Abject Object Relations and Epistemic Engagement in Clinical Practice

Abstract

This article engages with medical practice to develop a philosophically informed understanding of epistemic engagement in medicine, and epistemic object relations more broadly. I take my point of departure in the clinical encounter and draw on French psychoanalytical theory to develop and expand a taxonomy already proposed by Karin Knorr-Cetina. In so doing, I argue for the addition of an abject-type object relation; that is, the encounter with objects that transgress frameworks and disrupt further investigation, hence preventing dynamic engagement and negatively shaping our epistemic pathways. This article is primarily theoretical, although partly grounded in qualitative fieldwork.

The diffusion of diagnosis and its implications for the epistemology and ontology of disease

“…The consolidation of epistemic power and the authority to diagnose in the institutions of biomedicine is often said to have begun with the emergence of the clinic in the eighteenth century (Foucault, 1973), to have become widely institutionalised in the nineteenth century (cf., Starr, 2017) and to have reached its zenith by the mid-twentieth century (cf., Freidson, 1970;Starr, 2017;Tremain, 2015). During this period, many assumed this consolidation would only accelerate and intensify with the expansion of 'objective' biomedical knowledge (cf., Parsons, 1951;Scott-Fordsmand, 2021;Stegenga, 2017). However, beginning in the 1960s, the largely unrivalled ascendency of biomedical approaches to diagnosis in the global west and north has been increasingly disrupted.…”