Personal statement of research interests
Typically, one’s biography shapes one’s scholarship. In my case, the central challenge was to bridge two careers, biomedical research/clinical medicine and philosophy. That transition occurred after establishing myself as a scientist, and thus my journey into the humanities has been framed by an over-arching question: how might such a bridge be constructed and what drove me to build it? Early publications focused on my laboratory interests that resulted in philosophical studies of immunology. The central themes concerned biological identity and individuality, which then expanded into the general topics of personal identity, and as explained below, moral philosophy in the context of clinical medicine. Thus I drew a wide philosophical circle around various professional personae. While I acknowledge that a bioethicist might not initially appreciate how discussions of patient autonomy relate to the reactions of the Romantics to positivism or how a study of psychoanalysis complements my descriptions of immunological theory, at least for me everything is of one piece. Below, I outline the architecture of these explorations and refer them to the theme that links all my scholarship, which is more fully developed in my intellectual autobiography, The Triumph of Uncertainty. Science and Self in the Postmodern Age (Central European University Press, 2022) and in shorter form, “Philosophy as self-knowledge,” Philosophia, 42:1-23, 2014 (DOI 10.1007/s11406-013-9474-x)
1. Immunology
My critical writings on the theoretical development of immunology have followed the key historical evolution of the discipline. These studies originated in exploring the historical and philosophical origins of my laboratory investigations of inflammation, more specifically, phagocyte biology. Metchnikoff and the Origins of Immunology (co-authored with Leon Chernyak, Oxford University Press, 1991) dissected the various strands (microbiology, host defense, and evolution) that combined to form the new science of immunology in the 1880s. Ilya Metchnikoff presented the first theory of active immunity, which he constructed in stark contrast to the conceptual commitments of the microbiologists and chemists who first claimed the science. Given his background as an embryologist, he regarded the organism in terms of life-long development, while his competitors thought of identity as established at birth and left essentially unchanged throughout life. In this latter formulation, the animal requires defense to preserve its integrity, a model that closely fit the understanding of immunity in terms of combating pathogens. Metchnikoff’s key insight challenged that vision by arguing that immunity is first concerned with establishing identity and then protecting the animal’s integrity. In other words, identity was not set but developed as a product of dynamic processes in which the organism adjusts to the challenges and opportunities of living in its environment. By disputing the standing of some set, unchanging identity, that dynamic formulation thus challenged the primacy of self/nonself discrimination as the organizing principle of the science.
Immunology’s prominent 20th century model was derived from immunity construed in its defensive modality, i.e., to protect an autonomous body. I challenged that paradigm by proposing that the “immune self” is a metaphor for describing the functional state of immune reactions: “self” evokes no response; nonself stimulates reaction, but there is no such objectified entity as such. The Immune Self (Cambridge University Press 1994), the first extended philosophical study of immunology, set this conception of organismic identity drew parallels from the philosophical tradition of personal identity beginning with Descartes and terminating in the phenomenology of James and Husserl. Indeed, agency follows immune theory like a shadow. The animal, through its goal-oriented engagements, seeks pragmatic success and the selections chosen in the universe of opportunities is assigned to a selecting agent. Psychologists call this function “consciousness” (with easy slippage into various iterations of “selfhood”) while immunologists describe immune cognitive functions (e.g., lymphocytes “see” and “act” through their “perception” and “memory” ) in which the immune system also acts as a purposeful agent. Immune reactions follows immune perceptions that closely corresponds to the cognitive model of how the brain perceives and then sends directives in response. From this perspective, the immune system becomes an information processing faculty that mediates the interactions of the organism in its environment (both deleterious and benign) to join a complex neuro-endocrine-immune network, whose afferent limb of perception leads to immune reactions.
While immune selfhood continued to be employed as a powerful idiom, late 20th century immunologists expanded the insular autonomous model of immunity to one based on a Hegelian relational depiction of identity. On this view, animals function within an ecological collective in which cooperative relationships define their physiology and evolutionary fitness. Early immunologists had assumed that immunity evolved in the higher animals to protect an autonomous entity. While defense is undoubtedly a critical aspect of immunity, that model failed to appreciate that tolerance also required identification, for much of the foreign is recognized and tolerated in the air breathed and the food ingested. Moreover, the myriad microbes living within the animal that co-exist with each other and the host reside in harmony because the immune system tolerates their co-habitation. From this perspective, immunity functions as a gatekeeper that decides acceptance or rejection. Indeed, without immune tolerance and active assent, the host organism cannot survive. Nutrients are obvious necessities, but resident bacteria are also critical for normal physiology. Such “foreigners” mediate functions that range from blood clotting to affecting emotional states. Symbionts even play crucial roles in embryonic development. Understanding the extent and importance of these cooperative relationships has transfigured notions of biological identity from the traditional autonomous model to a more complex construct in which selfhood shifts from the individualistic configuration to a dynamic, elastic organization in which circumscribed borders of individuality no longer hold.
This “relational” counter construction of identity draws from “ecology,” the science of biological communities, and from this vantage, the individual melds into the collective. Accordingly, the notion of an individual entity, an objectified thing residing at the foundation of the organism’s identity, has been displaced by a communal construct. That lesson led to a radical re-formulation of biological identity, in which individuality assumes new complexity and immunity must adjust to ambiguous criteria of inclusion or rejection. So, instead of an on/off immune reaction triggered by prescribed self/nonself identifications, a gradation of responses mediates assimilation at one end of the immune spectrum to destruction at the other end. Note, in this ecological format, instead of defending the integrity of a pre-determined individual, immune processes construct identity, which emerges in the on-going dynamic of immune decision-making upon a range of responses, just as Metchnikoff proposed. The immune system thus arbitrates what stays and what goes, and in that process, identity is defined not by some molecular definition but by the exercise of functional benefit. The full implications of this theory of the science are summarized in my Immunity, the Evolution of an Idea (Oxford University Press, 2017).
2. Moral epistemology
Henry David Thoreau and the Moral Agency of Knowing (University of California Press, 2001) served as the hinge of my career’s inflection. This study followed The Immune Self conceptually inasmuch as my study of immunology highlighted how metaphors of selfhood had infiltrated the science from psychological and philosophical sources. These extrapolated identifications of autonomous individuality drawn from common experience appeared embedded in the science, much to its detriment. With that general orientation, the larger question opened, namely, 1) how is scientific knowledge influenced by the cultural, historical, and philosophical contexts of its acquisition, and 2) how is a scientific worldview translated into personal significance. In the case of immunology, theoreticians had cast Western notions if individuality onto the science and thus demonstrated the interplay of supporting non-epistemic factors in the construction of its theory. After demonstrating how such cultural elements influenced immunology, the converse issue was to discern how the reality offered by science drives existential and psychological understanding. Disenchantment, on the one hand, and robust creative rebuttal, on the other hand, had framed the Romantic responses to consilient scientism, and in exploring the origins of this issue, I focused on Thoreau’s fecund reaction to the 19th century’s professional transformation of natural history into the academic discipline of biology.
The ascendancy of positivism that challenged Thoreau offered me a case example of how science might be contextualized into its larger humanistic meanings and thereby present a picture of reality in terms that Michael Polanyi described as “personal.” The effort of finding humane significance in the objectification of nature does not pit scientific ways of knowing against other epistemologies, but recognizes how moral, aesthetic, and spiritual dimensions of experience might cohere within the reality offered by science. That effort built upon Thoreau’s credo of imaginative individuality, one that I embraced as a powerful antidote to the disenchantment (and eventual nihilism) born in his era, which led to the postmodern suspicions of individual autonomy so current in our own.
The basic message of Thoreau was extended in Science and the Quest for Meaning (Baylor University Press, 2009). There I presented contemporary science from the perspective of post-Kuhnian history and philosophy of science that generally maintains that science is unified neither in its methods, its standards, nor its interpretative strategies; that its various epistemologies fail any final form of objectivity; that theories and models evolve from loose creative strategies; and that the pragmatic assembly of facts relies on varying degrees of certainty and interpretative facility. These positions had been amply illustrated in my earlier critique of immunology’s governing theory, but with Quest I had a larger agenda, namely, a humanistic account of how science 1) must ultimately be integrated into a larger social reality, and 2) creates the “world picture” (Heidegger) that places humans in their natural cosmos. The metaphysics of science and the metaphysics of personal experience can hardly be the same, but the effort to find coherence represents a critically important unfulfilled project.
3. Ethics
Seeking an integrated epistemological position had been inspired, in large measure, by the challenge of practicing humane medicine. As a research clinician, I faced the task of integrating my scientific persona, and the demands of employing a scientific medicine, with the imperative of offering empathetic care. In Confessions of a Medicine Man (MIT Press, 1999), I explored the emotional and moral tensions that arise in this conflicted clinical setting. This short book is a testament of my own professional awakening of the physician’s moral identity. Readers appreciated the personal vignettes sprinkled among discursive descriptions of modern health care and my pleas for making medicine’s science and technologies subordinate to the moral mandate of caring for the patient. Such a philosophy of medicine requires melding the objective stare with the empathy of care, an application of what I called in my Thoreau, a “moral epistemology.” In a series of papers (see Publications) I developed this philosophy in practical terms with explicit proposals for reforming medical education and improving patient care.
While Confessions combined autobiography and analysis, Patient Autonomy and the Ethics of Responsibility (MIT Press 2005) offered a detailed examination of the doctor-patient relationship coupled with a critique of current notions of patient autonomy. I argued that differing notions of autonomy depend on how personal identity is construed (thus drawing on my previous scholarship about selfhood). In my view, politico-judicial models of citizen autonomy only confound the lived experience of illness and the realities of the clinic. I maintain that physician responsibility must be based on an interpersonal, relational construct of identity, not the severe autonomy of patient-as-independent-agent-and-consumer now so well adopted for the commodification of health care. Again, the relational construct of identity under-girded this philosophical analysis: The Immune Self forecast the various constructions of identity that ordain differing views of physician moral agency, while my Thoreau grounds my own ethical position by highlighting sensitivity to everyday experience coupled with the requisite self-awareness to understand not only others, but also oneself. Thus the notion of “moral-epistemology” consolidates my writings on science and medicine, which holds that all knowledge is embedded in a medley of values. Values not only evolve over time and across and within cultures, but they are also at play as each of us constructs the world in which we live. Following William James (Pragmatism 1907),“we add, both to the subject and to the predicate part of reality. The world stands malleable, waiting to receive its final touches at our hand,” guided by a constellation of human-centered, human-derived, human-constructed, and human-intended values. This is the Thoreauvian project, “a person-centered science” – note, personal, not subjective (per Michael Polanyi) – in which meaning assumes its rightful place in the world picture offered by science.
4. Psychology
Who am I? is the key moral index of human identity, the issue that organized both my writings on immunology and clinical medicine. Given that epistemological definitions failed prescribed demarcations (my studies of immunity) and the problematic status of ethics without a foundational ontology (my medical ethics writings), with Freud, the Reluctant Philosopher (Princeton University Press, 2010) I sought the sources of moral agency in what has become the dominant version of the introspective ego. Dispensing with arguments about the scientific standing of Freud’s theory (a matter no longer contested), he nevertheless offered an abiding conclusion: We are strangers to ourselves, because of unconscious desire and fantasy; and as we recall and recast our past, a reconfigured personal history emerges upon which we gain the opportunity to assume responsibility for who we are and what we might become. That Freud created a powerful modern myth of personal identity seems perfectly apt to me. Freudianism holds that insight leads to redemption, a promise that despite the determinism governing our inner psychic life, a circumspect freedom beckons. At least, that conclusion largely explains the persistent appeal of psycho-analysis (in whatever form). Thus my portrait of Freud’s moral theme bypasses claims made by putative objectivity and resides squarely in the ethical domain in which agency is configured by a construction of identity based not on who-am-I? but rather on who-I-want-to-be. At base, this is Freud’s moral inquiry.
A beguiling problem has preoccupied me since writing my Freud, namely, on what basis can Freudianism hold any credence as a portrait of the mind and, more deeply, our very identity given its discredited scientific claims? And that query depends to what extent mental life can be objectified. In other words, if a narrative is constructed, on what foundation is the edifice of identity built? Indeed, what are the limits of objectifications (usually under the guise of science) that have infiltrated into every aspect of human appraisal? And if objectivity is discredited from such introspection, how then might human agency be portrayed? These questions are easily highlight by psychoanalysis, but the general standing of scientistic explanations of human being fall well within the problematics of Freud’s invention. In Requiem for the Ego. Freud and the Origins of Postmodernism (Stanford University Press, 2013), I assembled the key philosophical critiques of psychoanalysis by Wittgenstein, Heidegger and Adorno (followed by Lacan and other French postmodernists) to show how Freud’s representational model of the mind (a cognitivist construction) could not fulfill his ambitions to create a “science of the mind.” And after crediting their critiques, I asked what would be required to construct an alternate view of the mind given the philosophical weaknesses of psychoanalytic theory and the distortions that follow? If psychology, the science of the mind, was so discredited, what Phoenix would rise from the debunked cognitivist paradigm? William James and Sigmund Freud on the Mind: Saving Subjectivity (Routledge 2025) provides my ‘answer.’
As psychology turned the soul into the mind, James sought a humanistic philosophy to counter that displacement and thereby find ways to better balance objective ways of thinking with subjective ways of knowing, the central problematic of my writings. Freud’s basic error (also those like-minded committed to the cognitive paradigm) resides in the dualist metaphysics in which he attempted to objectify subjective mental states. What James called, “the psychologist’s fallacy” requires splitting “the I” into an observing subject viewing her own “self” as an object. The criteria for such objectification are simply not applicable. In my James and Freud, I explore how James developed an alternate phenomenological depiction of the mind by dispensing with the dualism underlying Freud’s approach and in that discussion my earlier interests coalesce: What are the limits of a science (and analytics more generally) that has infiltrated into every aspect of human appraisal? James’s pluralism coupled to pragmatism effectively sheds Freudian scientism and in so doing provides a very different sort of Wittgensteinian ‘philosophical therapy,’ one I believe better attuned to our current appreciation of human experience and the voice of the human soul.
Summation
The problems that intrigue me – personal identity, the value structure of science, and the attempts to find coherence in a world fragmented by competing notions of truth – have required unpacking the complex calculus of integrating objective and subjective ways of knowing. So, despite the diversity of subjects considered, a singular problem of defining identity – allowing for the limits of analytics – holds these expositions together. The “resting-spot” of my explorations fits most snugly in a “neo-romantic” humanism that resists the positivism and scientism that so dominated the ideals of my youth. Indeed, as Alain Badiou opined, “It may be that, as Bergson maintained, a philosopher only ever develops one idea. In any case, there is no doubt that the philosopher is born of a single question, the question which arises at the intersection of thought and life at a given moment in the philosopher’s youth; the question which one must at all costs find a way to answer.”
