When Explanations Rest

“Good-Enough” Brain Science and the New Socio-Medical Disorders. Published in in Living and Working with the New Biomedical Technologies: Intersections of Inquiry, eds. Margaret Lock, Allan Young and Alberto Cambrosio.

Explanations come to an end somewhere. – Wittgenstein

Wittgenstein’s opening to Philosophical Investigations points to a funda­ mental 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 weak­ ness – afflicts a group of persons working together, what kind of expla­ nation is good enough? Is finding a food they all ate, or common expo­ sure 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 dis­ orders. Under this name, I include Attention Deficit Disorder (ADD), Chronic Fatigue Syndrome (CFS), Gulf W ar Syndrome (GWS), Mul­ tiple Chemical Sensitivity or Environmental Illness (MCS) and, to a lesser extent, Post-Traumatic Stress Disorder (PTSD), schizophrenia and depression. Each of these has been and continues to be the object of anthropological, sociological and psychological studies. Each is very different from the others in terms of history, demographics and the social location of controversies.