Académique Documents
Professionnel Documents
Culture Documents
and London: Duke University Press, 2002. Pp. xii+196. $59.95 (cloth); $19.95 (paper).
Arthur W. Frank
University of Calgary
The Body Multiple is my nominee for defining medical sociology in the twentyfirst
century. Unless it defines sociological theory, but effacing that distinction is part of what
is so engaging about Annemarie Mol’s work. Mol herself exemplifies the boundary
deconstruction that’s central to how she understands social life: she has medical training
but has never practiced medicine; she describes herself as a philosopher but is
wonderfully conversant with sociological literature; she works and did her research in the
Netherlands but chooses to write in English, for reasons that are as fascinating as
everything else she discusses. These multiple vantage points allow her to understand
what takes place within certain boundaries—whether these are professional, academic, or
national—as enacting things that can be talked about. She prefers the verb enact to older
usage of social construction (32, 41). Her book is about things, as enacted in different
sites in a hospital.
The Body Multiple is also a multiple text, with each chapter written as two parts.
The top twothirds of the page is an ethnography of how atherosclerosis is done, in an
ethnomethodological sense of practical accomplishment, “in a university hospital in a
mediumsize town in the center of the Netherlands” (1). The bottom third of the page, in
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smaller but readable type, discusses the theoretical literature. These texts respectively
demonstrate and argue for a shift from Parsons, Goffman, and Foucault, to Bruno Latour
and Donna Haraway. Mol suggests surfing between the two texts (ix). I read in my old
fashioned, linear way, and that worked fine.
Unlike medical sociologists of the last century, Mil does not attempt to take a
position outside medicine. Rather she seeks “to open up differences inside medicine and
create better access to them” (viii). In practice opening up differences means watching
specialists at work enacting different versions of atherosclerosis, depending on their
instruments, tools, and purposes. In a clinic, physicians ask patients how far they can
walk without pain; disease is a functional problem (or a mistaken referral). A pathologist,
by contrast, locates atherosclerosis in a lab, examining slides taken from an amputated
limb. “Look,” a pathology resident tells Mol. “Now there’s your atherosclerosis. That’s
it. A thickening of the intima. That’s really what it is.” Then he adds, after a telling
pause, “Under a microscope” (30).
The pause is telling because the pathologist knows that his version of “it” is
different from internists’ and surgeons’ enactments. Each version has to be workably
complementary with the others, but the differences are never rendered congruent with
each other. One of Mol’s most fascinating discussions concerns “translations” between
two methods of measurement: duplex and angiography. The former is a noninvasive
ultrasound technique, and the latter involves invasive injection of dye through the arteries
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(72 ff.), which are then xrayed to visualize blockages. Measurements fail to correlate
often enough for physicians to require a translation rule. One such rule “submits duplex
to angiography,” since the latter is judged to be the gold standard (78). But ways of
translation multiply, as discrepancies multiply.
Such detailed ethnographic descriptions make Mol’s theoretical point that
medicine “has gaps and tensions inside it. It hangs together, but not quite as a whole”
(84). She expands this point, revising the program of twentiethcentury social theory:
“So where we started out with a society that mimics the organism, what we end up with is
an organism that clashes and coheres—just like society” (84). Translations between
disparate versions are sufficient for medical work to cohere, but these translations are
“never fiction free” (85). The old dream of latent pattern maintenance and consensus has
left the hospital, but not because the dissenters from that dream, conflict theorists, were
right either.
One of Mol’s best descriptions of her method is that it “no longer follows a gaze
that tries to see objects but instead follows objects while they are being enacted in
practice” (152). She calls that enactmentinpractice theory praxiography, but positing a
unifying label for her work seems to go against Mol’s crucial revision of earlier social
theory. Contingency, she shows, is not disorder. “Though nothing is sure or certain,” she
writes, “the permanent possibility of doubt does not lead to an equally permanent threat
of chaos” (181).
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In Mol’s world, “reality moves” (156) too fast to speak of the order of institutions
and societies. “It multiplies” (66), she writes as she explains why even Foucault must be
abandoned—however carefully she attends to him in this abandonment. Mol need not
invoke slogans to claim she is writing in and of a new century. She follows objects,
details enactments, reviews the literature, and her compelling, original view of society
seems like it’s been there all along, as it has. Awards committees should take notice of
this major contribution.
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