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21 A Kairology of Biomedicine 1 A Kairology of Biomedicine Some sure evidence that biomedicine, notwithstanding its scientific basis, is subject to the vagaries—and the rhetoric—of situation is the instability of the nosology, the catalogue of illnesses. Both Edward Shorter and Elaine Showalter, for example, say that certain diseases, such as chronic fatigue syndrome and Gulf War syndrome, represent points of convergence of symptoms that articulate distress at a place and a time; Showalter, controversially, calls these diseases “hysterical epidemics.” Andrew Malleson, writing especially about whiplash and associated disorders , says that diagnoses of particular conditions may multiply for reasons that have little to do with science. Diagnoses of whiplash, he says, are more frequent where soft-tissue injury is compensable by insurers than where it is not. What counts as illness, in Malleson’s view, has a lot to do with money. According to Joseph Dumit, The very meaning of “definable illness” and especially the entailments of that definition—whether a person with symptoms receives help or blame or dismissal—depend upon who is doing the assessing, where they are doing it from, and within what regime of social good and compassion they are operating. . . . We may not like the implication that a person is sick in one place but not in another, but socially this may be a fact. (“When” 209)1 The most salient narrative of medical history is the narrative of progress, the narrative that says, “We used to have things wrong, and now we have 22 A Kairology of Biomedicine them right, or are on the road to having them right.”2 But a rhetorically informed medical narrative is a narrative of fitness. The history of medicine is a history of shifts that can be understood as responses to changes in situation where situation includes the record of scientific discovery. The rhetorical principle undergirding this chapter is the principle of kairos, the principle of contingency and fitness-to-situation. Arguments are persuasive, said the Sophists, early rhetoricians, when they aptly meet conditions of time, place, and audience; arguments have a quality of truth in those situations. In a well-known example of Sophistic thinking, death is said to be bad for those who die but not bad absolutely, because it is good for undertakers and gravediggers. While Plato tells us that tyranny is bad for everyone (both the tyrannized, obviously, and tyrants, whose actions are bad for their immortal souls), the Sophist is willing to say that tyranny may be good for someone. Indeed, it might be true, for example, that tyranny is good when it spurs the tyrannized to seek a better state. Furthermore, for the Sophist, the dialogue on the possible benefits of tyranny is good in itself, a means of deriving knowledge about values. In its dyslogistic, or negative, form, kairos is the principle of moral relativism, and, in fact, moral relativism is a criticism of Sophism mined by Plato. Kairos is rehabilitated in contemporary rereadings of classical rhetoric where Sophists are credited with having a pleasingly dialogic sense of truth (see Jarratt). As a part of a contemporary epistemology, kairos gives a good account of local and present knowledge in contrast to a Platonic and perhaps obsolete notion of absolute knowledge. Kairos has heuristic value for understanding health and medicine both historically and currently. A compelling account of the coming and going of disorders in both medical fashion and patient experience is provided by Ian Hacking, who writes about “transient mental illness,” an example of which is fugue, a dissociative disorder prompting travel, occurring primarily although not exclusively among European men of the late nineteenth century (Mad Travelers). Not only disorders but also medical institutional structures take hold at a time and a place, according to Michel Foucault, who writes about the “birth of the clinic” in eighteenth-century Europe and about attendant changes in ideas of the hospital, the home, medicine, and the body. The shifts Hacking and Foucault describe are among other things, by the account of the authors themselves, discursive shifts. Changes in practice are importantly reciprocal with changes in the terms of practice. They are for the same reason rhetorical shifts. Rhetorical theory is below the surface in the accounts of Hacking and Foucault. Neither uses the lexicon of rhetorical theory predominately. 23 A Kairology of Biomedicine Kairos delivers some explanatory advantage, however, revealing medicine as a scene for persuasion and persuasion as a scene for medicine. Kenneth Burke describes a world seething with rhetoric. Naming...


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