On Annemarie Mol’s The Body Multiple

(A talk given at the SAHN seminar at Cambridge University, 2 October 2013)

Instead of summarizing the chapter, I thought I might use this introduction to try and situate The
Body Multiple in the tradition of which it is a part. I will thus draw some connections between
Annemarie Mol’s book and actor-network theory, and specifically to Bruno Latour’s work. Hopefully,
after having read works by both Latour and Mol, we can start to feel relatively familiar with this
theoretical tradition known as ANT.

Mol devotes a section from the first chapter of her book to reflect on the way the social sciences
came to talk about diseases – starting from Parsons’ ‘sick role’ and to this day.

The division that was originally established was the relatively well-known distinction between
disease and illness; disease as the physical reality of malfunctioning body systems, and illness as the
social and psychological consequences of that physical reality – namely the patient’s experience.
Then, several decades later, with what Mol refers to as perspectivalism, came the idea that medical
knowledge is no less interpretive or discursive than the social sciences. As a result, the nature of the
distinction between disease and illness changed. Instead of pertaining to different spheres of reality,
disease and illness now simply referred to different discourses; the first an object of study for
medical professionals, the second for social scientists. None of which more “real” or objective than
the other, but simply talked about by different disciplines and studied in different ways. However,
the distinction itself, between disease and illness, retained its importance, and it arguably still does.
It is this state of affairs with which Mol is dissatisfied. Why? Because reality, in perspectivalism,
always remains unaffected by those who study it. It is too powerful and shielded to ever be moved
or changed. Scientists are perceived as observers rather than actors.

Mol feels this view of reality as independent of science and medicine is too limiting, and also plainly
inaccurate. Thus, throughout The Body Multiple, the status of reality is constantly being negotiated,
as object and subject, nature and culture, disease and illness are mixed together and made virtually
indistinct. Her conclusion, as she presents it right in the beginning, is that reality is in fact made-in-
practice, enacted in various ways by different actors; and that there is no one reality; that instead, it
is multiple. This could be said to be the central thesis of the book.

But how is any of this related to actor-network theory? I’ll try and draw out just several connections.

In her references to literature, Mol invokes Latour’s We Have Never Been Modern (1991), where he
argues that the divide between object and subject is artificial – much like the divide between the
natural and the social. He argues that object and subject are merely two opposites of a spectrum,
that object and subject “have many quasi subjects and quasi objects, mixtures, in-between them.”
(p.31) Thus, importantly, Mol and Latour both share the doubt that nature and society, object and
subject (and also by extension, disease and illness or sex and gender) can ever really be thought of as
distinct. Importantly, both Mol and Latour rely on practices rather than on knowledge, and on
events rather than on their interpretations, to observe the artificiality of these distinctions.
Mol quotes Latour and Woolgar’s Laboratory Life (1979), where they argue that "Scientific activity is
not 'about nature,'” but that “it is a fierce fight to construct nature.” This notion that science creates
or constructs – rather than simply reveals – is clearly central in Mol’s book as well, and possibly an
overarching theme in many works in ANT.

Yet, to refer to either Latour or Mol as constructionists might be misleading. Usually,

constructionism implies a sort of idealism; a belief that nothing is real, that objectivism does not
exist; that all that exists is representations and interpretations. Constructionism is also likely to imply
a sort of radical relativism, by which any explanation is always as good as the next. After all, if reality
is merely constructed, what standard would we have to assess the validity of any scientific claim,
other than its general acceptance by others? But in Reassembling the Social, Latour makes it very
explicit that he is far from holding such an idealistic world-view. Because when Latour argues that
reality is constructed, the constructs he speaks of are made from much more than just ‘social’.
Instead, according to Latour, constructions are heavily imbued with objects. Atoms and molecules,
streets and airplanes, books and factories, crops and dining rooms – and also ideas, beliefs, language
and emotions – these are all potentially crucial building blocks in the construction of reality. Thus,
the type of connection between two or more people – the kind of connection that would usually be
considered ‘social’ – is not necessarily more or less meaningful than the connections between man
and machine, or even between plant and insect. These are all potentially equally important
connections. It is up to the social scientist to pay attention to these connections, insofar as they are
significant in making a difference, in affecting reality.

So when Latour argues that reality is constructed in the laboratory, he makes it clear that this
construction is neither random nor entirely contingent. It is not simply a ‘social’ invention. An
experiment will fail if its planning fails to take all its objective elements sufficiently into account –
materials, surfaces, technology, bacteria, light. Conversely, a successful experiment depends just as
much on the diligence of the scientist as it does on the validity of the hypothesis it is meant to test. It
is in this sense that reality, according to Latour, is constructed, and it is also this that prevents any
implications of idealism. In short: the material world matters, but so do people.

Another important theme, therefore, that Mol shares with Latour is both authors’ extensive
emphasis on material artefacts, on objects, and on bodies. Objects – blood, flesh, and body organs
included - are seen as actors; they have agency and they carry fragile and changing identities.
Objects may also retain knowledge, belief systems, and even affect. We all noticed that in The Body
Multiple bodies and objects are treated with much respect. Severed feet, veins, microscopes, knives,
uniforms, examination tables, seminar rooms, operating theatres, shoes, and even the patient’s dog
– these are all part of the story. In strict ANT terms, these objects – as well as research agendas,
funding grants, medical ethics, insurance systems and policy decisions; and also doctors, nurses,
patients, and ethnographer – all take part in enacting atherosclerosis. In that sense, these can all be
said to be actors. They have an effect on its reality. They affect atherosclerosis, but in turn they are
also affected by it. That would be the ‘actor’ part of actor-network theory.

But all these different actors do not exist in isolation from one another. Instead they relate to each-
other in various ways. They are connected, but their connections are not all of the same kind, nor
are they always predictable. Microscope and pathologist interact differently than a patient and his
wife do – but both are examples of a relation; of a connection, an association. Yet as Mol had
written elsewhere, “the term “association” cannot begin to cover all forms of relatedness. Further
words are needed: [like] collaboration, clash, addition, tension, exclusion, inclusion, and so on.
Terms variously adapted to various cases.” (2002:259) Actors affect one another and are virtually
indispensable to the existence of each other. These various relations between these various actors
are what forms a network. This would be the network referred to in ANT.

So mainly due to her sensitivity to different kinds of actors and to their specific connections, Mol’s
work can be said to be a work in ANT. But that’s not the only reason. Her sensitivity to events, to
practices, and to objects (which in her account are treated with as much respect as human actors) –
make this book, as far as I can tell, a great example of actor-network theory, and of how it can be
applied in ethnographic research (or as Mol would probably have it, not so much applied as enacted
or performed).

So unlike Latour’s paper that we read 2 months ago (“How to talk about the body - The normative
dimension of science studies” 2004) – Mol’s book seems to aim at actually providing some answers
rather than just asking questions; to make things clearer rather than confuse. Even though the
various principles of ANT are not explicitly mentioned, they are nonetheless made obvious
throughout. But importantly, one doesn’t really have to be conscious of ANT to read and enjoy this
book, and to find it helpful. This is also reflected in Mol’s separation of the main text from the
references to literature. It’s as if she invites the reader to either locate this work in tradition, or not.
She gives off the impression that her goal was to be as clear and honest as possible in making her
point. If Latour asked ‘how to talk about the body’ but left us with little actual answers, Mol steps in
to do his work for him.

It’s also quite clear that this is not really a book about Atherosclerosis. Mol seems to have made a
conscious decision to choose a disease that is arguably as straightforward and simple as diseases get
– with a known cause, well understood mechanism, and several effective treatments. A disease that
involves little shame, blame, or stigma; a disease that has very little controversy attached to it, if
any. This is because atherosclerosis is not really the issue. More than this is a book about a vascular
disease – or even about a Dutch hospital – this is a textbook, an example of a specific kind of
ethnography, a book that aims to teach a theory rather than just use it. In Mol’s words, her aim is to
‘create a theoretical repertoire’.

But Mol, I felt, may have offered too few tools to study diseases that are not as straightforward as
atherosclerosis. Disabilities, chronic diseases, mental illnesses, fatal diseases, and diseases that are
undiagnosed, controversial, hidden, denied, stigmatized – or plainly unknown. Diseases whose
bottom line cannot simply be bracketed, because they have no bottom lines. At best (to draw on
Mol’s idea of knowledge-in-action) they are works-in-progress.

Ben Belek

References:

 Latour, Bruno. "How to talk about the body? The normative dimension of science
studies." Body & society 10.2-3 (2004): 205-229.
 Latour, Bruno, and Steve Woolgar. Laboratory life: The social construction of scientific facts.
Princeton University Press, 1979.
 Mol, Annemarie. The body multiple: Ontology in medical practice. Duke University Press,
2002.
 Mol, Annemarie. "Actor-Network Theory: sensitive terms and enduring tensions." Kölner
Zeitschrift für Soziologie und Sozialpsychologie. Sonderheft50 (2010): 253-269.