particular exploration, but even as I keep thinking about it, it still feels a bit wishy-washy. There’s no clear takeaway beyond the multiplicity and perhaps messiness of medical practice. I suppose it provides a new frame(work) for thinking about medicine and disease and illness, which I think is exactly the goal with this text, but I struggle to see how this framework is broadly useful or can be applied concretely. I grapple with this because it’s perhaps not necessary for it to be broadly useful or concretely applicable; this may not diminish its usefulness. This may just be my personal preference or desire for a clear(er) takeaway as a reader. Similarly, I wished the text was more clearly political, and simultaneously I recognize that this was not an ostensibly political text and instead is really about a philosophical concept in practice. This may again be my personal preference for political framing (mind you, philosophy is and can be political as well...so the philosophical nature of the text shouldn’t preclude politicism...but I acknowledge the politicism is just the frame I like and not necessarily a weakness of the book). But I will say that I think all of these gripes culminate to my opinion that while this text is very strong at explanation and demonstration, it is not as argumentatively strong, both in the clarity and nature of arguments being made. I think the book successfully does what it sets out to do, so it’s difficult to make this critique, but I’m still left with a sense that it could have had more of a tangible takeaway. Perhaps this text just needs to be viewed as a novel sketching-out of a specific concept that, as Mol notes, deserves further investigation, and perhaps it is just these further investigations that should provide the more tangible takeaways.
Another aside: the fleeting attention to gender in medical practice is really interesting, and also not as sophisticated in its critiques or analyses of gender as I would have hoped. Gender is binarized and biologically essentialized here, which was disappointing to see and a bit surprising considering Mol touches on performativity (although not explicitly in relation to gender - but I believe Butler is still cited there). I think there’s a lot of rich and interesting and important analysis to be done with respect to gender in medical practice, especially with gender uncoupled from biological essentialism and from the binary, that I wish I would’ve seen here. Of course, the gender stuff is not central to this book or its arguments and so is not a critique I can substantively level at the entire book, but as an aside this little portion of it left me wanting!
As I said to a friend (S/O when you read this): I would probably recommend this book to someone for its interesting, novel, fresh (as much as it could be for a book published in 2002, lol) approach, but with the caveat that it’s a bit of a frustrating read and that the arguments really come together at the very end. My opinions of the book in the middle of reading it and having finished it are very different: that last chapter does a lot of work to make everything come together and kind of has the book redeem itself. It’s a detailed, granular account of ontology and multiplicity in medical practice through the disease atherosclerosis, and so to anyone who wants to understand or think about ontological multiplicity in a medical context, I would recommend this.
August 26, 2024
Would it be strange to say that this charming ethnography of the treatment of one single disease in one single Dutch hospital published in 2002 has things to teach us about the perennial question of Being itself? That, to the esteemed Parmenidean inquiry into “What Is?”, can answers be found in the clinical practices of vascular medicine? Annemarie Mol doesn’t put it this way - she writes personably, clearly, and without pretension - but that’s really what’s at stake in this intriguing and one-of-a-kind book. As for what, in fact, ‘Is’, Mol’s answer is disarmingly simple: practices. In fact there are as many distinct ‘things’ as there are things done, and it is in the doing - the ‘enacting’ as Mol says - that things themselves come to be individuated as things as all. To show that there are multiple actually existing realities in the here and now - and not just multiple ‘perspectives’ on reality: such are the grand ambitions of this powerful punch of a study.
Mol’s ‘thing’, the object of her book, is atherosclerosis. Often understood as a disease of artery walls, Mol’s attention to the various ways in which atherosclerosis is enacted in the hospital discloses not 'an' atherosclerosis, but a multiplicity of the illness. Simple example: that atherosclerosis is a pain in my leg, degrading my quality of life, is rather different from the atherosclerosis of the doctor, for whom it is a thickening of the intima (innermost layer) of my vessel walls. And so too is it different again for the technician taking measurements with his instruments for diagnostic reasons, no less than for the surgeon in her operating theatre with her own quite distinct set of tools and aims. This multiplicity of atherosclerosis, whose unity is often simply taken for granted, is exactly what is challenged by Mol’s patient and careful attending to the practicalities of the disease - here under the microscope, there in the clinic, further afar beneath the knife.
That they are in fact ‘different’ at all - an already startling claim on the face of it - is the burden that The Body Multiple takes up, and it does so compellingly. Much of the book is given over not just to arguing that there are differences between these modes of atherosclerosis, but in demonstrating how they cohere, conflict, avoid, include and generally interact with and against each other in different settings. This is the true wonder of the book, and Mol’s incorporation of a range of testimony from hospital personnel and patients shows just how each enactment of atherosclerosis really does figure the disease in different ways. From diagnosis to research, epidemiology to treatment, each practice of atherosclerosis crosses paths in sometimes unexpected and always interesting ways with its ‘fellow practices’, spurring resonant effects which can only be accounted for by the multiply enacted reality of the singular illness - or so argues Mol.
It’s this last move, of pitching the ‘advantages’ of treating ontology as a matter of practice(s), that gives this book its cutting philosophical edge. Indeed ‘practice’ here is shown to slice across a great many of our cherished classical distinctions: between subject and object, self and other, population and individual - each singular advent of atherosclerosis instead ‘distributing’ such distinctions only as appropriate to the particular case in hand, without those distinctions determining ontology from the outside. It’s a brilliant and quietly subversive procedure, especially for a book with so hyper-focused an object of study. Still, one is tempted to ask, for all its detailing of multiple realities - does this all nonetheless lend itself to ‘an’ ontology regardless? Can there be, at the end of it, a revenge of philosophy on the dispersive effects of ethnography? At least that’s the question I was left with!
A closing word on the book’s form: The Body Multiple is, equally, a text multiple. I mean this quite literally: the book in fact comprises of two parallel tracts of writing, one above the other, the first being the ethnography proper, the second, a running commentary on selected relevant literature. Without speaking to the content of these tracts, I’ll simply mention that I adored this two-track format, and wish it were more often used. It gave reading this book a really interactive feel, and I found myself just that much more engaged with the text(s) - trying to relate top and bottom, pages I’d read ahead to those I’d have to return to for the alternate track: a kind of pared down academic version of those ‘choose your own adventure’ stories - the adventure here being rather in the contingent connections of ideas multiply realised.
Mol’s ‘thing’, the object of her book, is atherosclerosis. Often understood as a disease of artery walls, Mol’s attention to the various ways in which atherosclerosis is enacted in the hospital discloses not 'an' atherosclerosis, but a multiplicity of the illness. Simple example: that atherosclerosis is a pain in my leg, degrading my quality of life, is rather different from the atherosclerosis of the doctor, for whom it is a thickening of the intima (innermost layer) of my vessel walls. And so too is it different again for the technician taking measurements with his instruments for diagnostic reasons, no less than for the surgeon in her operating theatre with her own quite distinct set of tools and aims. This multiplicity of atherosclerosis, whose unity is often simply taken for granted, is exactly what is challenged by Mol’s patient and careful attending to the practicalities of the disease - here under the microscope, there in the clinic, further afar beneath the knife.
That they are in fact ‘different’ at all - an already startling claim on the face of it - is the burden that The Body Multiple takes up, and it does so compellingly. Much of the book is given over not just to arguing that there are differences between these modes of atherosclerosis, but in demonstrating how they cohere, conflict, avoid, include and generally interact with and against each other in different settings. This is the true wonder of the book, and Mol’s incorporation of a range of testimony from hospital personnel and patients shows just how each enactment of atherosclerosis really does figure the disease in different ways. From diagnosis to research, epidemiology to treatment, each practice of atherosclerosis crosses paths in sometimes unexpected and always interesting ways with its ‘fellow practices’, spurring resonant effects which can only be accounted for by the multiply enacted reality of the singular illness - or so argues Mol.
It’s this last move, of pitching the ‘advantages’ of treating ontology as a matter of practice(s), that gives this book its cutting philosophical edge. Indeed ‘practice’ here is shown to slice across a great many of our cherished classical distinctions: between subject and object, self and other, population and individual - each singular advent of atherosclerosis instead ‘distributing’ such distinctions only as appropriate to the particular case in hand, without those distinctions determining ontology from the outside. It’s a brilliant and quietly subversive procedure, especially for a book with so hyper-focused an object of study. Still, one is tempted to ask, for all its detailing of multiple realities - does this all nonetheless lend itself to ‘an’ ontology regardless? Can there be, at the end of it, a revenge of philosophy on the dispersive effects of ethnography? At least that’s the question I was left with!
A closing word on the book’s form: The Body Multiple is, equally, a text multiple. I mean this quite literally: the book in fact comprises of two parallel tracts of writing, one above the other, the first being the ethnography proper, the second, a running commentary on selected relevant literature. Without speaking to the content of these tracts, I’ll simply mention that I adored this two-track format, and wish it were more often used. It gave reading this book a really interactive feel, and I found myself just that much more engaged with the text(s) - trying to relate top and bottom, pages I’d read ahead to those I’d have to return to for the alternate track: a kind of pared down academic version of those ‘choose your own adventure’ stories - the adventure here being rather in the contingent connections of ideas multiply realised.
June 4, 2022
Para Annemarie:
Una vez finalizado tu libro me veo en la necesidad de escribirte, y no sólo por iniciativa propia, sino porque tú misma invitas a conversarte en cada uno de tus capítulos. Pasarlo por alto sería como dejarte hablando sola.
Primero te anuncio un enorme gracias por compartir tu experiencia, que más allá de ser solo una experiencia investigativa, eres tú y tu experiencia vivida. Toma mucho sentido la investigación académica si se construye como un proceso íntimo y no como un trabajo que busca ser galardonado y citado. Tuve que imprimir tu libro para poder leerlo. Y resultó una forma muy eficaz de involucrarme con tus pensamientos.
Sobre el contenido del libro, te comento que me acompañó durante toda la lectura una idea que un profesor de universidad comentó alguna vez “la antropología es hacer filosofía de la vida humana”, y justamente tu experiencia aquí escrita y descrita es eso, filosofía echa praxis, es involucramiento y es desmenuzamiento (de desmenuzar) con y de la dinámica del tan voluptuoso hospital Z.
Te entrometes con temas fundamentales para el quehacer reflexivo de la antropología con intereses en el estudio de procesos de salud y enfermedad, como la relación profesional-paciente/cliente, las diferentes dimensiones de la enfermedad, los idearios respecto al cuerpo y sobretodo los idearios hechos "acción" en el cuerpo y desde el cuerpo.
Usar el término ontología no es algo tan ligero. A mi se me hace difícil comprenderlo y creo firmemente que no es un problema cognitivo exclusivamente mío, más bien es un problema que recae en el poder significativo de las palabras. Éstas, tienen un especial poder de absorción, y si la gente históricamente ha sostenido que ontología es una palabra compleja, entonces, lo es con tan solo oírla. Sin embargo, debo admitir que me despierta una curiosidad tremenda y como decidiste usarla para el título de tu libro, fue esa curiosidad la que me llevó a leerte. Para mi agradable sorpresa pudiste abordarla, explicarla y por sobretodo ejemplificarla de maneras que creo son necesarias de propagar y por supuesto no únicamente dentro de formaciones médicas, sino de cualquier formación educativa. ¿Por qué? porque ontología no es más que la creatividad humana puesta en práctica. No hay una sola forma de hacer biomedicina, es un hacer múltiple, transformativo e inquieto. Como así no hay solo un tipo de vida indígena, ni un tipo de vida empresarial, ni un tipo de vida judeo-cristiana, ni budista. Todo tipo de vida que parece una esfera homogénea, es en realidad una selva múltiple e infinita. Y trabajar con el hacer y entenderlo como múltiple abre espacio no sólo a entender lo diverso sino que también a re-pensar el lenguaje en tanto elemento que fija idearios. Por ejemplo, he aquí algunas frases con las que me he relacionado últimamente:
“En los hospitales matan gente”
“La salud está super mal en el país”
“Los hospitales son lugares desagradables”
“Los médicos no quieren nuestro bienestar”
Todas son parte -y sin saberlo- de una bolsa gigante de frases que construyen el ideario sobre lo que es salud en Chile (el país donde resido) y que nos predisponen a ser salud (en tanto estado) y ha relacionarnos con la salud de determinada forma. El trabajo que haces de responder qué es lo que realmente ocurre en el hospital Z, en la sala de cirugía, en el laboratorio laboratorio, o incluso en las conversaciones que allí emergerion, es fundamental para dejar de influenciarnos por nuestros propios (que son también colectivos) prejuicios. Este ejercicio de detener el pensamiento y desmenuzarlo para entender que materia prima lo construye, que materia construye nuestro lenguaje, y por sobretodo que materia prima construye nuestras ideas (esas que nos acompañan a vivir) es un profundo ejercicio de autoconocimiento y autocuidado.
Gracias por no decretar verdades únicas y gracias por dejar un final abierto que permite seguir tejiendo la red de ideas que nos regalas en este lindo viaje del hacer .
Una vez finalizado tu libro me veo en la necesidad de escribirte, y no sólo por iniciativa propia, sino porque tú misma invitas a conversarte en cada uno de tus capítulos. Pasarlo por alto sería como dejarte hablando sola.
Primero te anuncio un enorme gracias por compartir tu experiencia, que más allá de ser solo una experiencia investigativa, eres tú y tu experiencia vivida. Toma mucho sentido la investigación académica si se construye como un proceso íntimo y no como un trabajo que busca ser galardonado y citado. Tuve que imprimir tu libro para poder leerlo. Y resultó una forma muy eficaz de involucrarme con tus pensamientos.
Sobre el contenido del libro, te comento que me acompañó durante toda la lectura una idea que un profesor de universidad comentó alguna vez “la antropología es hacer filosofía de la vida humana”, y justamente tu experiencia aquí escrita y descrita es eso, filosofía echa praxis, es involucramiento y es desmenuzamiento (de desmenuzar) con y de la dinámica del tan voluptuoso hospital Z.
Te entrometes con temas fundamentales para el quehacer reflexivo de la antropología con intereses en el estudio de procesos de salud y enfermedad, como la relación profesional-paciente/cliente, las diferentes dimensiones de la enfermedad, los idearios respecto al cuerpo y sobretodo los idearios hechos "acción" en el cuerpo y desde el cuerpo.
Usar el término ontología no es algo tan ligero. A mi se me hace difícil comprenderlo y creo firmemente que no es un problema cognitivo exclusivamente mío, más bien es un problema que recae en el poder significativo de las palabras. Éstas, tienen un especial poder de absorción, y si la gente históricamente ha sostenido que ontología es una palabra compleja, entonces, lo es con tan solo oírla. Sin embargo, debo admitir que me despierta una curiosidad tremenda y como decidiste usarla para el título de tu libro, fue esa curiosidad la que me llevó a leerte. Para mi agradable sorpresa pudiste abordarla, explicarla y por sobretodo ejemplificarla de maneras que creo son necesarias de propagar y por supuesto no únicamente dentro de formaciones médicas, sino de cualquier formación educativa. ¿Por qué? porque ontología no es más que la creatividad humana puesta en práctica. No hay una sola forma de hacer biomedicina, es un hacer múltiple, transformativo e inquieto. Como así no hay solo un tipo de vida indígena, ni un tipo de vida empresarial, ni un tipo de vida judeo-cristiana, ni budista. Todo tipo de vida que parece una esfera homogénea, es en realidad una selva múltiple e infinita. Y trabajar con el hacer y entenderlo como múltiple abre espacio no sólo a entender lo diverso sino que también a re-pensar el lenguaje en tanto elemento que fija idearios. Por ejemplo, he aquí algunas frases con las que me he relacionado últimamente:
“En los hospitales matan gente”
“La salud está super mal en el país”
“Los hospitales son lugares desagradables”
“Los médicos no quieren nuestro bienestar”
Todas son parte -y sin saberlo- de una bolsa gigante de frases que construyen el ideario sobre lo que es salud en Chile (el país donde resido) y que nos predisponen a ser salud (en tanto estado) y ha relacionarnos con la salud de determinada forma. El trabajo que haces de responder qué es lo que realmente ocurre en el hospital Z, en la sala de cirugía, en el laboratorio laboratorio, o incluso en las conversaciones que allí emergerion, es fundamental para dejar de influenciarnos por nuestros propios (que son también colectivos) prejuicios. Este ejercicio de detener el pensamiento y desmenuzarlo para entender que materia prima lo construye, que materia construye nuestro lenguaje, y por sobretodo que materia prima construye nuestras ideas (esas que nos acompañan a vivir) es un profundo ejercicio de autoconocimiento y autocuidado.
Gracias por no decretar verdades únicas y gracias por dejar un final abierto que permite seguir tejiendo la red de ideas que nos regalas en este lindo viaje del hacer .
June 8, 2018
A great book where Annemarie Mol questions not the epistemological approaches to atherosclerosis, but rather looks at the multiple ontologies of atherosclerosis made in different sites across a hospital. It does a great job of answering and demonstrating how a single object, like the body (not bodies), can be multiple and still hang together (a question that Lisa Blackman also asks). To me it really demonstrates an analogous example of the 2 slit experiment Karen Barad discusses, where the electron is diffracted, dispersed, and multiple (like the body), until a which-slit detector is used (or perhaps an angiogram in this case, or even a doppler). I think Vicki Kirby's work on representation and the figure could add a bit more nuance to her conceptualization of representations of atherosclerosis v. atherosclerosis itself. Overall great book that demonstrates what theory looks like in practice and how valuable it is, and how despite the endless controversy about diseases, what they are, and what causes them - in practice we don't see often see bursts of arguments about what to do, life is able to go on regardless of contradiction, and this book explains how.
August 22, 2013
I don't know what to think of this one yet. It's not an ethnography, it's a mixture of really smart playing with genres and a bit of smoke and mirrors. Two parallel texts the upper supposedly ethnographic and the bottom supposedly theoretical. But really, they're both theoretical. And the book is not about arteriosclerosis or really even about the body. In its own vocabulary, it does political ontology (err, enacts political ontology) via the body. Things I like: the notion of the body as (as per Hacking) "technique dependent multiplicity"--being more than one but less than many. I think this sort of approach is what later gets called fractality (one of the emergent -alities of Post-ANT) though that term doesn't actually crop up in this book. I like that she "doesn't forget the microscope"--the techniques/technologies necessary to enacting versions of disease--it gives the argument a pleasing CLUE-ness (Professor Plum in the Conservatory with the Nightstick--Arteriosclerosis in the Pathology Lab with the Sardonic Resident with the Microscope). I don't know if this not being ethnography excuses some of the ethnography. The one thing that sort of stuck in my craw is that at one point she attributes all of David Schneider's work on kinship to Marilyn Strathern. My undergrads didn't like this as much as Expressiveness of the Body but had a lot more to say about it.
8/13 -- Fractionality, no? Having taught this a second time, it's fair to say that no undergrad likes this book, but still, it's useful to think with. Next time to be read in concert with Barbara Duden....
8/13 -- Fractionality, no? Having taught this a second time, it's fair to say that no undergrad likes this book, but still, it's useful to think with. Next time to be read in concert with Barbara Duden....
January 25, 2015
The book, its focus and aim, and unique construction are interesting, but to what end? Particularly given her reticence with regard to collaboration and the absence of an applied component to Mol's anthropology, the work presents a compelling depiction that ultimately garners no real academic or tangible gain.
October 24, 2021
read for class. in the genre of books looking for the third step to the take in the positivism -> constructivism -> ... sequence. i enjoyed the ethnography but found the theory fairly dense and intermittently off-putting
September 13, 2018
Fantastic situated theory, compelling and acute yet clear writing. Made me rethink dichotomies and their multiplying.
Read
May 24, 2023The idea of having two distinct texts juxtaposed one above the other, running in parallel throughout a book, sounds like an interesting experiment in theory, but at least in this instance, I found it very difficult to follow arguments and the general course of Mol’s narration. I’m notorious for reading many books at once, but there’s something about switching between texts after every single page that makes this so difficult. This would also not be an accessible text for those who depend on having devices read texts out to them, because it’s very difficult to follow when the speech synthesizer is switching between the main text and subtext.
Mol's main proposal here is that instead of dwelling on issues of medical epistemology, we think about medical practices.
One question this book addresses, one might say is: what is atherosclerosis? It is generally described as a condition where plaque accumulates in arteries and limits blood flow and hence oxygen reaching muscles, resulting in pain. However, Mol suggests instead of focusing on knowledge about athereosclerosis, what if we instead think about the multiple ways this condition is enacted. Mol studies four different practices of enacting lower-limb atherosclerosis, and concludes that these different practices actually enact different types of atherosleroses. Theoretically its all the same condition, but in practice it is not.
While this is a constructivist account in many ways (in my view), Mol prefers the metaphor of performance. In the same way an opera production takes resources and good money, successfully performing an object like atheroscleroses is not an arbitrary matter of improv, but it requires costly artifacts and spaces like the hospital departments Mol describes in this book.
I much more enjoyed Mol’s paper on the Zimbabwe bush pump written with Marianne de Laet. I wonder though if the reason I enjoyed it so much was because I was an engineering student who found it refreshing to hear technical drawings and specifications described in such an unfamiliar way. Perhaps if I was a medical student this book would have been as enjoyable.
Mol's main proposal here is that instead of dwelling on issues of medical epistemology, we think about medical practices.
One question this book addresses, one might say is: what is atherosclerosis? It is generally described as a condition where plaque accumulates in arteries and limits blood flow and hence oxygen reaching muscles, resulting in pain. However, Mol suggests instead of focusing on knowledge about athereosclerosis, what if we instead think about the multiple ways this condition is enacted. Mol studies four different practices of enacting lower-limb atherosclerosis, and concludes that these different practices actually enact different types of atherosleroses. Theoretically its all the same condition, but in practice it is not.
While this is a constructivist account in many ways (in my view), Mol prefers the metaphor of performance. In the same way an opera production takes resources and good money, successfully performing an object like atheroscleroses is not an arbitrary matter of improv, but it requires costly artifacts and spaces like the hospital departments Mol describes in this book.
I much more enjoyed Mol’s paper on the Zimbabwe bush pump written with Marianne de Laet. I wonder though if the reason I enjoyed it so much was because I was an engineering student who found it refreshing to hear technical drawings and specifications described in such an unfamiliar way. Perhaps if I was a medical student this book would have been as enjoyable.
September 18, 2023
Es un libro increíble en muchos aspectos. Se trata de un estudio etnográfico de la arterioesclerosis en las piernas y su objetivo es mostrar como las prácticas médicas "ponen en acción" la patología generando arterioesclerosis diferentes. De la misma manera, el libro pone en acción, como su objeto de estudio, diferentes realidades (más de una, pero no muchas) a través de un mismo relato: una etnografía de las prácticas médicas en hospitales, una introducción accesible pero rigurosa al estudio social de la ciencia y la tecnología, un libro sobre ontología y empirismo y, que además, exuda política por todos sus poros. Por último, un libro sobre constructivismo a la altura de una disciplina que ha perdido demasiado el tiempo defendiéndose de "hombres de paja" creados por sus adversarios (aunque a veces los peores enemigos del constructivismo son ellos mismos). El constructivismo, se esté de acuerdo o no, es una teoría muy seria, compleja y refinada, y este libro es una muestra excelente.
Una maravilla, instant classic.
Una maravilla, instant classic.
July 22, 2025
Interesting and overall very readable. Very happy to read a Science and Technology Studies book that does not take place in a lab or some other prestigeous place, but at a normal hospital.
What I found difficult is the double text layout (Every chapter is two texts, the top 2/3 taken by one text, the bottom 1/3 by another text). It would be worth it, if the subtext (haha) would directly relate to what the text says on any given page but the layout reflects only that the two texts in each chapter relate to each other as two chunks of text. This makes it 90s-ironic-STS-fun for 10 pages but annoying afterwards.
What I found difficult is the double text layout (Every chapter is two texts, the top 2/3 taken by one text, the bottom 1/3 by another text). It would be worth it, if the subtext (haha) would directly relate to what the text says on any given page but the layout reflects only that the two texts in each chapter relate to each other as two chunks of text. This makes it 90s-ironic-STS-fun for 10 pages but annoying afterwards.
November 21, 2020
A few quotes:
“Practice manipulates the object, differences and variation between practices results in that reality multiplies” (Mol 2002, p. 5).
”This book tells that no object, no body, no disease, is singular” (Mol 2002, p. 6).
“The ‘disease’ that ethnographers talk about is never alone. It does not stand by itself. It depends on everything and everyone that is active while it is being practiced. This disease is being done.” (Mol 2002, pp. 31-32)
”Enacting reality involves manipulations” (Mol 2002, p. 89).
“Practice manipulates the object, differences and variation between practices results in that reality multiplies” (Mol 2002, p. 5).
”This book tells that no object, no body, no disease, is singular” (Mol 2002, p. 6).
“The ‘disease’ that ethnographers talk about is never alone. It does not stand by itself. It depends on everything and everyone that is active while it is being practiced. This disease is being done.” (Mol 2002, pp. 31-32)
”Enacting reality involves manipulations” (Mol 2002, p. 89).
December 30, 2021
These days more than ever, perhaps, due to the attention medical practices are getting in the context of the pandemic, this book is a must read. And definitely not just for anthropologists or students and academics in the fields of social sciences.
It's also, in my opinion, a very provocative and innovative kind of writing. Not exactly what you would expect if you're used to academic writing, but in some ways it reminded me of some of Latour's gimmicks.
It's also, in my opinion, a very provocative and innovative kind of writing. Not exactly what you would expect if you're used to academic writing, but in some ways it reminded me of some of Latour's gimmicks.
February 2, 2025
read this at the perfect time to think through healthcare, ecological crisis, and the de facto death of medical neutrality.
if a praxiographic analysis shows us there isn't a formal process that can be trusted to lead us to one reality, nor one reality at all, we have some choices to make about which enactment of reality does 'us' the most 'good'. to navigate this reality multiple, we need a 'politics of what'.
if a praxiographic analysis shows us there isn't a formal process that can be trusted to lead us to one reality, nor one reality at all, we have some choices to make about which enactment of reality does 'us' the most 'good'. to navigate this reality multiple, we need a 'politics of what'.
July 24, 2025
Es cierto que puede dar miedo empezar un libro cuyo tema central es la ateroesclerosis y sobre el proceder médico, pero de verdad, creo que este libro debería ser de lectura obligatoria. Masterclass de cómo hacer ciencia, de cómo abandonar binarismos y aceptar las interferencias, las complejidades, de que el conocimiento no se descubre, se pone en práctica y entra en mezcla continua con todo lo que le rodea.
July 1, 2019
Exquisitely written, this might very well be the best book I've read in a while.
Read
September 25, 2021A really interesting and well-researched book, I just had difficulty navigating the parallel narratives on every page.
October 30, 2022
Brilliant.
Read
September 9, 2024Exploding the ontology of diagnosis itself into the fleshy affair of unbracketed practicalities.
November 28, 2024
Read this for my grad school anthropology class. Super fascinating read! Incorporated a lot into my own research.
January 15, 2024
if anything, this was the cornerstone of all my medical anthropology seminars and lectures, so in that regard, i think of this book very fondly. as for the actual experience of reading it, it’s a little complicated. mol uses a unique format in her book, choosing to split the text between the pages so that two separate chapters run concurrently on the same page. the top half discusses the ethnographic material while the bottom half discusses the literature. she does mention that it might be easier for more modern readers who are used to watching multiple things to read, but personally, i didn’t find that to be the case at all. however, the unique structure also allowed her to experiment with distribution and multiplicity physically within the pages, so i can see why she chose to do it.
here is also where i put in my usual disclaimer about these types of books. this is an academic book so it’s not going to be very accessible to the general public. i only ever started reading the book because it was assigned for a class. still, it’s a rich text that i think you can gain a lot out of, especially if you are interested in the field.
on to the review:
simply put, mol looks at the way atherosclerosis, a disease of the veins and the arteries, is defined, diagnosed, and treated in a dutch hospital. however, in crafting a divergent lens of simultaneous ontologies, mol presents the body multiple, whereby the disease is realized in differing manners through the perspective of the patients, doctors, and other medical practitioners. rather than thinking about disease as a single object that exists by itself, mol proposes that disease is a multiplicity of intricately related practices that are then enacted. thus, the ontology of an object is decentered and is always in relation to others. that is not to say that the body itself is fragmented, but rather, that the body multiple exists together in multiple layers. multiplicities are then negotiated through various forms of coordination which seek to draw together “a diversity of objects that go by a single name” (54).
i also find this quote to be a good explanation as well: “the ‘disease to be treated’ is a composite object. the elements that compose it may stretch all the way from the numbers that come out of the vascular laboratory to the possible future anger of someone’s disappointed children. such different elements together make a patchwork, a patchwork singularity, the disease-to-be-treated of a specific patient” (72)
mol also uses the spatial metaphor of distribution to demonstrate how different styles of enacting reality and experiencing disease are spread out through multiple localities. for example, she uses different wings in a hospital building or different boxes in schematic illustrations of disease as a representation of the different localities over which the reality of the disease in question exists.
she utilizes ethnography in a way that she describes as praxiography, which is enactment-in-practice theory. within the book, mol combines her thick descriptions with her brand of ontological politics, which are “a politics that has to do with the way in which problems are framed, bodies are shaped, and lives are pushed and pulled into one shape or another” (vii). she proposes that ontology is not necessarily given in “the order of things” but rather, that multiple ontologies are brought into being in every day practices (6). typical ontology in medical practice is bound to a specific site where the disease exists, but there are different ways in which disease manifests itself in multiple situations and sites.
ultimately, i think this is a difficult read but well worth the time. her theory of the body multiple is used frequently across the field of medical anthropology, and it serves as a useful tool to understand how medicine exists and operates in our society. does that equate to an enjoyable reading experience? personally, i didn’t feel that way, but who knows? you might.
here is also where i put in my usual disclaimer about these types of books. this is an academic book so it’s not going to be very accessible to the general public. i only ever started reading the book because it was assigned for a class. still, it’s a rich text that i think you can gain a lot out of, especially if you are interested in the field.
on to the review:
simply put, mol looks at the way atherosclerosis, a disease of the veins and the arteries, is defined, diagnosed, and treated in a dutch hospital. however, in crafting a divergent lens of simultaneous ontologies, mol presents the body multiple, whereby the disease is realized in differing manners through the perspective of the patients, doctors, and other medical practitioners. rather than thinking about disease as a single object that exists by itself, mol proposes that disease is a multiplicity of intricately related practices that are then enacted. thus, the ontology of an object is decentered and is always in relation to others. that is not to say that the body itself is fragmented, but rather, that the body multiple exists together in multiple layers. multiplicities are then negotiated through various forms of coordination which seek to draw together “a diversity of objects that go by a single name” (54).
i also find this quote to be a good explanation as well: “the ‘disease to be treated’ is a composite object. the elements that compose it may stretch all the way from the numbers that come out of the vascular laboratory to the possible future anger of someone’s disappointed children. such different elements together make a patchwork, a patchwork singularity, the disease-to-be-treated of a specific patient” (72)
mol also uses the spatial metaphor of distribution to demonstrate how different styles of enacting reality and experiencing disease are spread out through multiple localities. for example, she uses different wings in a hospital building or different boxes in schematic illustrations of disease as a representation of the different localities over which the reality of the disease in question exists.
she utilizes ethnography in a way that she describes as praxiography, which is enactment-in-practice theory. within the book, mol combines her thick descriptions with her brand of ontological politics, which are “a politics that has to do with the way in which problems are framed, bodies are shaped, and lives are pushed and pulled into one shape or another” (vii). she proposes that ontology is not necessarily given in “the order of things” but rather, that multiple ontologies are brought into being in every day practices (6). typical ontology in medical practice is bound to a specific site where the disease exists, but there are different ways in which disease manifests itself in multiple situations and sites.
ultimately, i think this is a difficult read but well worth the time. her theory of the body multiple is used frequently across the field of medical anthropology, and it serves as a useful tool to understand how medicine exists and operates in our society. does that equate to an enjoyable reading experience? personally, i didn’t feel that way, but who knows? you might.
July 18, 2020
This book is written at such a high academic level I had a hard time following a lot of her argument. I also was not a fan of how she split up the pages into an upper and lower section. I know that was for research purposes but it became very hard for me to keep the two narratives in line. I think a lot of the material was just over my head even after discussing it with my professor for my independent study.
September 6, 2015
One of the best books I ever read that joins ethnography and literature review without losing the focus: arteriosclerosis as an object, multiple and multi paradigmatic and even thou, it still make it to survive. Arteriosclerosis really lives in those places, totally different and separated from each other and the way they manage to survive in so different paradigmatic ways of seeing it and dealing with it.
One excellent book to understand the complexities of the objects and go further than seeing it in only one perspective rejecting the others.
The world is complex and does not, in a pragmatic reality, expel the other different realities as some theories said in the past (Karl Popper, Thomas Kuhn and so on). But it ain't a easy reading.
One excellent book to understand the complexities of the objects and go further than seeing it in only one perspective rejecting the others.
The world is complex and does not, in a pragmatic reality, expel the other different realities as some theories said in the past (Karl Popper, Thomas Kuhn and so on). But it ain't a easy reading.
October 20, 2008
While I haven't actually finished reading the entire book, what I have read is very interesting. The book is written cleverly with an Ethnographic account along the top of each page, and the relation to theory along the bottom. Its a bit strange at first and her style is refreshingly personal for an academic text. But definitely something to re-read.
April 14, 2012
Thought provoking and written in a lovely clear style that made it a pleasure to read. The untraditional format--a literal subtext below the main text containing the ethnography--was surprisingly easy to get used to. The linkages between the two portions made toggling back and forth (at least that's how I read it) intuitive.
October 17, 2016
What a strange, fascinating book. Mol illuminates the way that the body and other subjects/objects are enacted in multiple forms through a "praxiological" inquiry which foregrounds ontological (rather than epistemological) enactment (rather than construction). In many ways, this study aligns with Bruno Latour's "modes of existence" project. Lots to think about here.
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