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  • The Bioculture of Caregiving:A Commentary on “Biocultures”
  • Arthur Kleinman (bio)

It may surprise readers, but caregiving has relatively little to do with medicine. The two helping professions that have made caregiving central to their knowledge and practice are lower in status: nursing and social work. The real experts in caregiving are usually lower still on the status ladder: families and the sick or disabled themselves. Caregiving is, at the existential core, a primary quality of what it means to be human. It is telling that it seems inversely correlated with status. I will return to caregiving as a concept for applying a biocultural approach to the medical humanities, after I have set out my own way of thinking of biocultural processes and how I see the papers in this special issue contributing to humanistic studies of science and medicine

Life overflows with many things, yet much of it is about danger and uncertainty. Financial pressure, job problems, accidents, chronic illness, man-made and natural disasters, disappointments in relationships and careers, and the fears and anxiety they induce affect just about all of us—the poor most of all. In spite of the claims (and splendid achievements) of scientists, physicians, and asset managers, most of what is now described as "risk management" concerns unknowable, unpredictable, and uncontrollable dangers, ordinary and extraordinary, that make living uncertain and very serious. The progressivism central to the hyping of science and medicine is balanced by a humanities perspective that is more realistic about disappointment and defeat.

In an ethnographic and social-historical sense, one that seems to perplex philosophers, life is moral because living turns on the most serious questions of what really matters and what to do.1 These are the lived values that define what moral experience means for people in a local world and what moral life is about for the individual. The moral, in this existential sense, connects affect with social life, physiology with culture, illness and disability with politics and economics, and medicine with life. Here "the moral"—the lived values of groups and individuals—is different than "ethics"—what laypersons and professionals aspire toward in the way of doing good, being just, and so on. Thus the moral can in practice be injuring or outright destructive. [End Page 593]

There is moral physiology—a bridge between value, affect, and social life—and that is in part what bioculture means for the medical humanities. Whether the term is biopower, biosociality, biological citizenship, or psychosomatics—each of which carries a different emphasis that makes a difference—the more general meaning is that biocultural connections extend between the disciplinary domains of knowledge generation and transmission that constitute the modern university: natural science, applied science and technology, social science, humanities, and the arts.2 We are living through an era when this crosscutting reality has not just intensified interdisciplinarity, but also promoted new ways of conceiving disciplines and professions.

This issue of NLH presents examples of biocultural approaches in the humanities. Manifestos are out of fashion today. But what Lennard Davis and David Morris mean by their low-key "manifesto" is tolerant, plural, and generative enough to form, what seems to me, a usable framework for the works that follow and for other biocultural approaches in the humanities. I wrote my own "manifestos" in the 1970s for medical anthropology, the medical social sciences, and social medicine.3 No one seemed to take them too seriously. The revolution I announced, after all, had long been underway with such champions as Rudolph Virchow (mid-nineteenth century); W. H. R. Rivers (late nineteenth and early twentieth century); Erwin Ackerknecht (mid-twentieth century); and Renée Fox, David Mechanic, Charles Rosenberg, and others still very much alive and active. And the same might be said for "Biocultures." There are increasing numbers of publications in the humanities that are serious about physiology, evolution, molecular medicine, pharmacology, and neuroscience, as well as the practice of biology in the laboratory and its translation into programs and policy. And what the contributors to this issue demonstrate is that there are multiple ways of taking bioculture into account that reflect the robust differences (theoretical, methodological, and stylistic) that make the humanities...


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