Friday, 4 June 2010

The initial history of psychiatric epidemiology

I’ve spent the last couple of days, here at Paris-Descartes, at a conference on the history of psychiatric epidemiology, an area twice removed from my own interests. By contrast with the last such intellectually distant conference I braved, I do feel a familiarity with the methodology or methodologies involved. That is not so much because the history or social history of epidemiology is philosophical in the way a Winchian might hope. Nor because there is much by way of a familiar philosophy of psychiatry issue: that the possibilities of psychiatric epidemiology turn on issues of classificatory validity. Only Allan Horwitz’ paper was explicitly concerned with the way that operationalising depression had made it over inclusive. (Allan Young's (pictured) fascinating paper on PTSD didn't really address the connection to epidemiology to my ear.)  But rather, having spent time in the Cambridge HPS department I still have some sense of the disciplinary standards of social history of science.

That said, there is still something that I just didn’t ‘get’. Even though the subtext of the conference was that the history of psychiatric epidemiology has only just got off the ground – such that there isn’t yet an agreed history – and even though there is obviously something interesting about the choices that were made by earlier actors (psychiatrists and more general epidemiologists) in looking at health or illness and the quirky contingencies of just what data was to hand in different countries, still I’m not sure why this is an area one would select for an academic life. No one pulled off what seemed so striking about Schafferite history of science: the sense that the negotiations of historically distant agents were both vitally interesting in their own terms but also had something interesting to tell us about ourselves in an almost novelistic sense.

(I wonder, however, what one of the historians here would make of a philosophical conference on the unboundedness, or otherwise, of the conceptual. Involvement in that, also, might seem a worse choice than becoming an engine driver or firefighter.)

More specifically, I also wonder whether the history of epidemiology will already be over, by the time it’s written (which is not at all to suggest that epidemiology will be either over or uncontested). It has been hard to avoid a sense that, other than the problems of psychiatric validity (ie not specific to epidemiology), stirling progress has been made by great men and women in striving towards enlightenment. It has seemed quite teleological. (Even Allan Young's paper left me in doubt as to whether it really was critical or just suggesting a complexity about how to capture the real distress in the area (an instance of the slippage between debunking and validating).)

This seems an odd impression because one thing that has clearly happened is that choices made previously in epidemiological study constrain present views about what us real and thus researchable and it is at least plausible to say that some choices that have been made were questionable. But that hasn't been made explicit this week. That said, there are other confereneces to come in the same series which may make that more of an issue.