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On Moving Beyond “Context”

Updated: Aug 30, 2023

Perhaps it is because I teach in a medical school, rather than a traditional academic history department, but over the past two years I have become increasingly interested in thinking about how historical scholarship can directly contribute to solving current problems. When people discover where I teach they often ask me, in a somewhat quizzical way, what I actually do. How do I spend my time? What do I contribute? Why have a historian at a medical school at all?

It’s a good set of questions. I typically respond with something about “context”  – how history helps us understand the present, or raises interesting questions about the direction we are going, or some other such formulation. This is all true, of course, and its important. I wouldn’t be a historian if I didn’t think in these terms. But I have also started to wonder if historians can do more – and, if we can, whether or not we should. So, I’ve started to ask myself: what can historical scholarship contribute to the design and implementation of health interventions? To the crafting of public health policy? To the definition and measurement of quantifiable problems and outcomes? To the generation of grant money? Can historians do more than talk about the past in order to provide “context” for the labor of others? And should we?

William James, in “What Pragmatism Means,” wrote that “[a pragmatist] turns away from abstraction and insufficiency, from verbal solutions, from bad a priori reasons, from fixed principles, closed systems, and pretended absolutes and origins. He turns toward concreteness and adequacy, toward facts, toward action, and towards power.” With this in mind, I’d like to ask how historians – and historians of drugs in particular – can turn away from our reliance on “verbal solutions” and “abstraction.” I’d like to ask how historians can turn toward “action” and “power” – toward making things happen in the world in which we find ourselves, today, now. What is the “cash value” of our work, as James might put it, and how can we increase the return on our investment – intellectual, personal, professional – in the study of the past?

One obvious possibility is drug policy. Historians have certainly had a lot to say about the failure of criminalization and the many harms it has caused. Indeed, historical arguments have been an important part of the political effort that have, after many years of hard work, finally made it politically feasible to talk seriously about reform. Yet, for the most part, historians have not really moved beyond the standpoint of critique and into the domain of actively defining and implementing concrete policy goals. There are probably exceptions – and if so I’d love to hear about them – but for the most part scholars have largely limited ourselves to making general statements about the failure of current policy and the need for change.

These sorts of broad arguments are important, of course, and have had political consequences. But they are also quite different from the type of work necessary to conceptualize and enact specific policies, let alone the type of work necessary to understand and track the results of such efforts. Equally important, general statements about ending “the drug war” and promoting reform do little to help us think about the productive role of law in promoting the public good. What role can historians play in formulating and enacting policies to reduce drunk driving, to limit the use of steroids among children, to promote the use of clean needles? Decriminalization is only one part of a very complicated puzzle about how to reduce the harm associated with certain types of drug use, and even decriminalization will probably be more difficult to enact, and have more unexpected consequences, than most people assume. Promoting the public good through the design and implementation of policies intended to reduce the harms associated with drug use in other ways is an equally important part of the puzzle. Whether or not historians have anything substantial to contribute to these sorts of projects, beyond describing the “context” in which such issues play out, is something worth seriously considering.

Of course, policy is only one possibility. We know, for example, that disease definitions shift over time, with the specific signs and symptoms associated with particular conditions being contingent on a variety of historically constituted factors. One idea, then, is to look to the past for signs and symptoms that were previously associated with a disease but have since been excluded from its definition; alternatively, historians can trace the process through which disease definitions have been expanded to include new problems or new signs and symptoms – one notable example of this type of work is Allan Horowitz and Jerome Wakefield’s The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder (Oxford, 2007). This is a truly brilliant piece of work, and it shows that when done right historical analysis can make a powerful argument for the redefinition of disease categories, and thus for the transformation of medical and public health practices.

Addiction – or dependence, or whatever you want to call it – may be open to these kinds of interventions. Historians may be able to contribute to the ongoing effort to define and ameliorate the problem of addiction by asking how the condition was constituted in the past, how it has changed over time, what types of treatments have or have not worked in the past, and similar questions. Yet to do so, we will need to be willing to move beyond the framework of critique and begin to ask ourselves how our scholarship can productively engage both the difficulties that addicts face on a daily level and the assumptions and methodological approaches of those who care for them. Doing so, I suspect, will allow us to begin to make concrete contributions to the betterment of people’s lives.

Of course, it might also make things worse. The question of how to make historical scholarship useful in an applied sense is obviously not an easy one. But it is even more difficult to figure out whether or not we should attach our work to what Geoffrey Rees has, in a fine recent article, called “the unrelenting technological and administrative drive to improve the efficiency and utility of medicine.” The financial metaphors I used earlier evoke both the possibilities and dangers of doing so, and in an age of shrinking budgets and increasing calls from university administrators for historians and other scholars to justify our existence I don’t want to downplay the intellectual dangers of endlessly chasing the next grant or the ethical dangers of linking our work to the police powers of the state. What does it mean for historians to attach their work to the definition, quantification, and management of health problems? What are the implications – intellectual, professional, ethical – of attaching historical scholarship to the design of treatment protocols, the implantation of public health interventions, the passage of laws and regulations, to the penalization of those who do not follow our dictates? To the embrace of power, rather than its critique? I really don’t know, and I’ve only recently begun to think about such questions in anything more than a superficial way. I could certainly use some help figuring it all out.


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