elites. Thus, it is not surprising that expert knowledge is likely to be directed away from social criticism and toward regulating individuals. Medicine, in particular, locates individuals in the crosshairs of classificatory schemes and definitions that focus attention on their personal difficulties and shortcomings (Foucault 1973; see also Sontag 1989).
While states can use force to ensure compliance, most expert systems survive in part on the simple willingness of nonexperts to trust in their complicated and often mysterious powers (Giddens 1990). There are strong cultural pressures for people to follow the advice of their physicians, or at least not to resist receiving advice. People who narrate stories about bodies that are increasingly intolerant of ordinary places and things are routinely advised by their physicians to reduce the stress in their lives, or to medicate daily with allergy drugs, or to seek psychological or psychiatric help. The problem with this expert advice is, simply, that it doesn’t work. People remain sick or become even sicker when they follow their physicians’ recommendations.
Rather than rejecting biomedicine entirely, however, these people are appropriating the symbols of biomedicine—in effect, separating the physicians from their language and shifting the site of biomedical theorizing from hospitals, clinics, and offices to kitchen tables, living rooms, and patios. The sick people encountered in these pages are not abandoning expert knowledge but they are moving away from the expert system. They perceive the need for expertise at the same moment they have lost faith in the experts and their administrative worlds.
What might happen to biomedical knowledge once it is separated from the profession of medicine and relocated in mundane, ordinary worlds? One thing seems certain: the constitutive authority of physicians to create and control the objects of medicine in the interests of the state is not likely to go unchallenged. Ordinary people exercising control over medical discourse are likely to bend and twist at least a few of its paradigmatic assumptions to fashion ways of knowing that help them explain their miseries. In theorizing their somatic distress, the environmentally ill, in particular, are locating the sources of their troubles outside of themselves, in the practices and habits of intimate and institutional others. They are claiming to know something biomedical about the body and environments that is at once an explanation of chronic somatic distress and a representation of imperfections in the body politic—at once, in other words, a theory and a social criticism.
Bodies do not talk, of course. We do. But bodies do make noises, tremble, break, change shapes, and act in unusual ways. In short, our bodies invite, if not demand, someone to speak for them.1 As bodies become increasingly exposed to environmental dangers whose immediate and long-term health effects are endlessly debated by experts, ordinary people are frequently compelled to speak for their own bodies. Problems with bodies and environments are challenging the orthodox boundaries between medical experts and lay forms of knowledge.
More generally, we might say that lay expertise is emerging as an alternative form of rationality, one that begins and ends with concrete human, indeed physical, experiences. A common denominator of these physical experiences, however, is their high degree of uncertainty, ambiguity, or, perhaps better said, mystery. If the cry “I am hungry” demands not reflection but concrete action, the cry “I am poisoned by invisible chemicals whose presence is not detectable using standard monitoring equipment” is an occasion for reflection, deliberation, sorting out what is known from what is not known, testing, drawing conclusions, and checking them against some standard of validity (Beck 1992). Not surprisingly, the “I am poisoned …” mysteries must be transformed into puzzles, changing their status from things that cannot be known with certainty to things that can be figured out.
The chemically reactive are not the only people who find the rational explanations of legitimate medical authorities to be fuzzy and confusing, if not incoherent, accounts of their troubles. Multiple chemical sensitivity is an example of a broader populist revolt against the hegemony of expert medical systems in what Giddens calls “late modernity” and Beck calls the “risk society.” Participants in this revolt do not reject medical knowledge; rather, they refuse to allow it to be identified solely with the interests of state-sponsored professions. Participants, in other words, are likely to criticize the medical profession while appropriating its complex theories.
A recent article on the AIDS movement in the United States describes activists who
wrangle with scientists on issues of truth and method … [and] seek to reform science … by locating themselves on the inside. They question not just the uses of science, not just control over science, but sometimes even the very contents of science and the processes by which it is produced.… They seek to change the ground rules about how the game is played. (Epstein 1991, 37)
In a similar manner, citizens are claiming to know about “women’s health, fetal tissue research, and recombinant DNA research” (Epstein 1991, 36). The current controversy over the etiology of the unusual symptoms and diseases experienced by veterans of the Gulf War is pitting the ordinary soldier against the health machine of the Veterans Administration (see chapter 7). Workers are learning about accident rates and types of technology to argue for a safer workplace (Nelkin and Brown 1984). And the problems of chronic fatigue syndrome and repetition strain injury are sending citizens to the libraries in search of answers physicians cannot provide (Lawson 1993; Bammer and Martin 1992). The problem of MCS joins a new class of hazards that are characterized by the absence of concrete, tangible measures of cause and effect, that are not apprehended immediately but require rumination, deliberation, cogitation—in short, the construction of abstract explanations, theories if you will.
Theorizing is a task normally assigned to scientists and intellectuals, while nonexperts are likely to improvise ways of knowing that occur well below the level of genuine theory construction (Berger and Luckmann 1966). Today, however, an increasing number of average citizens are appropriating the privileged voice of the theorist to construct coherent groups of general propositions to use as principles of explanation and persuasion. Consider Ulrich Beck’s (1992) rhetorical question:
Why shouldn’t laypeople—who are no longer what they used to be, namely, just laypeople, and who ultimately have to pay for all the benefits—ask questions that are forestalled by the false a priori of scientific theory, and in that way provide a critical supplement to the model of experimental testing? (55)
Problems of health and disease are only one example of a popular struggle to wrest control of a rational knowledge system from its institutional moorings and challenge society to change based on a claim to know something “true” or “scientific” about how the world works. Public hearing testimonies offered by citizens organized to define and control disposition of nuclear materials at the seventeen Department of Energy sites in the United States argue in the languages of nuclear engineering and toxicology for their version of appropriate cleanup criteria (U.S. Department of Energy 1991). Other citizens are mastering the intricacies of zoning and planning regulations to hold industrial developers accountable for various land-use initiatives involving hazardous or toxic materials (Couch and Kroll-Smith 1994; Minor 1994).
Human agency in liberal democracies has always depended on the ability of people to articulate their concerns and grievances using the discourses of civil rights. Today, however, what is just and unjust is often confounded with claims to know the world through categorization, calculation, and measurement. Civil rights, in other words, are increasingly dependent on the capacity of ordinary people to appropriate the languages of instrumental rationality and cast their arguments for equality and justice in the measured cadence of expertise.
Note, however, the distinction drawn here between acquiring expert knowledge and soliciting the counsel of experts. As people are becoming aware of their increasing dependence on expert knowledge they are also increasingly distrustful of experts. Perhaps this explains, in part, Beck’s observation that “monopolies on knowledge…are… moving away from their prescribed
