Culture, Medicine, and Psychiatry

, Volume 41, Issue 2, pp 304–308

Comments on Moral (and Other) Laboratories

Culture, Medicine and Psychiatry, Special Issue Edited by Lone Grøn and Teresa Kuan
Commentary

It is a pleasure to discuss these articles and especially, to celebrate the work of Cheryl Mattingly. Cheryl’s arguments on ethics are profound and seamlessly encased in powerful and poignant ethnography. As these articles show, her work is also extremely fertile; the authors are at their best when they respond to Mattingly’s ideas. Indeed, she becomes something of the exemplar to which Janelle Taylor speaks.

Marx famously said that we make history but in circumstances not of our own choosing. I take the same insight to be true of ethics. Practical ethics entails the exercise of judgement around circumstances that include unexpected challenges and obstacles, as well as various givens of citizenship, embodiment, family, class, and so forth. What do we make of them, how do we acknowledge them and move forward without undue despair, complacency, naiveté, betrayal, incontinence, or incompetence?

The circumstances we are in can be imagined in a number of different ways. In her insightful and elegant work Mattingly has described one kind or set of circumstances and responses as though they were a moral laboratory. I take the laboratory to mean in part, that people are figuring out what to do as they do it, addressing novel and unexpected, generally unwelcome circumstances, navigating without a map—and that such circumstances render people particularly self-conscious and open to the possibility of doing things otherwise. The editors nicely contrast the scene of the laboratory with those of the workshop and the trial.

The idea of a laboratory implies that someone—whether the people themselves, the institutional powers, or the anthropologists—are constructing the situation in this fashion, constructions that could be deliberate or institutionalized, with specific parameters. For the most part, the authors here follow Mattingly in being less interested in institutions than in existential circumstances that provoke or ask us to reflect and act or that push us to query our assumptions, encourage us to go further, do more, act differently, or perhaps learn to accept things as they come. The responses illustrated in these articles are different from direct or deliberate exercises in self-fashioning, as developed in the light of the influential late writing of Michel Foucault, because the challenges come at moments of adversity, what Lone Grøn aptly calls “the pathos of the demand,” and because for the most part they lead their subjects outward into the world rather than inward, less to change themselves than to challenge facets of the lifeworld. Hence they can be closer to politics than to discipline or piety or even self-reflection. The people in Mattingly’s world and in these articles are busy with practical matters, addressing the uncertainties of illness, navigating the health care system, and caring for others.

The articles raise the following themes or questions among others. First, how well does the model of the moral laboratory work, what is its scope and what are its limits? On the one hand, the term is a metaphor for life and the open-ended ways in which people live it. Here the metaphor overcomes a limitation of certain readings of Aristotle that suggest the virtuous person responds to circumstances more or less smoothly. Ethics takes place in time and under somewhat broader temporal horizons than virtue theorists generally imagine. Mattingly shows that when the path forward is unclear, sometimes you just throw something out there, a kind of trial balloon, to see how it works, how others respond, and how you do too. We don’t always know where we are going and there is no assurance that any given act will turn out well or that every performance will be felicitous.

The laboratory metaphor also has its limits, first, because in life there are no controls and second, because the people described are not doing research that is subject to rigorous methodological adjustment of variables and context or that is conducted purely for its own sake. As Teresa Kuan cites a physicist quoted by Peter Galison (1987, p. 24), “in a Scientific Experiment the circumstances are so arranged that the relations between a particular set of phenomena may be studied to the best advantage. In designing an Experiment the agents and phenomena to be studied are marked off from all others and regarded as the Field of Investigation.” In fact, several of the articles do examine ethical life in laboratories in this more literal sense, encountering the lab as a field framed off from the circumstantiality of everyday life, whether in maintaining control of the variables or in permitting certain kinds of interaction within its frame that are not ordinarily permitted outside. The articles by Lesley Sharp and by Teresa Kuan each take the laboratory in this more literal mode, albeit with very different kinds of authorized experiments and modes of procedure. There is also the question of whether any health care institution can be considered a laboratory of sorts. The article by Mette Svendsen et al. compares several controlled institutional settings, while Janelle Taylor takes us explicitly outside the institution. But at the same time, all of these authors also return to Mattingly’s more metaphorical formulation thereby raising not only the question of how institutional settings frame themselves off from ordinary life contingencies but also how ordinary life penetrates the frame and how an experimental attitude penetrates life. When Sharp considers the scientific laboratory as a moral laboratory, she brings the metaphor back home, as it were.

Experiment entails uncertainty. In every case, the question is raised, who is taking the risk and who is likely to suffer if it fails? In this respect the laboratory model differs productively from more common accounts of ethical life in which the central feature is accountability, something that is backgrounded here.

A second theme apparent in all the papers concerns the limits of the human and the relationship of human being to ethical being. Here is where I have a slight disagreement with the otherwise outstanding paper by Mette Svendsen, Iben Gjødsbøl, Mie Dam, and Laura Navne. They repeat a misunderstanding common to many posthumanists, namely the assumption that “humanists” want to create or enforce a rigid distinction between humans and animals. But when I describe ethics as intrinsic to the human condition I am not denying that animals have ethical value or the possibility that they might have ethical capacity; moreover, I would not want to lump all “other” animals together, but leave open the possibility that each species has its own “nature” or species-condition. The question of individual members of a given species (including humans) who, for reasons of extreme premature birth, disease, or injury, cannot exercise their full species-capacities is of course, as the authors show, a complex matter. But the point is less one of “dissolving the dichotomy between human and nonhuman” (and the latter is not itself a substantive category) than of studying sites at which this boundary is or has been put into question (and differently by different parties). This is what Svendsen et al. show us, for example, as they explore “how practices of feeding precarious lives end up creating new ways of doing the human.” And one of the paradoxes their work in the nursing home reveals is that feeding is withheld only if the person shows signs of will and autonomy; the more ‘animal-like’ the subject, the more the feeding will be pursued. While I think their conclusion that the feeding practices they examine “contest the concept of the human at the heart of anthropology” is itself contestable, I agreed with their move to ground the ethical in action. Indeed, I found this essay particularly perceptive; the comparison of three sites along the axis of feeding is exemplary and yields extremely rich insights.

Taken together, the articles reveal the complexity of what we might mean by the ethical. They show that judgment or discernment (in my view, Lambek 2015a, a central feature of the ethical) transpires along several axes. We see the pull between care and complacency; between self-interest and concern for others; and between action and passion, or agency and responsivity. It is a matter, along each axis, of getting the balance right, both to meet new circumstances as they arise and to maintain some kind of personal consistency. “Care” is a particularly complex and multivalent word, both as noun and as verb (Lambek 2015b). This is not the place to address the concept fully but it is evidently central to the medical field, which, after all, we also call health “care.” One of the issues here is how caring for others, in both formal and informal settings, is closely linked to the ethical self and our being in, and attentiveness to, the world. Moreover, as medical practitioners and health care providers well know, the dignity and wellbeing of the recipients of care must be balanced with the ethical condition and wellbeing of the caregivers themselves. We see this productive tension in the accounts of the nursing homes, the neonatal unit, the neighbours and friends of those suffering from dementia, and also with respect to the treatment of laboratory animals.

One of the interesting features of Sharp’s analysis is how the relationship to the macaques varies with the subject position (or professional role) of researchers and animal caretakers as well as the distinction she makes here between “morality” and “bioethics.” Does the laboratory force the human keepers into various kinds of moral compromises and rationalizations? Is it productive of complacent routine or moral anxiety, or does it expand moral horizons? The question for the caretakers is not about hope or pitting the possible against the predictable, as it is for personnel in the neonatal unit or Taylor’s good neighbours, but about balancing the distant and abstract aims and outcomes of the experiments with the day-to-day lives of the monkeys. Their dilemma is continuous and they cover it over by resorting to the television, as if this could ameliorate the macaques’ condition or perhaps simply ease the lab workers’ own conscience. The TV is supposed to counter boredom yet it is played in a continuous loop. One might ask why the monkeys aren’t given a button to change the channel–or to turn the damn thing off. Much more could be said here, but the central point is to question whether the presence of the TV is a sign of moral virtue on the part of the keepers—or rather a sign of moral failing, lack of imagination and perhaps of sheer laziness on their part. Television may display the “humanness” of the monkeys or the “humane” quality of the caretakers, but one vision of hell is being forced to sit for eternity in front of television monitors in some anonymous waiting room.

More generally, Sharp’s argument illustrates a matter found implicitly in all the articles, namely how much can one expect of care givers and how much can they expect of themselves? The care givers in these essays are generally portrayed in the best light, and rightly so, but we should also ask about the limits of care, attention, insight, and empathy—and what happens as these limits are reached. This is a feature of ethical life in general, but highlighted in contexts where there is an explicit balancing of care for the self with care for others.

Teresa Kuan’s paper was the most difficult for me to digest because here the “edge of safety,” as she calls it, appears to be the sharpest and the therapists appear to be experimenting with other peoples’ lives as well as their own. It is one thing to disturb a pathological family system or to provoke people and quite another to stay around for a positive outcome. Kuan quotes Salvador Minuchin to the effect that what is ethically unfair might be therapeutically correct. As with the debate on medical research that makes use of nonhuman animals, the question is who is in position to monitor the situation, decide the right balance, or ascertain that the wager has been won. Questions of power are raised. However, this is one field where the training procedure does entail explicit work on the self and the supervisory relationship is critical and provides oversight. Dr. Wai-Yung Lee is admirably frank about her own experience of supervision. As Kuan acknowledges, moral experimentation “risks the possibility of tragedy.” Whether or not it is worth the risk, and for whom, family therapy is, as Kuan concludes, good to think with, and its trajectory in the ethically uneasy context of contemporary China will be interesting to follow.

In virtually all respects these ethical situations seem to be the very opposite of the good friends and neighbours described by Janelle Taylor. Here I particularly like the point about the courage in turning away from reliance on science and the promise of a future cure, which is also, of course, turning from preoccupation with the self to attendance on others. The “experiments in friendship” offer a nice complement to “experiments in kinship” and, like them, are often quiet and beyond public acknowledgment. In fact, Taylor insightfully points to the fact they may not be “readily legible” to the state. The helpfulness of friends is thus not only called for by a lack of available social services, but is constrained and put at risk by the law, though in rare case the law can confirm it. Her article is nicely complemented by a news item that I saw as I was writing these comments (Bruck 2017), concerning two women friends who won a legal battle in Canada to co-parent a disabled child.

Finally, the issues in Lone Grøn’s paper are somewhat different insofar as the care giver and the subject of care are one and the same person, albeit there is the sense that Rita is under constant evaluation by others. Here the matter of care becomes explicitly one of getting right the balance of action and passion and it is extremely interesting how the perception of where the balance lies changes over time for the subject. As in Taylor’s account, it is in part about transcending reliance on scientific or mechanistic models and recipes. Grøn’s insightful reading also introduces the phenomenological approach of Bernhard Waldenfels concerning the “responsive self.” This is perhaps a necessary counterpart or counterweight to Gadamerian conversations or Habermasian communicative rationality, insofar as obesity, says Grøn, after Waldenfels, is a “haunting that exceeds ones grasp.” However, I would be hesitant in calling the self “highly” experimental and would like to keep open a separation between models of the self and the self that they model. The self here “originates in the pathos of the demand” yet is not determined by it. Pairing and contrasting Grøn’s features of the self we can say that it is pathic yet agentive, and continuous yet disjunctive. Grøn thereby offers a very perceptive way to summarize and develop some of Cheryl Mattingly’s central insights.

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.University of Toronto ScarboroughTorontoCanada

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