The Grey Zone of Health and Illness
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The Grey Zone of Health and Illness

Culture, Disease, and Well-Being

Alan Blum

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eBook - ePub

The Grey Zone of Health and Illness

Culture, Disease, and Well-Being

Alan Blum

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About This Book

Most discussions of health care center on medical advances, cost, and the roles of insurers and government agencies. With The Grey Zoneof Health and Illness, Alan Blum offers a new perspective, outlining a highly nuanced theoretical approach to health and health care alike. Drawing on a range of thinkers, Blum explains how our current understanding of health care tends to posit it as a sort of state of permanent emergency, like the nuclear standoff of the Cold War. To move beyond that, he argues, will require a complete rethinking of health and sickness, self-governance and negligence. A heady, cutting-edge intervention in a critical area of society, The Grey Zoneof Health and Illness will have wide ramifications in the academy and beyond.

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Year
2010
ISBN
9781841503585

1

THE GREY ZONE AS A PRIMORDIAL FIGURE: GREEK ORIGINS

Introduction

The notion of the Grey Zone as a site of ambiguity can be seen in the conventional approach to health and illness but resonates in a primordial way with various usages and figures of speech developed by the Greeks and the ways they achieved the question of what can be known, of the relation of the subject to the unknown.
(A) At the most fundamental level, the discourse derives from the imagined bifurcation of nature and the social, a division assumed to produce a perplexity around the enigma of nature (which would include–besides the cosmos, terrestrial and extraterrestrial matters and the like–the body). That division was perhaps first honored in the contrast between physics and philosophy enunciated in Plato’s (1955) Phaedo, where the human subject was formulated by Socrates as “fallen” in a way, being unable to directly and immediately access externals without the mediation of language and representation, that is, without discourse. Thus, discourse as a second sailing in the absence of the immediate apprehension, fantasized by the subject as lost (which we know was never possessed), is assumed to “interrupt” the undifferentiated formless immersion of the subject in the world, a formlessness conveyed in Baudrillard’s (1998, pp. 191–192) conception of the actor as having no “shadow, reflection, or double,” that is, as being undivided without the desire to take a perspective on oneself, to be without a self and so assumed to inhabit a world in the absence of any relation of original to image (everything is either/or, one thing or the other), that is, in the absence of desire. The relation between what we know and what we cannot know can only be abridged by discourse, but in ways that leave a remainder because of the secondariness of speech.
(B) At the second level, desire itself accentuates this division as the experience of a split between the internal (intimate) and external (real), an experience necessarily oriented to fulfilling what is irresolute, an imaginary and impossible reconciliation released by the obscurity of the division as the enigma (puzzle, riddle) of being human as two-sided, two-in-one or one-two (both body and mind), the enigma whose obscurity exercises the subject dramatically in Lacan’s (1992) figure of das Ding (the intimate experience of exteriority, the external experience of intimacy) and is dramatically represented in his version of the mirror stage. This sense of das Ding was perhaps best captured in Plato’s (1949a) Theaetetus in the discussion of the difference between having knowledge (as if one wears it or has it about one) and possessing knowledge (as if one might make it over and take it as one’s own). Having knowledge in the way of being literate and capable of using terms and enacting the grammar through following rules and the like is not the same as being able to use the language in new and inventive ways, influencing it and being influenced to create and develop unexpected situations. In possessing knowledge we do not mechanically apply a code, but perhaps reinvent the word in different ways, find our voice in the word and the word as an expression of our voice, creating opportunities for figuration and the fluency of expression rather than rule-governed competence. The narrative represents the movement from having to possessing knowledge as the trajectory of the ideal speaker, striving necessarily but impossibly to bring together external and internal.
The split between having and possessing knowledge, itself not an either/or choice, is an example of the Grey Zone and applicable to any phenomenon or usage, including having an experience, having a self or whatnot, making reference as it does to the requirement of self-knowledge as a pursuit insofar as self-possession acts upon what we have (commonplace distinctions) by rethinking them for the purpose of making over both and jointly the distinction and ourselves as a matter of import, resuscitating the distinction and grounding ourselves through the practice of such a renewal. This movement from having to possessing oneself in one’s speech is intended as a trajectory that is mimetic insofar as it is performed as an imitation of such desire as a pursuit. Despite the reputation of the Greeks as unformed in this respect, this is not an essentialist definition of the human as being reflective in practice but as needing to drive towards a mimetic relationship with respect to self-knowledge in ways that are both necessary and desirable (Kenneth Burke’s [1957] “equipment for living”) and also impossible to fulfill.
Note in Greek the three-fold nature of this division between the inside and the exterior: first, between the word and the thing as we pointed out for the contrast of science and philosophy; second, the division between the intimacy of the word itself (its interiority) and its externality in ways the word is assumed to “kill” the experience to which it refers (as in Lacan [1992], if the first assumes a split between signifier and signified, then the “advance” that sees only the signifier still recognizes its split or division between its intimate and external senses). Finally, the notion of en medias res, of being in the middle of things, is the Greek way of acknowledging the secondary character of the human, its inevitable position as a space of inheritance, of always beginning in the middle of a story (just as the talk here on the Grey Zone is en medias res since I can in no way pretend to be at the origin of this discourse). Each of these levels identifies a different tension in relation to the unknown.
The distinctions of having from possessing knowledge and of en medias res are nicely joined in Lacan’s conception of das Ding as the irrevocable border between the intimate and the external experienced by the subject of language. The subject, said to be divided by the tension between the signifier and the jouissance that exceeds it, treats the word as the corporeal outside of the experience it represents. In line with Freud’s (Freud and Breuer, 1952) conception of symptom formation, the word converts the internal excitation aroused by the trauma into an external point of reference that can only reduce that experience as if the subject is two-sided in her loyalty both to the signifier and to the signification that is felt as exceeding it and that seems both to identify its authenticity and to mark it invariably as lost. This border is indicated by the signifier (word, category) itself and its relation to signification. Conversion describes the process where signification brings the signifier into existence through the physis of language and the emergence of what is positive (the name), for what is negative (the experience of one’s arbitrary groundless nothingness). What Lacan calls a “nonrelation of signifier to signified” (Fink, 2004, pp.132–135, 137–140) means that the symbolic order neutralizes the imaginary wasteland of the subject, organized around the negative experience of loss and abandonment (castration). This relation of exteriority to intimacy experienced as the split in any relation to the word confirms for him the body as the paradigm of identity, because the word is conceived according to the model of corporeality. Such a subject is necessarily driven by the split to imagine that there must be something better than the signifier, such as an ideal or standard that “never fails to make things worse,” because it is bound up with the inevitable frustration and aggression of the subject in her disappointment at not being able to realize this standard in action. If for Lacan it is the failure to reach this ideal that is a constant source of frustration, for Plato the commitment to such a standard is necessary and desirable as long as it is understood for what it is, as a playful and provocative “guide for the perplexed” rather than as a final solution to be resolved or reconciled.
If we think of the signifier in the way Plato thinks of any notion, then we recognize it as an ideal, or even better, a standard guiding action, but a standard not capable of being realized. Here is Benardete (1989, p. 9) on the way such a standard (for example, the notion of justice as the ideal regime) functions in the Republic: “regardless whether it is of necessity imaginary or not, the one best regime comprehends the manifold of all inferior regimes. It guides one’s understanding of political life even if it never shapes one’s actions.” Think of the “one best regime” as akin to the notion of the signifier that we pursue and that we intend to comprehend the manifold of all usages that are inferior because they are partial. In this way the idea that the signifier has many senses (Aristotle [1966, s.1003b, p. 54] on “Being has many senses”) implies the prospect of imagining a systemic and hierarchical connection between these senses in the way the universal might stand to the particulars. This desire guides our understanding even while we cannot apply it in any particular way as an action; it is by necessity imaginary in the way the process of signification exceeds the signifier (that is, in the way the intimacy of justice must be oriented to as something that cannot be determined in speech as this rather than that according to an either/or formula). Here the ideal speaker modeled after the figure of Socrates as one so engaged in a pursuit of the impossible as a necessary standard could just as well in this respect be like Simmel’s (1971) description of Casanova the lover as one who desired the impossible. The ideal speaker, like Socrates and Casanova, desires the speech he will not complete and yet can only speak of justice within the framework of desire as such. What the ideal speaker idealizes is desire for the best speech in a pursuit that will end in dramatizing the difference between the influence of the pursuit in shaping one’s speech and shaping one’s actions, a difference correlative with the distinction between the symbolic order and the Real and with the hole in Being (the Grey Zone). That there is a difference between wanting to be the standard (Pygmalion) and knowing the standard shows the necessity of distance in relation to any ideal as Serres (2008a) has nicely captured.
(C) A third avenue of approach to the Grey Zone comes to view through this necessary ascription of desire to the human subject because the need to universalize it and assume it as true for anyone creates the occasion of “mutually oriented action” (Weber, 1947) as the imperative of conversation in which both the objectification of the situation of co-speaking and of the need to defer to someone to define the terms and conditions of the talk emerge as conditions needing to be accepted provisionally. The co-relating of desiring actors marks them as the same in that respect, similar but not identical as subject to the rule of desire, and so different and perhaps discordant unless moderated by some relationship to shared being. This requirement of what we can call intersubjectivity, though modernized by Hegel, only first appears as a problem rather than a stipulation in Plato’s (1945) Republic and in the various Platonic dialogues (see especially Meno and Philebus). Here, interlocutors such as Meno, Protarchus and Thrasymachus are persuaded to lay down their arms and give themselves to a version of conversation that they themselves did not create or choose, on the grounds that beginnings as such always need to be experimented with as practices that are done rather than accepted or rejected mechanically or on faith. That is, since the division of one subject must in principle be the division of all, intersubjectivity describes the relation between actors formulated as such, the condition for division itself becoming a phenomenon of social interaction where those necessarily the same and other in this respect must take up (and start from the position of) difference. Note too that this must include writing such as this with implications for practices of narrative and teaching.
What this means is that the imaginary of self-possession, when imputed to the other as well (rather than as a sign of one’s innate superiority), makes mutually oriented action, or what Parsons (1951, pp. 10, 48, 94) calls the double contingency (ego-orienting to alter’s orientation to ego), not only a parameter of speech but a prerequisite for dialogue, since viewing being viewed and the accountability this releases is a precondition of speaking, giving speech an intrinsically ethical and rhetorical character. This suggests not simply that the in-itself (the meaning of justice, virtue, capitalism, whatever) depends upon dialogue, but that dialogue in its way depends upon not only the commonplace intelligibility of the topic (usage and content) but on the desire to take it up by orienting to its otherness and to the different interests in this relationship as such.
This is where the notion of mathematics as preparation for philosophy acquires its force as a representation of the unstated beginnings in conversation that need to be accepted ironically as part of the play itself, indeed as a move in the conversational play rather than as a mechanical prelude such as in the signing of a consent form, because playfulness as an irony towards mastery in the expectation that it can come to fruition as “shared being” is part of conversation and demands a flexibility seen neither as weak or strong. Thus, the problem of the Grey Zone at this level seems to refer to the question of whether the method of dialogue itself is an imposition of force or not, whereas the real question created for both Plato and his ideological interlocutors such as the Sophists was not this at all (since everyone knows that conversation begins as a discourse of mastery) but rather a question of how such necessary persuasiveness can be converted into a shared resource or whether it is fated to recur as domination, that is, the question of the relation of teaching to power and persuasion and of the unstated but necessary place of force in conversation as a resource to be cultivated and dissolved. In other words, someone must define the situation. This is why the figure of tyranny haunted the Greeks. The Greeks identified the notion that a “discourse of mastery” is the context for any speaking in contrast to Lacan’s (2007, pp. 11–32) usage of differentiating it from other types of discourse. For the Greeks, mastery was a parameter of beginning and of co-speaking as that innate asymmetry intended as a frame to be disseminated and reshaped as such, shared and constantly reinvented as the focus of the talk, resembling mathematics in its need to accept the signifier as the mark of topos as a site of beginning.
The question for everyone above the Divided Line (see Plato’s Republic [1945]) is how to develop reciprocally and communally from an original inequality; that is, how to create justice in speech in the shape of a dialogical relation to diversity. This desire animates Plato’s vision of intersubjectivity in a way that resituates its object, not in the topic being discussed (virtue, piety, justice or pleasure), but in the imaginary of conversation as a means towards community that is envisioned in the desire of the ideal speaker. What the Grey Zone discloses is that the object in intersubjectivity is less the content or concrete topic exchanged than the methodological imaginary. Further, if the interlocutor to dialogical intersubjectivity seems to be the tyranny that is monological, then deeply it must be the sophist who agrees in rejecting tyranny and accepting dialogue, but exploits it in the name of generic formats governing argument and refutation, subject to a code in a way that takes rather than gives voice. These versions of tyranny and sophistry correspond to Arendt’s (1958) conceptions of tyranny and “anything goes” as extremist solutions to the problem of human plurality in contrast to the “mean” of politics, which this book is calling dialogue.
(D) The drama of the Grey Zone must come alive in the narrative, and the best example of this might be Plato’s Republic because the ostensible topic of justice that appears to bind the various speakers conceals the real topic as desire of an ideal speaker, committed to the forceful unfolding of conversation in dialogue as part of the dream of communal perpetuity. Thus, what is concealed as the object is the split intrinsic to justice itself between the mundane conceptions that assume the authority of the conventions regarding what is justice and the implicit notion of a just speech imagined as the standard to which justice ought to be true, a tension in the usage itself imagined as a space of inquiry exemplified by an ideal speaker seeking to recover it in these views of ordinary justice (this division between the subject of the signifier and of jouissance was discussed under B above). Such an ideal speaker seeking to resituate the source (its image) in what comes after (images) strives not for an impossible vantage point but for a path or way of access, a road to traverse in pursuing the enigma as if it is the pursuit itself that is life-affirming. The figure of the ideal speaker centers the division in justice itself, in the usage, as if the discourse speaks about two sides of justice at once, as a relation between justice as common speaking and as just speech, disclosing just speech as neither the same nor as different from common speech but rather as a way of making reference to its ground or form. Being en medias res, though, means that the ideal speaker is part of the discourse (together with it in that sense) and so, seemingly fated to “an impossible gaze,” as
image
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image
ek (1997) says, a degree of alienation from source or end that requires of any narrative an objectification that is not historical but provocative, driving the subject to analogically orchestrate the voices in whose midst it necessarily appears as if a whole, as if a fictitious dialogue that orients to the problem it imagines as obscure. The narrative forces all speakers to orient to its enigma as a puzzle for each and all, its enigma as the riddle that collectivizes the discourse. The narrative makes the speakers analogically congruent to and with one another by virtue of the content as if a third party, socializing them around the content so to speak, by using this content (the speech about justice) as a way of making reference to a just speech.
image
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image
ek’s “impossible gaze” is the deceit of using the content as the object, as the center of the exchange, masking its place as medium (and so the message that the medium massages speakers, redirecting them through the pleasure of co-speaking as such). The impossible gaze ruling the ideal speaker is not a position or destination but a provocation. Here is how this works: speech about justice could never tell us what is justice because of the limitation of opinion, but it could show us how the obscurity of justice that fertilizes this very variety is the incentive for distinguishing just from unjust speech through the figure of the desire of an ideal speaker. In other words, while the narrative confirms that speeches about justice will never add up to justice, it shows in the same way that justice can be nothing other than the pursuit of what justice is, the desire animated by the enigma as such, through speeches that will never add up. (As Simmel’s [1971] comment on the figure of Casanova as a stage prop for the adventurer, his desire for the impossible, stamps the lover, here the ideal speaker for justice as the lover of justice must pursue the impossible through the diversity of speeches about justice.)
So both extremist temptations, of accepting the speeches about justice as what justice is, and rejecting the speeches about justice as what justice is, both of these extremes of obsessive and hysterical inquiry, are to be moderated in view of the need to pursue justice by giving form to the speeches about justice in a reflection that seeks to moderate the extremes. Inquiry, neither copulation nor abstinence, is foreplay. Here then justice moderates temptations towards extreme speech by listening to the views and reformulating them, knowing that an eradicable distance must remain between the speeches about justice and what justice is.

Form, the hypothetical, the image

The fiction of narrative follows from the notion of the relati...

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