A Philosophical Disease: Bioethics, Culture, and Identity

A Philosophical Disease is a Wittgensteinian critique of Western biomedical culture. Carl Elliott engages the intersection of language and our construction of reality, morality, and relationality.

For an example of how this sort of critique works, Elliott's discussion of the construction of gender is paradigmatic. There are a number of medical conditions--including birth defects, genetic abnormalities, and medical mishaps--which render a person's sexual identity . . . well, complicated.

In one part of the Dominican Republic, one such condition is sufficiently prevalent that there is a name for it: guevedoche. (Penis-at-twelve.) Individuals with this genetic condition are genotypically male, but appear female from birth through puberty. Most guevedoches, although they had been raised as females, make the transition to male societal roles after puberty--including marrying women and taking jobs usually given to men. It is not so much that this culture is blase about gender roles (quite the opposite); it is rather that their experience with a particular condition allows them to code for a third gender, as it were. They have the experience of it, they have a name for it, and they have cultural practices which surround it.

By contrast, the US has retained a more strict understanding of the world as divided into male and female. Thus, their cultural practices surrounding the same genetic condition--or conditions in which gender identity is similarly ambiguous--are different. They have a medical name for the condition (5-alpha-reductase deficiency), but not for persons afflicted with the condition. Indeed, the cultural experience of such conditions is so rare that medical practices surrounding these conditions tend to involve surgery to make the genitalia match the individual's perceived sexual identity. (That is, if the individual feels more "female," the genitalia are surgically altered to match that feeling.) American language and experience is almost exclusively bound by the male/female dyad, such that surgical intervention is required to make one's biology match the linguistic and philosophical convention.

Elliott similarly investigates the way language about identity intersects with psychiatry. These chapters were some of the most interesting, as that intersection has received far less attention than it should in the bioethics literature. How does severe depression affect competence to consent? Do emotional ties reduce or enhance rational decision-making? Why do we have an intuitive sense that a willingness to sacrifice oneself is morally praiseworthy, while a willingness to profit from someone's sacrifice is morally reprehensible?

This is, in addition, an eminently readable book. The motivated amateur could certainly tackle this book, although it is geared toward an academic audience. If your interest is in the culture of medicine--not just the hot topics in bioethics, but the culture in which these topics get discussed--this is a book worth reading.

Something the Lord Made

Even though this movie was recommended by a normally reliable source, I can't say that I had terribly high expectations of it--at least not after looking at the back matter. An HBO film? With, well, Mos Def?

I mean, I thought it would be "loosely based" and formulaic (like Remember the Titans or some such), with stupid dialogue and trite sermonizing. But, I thought, at least it would deal with "important issues" or something, so it would be worth watching.

It was none of the things I had thought.

Well, yes, it dealt with "important issues" (see here for the historical background), but so gently and subtly that it didn't feel like an "important issues" movie.

It was not at all formulaic, either. And the dialogue was restrained, well-written, appropriate.

And Mos Def did an outstanding job. His Vivien Thomas was gentle, subtle, restrained, yet completely compelling.

I keep using those words--gentle, subtle, restrained. That's how I would characterize the whole movie, actually. With the exception of Alan Rickman's southern accent (which is about as successful as Kevin Costner's British accent in Robin Hood), nothing was larger-than-life or overdone. It felt real--no small feat for a movie portraying incidents of another era, one with high probability for emotionalism and sermonizing.

If I had one negative thought about the movie, though, it was that Vivien Thomas was a rather "safe" black hero. He was a man who suffered quietly the insults he was offered more often than not, who accepted with gratitude the recognition he was finally given (decades late and still fairly inadequate), and who cared more about the life-saving work he was doing than what he had to endure to do it--or how his using his gifts benefitted and enriched everyone but himself.

Yes, his character is a shining example of Christ-like virtue (patient suffering and self-giving in the face of others' vainglorious pursuit of "success"), but he may have been rather too easy on Blalock and Johns Hopkins--and, by extension, us. It was too easy for Blalock to enjoy the material and societal benefits of his association with Thomas (who enjoyed only the moral satisfaction of his work), and to atone for it at the end of his life with the recognition that "I have some regrets."

And too easy for us. As James Cone supposedly said at a recent AAR conference (I'm getting this third-hand, so my apologies if I'm getting the story wrong), "You white theologians always wanna talk about Martin. When are you gonna talk about Malcolm?" If our pantheon of civil rights saints is limited to figures like Vivien Thomas and, yes, even MLK, we (white America) are letting ourselves off rather too easily.

What Mike Pressler Should Have Done

Or, Why I'm Not Rallying Around the "Innocent" Lacrosse Players

Don't get me wrong. I'm happy that three men are no longer under an undeserved indictment, that what appears to have been a cruelly false accusation has been set right, and that the legal system has proved itself able to negotiate a complex case with relative justice.

But I don't particularly care for the triumphalist tone being bandied about: "Innocent Lacrosse Players Vindicated!!" "Finally, Justice for the Dear Sweet Boys Who Never Did Anything Wrong!" "Mounting Pressure for Duke To Apologize to the Clearly Wronged Former Lacrosse Coach!"

Uh, no. Especially not to that last one.

Mike Pressler tolerated an atmosphere among his players that should never have been tolerated. This permissive attitude is what led to the night which remains an embarrassment to the University, irrespective of whether a felony was committed.

Had Pressler done, say, something like this a long, long time ago, this painful night might never occurred. And, more importantly, those boys might have had a chance to grow into real men. I fear that now, they never will.

The Sacrificial Lamb

Chinese Food and Drug Chief Sentenced to Death


I was wondering how China was going to navigate the ever-increasing scandal of contaminated food and drug products. Actually, I was wondering how the US was going to navigate it--whether the dire need for an expanding market would trump basic food and drug safety issues.

But now that China has helpfully "solved" the problem via the classic "scapegoat" method, we can all get back to our regularly scheduled global capitalism.

"Lybrel says 'You don't need a period.'"

"Surveys have found up to half of women would prefer not to have any periods, most would prefer them less often and a majority of doctors have prescribed contraception to prevent periods.

. . . . . .

Most doctors say there's no medical reason women need monthly bleeding and that it triggers health problems from anemia to epilepsy in many women. They note women have been tinkering with nature since the advent of birth control pills and now endure as many as 450 periods, compared with 50 or so in the days when women spent most of their fertile years pregnant or breast-feeding."

I really thought we had moved past early-eighties feminism, where women had to become honorary men in order to be equal.

Did you notice how the justifying moves go? A) Most women don't want to have periods. B) There are women for whom menstruation presents a medical problem. C) Therefore, this product is okay. D) And plus, we've conquered the inconvenience of childbearing and lactation. This is just one more inconvenience to conquer!

So, once again, a potential (hypothetical? rare?) medical problem is used to justify the development of a product that will be prescribed to the population at large, apart from any medical need. Another wildly profitable product for pharmaceutical companies--because of our incapacity to endure any sort of inconvenience.

Why are women's bodies so to be feared and despised?

Nuns Continue Calcium Study

I know this was supposed to be a sweet story about a bunch of grandmotherly-type ladies who have been contributing to scientific knowledge for decades, but I couldn't help thinking how it exemplified the sort of gender blindness that plagues biomedical research.

Let me give you an example of what I mean.

What are the top three symptoms of a heart attack--do you know?

[Takes responses from the audience]

Yes, that's right. Chest pains, tingling arms, and shortness of breath.

Actually, that's also wrong. Those are the top three signs in men. In women, it's totally different. Bet you didn't know that, did you?

Bet you also didn't know that most pharmaceuticals are not tested on women of childbearing age--men and post-menopausal women (if women are included at all) form the research pool for most drugs. Between a woman's monthly hormonal fluctuations and the possibility that she might be/become pregnant during the study, she is considered a completely undesirable subject for research.

Even if the drug in question is likely to be prescribed to women of childbearing age.

Isn't that interesting?

Anyway, back to the nuns. According to the article, this study has been the source of the government's recommendations for calcium intake for women for decades. The study population is comprised exclusively of nuns--a very convenient study population, the researchers noted with glee, because of their lack of family commitments. (Women with families tend to be too busy for such an involved longitudinal study.)

Hmmm . . . does that make you think anything? Lack of family commitments, lack of family commitments . . . hmmm . . . Gosh! These seem to be women who don't have children!

So, "scientific" recommendations about women's calcium intake are primarily based on a study whose research population is comprised exclusively of women whose bodies have never done what over 80% of women's bodies will do some time in their life.

Anybody see a problem here?

It's the same problem as the pharmaceutical studies, really. The normally-functioning female body is seen as an impediment to proper research, so it is ignored during the period of research. Presumably, if they think of it at all, scientists are assuming that pregnancy is something that is "added on" to a "normal" female body. So, if we know what "normal" women need, then we can just slap on some extra pregnancy recommendations onto that.

There seems to be no understanding whatsoever that pregnancy and childbearing (much less childrearing) might change a woman's body such that her needs are completely different from these darling nuns' needs. That pregnancy and childbearing are not conditions superadded onto a "normal" body--they are constitutive of "normal" for the vast majority of women.

You'll forgive me, then, if I don't ask "How high?" every time the "latest nutritutional study" says "Jump!"

The Next Stage

I have finished Preliminary Exams (called Comprehensive Exams at other schools) and am now officially ABD.

My advisor has already alerted me to several job listings for which I am now eligible to apply. Scary!

I'm published. . . at least in cyber-space.

The above title links to a paper I delivered at Christmas Conference, 2006, for the John Wesley Fellows, those people who are being and have been funded by AFTE, A Fund for Theological Education.

The paper (click on "Sours" for a pdf download) concerns Thomas Aquinas' understanding of the body and its goods, with some comments on how he might contribute to a theological conversation about bioethics.

What am I again?

Reading an oldish (1970s) review article this morning, I came upon a curious designation for practitioners of my academic field: ethician.

Ethician.

Ethician.

Is that what I am?

Hmm. What a strange word! Perhaps it's intended to convey a discipline in which participants are both students and practitioners of their discipline--like physician.

Still, I think I'm glad it didn't stick. I prefer ethicist.

Incidents in the life of a grad student

I begin prelim exams today. I will defend April 17th.

I should have been blogging about all the things I've been reading to prepare for the exams. But, alas, no go.

The good news is that after exams, I'll start preparing to write my diss. That, I'll blog about. Stay tuned.