Sunday, July 12, 2015

Vinh-Kim Nguyen on Biomedicine, Unhappiness, and the Epistemology of Crisis by Michelle Pentecost

'I study wars and epidemics...happiness isn't really my thing.' Like other speakers over the past 10 days, Vinh-Kim Nguyen addressed the packed WISER seminar room with a wry opening caveat - happiness would have to be approached via its other. The title of his offering had already alerted a return to crisis as an orientating theme for thinking happiness in this workshop. Nguyen proceeded to engage the audience in an experiment: to think through (un)happiness from the perspective of an urban general practitioner. He situated this experiment in 'the clinic', a space that varied from the doctor's office in Montreal to the multi-bedded camp tent of an Ebola unit in Guinea. Nguyen reminded us that not all of these spaces fit into Foucault's clinic, the birth of which is distinctly tied to a biomedical rationale that standardises affliction. Common to all of these spaces, however, are underlying historical and social configurations that determine 'who gets to be a doctor and who gets to be a patient' - a social relation that definitively shapes the conditions of knowledge production. Against these provisos, Nguyen offered us 'doctor stories'. He did not deliver packaged vignettes, but rather a series of recollections that illustrated the practitioner's task of holding and cobbling together not-neat narratives over time. 'I wanted to give a sense of the texture of unhappiness.' As such, Nguyen's anecdotes are not another version of 'the case', that central methodological trope of both medicine and anthropology. Like the patient, the speaker did not arrive and announce his diagnosis, which could only be elicited through careful attention to his story. So what did Nguyen's tales of biomedicine and (un)happiness reveal? Nguyen placed his patients' unfolding stories within what he calls an epistemology of crisis. Here, it is hard not be reminded of Janet Roitman's description of crisis as 'an enabling blind spot for the production of knowledge...not a condition to be observed [but] an observation that produces meaning'. Crises, or turning points, precipitate the patients' visits to the clinic. For the doctor, these crises produce a series of revelations, through which the patient as person slowly emerges. Thinking with (un)happiness, Nguyen observes that for the urban GP, the patient's crisis is often one of loneliness. For Nguyen, the crisis of recognition is given no less importance than the crisis of an Ebola diagnosis - implicit here is that neither crisis nor suffering can be qualified or measured. Nguyen works across multiple registers of crisis, as well as different registers of happiness. He outlines biomedicine's versions of happiness, within the domains of psychiatry, pharmacology, the neurosciences, and 'happiness studies', and the ways in which these deploy old and new pharmaceuticals. He cites Anita Hardon's work on pharmaceutical experimentation in the Global South, where 'chemical youth' are using illicit and legal drug combinations in their everyday lives. And yet not all versions of (un)happiness will respond to a selective serotonin reuptake inhibitor, or a round of cognitive behavourial therapy. If the clinic is a site for the management of (un)happiness, 'not being unhappy may be as good as it gets.' However, although Nguyen's 'doctor stories' are overtly concerned with crisis, they also offer moments of happiness. Eileen's Moyer's paper, Happiness After Crisis, argued that happiness is not the opposite of crisis. Happiness can be experienced in the midst of crisis, a sentiment echoed by François Vergès in her offering on happiness amidst revolution. I would add to this the potential of happiness amidst crisis in the clinical space, a possibility borne out by Nguyen's recollection of joking with his patients, his exchanging of smiles with a familiar patient in the waiting room, and his moving description of a family reunited in the midst of the Ebola epidemic. These brief moments of respite - from loneliness or pain - are a different kind of happiness, which support Nguyen's argument that like crisis, happiness cannot be standardised. As such, the general practitioner must always also be engaged in social critique - a disposition that starts to blur the boundaries between physician/anthropologist. As a medical doctor halfway through a doctorate in medical anthropology, I am also navigating this productive margin between medicine and anthropology. In particular, I am interested in how to think and write from this space from the Global South, and Nguyen has certainly inspired further exploration at this intersection. Michelle Pentecost