I recently read Annmarie Mol's The Body Multiple. In reading this book, I came to understand with more clarity why I have always had two minds about the works of the 'actor-network' school, broadly considered (Latour, Callon, John Law, Mol). On the one hand, I have always found their critique of the “culture concept”, or efforts to go beyond the binary presumptions of sociology ('society') and economics ('rational individual), impressive and effective. And yet when I read on to their own work (the 'beyond culture'), I come away at best unconvinced and more likely displeased. I now understand that this is because this school moves away from the culture concept in almost exactly the opposite direction as Rabinow does with the anthropology of the contemporary.
The actor-network school moves from culture to action. Mol begins the work by arguing that ontology must be completely separated from the question of knowledge. She states that most anthropological works on medicine are centered on epistemological problems: the logic determining representations; how medicine knows its object; different “perspectives” on the body and its diseases. What she means here is the dominant move of medical anthropology to distinguish 'disease'--the biological pathology; from 'illness': how the patient experiences and lives with the biological pathology. Like similar distinctions of nature/culture; or sex/gender; these derive from the classical works of anthropology, and in particular American anthropology (Boas on race; Mead on sexuality, etc). In the case of medicine, Mol acknowledges that this approach opened up a space for anthropologists beside the medical doctor. But only beside; they operated on different aspects of reality. And this is the problem. Mol's resolution of the problem is to trouble the distinction between levels of knowledge (biology, culture) and replace it with another “axis” which she calls “practice”: practice “encompasses molecules and money, cells and worries, bodies, knives and smiles” (157). Practices enact reality: atherosclerosis exists under the microscope. That is, the microscope (and a host of other instruments and activities) enact atherosclerosis; in the clinical interview, atherosclerosis is different because it is enacted differently. Once you have this view of practice and enacted reality, you have a world that is “multiple” and yet remarkably homogenous. It is all simply actions and matters, almost like a rebirth of social physics.
The anthropology of the contemporary, by contrast, moves from culture to problematization. As Foucault described it, problematization is neither “past people's behavior (which is something that belongs to the field of social history), nor ideas in their representative values. What I tried to do from the beginning was to analyze the process of 'problematization' - which means: how and why certain things (behavior, phenomena, processes) became a problem. Why, for example, certain forms of behavior were characterized and classified as 'madness' while other similar forms were completely neglected” (Fearless Speech, 171). Foucault, like Mol, rejects a program which replaces reality with ideas, which he calls 'historical idealism' but could equally apply to Mol's nemesis 'culture'. Instead, a problematization is “an 'answer' to a concrete situation in the real.” Discussing his work on parrhesia, he says that the answers of the questions about the nature of parrhesia “are not collective ones from some sort of collective unconscious. And the fact that an answer is neither a representation nor an effect of a situation does not mean that it answers to nothing, that it is a pure dream, or an 'anti-creation'. A problematization is always a kind of creation; but a creation in the sense that, given a certain situation, you cannot infer that this kind of problematizaiton will follow. Given a certain problematization, you can only understand why this kind of answer appears as a reply to some concrete and specific aspect of the world” (173).
For Foucault and problematization, what is of concern is the relationship between thought and reality (cf. p. 173). For Mol, there is much concern with the nature of reality, but hardly any interest in thought. Resonating with Latour and Woolgar's Laboratory Life, she argues that there is no difference between the laboratory manipulations and the writing of the scientific report in an experiment. Both are enacted realities. But what such an approach cannot seem to answer is: what is significant? The book could be about atherosclerosis, or it could be about cancer, or it could be about basketball: all of these are equally good examples of enacting reality. See Stephen Collier's review of Latour's Reassembling the Social for a similar argument.
Despite the power and beauty of Mol's ontological descriptions, these descriptions serve only an exemplary function. In her conclusion, she attempts to draw out the ethical significance of her move towards an 'enacted reality of disease'. She claims that in the world of enacted realities, the primary question is not an epistemological one: “how can we be sure?” but rather an ethical one: “how to live with doubt?” That is, how to live with the knowledge that reality is always enacted, and enacted worlds multiply. But beyond rejecting a model of 'choice', she provides little in the way of equipment for living with this ethical problem, or inquiry into the ethical equipments that are guiding how actors act and enact reality.