anton_ego_motivation_by_keep_me_posted-d4t0y6vHo hum.  Another day, another person doubting the worth of [insert humanities field here] history.  Most recently, we have Richard Horton, an editor of The Lancet, writing a commentary in which he declares that

Most medical historians, it seems, have nothing to say about important issues of the past as they might relate to the present. They are invisible, inaudible, and, as a result, inconsequential.

*Pauses to note irony of editor of THE LANCET proclaiming the history of medicine moribund*

Horton is not disdainful of the field itself; he is really lamenting a Golden Past, itself a common historiographical narrative:

Medical historians have made critically important contributions to public debates about health, health services, and medical science.

*Pauses again for irony*

Horton goes on to list a number of texts that he thinks provide such a contribution, but opines that

for almost two decades, medical historians have produced little that has provided truly fresh insights into our understanding of health and disease . . . it seems fair to conclude that medical history is a corpus of activity lying moribund on its way to the scholarly mortuary.

Goodness me . . . glad I’m not involved in any corpse animation such endeavors . . .

Carsten Timmermann at Manchester and Simon Chaplin of The Wellcome Library (The Happiest Place on Earth for historians of medicine & public health) issued excellent responses.  Given that Horton professes, at least, to see the value in the history of medicine per se, the most direct response is to declare that the critic’s opinion is mistaken, and point to just a few of the large number of examples of meritorious works.

I endorse these rebuttals wholeheartedly.  But part of me wonders whether engaging on these terms itself cedes too much ground.  That is, Horton’s view of the value of the history of medicine as a field of inquiry is entirely instrumental.  It is of value only to the extent that it provides contributions to ongoing debates about public debates on health, health services, and medical science.  The contrapositive proves the rule, which means that insofar as the history of medicine and public health is not providing such contributions, it lacks value.

Because I do public health law/policy/ethics AND the history of medicine/public health, I spend an inordinate amount of time thinking about the advantages and drawbacks to thinking about the latter fields in this instrumental sense.  I’ve presented on it (slides here; precis here), blogged about it, and discussed it with other historians in person and on social media.  I actually do not think it is as tricky as it seems.

The only problem with reductionism is that it is reductionist.  What I mean is that the problem with saying that the history of medicine/public health is valuable because of the light it sheds on contemporary issues in health and medicine is absolutely not that the proposition is false.  It is most assuredly true.  As Drs. Timmermann and Chaplin note, there are no shortage of outstanding recent works in the field that are indisputably relevant to public conversations in health and medicine.

But what if there weren’t?

That is, let us assume for the moment that a key premise of Horton’s critique is true, that it accurately reflects the state of the world — that, in point of fact, there have been precisely no recent works in the history of medicine and public health that can inform contemporary public conversations on health and medicine.

Horton’s conclusion — that the fields are moribund — would nevertheless be invalid.  It does not follow even if we grant his factual premise.  This is because of the central unstated premise in Horton’s position: that history, or at least, certain subfields, is of value only insofar as it is useful in illuminating contemporary problems.

I think we should reject this premise with extreme prejudice.  We ought to study history — or anything else for that matter — because it is of inherent worth, because understanding how things happened, how people acted, and what may have motivated them is inherently valuable.  As I have remarked, reducing history to its (very real) instrumental value is enough to bring Clio’s wrath down upon all of our heads . . .

What I’m interested in here is the idea of enterprise justification.  That is, Horton, and critics like him, are not, IMO, simply asking for an accounting of the value of the field.  Such is relatively easy to provide, although in saying as such I do not mean for a moment to denigrate the time and energy expended by those noble souls who deliver such.  Rather, I think what the critics are seeking is a justification for the entire enterprise.  It reminds me of the rasha, the “wicked” son in the emblematic Passover story of The Four Sons:

The Haggadah explains that the “wicked” son looks around at all of the participants engaged in telling their stories, relating their shared history, and says, “What does all of this mean to YOU?” The Haggadah instructs that by phrasing the question this way, he has excluded himself from the community of storytellers.  He is, in essence, challenging the justification for the entire enterprise.

I guess the point — there’s a point! — of all of this is to suggest that while responding to critics like Horton by detailing some of the outstanding works that do in fact have great relevance for contemporary discussions of health and medicine is — while important and worthwhile — to some extent still playing in the critic’s dojo.  At the same time the challenge is and should be met on the critic’s terms, I think it is also important to destabilize the assumed framework for the contest: the justification for studying the history of medicine and public health is not (exclusively) the insights it provides for contemporary policy and practice.

Even where we historians of medicine & public health ought to highlight and lionize the significance of those insights, history ought never be reduced to its instrumental value.