1The paper takes its starting point from recent debates about expertise and expert systems in the social sciences in the late 20th and early 21st century. In these debates, expertise, expert knowledge or expert systems are understood to be key elements of late-modern “knowledge societies” (Felt et al. 2007). Expertise figures prominently, among other fields, in political science or transformation studies understood here as a central means of governing modern societies, potentially in conflict with democratic processes of deliberation; or it is held in science and technology studies to be a repository of innovation and development. But, needless to say, expertise is focused upon also in academic studies of learning and education or in psychology and the neuro- or cognitive sciences, as well as in applied fields where expert knowledge, skills and competencies of actors have to undergo rapid transformation (e.g. in biomedicine, in nursing or organizational studies etc.); and of course, expertise is the target of systematic assessment and evaluation in management and economic studies. The problem of expertise, of its creation, evaluation, distribution etc., then, has a nearly ubiquitous presence in current scholarly, political, and public debates. However, in puzzling contrast to the undisputed centrality of expertise, dominant ways of conceptualising expertise in the social sciences are focusing more on knowledge as an idealistic “content” (Bestandsmodus) than on knowledge practices in a broader sense, that is, on the ways experience is made, transformed from emplaced/contextualized knowing (integrated into practices) to generalizable knowledge (abstracted from concrete practices), from its social organisation or contestation to its distribution and (after learning) its application in “skilful practices” open to reflection and revision (Praxismodus).
2The central argument pursued in what follows is simple: in order to address these desiderata, an amended theoretical as well as methodological approach is needed. Inspiration for a revision might be drawn from a rather “disorderly,” rarely connected set of theoretical programs: from pragmatist theories of experience, from the anthropology of knowledge and “situated cognition,” from phenomenological analyses or Lebenswelt-sociology à la Schütz as well as from science studies and the sociology of scientific knowledge. These theoretical approaches might be seen as unfamiliar bedfellows, but – as will be argued in the following – they all share an interest in what might be termed “ecologies of expertise,” in the processuality of perception, cognition, and action, in the social and cultural impregnations of thinking and acting in context. Clearly, this perspective has many intellectual roots, but American pragmatism in the versions of William James, John Dewey or Arthur Bentley definitely constitutes a fascinating and still inspiring rhizomatic knot, a kind of theoretical “zero point” where many inspiring impulses originate.
- 1 This line of argument will not pursued further in the following paper. That this surprising absence (...)
3Yet, the way in which pragmatist impulses exerted direct and indirect influences – e.g. – on anthropological programs like Gregory Bateson’s “Ecology of Mind” (Bateson 1972), Edwin Hutchins’ “distributed cognition” or “cognitive ecology” (Hutchins 1995; Hutchins 2010), Lave/Wenger’s “communities of practice” (Lave & Wenger 1991), Tim Ingold’s relational anthropology that culminates in the suggestion to “re-animate” intellectualistic western concepts of thought (Ingold 2006) or Clifford Geertz’ view that anthropology should inquire into the uses of culture-specific artifice that makes “experiences” (Geertz 1986) is still under-explored, to say the least. What these anthropological approaches have in common is a strictly relational re-conception of perception, cognition, experience and knowing that stresses a) its emplacement, its embodiment as well as its temporal dynamics and b) an equally relational view on how knowledge is put into action reflexively. What is more, these approaches are supported by naturalistic perspectives on action and perception as they are suggested by the neurosciences and modern biology. While in all of these anthropological approaches an explicit reference to pragmatist theories is conspicuously absent, they share at least a strong family resemblance with pragmatism if not a partially concealed ‘genetic’ kinship.1
4I will go back to these subterranean conjunctions between recent anthropological theories and pragmatist thought in the second half of this paper in a rather pointillistic manner. In the first part, I will briefly sketch how expertise is conceptualized according to established disciplinary perspectives in philosophy, sociology, political science etc. As will be shown, these perspectives are only partially helpful to understand the dynamics of expertise, expert knowledge or expert systems from an anthropological point of view. These dominant approaches looking at expertise may:
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Cover how a phenomenon in the world can be adequately represented – this is an ontological question about “knowability” – and to what extent those representing the phenomenon possess a certain competence about it – here an epistemological question lingers in the background: it is about the very possibility of “knowing” something; or
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ask what an expert/what expertise is compared to non-experts or non-expertise. Here, questions regarding the specific form of knowledge or the social form of its application stand in the focus; or
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- 2 These “kinds” are usually not understood in the sense introduced by Hacking (2002). This perspectiv (...)
inquire into what “kinds of people”2 count as “legitimate contributors to decision-making” especially at those points where science, technology and the political domain intersect (Collins 2002: 252ff.). Hence, these studies inquire into the organizational or social fields (in the sense of Bourdieu) where expertise is contested and applied;
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- 3 It can be plausibly argued that these questions cover well covered ground: in the 1970s these issue (...)
analyse how expert communities produce truth claims and how these are mobilized and put to work in the political domain. Here, social or political scientists inquire how “expertise” succeeds or fails to better the social processes, how expertise is fed into political or institutional processes (Weingart), how (universal) “truth” meets (always partial) “interests.”3
5These questions are important but – as will be argued – somewhat miss core anthropological research interests, as Dominic Boyer argued already in 2008. However, as Boyer – I think rightly – observed, theoretical perspectives on knowledge and expertise in international anthropology remain at best underdeveloped. Boyer (2008: 39) defined the expert “as an actor who has developed skills in, semiotic-epistemic competence for, and attentional concern with, some sphere of practical activity.”
6This very helpful definition – blurring established distinctions between skilled actors and “certified experts” – opens up a much broader problematic that is anthropological, and not only social or philosophical in its nature: it forces anthropologists to take cognitive, social, cultural and epistemic processes into account as relational phenomena (see Beck 2008).
7Instead of following the well established paths of inquiry eyed by the social scientists, I suggest to follow a practice-focused theoretical approach that is informed by pragmatism as it was understood by William James, John Dewey or Arthur Bentley. And I suggest to start from scratch, and ask: how do certain abilities, skills, capabilities and aptitudes emerge in actors? How are they stabilized (using which technologies?) and how are they put into a form of practice that necessarily involves improvisation and creativity (to cope with known and unknown un-knowings)? How and through which social, cultural and cognitive processes is experience gradually turned into expertise? What distinguishes experienced practices from socially recognized expertise? Is this distinction only “external,” “ascribed”? How is expertise done, so that its specific performances get acknowledged by others as constituting expertness? From that it might follow a symmetrical analysis of how non-(yet-)experts make use of expert performances.
8Such a practice-focused theoretical turn on expertise and experts calls for a number of theoretical as well as methodological adjustments: instead of knowledge, knowings become central (Dewey & Bentley 1975), and the search for the favourable environments for re-producing knowings become the key question. As Tim Ingold argues, all knowledge is generated within a field of practices, and these practices are always characterized by bodily movements – be it moving in space (in Ingold’s phrasing “we know as we go”) or by gradually accumulating skills in time through practical involvement with changing social as well as physical environments (Ingold 2000: 44 ff.; 229). Knowings, then, need to be conceptualized as emplaced and embodied. As the Australian anthropologist David Turnbull argues, the “root meanings of many terms closely associated with making, meaning, and knowledge” are associated with bodily movement through space. Central to knowledge and to the dynamics of its generation, then, is
[…] the idea of active work, and of moving through space, cognitively and physically. [However, these …] elements of activity, work and movement are now almost absent and invisible [in recent, western perspectives on knowledge], as evidenced in our constant use of terms like “method” or “way” without realising they literally mean paths or trails. (Turnbull 2007: 142)
9Turnbull coined the term “knowledge space” to characterize the actively constructed “environments” where specific ways of knowing are generated (Turnbull 2000).
10According to the dominant approach in vogue in the social sciences, and in contrast to these perspectives informed by practice or performance theory, expertise – and the specific knowings involved – is held to be much more static and de-contextualized; expertise is conceptualized more like a fait accompli (still having some truth-index) than as a fait social in the making (embracing constructivism). Context and dynamics come into the focus only as secondary elements, as a problem of application, not as a problem of co-constitution. Instead of classifying expertise as either interactive or contributory (as Collins & Evans 2002 did, seeing expertise as rather stable, but applied in dynamic contexts) the main interest of anthropologists will be in ethnographic analyses of situations where actors successfully participate in the expertness of others through the co-construction of knowledge spaces or knowledge scapes. This – again – means thinking about expertise relationally: the interest is focused upon how expertise is shared between actors or made to bear on the situations others find themselves involved in.
11Yet while this practice-focused theoretical perspective resonates well with anthropological views on “apprenticeship” or “situated learning” (Lave 1991), “communities of practice” (Wenger 1998), “embodied knowledge” (Barth 2002) and so on, it is unclear whether it is scalable: the perspective is biased in terms of a pertinacious methodological and theoretical individualism or situationalism as well as a cognitivist heritage that can only partially be alleviated by interactionist insights. Obviously, any attempt to “scale” a practice theoretical approach on expertise in order to ethnographically analyze its workings in complex systems (organizations) or in assemblages of an equipped humanity (clinics, actor-network societies) will require some theoretical wriggling as well as methodological twists and turns.
- 4 The notion of transaction is borrowed from Dewey & Bentley (1975).
12As a starting point, the notion of “ecologies of expertise,” as it was recently introduced in social studies, might be helpful, pointing to an integrated perspective on material, social and cultural contexts where expertise is made and made useful. The notion introduces a distinctly relational perspective to knowing that seems to have the potential to be compatible with core pragmatist insights. Unfortunately, as it will become apparent later, the application of the metaphor of “ecology” is problematic in two respects. Firstly, it creates crucial theoretical pitfalls, especially when an expired, simplistic notion of “ecology” is borrowed from biology. Secondly, the concept is used in a limited way in its dominant usage, where the focus is more or less exclusively on applications of expertise in complex institutional settings, missing somewhat the question how acting in the world builds up a certain kind of reflective experience (cf. on the notion of “reflective practitioner” Rolfe 1997) that is consecutively – through lessons taught in practice and acquisition of transactional skills (on “skill acquisition” as a gradual process towards possessing expertise, see Dreyfus 2004) – transformed into expertise.4
13The notion “ecologies of expertise” was introduced by Berkeley Anthropologist Aihwa Ong during the workshop “Oikos and Anthropos: Rationality, Technology, Infrastructure” held in Prague in 2002. She used the term in order to analyse what she perceived as a re-assemblage of the forms of governance in the aftermath of the crisis experienced by the so-called “Asian Tiger” economies in the late 1990s. As a reaction to the crisis of the dominant model of manufacturing export-led growth, several governments in South-Eastern Asia attempted to rebuild the basis of their economies. The key points – according to Ong – were the strengthening of the educational system, the founding of research institutions, the attempts to attract expatriates and experts to boost local research and the development as well as the introduction of neoliberal forms of governance. According to Ong, the technocrats implementing these new forms of governance used terms such as
[…] web, cluster and ecosystem to suggest new forms of linkages, exchanges, and feedback loops that [were …] being forged between the distribution of knowledge flows and the technical resources, and techniques of management.
14As Ong observed, Asian technocrats tried to create favorable conditions for innovation and economic development that afforded mobility and interactivity of experts, knowledges and technologies. Ong (2005: 339) called
[…] this new techno-administrative zone that depends on novel combinations of mobile knowledge and actors to diverse sites and labors an “ecology of expertise.” Particular alignments of knowledge, politics, and ethics […] constitute an ecology of positions, whereby diverse subjects are administered in relation to each other.
15This perspective widens the classical approach to expertise, as it is applied in sociology of science or political science, productively in directing the attention towards organizational and institutional complexities for expertise in action. Two examples demarcate the range of problems that are tackled under this perspective.
161st example: organizational complexities and the division of labor in networks of expertise
17In a comprehensive report analysing the reasons for recent failures of American intelligence agencies to predict and adequately react to terrorist threats, Jeffrey A. Cooper argues that the specific systemic properties of the intelligence community produced “paradoxical effects” – the system as a whole adapted too well to dominant political perceptions of the uncontested role of the US in the post cold-war world as well as to pressures by neo-liberal programs restructuring and streamlining its internal processes:
With its fifteen diverse agencies and its wide range of functional responsibilities, the Intelligence Community presents a very complicated set of organizational arrangements. Thinking of it in terms of traditional organizational analysis or systems engineering methods in an effort to explain its working does not suffice because it far more resembles a living ecology with a complex web of many interacting entities, dynamic relationships, non-linear feedback loops (often only partially recognized), and specific functional niches that reflect momentarily successful adaptations to the environment. (Cooper 2005: 9)
18But paradoxically,
[…] the better they work, and, therefore, the more efficient the organization is at its routine tasks, the greater the danger that the organization will fail to be sensitive to its environment and changes occurring there. (Cooper 2005: 25)
192nd example: expertise to implement sustainable solutions to alleviate environmental problems
20A second example for the productivity – but also the limits – of the “ecological approach” to analyse expertise is a recent paper published by Ralf Brandt and Andrew Karvonen inquiring into recent attempts to implement more sustainable solutions to perceived environmental problems. The study looks at the complex relations and interactions between different specialized experts – technical experts, including engineers, natural scientists, architects, planners – in managing and implementing transformations in human-environmental systems. Instead of concentrating on the specific contents of the expertise put into action, they apply a relational perspective on interacting expertise and identify four idealtypical forms of applying expertise:
The outreach expert who communicates effectively to non-experts, the interdisciplinary expert who understands the overlaps of neighbouring technical disciplines, the meta-expert who brokers the multiple claims of relevance between different forms of expertise, and the civic expert who engages in democratic discourse with non-experts and experts alike. (Brand & Karvonen 2007: 21)
21Going somewhat beyond Cooper’s analysis of the internal pathologies of US intelligence services, Brand and Karvonen use the metaphor of “ecology” to address the complex internal as well as external structural, economic, technological and political conditions or obstacles that technical experts are confronted with in their attempts to address the necessary systemic transformations in modern societies towards more sustainable ways of living, consumption and production. In addition to knowledge in the core field of their expertise, these “sustainability experts” have to possess a complex, reflective understanding about both the life-worlds they attempt to transform and the often problematic epistemic limits of expertise, incongruous disciplinary styles of thought and structural-political barriers tthat he implementation of good ideas often confront. The notion of “ecology” here does a good job in directing the attention to the relational complexities of interacting types of expertise. However, Brand and Karvonen do not shed any light on what exactly makes an expert experienced in these forms of transaction, or how these transactional skills are acquired, what kind of reflexivity is necessary for successful performance. Here, a rich field for anthropological analyzes is waiting to be developed.
22The metaphor of “ecology” imported to the social sciences from biology is non-neutral: attached to it are several conceptual assumptions that – if not properly discussed – afford specific understandings and perspectives. I argue that the notion of ecology applied in the studies quoted above conforms to the classical notion of ecology and – more importantly – to the classical Darwinian notion of adaptation of an entity to its environment. In Darwinian biology,
[…] adaptation has been regarded as a process by which natural selection, stemming from an external environment, gradually molds organisms to be well suited to their environments. (Day, Laland & Odling-Smee 2003: 81)
23This assumes a linear process of adjustment of a species to pre-given circumstances. And indeed, this linear concept is applied by the Asian governments analysed by Ong; they set out to create what they see as “favourable environments” for the knowledge economy, hoping that experts and expatriates will adapt and become something like the “key species” in the local economy. Similarly, Brandt and Karvonen study how each different expert cultures settle into a specific “ecological niche” – be it as knowledge distributors in relation to the public, as knowledge brokers in relation to other disciplines or as political advisors. Cooper conceptualizes the failure of the intelligence system to adapt to external change as a problem of an overly integrated eco-system, producing stability by intensely interacting entities that have lost their adaptability to external selective pressures. All expert cultures analysed here are foremost characterized by boundary work in a twofold sense: a) internally, they are seen as building a system of densely interacting individuals sharing a common style of thought and developing mechanisms of quality control or evaluation of knowledge, characterized by a morality of professionalism and clearly demarcated from the outside. This perspective has inherited much from the early sociology of science à la Merton. But in addition, b) these analyses also point at how expert-systems are mobilizing expertise across their maintained boundaries.
24It is obvious that this classical notion of ecology and adaptation assumes certain determinisms and linearities that are – apologies for the pun – not well adapted for analytic purposes in the social sciences. But there is some conceptual help in biological and evolutionary theory to improve the metaphor.
Recently, a small number of evolutionary biologists have sought a reconceptualization of the process of adaptation by placing emphasis on niche construction (Gray 1988; Griffiths & Gray 1994; Laland, Odling-Smee, & Feldman, 1996, 1999; Lewontin 1982, 1983; Odling-Smee 1988; Odling-Smee, Laland, & Feldman, 1996; Oyama, Griffiths, & Gray 2001). These researchers treat niche construction as an evolutionary process in its own right, rather than as a mere product of natural selection. Through niche construction, organisms not only shape the nature of their world, but also in part determine the selection pressures to which they and their descendants are exposed. (Day, Laland & Odling-Smee 2003: 81)
25The concept of niche-construction is an important development in evolutionary theory since it demonstrates empirically that “organisms regularly modify both biotic and a-biotic sources of natural selection in their environments, thereby generating forms of feedback in evolution that are rarely considered in [classical] evolutionary analyses” (Day, Laland & Odling-Smee 2003: 83ff.). To sum up, niche-construction departs from a linear, deterministic concept where environments are conceptualized as imprinting specific characteristics on the inhabiting organisms through selection pressures; instead, a two-way process of mutual modification and selection – informed by modern cybernetics – is presupposed.
26While still in the mode of “metaphorical thinking,” this revised ecological perspective affords a much better stance on what expertise does: it shapes its environments and it is shaped by its environments in a fundamental way; historical evidence abounds that expertise successfully modifies its social and material environments in a fashion that is favourable to its own existence – be it the emergence of the psy-disciplines analysed by Nikolas Rose (1998), or the brand of Anglo-American economics celebrating “free markets” and de-regulation in the 1990s (with obvious miserable outcomes) brilliantly analysed among others by anthropologist Gillian Tett (2009).
27The amended notion of “ecologies of expertise” is well equipped to take this truly relational concept of expertise into account. But the concept will only become useful anthropologically when it will instigate a fresh, integrative perspective that productively informs empirical studies that succeed in producing new insights. I will suggest that it does so, especially as it opens up a way to think systematically about 1) how expertise is formed in gradual steps via learning and active involvement with material-discursive environments – in a way that John Dewey termed inquiry; 2) how expertise is stabilized and organized in systems of expertise, including the establishment of standards, evaluation criteria and professional morality; 3) how expertise is applied as a requisite of skilful, reflexive practices. The notion of “ecologies of expertise” will also provide a bridging concept that avoids a one-sided, mentalistic understanding of expertise as well as providing a testing ground to inquire into the parallels of expertness or skilful practices __ e.g. opening an egg without making a mess on the kitchen counter, where knowledge is applied to the material environment (the example is taken form Tim Ingold’s recent lecture in Berlin) – and of expertise as an intellectual practice – e.g. in knowledge work, where knowledge is applied to knowledge as Peter F. Drucker (1993: 69) defined it.
- 5 For a fuller account on “expert patients,” see Beck (2010).
28In order to provide an empirical basis to test the potential of the concept of “ecologies of expertise” I will very briefly introduce a recent phenomenon in the medical domain: the emergence of patient groups and the figure of the expert patient.5 Patient groups became a phenomenon in all western welfare-states in the 1970s and gradually grew into what is now considered – and acknowledged – as an important means of corrective action in the medical system. Patient groups also are increasingly shaping aspects of the medical system, the provision of care, and are involved in bioethical debates. Steve Epstein has demonstrated this regarding the US AIDS movement (Epstein 1996), Michel Callon and Volona Rabeharisoa through their analyses of the French Muscular Dystrophy Association (Callon & Rabeharisoa 2008). In all those cases, existential experience of severe, often life-threatening diseases and the problems arising during therapeutic interventions in the clinic but also – more importantly – in the life-worlds of patients is systematized and transferred to other, less experienced patients. Vololona Rabeharisoa and Michel Callon (2008) describe two crucial functions of patient groups: they serve as devices for – as they call it – the “primitive accumulation of knowledge” and as sites for “mutual learning”: experienced patients not only give emotional support and basic information to fellow sufferers, they also accumulate knowledge, for example about individual reactions to treatments, about side-effects or firsthand data about the course of diseases. Because many of these patient-groups are devoted to rare diseases of which clinical medicine – not only because of the small patient numbers – has no sufficient knowledge, patients and their associations are likely to collect data that has the potential “to enhance the efficiency of medical services. [...] patients and their association[s] are the origin of numerous documents on the effects of drugs, and readily discuss such issues with specialists” (ibid., 147f.), often as equals. The activities of most patient groups go decidedly beyond a “primitive” accumulation of knowledge. They can and should be analyzed as sites where the making of expertise can be studied in situ.
- 6 Note by the editors: Stefan Beck was head of the research project “The production of Chronicity in (...)
29This is even more so in my last example – I will draw on fieldwork of two members of a currently running research project at the Department of European Ethnology in Berlin,6 looking at therapeutic practices in two psychiatric clinics (Martina Klausner) and “Trialog-Gruppen” (Julie Mewes) in and near Berlin. The “trialog” approach in psychiatric care, which was developed in the 1990s in a Hamburg clinic, brings together professionals from psychiatry, patients, and their relatives in groups that are inspired by modes of interaction as they are practiced in many self-help groups. The key principle here is that all interactions have to be “at eye-level” (auf Augenhöhe), meaning that professional and medical knowledge is de-privileged on purpose, and that the perspectives of patients and relatives are treated as equally valid and important as the professional stance to diseases. The aim is to “widen the understanding of psychiatric phenomena” for all participants, to develop a common vocabulary and to implement an atmosphere of mutual respect (Bock et al. 2007: 10). It is argued here that this “de-privileging” or active concealment of therapeutic and biomedical expertise on the part of the professionals goes beyond the established psychoanalytic procedures which aim at eliciting narratives, views and emotions from patients.
30It is enlightening to observe the discursive and interactional practices that try to implement these programmatic goals in actual care settings, as Martina Klausner did in her fieldwork: the main instrument is the “Stuhlkreis” – sitting in circles – providing a material environment, symbolizing and enabling equality, where everyday experiences and perceptions of/with psychiatric states are articulated and reflected upon. The “Stuhlkreis” enables a mode of collective inquiry – in the sense of Dewey (Gewissheit) – of probing, evaluating, experimenting with perceptions and interpretations of “Erlebnisse” (experience1) and their step-by-step transformation into more stable “Erfahrungen” (experience2). In a gradual process, sometimes covering many months, bewildering, problematic, frightening existential experiences (Erlebnisse = experience1) of all participants are transformed into experiences that are open to rational reflection (Erfahrung = experience2) and finally to a kind of expertness in dealing with often chronic psychiatric disorders in a mode of expertise characterized by “Lebensklugheit” or even “Weisheit” (Baltes and Staudinger 2000). “Having a psychiatric disorder” is transformed collaboratively into the ability to skilfully and reflexively live with an exceptional psychic condition. What is characteristic here is that the psychiatric professionals do not act as the “outreach experts” described by Brand and Karvonen (2007) nor are they involved in engaging the “contributory expertise” of patients, like Collins and Evans (2002) described. Instead, the professionals engage in a truly collaborative mode of knowledge/expertise making.
31This approach is taken up and developed further in a recent project in Hamburg, where experienced psychiatry patients are systematically trained as “para-professionals” and “peer-councelors” for fellow patients in a year-long program. The program “EXperienced-INvolvement” (EX-IN) is funded by the European Union and the public health system; on the one hand it attempts to mobilize the existential expertise of former patients for the benefit of other patients, reacting to perceived deficits of psychiatric care; on the other hand it attempts to reintegrate these former patients into the workforce through applying them as lecturers and co-workers in psychiatric care units and Trialog-groups.
32What is emerging here is a new type of “knowledge space” where – in the words of David Turnbull – not the “idealistic linking of ideas [… is in the center of interest but the] social process of linking people, practices and places” (Turnbull 2001: 3). These processes aim at the production of expertise outside of the certified educational institutions invented by modern societies, universities, research institutions, laboratories. It is an expertise that is impregnated with a certain authenticity that – in the eyes of everybody involved – enhances the trustworthiness and reliability of disseminated knowledges. At the same time, and partially owing to this authenticity-index, the expertise produced is highly “localized,” integrated into specific “ecologies” and problem scapes. But at the same time, this localized, specific expertise is mobilized beyond the boundaries of the particular “knowledge scapes” in a systematic way.
33However, there are some anthropological problems with this implicit celebration of what might be called authenticated expertise. I interpret the success of these new forms of producing and mobilizing expertise in the medical domain as a reaction to a fundamental authority crisis of the medical profession, an attempt by professionals to overcome the lack of trust which many patients exhibit in relation the medical system and especially the abstractness and technicality of biomedical expertise. On the one hand, this can be interpreted as an attempt to “humanize” biomedicine – polemically, it is pills with a human face. On the other hand, these programs might run the danger to reproduce deeply and dearly held (mis-)understandings of the western subject. As anthropologist Robert Desjarlais (1997: 12) problematizes:
The problem with taking experience as a uniquely authentic domain of life – as the first and last court of appeal – is that we risk losing the opportunity to question both the social production of that domain and the practices that define its use.
34Desjarlais suggests to treat experience as a “historically and culturally constituted process predicated on certain ways of being in the world.” Experience results from
[…] specific cultural articulations of selfhood (namely, a sense of self as possessing depth, interiority, unity, stability, and the capacity for transcendence) as well as certain social and technological conditions that foster and legitimate that sense of the self. (Desjarlais 1997: 13)
35These caveats are important to caution against the naïve celebration of the “authentic experience” that “expert-patients” command or the assumption that these experiences are not carefully crafted artefacts. With the words of Clifford Geertz (1986: 380):
Experiences, like tales, fetes, potteries, rites, dramas, images, memoirs, ethnographies, and allegorical machineries, are made; and it is such things that make them. The “anthropology of experience,” like the anthropology of anything else, is a study of the uses of artifice and the endlessness of it.
36Yet, it would be myopic to miss two simple facts: one, that these expert patients and the mobilized experience of concerned people are valuable for other patients. And two, that beyond the well founded deconstruction of all claims for “authenticity,” these experiences/this expertise have a poietic quality – they make a difference in the life of other patients.
37The “Stuhlkreis” introduced above is a prototypical Geertzian instance of using artifice to craft experience, to accumulate experiences and turn them into expertise applicable to the benefit of others: the carefully designed physical and discursive environment of sitting in circles and the afforded interactions between patients, professionals and relatives at “eye level” constitute a machinery for assessing, evaluating, estimating, and re-producing experiences1 (= Erlebnisse), shifting or modifying their meaning and gradually turning them into experiences2 (= Erfahrungen). Experiences2 in this sense are conceptually enhanced or amended versions of life-world events. What is added post-hoc through the deliberations in the Stuhlkreis is a scientifically informed, collectively reflected perspectival shift. Experiences2 – then – differ decidedly from vernacular as well as philosophical notions of “experience” as they are held dearly in western modernity. In order to clarify this difference, a brief detour to John Dewey’s approach to “experience” is helpful.
38In chapter three of his Art as Experience, John Dewey differentiates between experience and an experience. While experience occurs continuously as an unavoidable result of the “interaction of live creature and environing conditions,” humans have an experience
[…] when the material experienced runs its course to fulfilment. Then and only then is it integrated within and demarcated in the general stream of experience from other experiences. […] a situation, whether that of eating a meal, playing a game of chess, carrying on a conversation […] is so rounded out that its close is a consummation and not a cessation. Such an experience is a whole and carries with it its own individualizing quality and self-sufficiency. It is an experience. (Dewey 1934: 35)
39Crucial for Dewey is further that an experience is characterized by the unity of emotional, practical and intellectual dimensions of the situations or events such perceived; these events have a certain “aesthetic quality,” they are characterized by καλον-αγατον, by a distictive perception of proportion, grace, and harmony (Dewey 1934: 39) between the situation and the situated human. In another passage, Dewey further elaborates his relational approach to experience as follows:
A man does something; he lifts, let us say, a stone. In consequence he undergoes, suffers, something: the weight, strain, texture of the surface of the thing lifted. The properties thus undergone determine further doing. The stone is too heavy or too angular, not solid enough; or else the properties undergone show it is fit for the use for which it is intended. The process continues until a mutual adaptation of the self and the object emerges and that particular experience comes to a close. What is true of this simple instance is true, as to form, of every experience. The creature operating may be a thinker in his study and the environment with which he interacts may consist of ideas instead of a stone. But interaction of the two constitutes the total experience that is had, and the close which completes it is the institution of a felt harmony. (Dewey 1934: 44; emph. S.B.)
40According to Dewey, the aesthetic dimension of experience refers to a specific relation between doing and undergoing, of activity and suffering, perception, appreciation, and enjoyment, that sustains the special status of an event that is perceived as an experience. Here, emotions, cognitions, and practices are inseparably intertwined; and they emerge in response and adaptation to an environment that is modified in turn. What Dewey defined as an experience corresponds to experience1 as it was introduced above. The aesthetic quality, the felt “harmony” and the integration of emotional, practical as well as intellectual dimensions that according to Dewey defines an experience for an individual affords a specific “authenticity”: the experience is inseparably linked with a person, his/her past and present, and the situation he/she suffered in or lived through; an experience is held to be a defining moment for the whole person.
41Against the backdrop of these observations, it becomes clearer what has to be achieved in the interactions of the Stuhlkreis and what is at stake when experiences of patients are to be turned into a resource for other patients, when patients are gradually transformed into expert patients. It would simply be futile on part of the professionals to try to “correct” the past perceptions of patients through providing “scientific explanations” for their perceptual experiences. Such an intellectualistic approach would leave the emotional and practical dimension of their experiences, the “aesthetic whole” unaddressed. Purely post-hoc intellectualisations will miss the interactive, ecological nature of experiences that are the outcome of a mutual, self-amplifying adaptation of actors and their natural, social, and cultural environments. And indeed, successful therapeutic interventions in the psychiatric clinic require an ecological approach to psychiatric pathologies which takes neurological, social as well as cultural phenomena into account.
42The “Stuhlkreis” is part of a clinical setting that first of all – according to professionals in psychiatric care – provides patients with a shelter (Schutzraum) that foremost has the function to disrupt the everyday entanglements of patients with their social and material environments; the clinic de-routinizes the patient, disrupts his habitual practices and customary behaviours. Psychotropic drugs have the same effect on a physiological, neurological level – they shift/modify cognitive pattern