Translating Medicine Part III: Interview with Colin Halverson

Roanne Kantor //

What does translation mean to you? Can you talk about the way that it shapes your academic project? 

The process of ‘translation’ figures centrally in my dissertation, “Individualized: An Ethnography of Translation in Genomic Medicine.” This title plays on the metaphorical extension of ‘translation’ in medical jargon, referring to the application of research science to clinical practice. More fundamentally in my work, though, I’ve considered ‘translation’ as a means for establishing a degree of commensuration between relatively discrete symbolic systems. In my piece that appears in Anthropology News, I use the figure of translation to describe what I see as medicine’s ongoing and widening appropriation of techniques of power previously associated with the classical state. I’m interested in how objects signified in a given system come to appear as ‘the same’ objects signified in another system – particularly when asymmetries between these systems persist – but are nonetheless recognized and tolerated by their users. For instance, in my book project, I’m considering the translation of medical concepts into ‘plain language.’ I’m also currently working on a project looking at different ways ‘the gene’ is understood when viewed through the lens of a variety of different nomenclature systems, e.g., genes names based on disease phenotypes versus those based on genetic or protein structures.

 

What does medicine mean to you, in the context of this project? (for example, you seem to discuss individual practitioners and therapies, but also the “field” of medicine as a rhetorical actor). 

In my work, I have to consider medicine as simultaneously a set of institutions within bureaucratic infrastructures and as a named set of discursive resources used by a diverse array of actors. In that sense, you can think of medicine as the interaction between these two things – the brick-and-mortar hospital and Michelle Obama’s MyPlate nutrition guide, the molecular genetics lab and the Last Week Tonight segment on CRISPR. Not only is medicine “multiple” in the sense that it encompasses dissimilar practices and persons, it even appears “multiple” to many people acting within it and in its name. For me, treating medicine as a discursive formation that stretches across several contexts – and as a site where various commensurabilities and asymmetries are established between those contexts – has proved vital in understanding everything from patients’ choices regarding genetic testing to clinicians’ pursuits of specific research and funding opportunities.

 

A lot of the medical anthropology with which I’m familiar emerges from the postcolonial world, and thus looks at the ways that differing systems of medical and healing knowledge compete or syncretize. This produces “translations” between various types of expert epistemologies. Your work is somewhat different (at least as I understand it). You seem to be focused on the “translation” between expert and non-expert in the context of genetic testing. How do you relate to the wider field of medical anthropology? What are the different stakes or risks associated with these different kinds of translation? 

There is some interesting work being done in medical anthropology and sociology on the role of patient advocacy as a form of expertise-like knowledge formation, and in my own work on the ‘mainstreaming’ of medical genetics, it is often the case that patients know as much – or more – about their genetic diagnoses than do their primary care physicians. At least at the contemporary moment, a strong division between expert and non-expert is not always easy to draw. That said, there is a large and interesting literature on more explicitly expert-lay ‘translations’ in biomedicine – e.g., on medicalization, biological citizenship, diagnosis, and the illness/disease distinction – which looks at the incorporation or exaptation of non-expert symbols and categories into expert/official systems.

You also talk about medicine “translating itself” into different fields. Can you say more about that? We might use other terms to talk about the slow creep of medical discourse outside of its traditional “proper” sphere. What, for you, is the utility of explaining this idea through the linguistic metaphor of “translation” as opposed to the property-based metaphor of “appropriation” or the territorial metaphor of “colonization”? Do you agree that translation operates as a metaphor here, or would you push back against that assumption? 

‘Translation’ as I’ve described it above is certainly a give-and-take process at its core, but the terms and flexibility of that process vary from case to case. In the instance of the “new sovereignties,” both the discourse of biomedicine and its various institutional avatars have significant power but are also up against other mega-agencies, such as that of the federal government (visible in things like the Dickey Amendment and physician gag laws). In order to ‘translate’ policy concerns into medical policies, the commensurability of the two strives to be recognized by both federal and clinical actors. At a different scale, the complexity of power dynamics is perhaps even more apparent: In the clinic, patients often refuse doctors’ interpretations of their distress. And yet even while rejecting their clinicians as competent representatives of biomedicine, they can actively reaffirm biomedicine as an ultimate authority in such interpretations. For instance, patients may be upset when clinicians tell them that their genetic test results were inconclusive. Yet they may (and in fact, my research suggests, often do) dismiss such dismissals and interpret the results for themselves, within what they still constitute as a biomedical framework, using their idiosyncratic interpretations to make future medical decisions. Authority, in the sense that it authorizes and enables particular action, cannot be reduced a priori to assumed power dynamics. An overemphasis on the ‘power dynamics’ framework can even sacrifice important nuance and analytic value for the sake of prior political commitments.

 

I notice you use literary theory as part of your framework (especially Bakhtin). Can you tell me more about that? Did you have any trouble “translating” this framework from one discipline into another?

There certainly are difficulties in ‘translating’ literary theory into social science, but luckily much of this work has already been done for me. Bakhtin especially is actually a bit of a mainstay in linguistic anthropology, providing us with descriptions of key concepts like voicing, genre, and chronotope. The thing that I find so fascinating about translation, though – as I mentioned above – is that it works to objectify texts such that they become separable (‘decontextualized’) from various aspects of their constitution, e.g., from their purpose within their source community. In particular, I find that literary theory is often translated clumsily into linguistic anthropology because of the differing extent to which we place theoretical weight on authorial intention. Likewise, semiotics in its original sense can run wild when theorists don’t attend to some of its more theistic founding assumptions about where ‘meaning’ sits in the universe. That said, I find reading broadly to be rewarding, because even when ‘translation’ is troubled, thinking about how it breaks down or runs into limitations allows for a critical reflection on my own project and how it might be transformed in the encounter with other disciplines as well.

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