By Prof Desiree Lewis

The State of Dis-ease transdisciplinary workshop organized by Beth Vale for the Johannesburg Institute for Advanced Studies (JIAS) (25 and 28 March) brought together artists, activists, academics and professionals who all work around or have some interest in disease, illness and the wellbeing of human bodies. I was invited to be a discussant for a session on food and disease because of my interdisciplinary work on food. An over-arching challenge for this conference on health and disease is one that also confronts work in food studies. On the first evening, in a conversation among four of us as participants, this was raised informally: “What is this creature called transdisciplinarity? And how is it different from interdisciplinarity, multidisciplinarity and all the other buzzwords referring – seemingly – to work across disciplinary and sectoral boundaries?”

Cynicism was expressed about how so-called “interdisciplinarity” often ends up being the “same old same old”: various talking heads in their respective silos (academics, writers, artists) only seem to engage one other – without really having difficult cross-border conversation and anyone doing much that is different from what they’ve done before. I have to admit that I feared this might happen at the workshop when, in the shuttle conveying some of us to the conference venue on the first day, I sat silently while the two visual/performance artists on the bus and (separately) the two novelists engaged each other animatedly about recent exhibitions, funding proposals, writers’ awards etc. etc. Since there were no academics on the bus, I had no-one to engage in equally incestuous talk (how SA universities are faring post FMF, the challenges of supervising a new generation of postgraduates, current funding for academic projects, what our Deans are doing or failing to do, and so on). It’s truly remarkable how we retreat so easily and readily into our comfort zones, and seem unable to have even the most basic light conversations across our work and professional boundaries.

But when the workshop began, I was very encouraged by the kinds of conversations that scientists, artists, humanities scholars, social sciences scholars, don’t easily achieve when they come together. Especially important was that many of the scientists who spoke were emphatic about centralising humanities and social science concerns. And this was stressed not by paying lip service to “using humanities and the arts to give the sciences a human face”, or “convey inaccessible scientific ideas to the public”. But in the form of a heartfelt conviction that it is simply impossible to pursue scientific work related to human bodies ethically and with intellectual rigour unless one squarely confronts humanities-driven questions such as: What are the social contexts and histories of our scientific knowledge and practice? What are the social, political and cultural constraints that affect the health and wellbeing of differently positioned human bodies? How are dominant relations and meanings constructed through socially dominant scientific technologies, discourses and practices? What different cultural and social understandings exist about the well-ness, disease and health of the human body, and which are prioritized and why?

With some of the sessions, it occurred to me how easily efforts at transdisciplinarity can shift into random add-on conversations: sessions in which each disciplinary or sectoral interest is represented without any sense of synergy, contestation or engagement among these. But some sessions definitely stimulated engagement, such as the very first session involving fiction and autobiographical writers’ discussing their work focusing on disease. I was struck by Maneo Mohale’s input, which raised some provocative ideas about, for example, what the relationship is between gendered, classed and racialized experiences and disease. (Why, she asked, is it that so many black women in their thirties and forties are experiencing such devastating illnesses. And why is it only when they are almost at death’s door that they realise how ill they are? When, she went on to ask, will we learn to pause and listen to our bodies?) Compared to Mohale’s discussion, Lauren Segal’s focus on her personal resilience and independence, spoke volumes about deeply entrenched ideas about disease, wellness and personal responsibility.

For me, another noteworthy panel dealt with the state of health studies in South Africa. As a medical doctor with decades of public health experience, Fareed Abdullah made powerful arguments, raising insight into how little headway South Africans have made in revolutionising thinking and practices about health. “I don’t think”, he said, “we have had the wherewithal to bring all the complexities of health issues together”, going on to stress that “the humanities have to be our habitus”. One of his remarks concerned the pre-eminence of statistical research and stats-based interventions in health care. “I don’t think we know what stats can do to the psyche of the nation”, he stated, drawing attention to the alarmism and bluntly quantitative information that is often galvanized in talk about HIV/AIDS in southern Africa. His sober judgement about how little we have done in establishing connections between the socioeconomic parameters and causes of disease, our treatment practices, and the norms we use to measure “success” seemed cynical but were in fact extremely inspiring in thinking about how to work differently. It raised the need for us to transcend triumphalist affirmations of (specialists and experts only) fighting disease, developing scientific solutions and democratising dominant health care practices and knowledge. Instead, it confirmed the need for collective serious conversations about how we transform language, practice and ideology.

Interestingly, the Minister of Science and Technology’s keynote was totally at odds with the gist of Abdullah’s talk. Foregrounding southern Africa’s challenges in the face of the region’s typhoon, the Minister focused on solutions resting on “self-sufficiency in health care and pharmaceutical innovation”, “coordinated innovation sites”, “harnessing knowledge to create partnerships between the DST, the MRC and academy”, “strategic health innovation” and “the national bio-economy project”. When these pseudo-technical buzzwords are invoked alongside interdisciplinarity, it usually means that ultimately standard scientific and biomedical priorities remain dominant. In fact, her talk highlighted the ways in which interdisciplinarity can be strategically and tactically engineered in entrenching technological and biomedical efficiency.

Carla Tsampiras, a historian based in UCT’s Primary Healthcare directorate, deepened Abdullah’s discussion by drawing attention to the need, in a country like South Africa, to explore the history of health practices and discourses of health. How ironic, she implied, that we immerse ourselves in practices of care with so little critical retrospective understanding of the implications, legacies and socio-political consequences of what we do.

Carla Tsampiras, UCT Primary Healthcare Directorate

Another panel I found interesting was one titled “the lives of pharmaceuticals”. Here there was a strong effort to analyse and debate the social lives of medicines and medical practices. Two presentations gripped me totally. One was by Zinhle Mncube, a philosopher based at the University of Johannesburg (UJ). She argued that the current fixation in the US with creating “race-specific” medicines demands critical scrutiny. First, the argument about the viability of these products is based on entirely skewed research. So, for example, very little comparative testing is done, which means that medicines targeting African-Americans are tested mainly on African-Americans, so there is very little actual proof of their being successful in racially specific ways. Her other argument, which was deeply disturbing and should be an eye-opener for South Africans, was that ideas about the scientific legitimacy of the concept of race (to identify genetically distinct groups with distinct biomedical needs) is being recuperated by research on race-specific medicines. Mncube demonstrated that the pharmaceutical industry is preying on people’s vulnerabilities and becoming increasingly market-driven in promoting more effective “race-specific” meds. She also stressed that the modern pharmaceutical industry is reactivating seemingly outdated discourses and categorisations based on “race”, and also probably on gender as well.

The other presentation that intrigued me was by Rebecca Hodes, who is based at the University of Cape Town’s (UCT’s) AIDS research Unit. She discussed her research using (not about) waste picking in areas of Cape Town to trace the kinds of medications that people use. The idea of waste-picking as a methodology for exploring consumption habits seems to have considerable possibilities. It allows for unique constructions and readings of narratives of what individuals and groups consume and dispose of.

Because of work commitments in Johannesburg, I wasn’t able to attend all the sessions and was particularly sorry that I missed one involving artists, healers and practitioners on mental health. I heard from others that this was a powerful session, and would very much have liked to hear the kinds of engagements across disciplinary boundaries on the subject of mental health.

Especially since it will need many more concerted and thoughtful efforts to speak across disciplinary boundaries for us to begin to embrace “transdisciplinarity”. The workshop’s wrap-up and “where to from here” session gave most participants the opportunity to reflect on how to take these forward. It seemed clear that for most, transdisciplinarity is:

  • Not easily funded, and as the organiser, Beth Vale admitted, she was given a rare opportunity to drive the workshop in ways she wanted to, rather than to tie in with any university’s agenda, university department’s agenda, or donor or government departments dictates.
  • Not easily achieved. As Vale stressed, the event was carefully curated and speakers were identified as those who were open to cross-disciplinary engagements. In organizing conferences, workshops or compiling essay or article anthologies or editing journal issues, one needs to select people who have a passion about working beyond their comfort zones, or opening themselves up to being challenged. Simply selecting speakers who are interesting in their respective fields is unlikely to guarantee fruitful conversations.
  • Facilitated by journal issues, website platforms, and discussion lists that set in place new ways of seeing and writing that can then become part of broader public debate and academic practice were options mentioned. I sincerely hope that some of these will grow out of this workshop. Transdisciplinarity sounds trendy, fun, and not that difficult. But really achieving it isn’t always the case.

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