In world mythologies the eye is frequently the emblem of light, power and wisdom – and often more than just wisdom, representing also the ability to read events in the future. Conversely, stupidity and ignorance are sometimes personified in the form of a blind god, or evil in the form of a sightless witch. It is not coincidental that some of the words we use for supernatural experiences are ocular. A seer has not necessarily got acute physical sight (often quite the opposite) and we understand ‘a vision’ as being quite separate from ‘vision’. In religion the faithful ‘see the light’ and the sceptics are ‘blind to the faith’.

In this chapter I will explore the power of the eye. This is not just the power of seeing; it goes beyond that. Eyes have a forceful influence on society through mythology, religious symbolism and philosophy. That we are a sight-dominated species influences everything from what we wear to what we build. However, our environment has changed to such an extent that our eyes are no longer protected to the degree they once were in the time of primitive man. Sight on the one hand is simply one of the five senses, but there is also the other hand …

Mythical and mystic eyes

Research shows that way back in the neolithic period, in quite different parts of the world, an eye or a pair of eyes was the magic symbol that represented the goddess of fertility. These early cults may have had some influence on the mythology of ancient Egypt, where veneration of the eye reached an extraordinary level never quite matched anywhere else. A remnant of the Egyptian ‘eye cult’ survives on the back of a US dollar bill, which has an eye symbol on top of a pyramid.

Egypt

In Egyptian mythology the eye (all sorts of eyes) had a very special place, so much so that saying their beliefs were eye-dominated may not be too strong. The eyes and their mysterious gift of sight must have had a profound influence on the day-to-day lives of the ancient Egyptian people because eye symbols became associated with the wonders and mysticism of their complex and ever-evolving religion.

The Eye Book has been a challenge to write because it walks a tightrope between being informative in the manner of a textbook and providing a book that is simply an interesting read about eyes. I intended a balance of both, but if I have slipped, then it is towards general interest. After all, there are many prestigious textbooks on eye structure and function, and just as many again that are totally unintelligible to the general reader who wants to know a little more about the most precious sense of sight.

Textbooks tend to be about eye structure, vision, visual aids, eye complaints and so on, but they rarely attempt to cover more than a narrow remit in great detail. What I have tried to do is to soar through all of these and also to embrace several other areas including the different kinds of eye professionals, historical eye care, famous people who have coped with eye problems, eye make-up, eyes in society, and eyes in mythology and religion. Finally I end up with a discussion of the appalling tragedy that is world blindness and what may be developed in the future to combat the evergrowing problem of visual handicap in both the developed and the underdeveloped world.

At whom is this book aimed? At everyone who has glasses or needs glasses, anyone who has a relative with an eye complaint, and basically all of us, because just about everyone will need to visit an eye professional at some time in their life. The general practitioner may find some parts of value, and I hope that the book will be a useful introduction for a student who is considering a future in orthoptics or optometry or for a nurse who might specialize in eye care.

As the book is not just for health-care professionals, I have tried to keep technical and medical words to a minimum. Unfortunately, however, I have had to include some specialized terms because eye professionals use them in their day-to-day work, and also too often when they try to communicate with their patients and the general public. If you do find an unfamiliar word (many of which are in italics at their first use) please refer to the glossary at the end of the book.

Hospital Z is a university hospital in a medium-sized town in the Netherlands. It differs in specific ways from other hospitals, but if one wants to study the form modern medicine takes in an affluent welfare state it is no better or worse than many others. In this chapter I will report on a study I conducted in hospital Z. This study was partly ethno-graphic. For several years I regularly went to this hospital and visited various departments in order to investigate the diagnosis and treatment of atherosclerosis of the leg vessels. The main aim of the study, however, was not to map faithfully what happens in the course of diagnosing and treating this single medical problem. Instead it was philosophical. I wanted to contribute to the crafting of better terms for analyzing the relations between medical knowledge and its objects.

In this chapter I'll present some of my findings – or maybe I should say some of my inventions. More specifically, I will present knowing not as a faculty of the human mind, but as an activity of the human body and the instruments it puts to use. This implies a shift in status for the objects of knowledge. Instead of being in the point of focus for a variety of eyes, each with their own perspective, they are presented here as objects that are being handled – by hands and knives; by questioning and listening; by coloured dyes and patient files.

Wittgenstein's opening to Philosophical Investigations points to a fundamental crisis in scientific and medical research: When is there enough explanation of a phenomenon to consider it settled and definable? If a cluster of symptoms – say dizziness, itching, extreme fatigue and weakness – afflicts a group of persons working together, what kind of explanation is good enough? Is finding a food they all ate, or common exposure to a rare gas, or a common brain pattern enough to say, “Okay, that is it”? Or is locating a certain gene they all share, or a drug that relieves some of the symptoms enough? What if only four out of five share the characteristic? Or yet again, do we need the entire pathophysiology of each symptom?

The fact that different people answer these questions differently points to the social location of these questions. 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.

In this paper I begin an ethnographic characterization of what is shared across a set of contested fields I call the new socio-medical disorders.

In a recent paper, Margaret Lock (1995b) reviews some of the programatic literature on transplant technology and finds a subtext through which this technology is sought to be “naturalized” and thus “the contradictions that inevitably arise from mixing self and other” are disguised, though not always self-consciously. “We have been warned,” she says “about the Shiva like character of invasive biomedical technologies: potential creators of happiness but, at the same time, destroyers of society as we know it: for it is now possible to manipulate nature/culture and self/other dichotomies of long standing – projects confined thus far to the realm of fantasy” (1995b: 391).

In this chapter I try to trace the different and multiple genealogies that go in to make the object – the “transplant world” – as a set of practices. Following Foucault (1972) in his analysis of clinical discourse, I do not look for a synthesis or for the unifying function of a subject – instead, I consider the dispersions which occur over various statuses, sites and positions that can be occupied within this discourse. From its inception to its implementation, transplant technology traverses realms that are ethical, legal and medical. It forges relationships between the highly technical worlds of super speciality wards in hospitals, the worlds of organ procuring organizations and individuals; and the families within which decisions about gifting, selling, “cadaver donations” are taken.

The argument

In this short chapter, I examine what I perceive as the historical relation between molecular biology, gene technology and medicine, and I touch on some aspects of its consequences in the context of the human genome project. I argue that the prevailing momentum of early molecular biology resided in creating the technical means of an extracellular representation of intracellular configurations. As such, its medical impact was not different from traditional biological chemistry. With the advent of recombinant DNA technologies, a radical change of perspective ensued. The momentum of gene technology is based on the prospects of an intracellular representation of extracellular projects – the potential of “rewriting” life. Its medical impact is virtually unlimited, although at present rather constrained. As a result, I question the very opposition between nature and culture. I argue that the “natural” and the “social” are no longer to be seen as ontologically different.

Introduction

Is there one culture, are there several different cultures of biomedicine? This conference seems to be based on the assumption of the latter. In the context of attempting an anthropology of knowledge, Yehuda Elkana stated almost two decades ago: “There is no general theory of culture or of a cultural system” (1981: 8). This is an apodictic statement, indeed; but it leaves room for crossing boundaries between scientific disciplines, systems of practices, and social contexts, just as molecular biology has overturned the boundaries of the traditional biological disciplines and their academic containment over the past decades. It allows me to follow the “molecularization” of biology with respect to some aspects of medicine, of medical care, and to the concept of health.

Reviewing the classification of lymphomas in the late 1970s, Henry et al. concluded rather gloomily:

Sixteen years later, having found the original reference for the Willis quote (Willis 1948), Rosenberg figured it was a case of plus ça change: “It was Willis who in his 1948 textbook stated, ‘Nowhere in pathology has a chaos of names so clouded clear concepts as in the subject of lymphoid tumours.’ The situation has not changed today” (Rosenberg 1994: 1359).

Taken separately, each quotation laments the lack of consensus in the classification of lymphomas. Taken together, they seem further to imply that the field itself is advancing at a snail's pace. This, despite the availability of radically new diagnostic tools, borrowed from immunology, cytogenetics and molecular biology. And yet, Rosenberg's somewhat jaded remarks appeared in an editorial criticizing a 1994 proposal for a new classification of lymphomas that incorporated (in addition to traditional morphological and clinical criteria) the latest antibody and cytogenetic techniques and that claimed, as a result, to have finally pinpointed well-defined, real disease entities (Harris et al. 1994: 1361).

Use of the term “intersections” in the title of this book undoubtedly evokes impressions of postmodernist rhetoric, yet it is also a term long used by symbolic interactionist sociologists to analyze “intersecting” lines of action and social worlds. This interplay of postmodernity and tradition is precisely one of the “intersections” we undertake to explore in this volume. Further intersections arise between the various analytical approaches exemplified by the authors represented in this book, and also between the human actors, the tools, the entities and the bodies that are constitutive of the new medical technologies. How these intersections relate to each other, in other words, how new biomedical objects and subjects call for new kinds of analyses, is one of the issues raised by the present collection of articles.

As indicated by the book's title, one can work with the new medical technologies, and we all live, directly or indirectly, with them. Some of the contributors tend to focus on the “working” side of this equation, others on its “living” side, while all struggle, more or less openly, to bring these two sides together. The authors display many differences in their choice of topics and approach (two not entirely independent elements). However, they share an understanding of “body politics” that, instead of rejecting or accepting recurring dichotomies such as that between Nature and Culture, looks at how dichotomies are produced. Yet, rather than focusing on either differences or commonalities, it seems more interesting to us to look at intersections, that is, temporary convergences that can lead to advances on some particular problem, with no pretence of providing a comprehensive world-view or a theoretical manifesto.

The field known as social studies of science is the province of those researchers who find science exciting at a philosophical and theoretical level, but who also are fascinated by scientists and what they do. Like the children and the governess in A. S. Byatt's story, “Morpho Eugenia” (1992), who watched and recorded the comings and goings and battles of the ant colonies, they observe the scientists. They sit in their laboratories, attend their meetings, collect their writings and persuade them to talk about their craft and their colleagues. If Latour's image of the black box is substituted for Byatt's ants, they want to lift the lid, peer inside the box, and make visible its contents. Once the period of observation is over, the researcher turns off the light, puts the lid back on the box and walks away. For understanding what goes on within the interior of the black box is an end in and of itself. How the box is sited in relation to the wider world seems of interest only insofar as this world impinges on events within the box. Hence, some critics have complained that too little attention is paid to the “processes of transmission of innovative knowledge from the benches of the laboratory scientist to the bedside of the patient” (Batchelor et al. 1996: 48).

Set against the complexity and diversity of the other chapters in this book, my characterization of social studies in science is clearly an over-simplification. Yet, like most over-simplifications, it is rooted in a grain of truth.

Epochs

Ethnographically, it is a distinctive fact that the field of the social studies of science is peopled by first-rate practitioners. These practitioners are frequently solicited to take meta-positions on the state of our present age and/or on the nature of things. Today, characteristically, these practitioners are responsive to such solicitations. This response is not so surprising when one considers the fact that the field arose in part to modify previous understandings of science as a rather atemporal, disembodied and theory-driven practice. Science studies in its plural manifestations has developed a dense and rich set of methods to study claims to knowledge, to analyze their embeddedness in fields of power and discourse, and to diagnose current pathologies of understanding (of nature, society and the self). There is but a small step to be taken from formulating a diagnosis of the state of the present to proposing a therapeutics. To devote oneself to the enterprise of studying the producers of the most valued forms of knowledge in our contemporary world places one in a position to pose questions about the status of all knowledge. In the light of this state of affairs the question I want to explore here is: what to make of a disjunction between the successful conceptual ground-clearing as well as often exquisite case studies that the field has contributed and some of the larger categorical meditations its leading practitioners put forward? What is at stake is an exploration of what the most encompassing analytic categories should be.