A Conversation with Edward Shorter

After reading the interview with Edward Shorter, “How Depression Went Mainstream,” I posted some critical thoughts about his dismissal of contemporary history of science. His point seemed to be that present history of science was boring because most contemporary historians of science do not have the technical training to understand the science. As John Wilkins pointed out, Shorter seems to be reviving the internalist/externalist dichotomy in favor of the internalist approach. Reflecting further on the interview, I wondered about the context that produced the interview and how much of Edward Shorter was coming through and how much of the interviewer. So I reached out to Edward Shorter and asked him a few questions. Below I try to summarize our conversation and try to refrain from commentary.[1]

When I first contacted Shorter I laid my cards on the table. I explained that I had read his interview and had posted some thoughts about his rejection of current scholarship in the history of science, and I included links to both posts. I then asked if he would be willing to talk with me about his approach to history and whether or not it has changed. As we spoke, we returned to a few central themes:

1. The value of current history of science.
2. How he would characterize his approach to history of science.
3. The role of technical or scientific knowledge in history of science, or internalism vs. externalism.
4. What does history of science have to offer current practitioners of science?

While I tried to use the term “history of science” broadly to include history of medicine, STS, and history of technology, Shorter limited his comments on the history of medicine. Recognizing that the various fields share certain characteristics, he thinks the history of medicine is distinct in many ways and wanted to focus on it.

Shorter was clear and unambiguous: He considers the questions many colleagues are asking to be marginal. The history of medicine, he said, continues to be informed by particular agendas inherited from the 1970s. He characterized them as, on the one hand, leftist studies that sought to blame capitalism for society’s ills and, on the other hand, a women’s studies agenda that sought to show how women had been oppressed. These agendas seem to shape scholarship on psychiatry. Too often, Shorter remarked, histories of psychiatry try to explain how psychiatry has oppressed women. The history of psychiatry risks becoming an appendage of women’s studies or a bland sociology.

I asked about how he would characterize his own work, which has dealt with both women and psychiatry. He said that he had written about women‘s bodies but indicated that his interests had moved on from his earlier book. In general, today he described his work as a blend of history of medicine and social history, as concerned with what he called “narratives of therapy and diagnosis.” The historian cannot understand those therapies and diagnoses without understanding the science that undergirds them. Here is where much contemporary history of medicine goes awry. “Faute de mieux,” historians who are unable to understand the science have no choice but to study the social contexts. Such studies are often driven by the 1970s agendas Shorter deplores.

This lead naturally to the question about the role of technical knowledge in studying the history of science.[2] Here again Shorter was clear: historians of medicine can only write good histories if they understand the medical science. He used the example of organic chemistry. Without a knowledge of organic chemistry, he said, his work on the underlying neurochemistry of depression and psychopharmacology would not have been possible. The science circumscribes the possible diagnostic and therapeutic options.

This approach, I pointed out, seems to depend on the internalist-externalist dichotomy, and to privilege the internalist approach. Shorter rejected a simple internalism as narrow intellectual history. Yet at the same time, he distinguished the science from society. It was important, he said, to have “an externalist perspective,” but the historian must understand the technical details. Only that way can the historian understand how scientists got from point “A” to point “B.” That scientific development may well involve society, it was a in the end a technical process. The historian must, therefore, have technical mastery of the science and medicine involved. This response still seems to depend on a distinction between social context and technical content and to privilege that technical knowledge. How, I asked, does the historian know when to include societal factors and how much force to give them? Shorter’s response: “When you understand why something happened.” The question remains: How do we know when we understand something?[3]

Given his requirement that historians master the technical knowledge, I asked about the uses of the history of medicine for practitioners.[4] Focusing on the technical aspects risks telling a teleological story about the triumph of whatever medicine you study. In what seemed a departure from the historiography he had outlined so far, Shorter said his work compels clinicians and practitioners to see “how fragile their knowledge is.” Far from being natural categories or even time-tested concepts, the concepts clinicians and psychiatrists banter around are often the result of recent consensus-based compromises. Clinicians often use concepts that have no demonstrated basis in scientific understanding but are, rather, the consequence of political and social compromises. In this context, Shorter‘s insistence that historians understand the science begins to look less like some retrograde project and more like a mechanism for revealing the lack of science in psychiatric practice. Rather than blindly endorsing current psychiatric practice, Shorter seems interested in uncovering psychiatry’s contingent and non-scientific features that are assumed to be science.

In the end, I find Shorter a bit enigmatic. I was uncomfortable with his privileging technical knowledge over non-scientific/non-technical knowledge. But then I was sympathetic with his goals of showing practitioners that their knowledge rarely enjoys a scientific foundation. I can see how a reasonable degree of technical skills are required for that project. I am not a historian of medicine, so I don’t know, but I wonder if he is painting with too broad a brush contemporary history of medicine—I wouldn’t characterize the history of early medicine I have read in those terms. Two key questions that remain, at least for me, are: Has Shorter’s approach to history changed over the years? And if so, why? In his comments about his early book on women’s bodies, it seems that his interests if not his methods have shifted. What I didn’t pursue is why. Maybe I can reserve that for our next conversation.[5]