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  • A New History of Identity: A Sociology of Medical Knowledge
  • Peter Conrad
David Armstrong . A New History of Identity: A Sociology of Medical Knowledge. Basingstoke, U.K.: Palgrave, 2002. x + 213 pp. £47.50 (0-333-96892-1).

David Armstrong, who is both a physician and a sociologist, provides an interpretive history of the last 150 years of medical perception and conceptual organization. This is a narrative history heavily influenced by Foucault, emphasizing the primacy of the text rather than authorship. In a manner, this is a history without actors or agency, social structure or social forces. The essence of the analysis arises from what Armstrong makes of how medical (and other) texts reflect the changes in what the medical eye sees, interprets, and acts upon.

This is a small but ambitious book. First, it is an attempt to present a sociology of medical knowledge; second, it is an original rendering of medical history; and finally, it endeavors to offer a creation story for Man (sic) based on medical texts in place of the Darwinian explanation. How successful Armstrong is at the first two tasks depends a great deal on how much validity the reader grants to Foucauldian analyses of history. The third goal of the book, the medical-textual creation-of-Man story, seems to me to be misguided and a distraction in an otherwise provocative book.

Basing his research on British and American medical (and to a lesser degree, sociological and ancillary) texts, Armstrong conducts what Foucault calls an [End Page 922] archaeology of medical perception: "What sort of body did the doctor see? How was it to be interrogated? What was the nature of the patient who lurked behind the corporal presence?" (p. 3). His examination provides a new look at old issues such as Sanitary Science and anatomy, as well as the more recent closing of hospitals and the rise of primary care. Armstrong's focus is on how medicine "sees" the body and the patient: what are its boundaries, how does it move, what are spaces between bodies, when does the patient speak, and what is the role of "lifestyle"? He uses these textual data as evidence to argue how our perception of disease, the body, and patients has evolved over time. It is at times a very engaging argument.

There are some real gems in the book. For example, I found Armstrong's analysis of the development of the concept of the infant mortality rate fascinating. At stake is what constitutes a live birth, when life begins, what "causes" infant deaths, how to designate premature and "still" births, what renders something as congenital, and so forth. Armstrong discusses how the medical eye shifted from looking at internal factors to external ones (e.g., social class), from a sanitary science to a social science of infant mortality, beginning in the early twentieth century: "The old axes of climate and urban living that reduced a population to a collection of separate bodies gave way to social dimensions as the corporal space of infancy was finally wrenched fully free from nature" (pp. 34-35). Other gems are Armstrong's rendition of the emergence of "the normal," and the rise of Surveillance medicine.

While Armstrong's sociological and medical-historical interpretations are incisive, this is by intention a schematic and selected history, moving quickly from one era to the next, distilling whatever perceptual structural essence he finds in his analysis. At the end of most of the first ten chapters, and again in one later chapter, he attempts to connect his analysis to an alternative to the Darwinian story of Man's (sic) origins. I found this to be intrusive, tangential, and unconvincing. For example, at the end of the section on infant mortality, Armstrong relates these beginnings to Darwin's evolutionary treatises, ending with: "The birth of the infant had become the origin of Man" (p. 35); this seemed to me added on, rather than essential to his medical perceptual analysis.

This book is at times brilliant, challenging, and perplexing. Armstrong is one of the best practitioners in the Foucauldian tradition working in social science; he has written an important book, worthy of the attention...

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