Diagnostic political practice

             Political life calls for reflection: What’s going on? What must we do? It might even be that the agitations of life become “political” only when such questions are asked. Also, that asking such questions is an essential part of political life. We should say then that our reflective thinking plays here three roles at once: it is deliberation about politics, it is constitutive of politics, and it is at the same time integrally part of it. The natural stance of this kind of thinking is towards the conditions in which it finds itself. Being located in the political plain and asking how life in it is to be understood and how to carry on with that life as well as we can, political reflection expresses itself in political speech. But political speech is soon surpassed by another form of reflection: one that seeks to remove itself from its location in the political plain in order to achieve a distanced and theoretical overview. This kind of theorizing can take a variety of forms. It can issues in claims about what all politics is and even must be or it can seek to spell out what all politics should be and what we must always and in all places do. Man is by nature a political animal. Man is man’s wolf. And: The meaning of politics is the implementation of justice -.are among the claims of political theory or philosophy so conceived (I have yet to find a compelling reason for distinguishing sharply between the two.). Comprehensive political theorizing of one or the other of these forms aspires to standing above the political plain, to deliver objective insights into its constitution, and to adjudicate what goes in the political fray. The aspiration of political theorizing is, in fact, that of Plato’s philosopher-kings. And there have never ceased to appear pretenders to that position. Against their overweening ambitions we must affirm an engaged and modest form of political thinking. We must defend political speech against the political theory. We still need to topple the philosopher-kings from their throne.

Political speech serves the needs of practical politics; but it can also drive further and ask more thoroughly about the condition in which we exist and how to proceed. If we call the former political speech, we can reserve the term “diagnostic practice” specifically for the latter. But we must understand that this kind of practice is not sharply separated from political speech. It differs only by degrees and is for that reason just as political as the former. Let us also recognize that the pretensions of the political theorists to detach themselves altogether from the political plain are no more than pretensions and that what these theorists deliver is, in fact, only another, unacknowledged kind of political diagnosis. Our theorists speak in the end always of the place and time in which they happen to be; they speak politically and not in a higher, purer, supra-political voice. This suggests that we can read their works in a different way from how they are usually read: not as contributions to the timeless truth about politics, but as disguised and perhaps only rudimentary diagnoses of their own time. We can read Plato’s Republic as a contribution to the Athenian and Greek politics of the 4th century; Hobbes’ Leviathan as a diagnosis of 17th century England and Europe torn by theological struggles; and John Rawls’ Theory of Justice as political speech on behalf of America in the 1960’s. We can add that these works would have been more transparent, if their authors had themselves been clearer about their undertaking or, at least, more explicit about it. To “historicize” these writings, as I suggest we should, need not deprive them of value for us. We can still learn from them what political  constellations may look like and what it means to reflect on politics in their variable contexts. We will see that diagnostic practice can never restrict itself to a narrow focus on the immediate present. In order to understand the present, we need to take note of the events that that have brought us to where we are now. In order to diagnose the present we need to track also that part of our political past that consists in its varying reflections.

            We still need to indicate more precisely what a diagnostic practice in political thinking will look like. “To diagnose” means to investigate a specific object or process in order to determine its nature, how it works, and to identify possible faults or flaws. We speak of diagnosis in this way in engineering, computer science and elsewhere, but most commonly in medicine. Diagnosis in engineering means an investigation of a particular machine or kind of machine, in computer science it means the testing of a particular program, and in medicine the examination of a particular patient. Diagnosis concerns thus always a specific object and seeks to reach specific conclusions about it. Diagnosis does not aim at making broad claims about all machines, programs, or human patients. Diagnosticians consider their object of diagnosis, moreover, not from a detached, timeless, and purely theoretical point of view but as it presents it to them at the moment and with practical conclusions in mind: in the workshop, the lab, or the examination room. Diagnosticians must, for that reason, also always take their own capacities for understanding into account, the skills, procedures, devices, and tools they have for conducting their investigation, and its circumstances, conditions, and limitations. The diagnosticians’ primary goal is, finally, not one of seeking to gain theoretical insight, but to reach a practical understanding of the object of diagnosis that can lead to an appropriate response which may determine that the machine is working, that the program functions, that the patient is healthy or, alternatively that the machine needs repair, the program needs redesign, and the patient needs treatment, or, as yet another possibility, that the machine is beyond repair, the program must be discarded, and the patient’s problem can only be alleviated.

Diagnostic political practice appears to be closest to the practice of medical diagnosis. One obvious reason for this is that in both cases we deal with human beings. We may be able to sharpen our conception of political diagnosis then by comparing it with and contrasting it to the medical kind . We can learn to gain a clearer understanding of what a diagnostic political practice might consist in because medical practitioners have, in fact engaged in diagnostic practices for more than two thousand years. Over time they have developed complex and organized diagnostic procedures. And there exists now an extensive medical literature on the topic.[1]

The first step in medical diagnosis is always to acquire knowledge about the patient. The patient may be coming to see the doctor for a regular check-up, for a general consultation, or because he/she feels unwell. And here we encounter the first dissimilarity between political and medical diagnosis. The latter is typically solicited whereas the former is most often not. And this relates to a second difference in that the doctor is confronted by a specific patient whereas the political diagnostician is located in the political system he or she is trying to diagnose. The physician can and is, indeed, called upon to distance himself from the patient. Medical diagnosis is well aware of the problem of familiarity bias which arises when that distance is broken. Such bias may taint the diagnosis. This can occur when the medical doctor is trying to diagnose him- or herself or a member of his or her own family or friends and acquaintances. By contrast, we might say that familiarity bias is almost impossible to avoid in diagnostic political thinking. There is, moreover, an additional problem here. Whereas the medical patient is a well-defined entity, it is not at all clear that there exists a distinct domain of politics separate from how we conceive it. Politics is not a natural kind but constituted by our reflection on it and, in particular, by the concept of the political with which we are operating.

Still, there are illuminating similarities between the two types of diagnosis. One concerns the kind of knowledge we require, the second the kind of concepts we have available.

The acquisition of knowledge in medical diagnosis begins as soon as the patient enters the examination room. The look, the gait, and the behavior of patient provide the medical diagnostician with first clues. “During a medical encounter the physician is being literally bombarded with information such as sights, sounds, smells, emotional affect, body language, and so on.”[2] It is part of the physician’s skill to be attentive to this wealth of information, not to overlook significant clues, but also not to be rushed into a false diagnosis. First impressions may after all prove misleading. The medical examination proceeds from this first moment to a more systematic attempt to gather knowledge and the first part of that is linguistic. The physician will ask the patient a series of questions. And this again requires skill for not every question and every kind of questioning will evoke an informative answer. For, “the patient may intentionally or unwillingly engage in denial and fail to openly convey critical information necessary to make the diagnosis.” The physician will want to know why the patient came for the examination and why now. He will want to hear about how the patient feels, whether there is pain, where it is, what kind of pain it is, and so on. He will also take notice of the patient’s description of how his symptoms have come about, how long they have lasted. He will record the patient’s medical history and the medical history of the family. Two features stand out in this: the crucial importance of the first person (i.e, the patient’s) report and secondly that a diagnosis of the present state of the patient depends on knowledge earlier states.  These two features carry directly over into political diagnosis. What is being said by all those who are operating in the political plain is essential for the political diagnostician and as in the medical case that information has to be carefully evaluated since the political actors may use language deceptively (by intention or inadvertently) and they do use language not only to communicate but also for rhetorical effect and to exercise power. But in listening to what is being said about the present, it is also important to find out is being said about the past. The political present can be understood only by knowing how it has come about. The political diagnosis of the present must involve thus a history of the present.

Medical diagnosis proceeds at this point to physical examination, laboratory tests, x-ray examination – procedures that are not available in the political case. The result will, however, be in both cases an overwhelming amount of information. The physician’s task is to determine what information provides him with clues about the patient’s state of health. Many bits of information will be irrelevant. Others may by indicate that something is wrong and that the patient is suffering from a disease. But which disease? Some bits of information belong together and point to a particular diagnosis. But which? There may be widely different symptoms which still are clues for one particular disease as well as very similar symptoms that indicate the presence of more than one disorder. The physician must take care not to over-diagnose and identify a disease when the patient is, in fact, healthy, not to overlook a disease that is actually present but may be manifesting itself in an unusual form, not to misdiagnose the disease that is present and prescribe a wrong treatment, and not to assume that a patient may only have one disease. There are no physical tests that the political diagnostician can perform, but otherwise his situation is similar to that of the physician. One crucial difference is, however, that the overabundance of information may be much greater in the political case than in the medical one – certainly so when think of contemporary politics.

The goal of the medical diagnostician is to identify the patient’s disease, if there is one present. The diagnostician will try to connect the identified clues with a name. Various techniques have been developed to do so. The exhaustive method is to gather and organize every available piece of data in order to arrive at a diagnosis. But this is not always practically possible, it is time-consuming, and does not always lead to a definite diagnosis. An algorithmic method sees the diagnosis as a series of decision procedure where each new bit of information leads to a choice between more definite conclusions. But such a method is not available for all medical problems because they prove too complex for this process.  A physician may also recall another patient or case he had seen or learned of before. Pattern recognition may help to reach a conclusion. But the method most often used in medical diagnosis is the hypothetico- deductive one in which the physician generates a hypothesis on the basis of his examination which is then evaluated and refined by further questioning of the patient, more tests, etc. At this point we must admit that the procedures of a political diagnosis are not as highly sophisticated and may never become so because of the uncontrollably large body of information, the impossibility of empirical testing, and the indeterminacy of the classificatory tools at hand.

And here we certainly encounter another significant difference between medicine and politics. Human patients are complex beings but political societies (particularly of the modern variety) are even more complex.  Human patients suffer from a large number of maladies but those can still be enumerated and are recurrent. The ills of politics are no so easily defined and as a large scale historical phenomenon it is not clear to what degree political ills are recurrent and enumerable. What is shared in the two attempts at diagnosis is that we seek to attach names (or concepts) to the identified clues. This is a case of tuberculosis we say, in one case. That is the case of a military coup, we say in the other.  Naming is important to both the physician and the patient and it is tied to therapeutic (or reforming) outcome of the diagnosis. It is also essential in politics. But the clinical practice of medicine is supported by a large body of scientific knowledge in biology, physiology, chemistry, and even physics. Such sciences are not in the same way available in politics. We may draw on socio-biology or anthropology or even climate science to reach our diagnosis but this support is more limited and perhaps less solid than the one we can rely on in medicine.

When we look at the history of medicine we discover, of course, that it has achieved its current scientific character only in the nineteenth century. Until then medical diagnosis was an art more similar to what we can now conceive as political diagnosis. We can also see in this earlier history how the practice of medicine involved a process of creating categories and concepts, of defining and specifying illnesses. Here the diagnostic practice involved not just applying given concepts to the observed phenomena but also to generate new concepts on the basis of observation.

We can thus identify two particular problems in the diagnostic process both medical and political. The first concerns the acquisition of knowledge: an overabundance of data, the need to sort those out into significant and insignificant, the difficulty of saying which data provide significant clues and which clues belong together. We need to attend, in particular, to the use of language in the diagnostic procedure; the question of how to assess what is being said. The second concerns the concepts (words, terms, or classifications) we have available to make sense of the data. We need to ask what they are and how they are to be understood, and how they are applied; we need to consider their adequacy and the possibility of generating new, better suited concepts. We need to recognize, moreover, that these two problems are substantially greater in politics than in medicine.

And because of this difference, we will also find it more difficult to evaluate diagnostic hypotheses when it comes to politics. And this is worth emphasizing because in politics we are still given to believe in the certainty of our convictions, and instead of proposing hypotheses we are inclined to speak our opinion loudly, assertively, and dogmatically. In fact, it is only rarely that we consider different hypotheses and seek to determine their degree of validity.  This differs sharply from the practice of medical diagnoses, where it is considered essential; to take all relevant hypotheses into account, where, in the course of the examination, the physician will try to whinny their number down always conscious of how easy it is to reach a false diagnosis.  The medical handbook finally advises us: “Physicians and patients must learn to live with some uncertainty.” How much more correct this is with political matters.

Finally, we must keep in mind that diagnosis, even when fully successful, produces always and only local knowledge in two senses of the word: (1) In medicine, for instance, it produces knowledge of an individual patient, the concrete states of an actual body, and of physically located cues. (2) It also produces knowledge whose validity may be limited to the diagnostic occasion. And the same thing holds in the political sphere. Diagnosis does not and cannot satisfy our hankering for a global theory though it may help us to at times to achieve a broader political view. In doing so it may diagnose our desire for more.



[1] Mark B. Mengel, Warren Lee Holleman, Scott A. Fields, Fundamentals of clinical practice,  2nd edition, 2002.

[2] John P. Langlois, “Making a Diagnosis,” loc. cit. All further quotations are from this essay.

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