甘瑟：一個醫療史家的觀點
Posted March 31, 2014; 12:00 p.m.
Name: Katja Guenther
Title: Assistant Professor of History and the Johanna and Alfred Hurley *61 P76 P82 P86 University Preceptor
Guenther trained as an M.D. in Germany before she earned a Ph.D. in the history of science from Harvard University. She also holds an M.Sc. in neuroscience from the University of Oxford. Guenther joined Princeton as an assistant professor of history in 2009.
在獲得哈佛大學科學史博士學位前，甘瑟在德國接受醫學學士學位訓練，也在牛津大學拿到神經科學學士學位。2009年，甘瑟以歷史學助理教授之職加入普林斯頓這個大家庭。
As a medical student, Guenther took classes in philosophy and medieval literature in addition to pathology and pharmacology. During clinical rotations in hospitals in Germany, and later in France and the United Kingdom, she became fascinated by the impact of cultural practices on medicine. In observing how medicine was practiced differently in different contexts, she began to ask how it had developed and why it was done that way. Guenther had discovered a new intellectual passion: studying medicine through the lens of history.
作為一名醫學生，甘瑟在修習病理學及藥理學課程外，選修了哲學及中世紀文學的課程。在各地醫院接受臨床輪訓的期間(起初在德國，後來則在法國和英國)，她對文化習俗如何影響醫學感到著迷。藉由審視不同脈絡下對於醫學實作所造成的差異，她對於醫學以往如何發展以及為何如是操演開始有所疑惑。甘瑟因此發現了一項新的學術熱情：透過歷史的框架研讀醫學。
Today, teaching at Princeton, Guenther interweaves her training as a physician, neuroscientist and historian to study the history of modern medicine and the mind sciences. She connects the sciences and the humanities, certain that a historical approach leads to deeper understanding of complex areas of study such as brain research.
如今，在普林斯頓任教的甘瑟，統合其所受的醫師訓練、神經科學訓練以及歷史學訓練，以求進一步釐清現代醫學及心智科學的歷史。她將科學及人文學科進行結合，增進對於各複雜學術領域的深刻理解，如腦科學。毫無疑問地，是透過歷史學的取徑。
Among the undergraduate courses Guenther has taught are "History of Medicine and the Body" and the seminars "Broken Brains, Shattered Minds: Disease and Experience in the History of Neuroscience" and "Medicine and Deviance: Defining Disease in the Modern World." This semester, she is teaching a new graduate seminar, "Freud to fMRI — Readings in the Histories of Mind and Brain."
甘瑟教授的課程有大學部的「醫學及身體的歷史」以及研究所的「破腦刳心：神經科學史中的疾病及經驗」和「醫學與偏差：在現代社會中定義疾病」。這個學期，她開授了一堂新的博士班課程：「從佛洛伊德到功能性磁振造影：歷史讀本中的心與腦」。
In her teaching, Guenther discusses how practices of medicine have changed across cultures and throughout time; the scene above is of medieval bloodletting. (Image courtesy of Katja Guenther)
在甘瑟的課堂中，她會帶領學生討論醫療實作如何在橫向的文化面及縱向的時間軸上發生改變，上圖為中世紀的放血治療。(相片由Katja Guenther提供)
Guenther has published a number of articles and edited and translated into English one of Sigmund Freud's early texts, "Critical Introduction to Neuropathology." She recently completed a book manuscript focusing on the history of psychoanalysis and the neuro disciplines (neurology, neurosurgery and the neurosciences). She is working on a new project on mirrors in the mind and brain sciences to explain why the mirror is an object of fascination for a wide range of researchers, and to examine how it has allowed the development of new theories of the mind and approaches to treatment.
甘瑟已經發表為數不少的研究論文，並將西格蒙德‧佛洛伊德的早期著作《批判神經病理學導論》重新編譯成英文。她也在近期完成一本專書的手稿，主要關注的內容是心理分析及神經相關學科(神經學、神經外科及神經科學)的歷史。現在，她正在進行一個有關心智及大腦科學的鏡子的研究計畫，藉以闡述為何鏡子這個物件受到廣泛研究者的青睞，進而覺察它如何影響與其相關的心智理論發展以及治療途徑。
"Katja's work bridges the divide in the mind sciences between laboratory approaches and psychoanalysis, showing how both grew out of 19th-century physiology," said William Jordan, the Dayton-Stockton Professor of History and chair of the department. Describing Guenther as a "genuinely exciting scholar," Jordan also commended her teaching, noting in particular that "many of the pre-meds at Princeton yearn to learn more about the technical history of medicine, and Katja's 'History of Medicine' course offers them a rigorous entry into this subject."
「凱雅(譯註：甘瑟的姓)對於心智科學的研究將原先分裂的實驗室取徑和心理分析重新橋接在一起，藉以顯示兩者如何從19世紀生理學基礎中各自發展。」 普林斯頓Dayton-Stockton分校的歷史學教授兼該系系主任威廉‧喬丹說。喬丹不只形容甘瑟是個「真誠且充滿活力的學者」，也同時對其教學讚譽有加，他特別提到「有許多普林斯頓的醫預科學生渴望學習更多有關醫學技術的歷史，而Katja開的醫學史課程提供他們切入這個主題的紮實訓練」。
Below, Guenther describes making the connections between history and science and what inspires her teaching and research.
下文中，甘瑟描述了如何在歷史及科學間取得連結以及激勵她教學及研究的事物。
Why did you study medicine?
為什麼妳當時會念醫學？
I decided to study medicine because I was interested in science and I was also interested in people and enjoyed interacting with them. Medicine combines complex specialized knowledge and the human in unique ways. It is about understanding how the body functions, but just as crucial for medical practice is the relationship between doctor and patient. The doctor has to explain to the patient how a treatment works, she has to humanize what can be very abstract and technical knowledge.
我那時決定念醫學是因為我對於科學和人都相當有興趣，也很喜歡和人們互動。醫學這門學問以它獨特的方式將複雜的專業知識和人類結合在一起。它攸關我們對於身體功能的認識，也同時在醫療實作中決定性地影響病醫關係。醫師必須向病人解釋一項治療會如何發揮功效，他們必須將深奧且富技術性的知識轉化成一種通人情的說詞。
Why did you follow an M.D. with a Ph.D. in history of science?
妳為何決定在醫學學士學位訓練後攻讀科學史博士？
During my clinical rotations in different European countries, I came to the realization that the human side to medicine was even more important than I had previously imagined. To give you an example, in the German context, doctors are more likely to treat hypertension (high blood pressure) by giving drugs. In France, however, I found that doctors were much less likely to give medication, and would talk instead about diet and exercise. It wasn't simply that the human element to medicine existed alongside but remained distinct from the scientific technical element; this experience suggested that they were closely intertwined. That was what sparked my interest in the history of science. I was fascinated by the ways in which cultural factors could play a profoundly important role in the way in which medical ideas developed and how treatments were performed.
當我在歐洲各國進行臨床訓練的期間，我開始了解人性之於醫學比我以前想像的更加重要。我舉個例子向你說明：在德國，醫師在治療高血壓時傾向於給藥；然而在法國，我發現醫師們比較少會給予藥物治療，而是改以飲食及運動控制替代。人的各種要素並非外在於醫學，也無法和科技元素得以明顯區隔，上述的例子讓我認為他們是緊密交織的。那正是激發我對於科學史興趣的主因。我對於文化因素如何在醫學概念的發展及治療的實作得以扮演重要角色進而深遠地影響感到相當有興趣。
This spring, Guenther is teaching "Freud to fMRI," a graduate seminar that explores human subjectivity and how "scientific and cultural perspectives are entangled" in the mind sciences. (Photo by Denise Applewhite, Office of Communications)
今年春天，甘瑟教授「從佛洛伊德到功能性磁振造影」課程，這是一堂探索在心智科學中的人類主體性及「科學面和文化面如何糾結」的課程。(編輯室Denise Applewhite攝)
What do you hope students learn about the history of medicine?
妳希望學生從醫學史中學到什麼？
I want to encourage my students to think in these terms as well.One of the major historical problems in my history of medicine survey course is the persistence of the humoral system for over 2,000 years. Well into the 19th century doctors and patients understood disease in terms of the balance of bodily liquids: blood, yellow bile, black bile and phlegm.To us today this seems wrong-headed, but such a judgment does little to help us understand how the humoral system remained dominant for such a long time. What we need to do is to go beyond the physiological understanding, and work out how it impacted upon the relationship between the physician and the patient. In contrast to much modern biomedicine, the humoral system was comprehensible to both parties. The theory of the humors helped the patient make sense of their experience, and provided the doctor with relatively clear therapeutic possibilities. This was a mutually affirming relationship.
我想要鼓勵我的學生也去想這個問題。在我教授的外科醫學史課堂中有一個著名的歷史學問題：體液學說為何能持續兩千年而歷久不衰──直到十九世紀，醫師和病人都將疾病視為體液(血液、黃膽汁、黑膽汁及粘液)間的不平衡。對今日的我們來說，這似乎是種執迷不悟，但這樣的判準無助於我們理解體液學說為何能在這麼長的時間中扮有重要地位。我們必須要做的事是超脫既有的生理學框架，回頭看體液學說如何在病醫間產生影響。相較起現代生物醫學，病醫雙方對體液學說都得以具有較高的掌握度。體液學說幫助病人合理化自身經驗，並且提供醫生相對清晰的治療選擇。正是體液學說使得病醫能夠互相肯認雙方這份關係。
What ideas have you found most engage students?
妳覺得什麼樣的概念最吸引學生？
Medicine has enormous cultural authority today. Not only do we begin and most often end our lives in medical settings, medicine pervades the life that comes in between. Such authority helps produce discontents, and we don't need to look far to see a number of activities and cultural practices that present themselves as reactions or antidotes to modern biomedicine. This means that a history of medicine in the modern world often has to step outside of the boundaries of the hospital and doctor's office, and students find it very revealing to take the history of medicine approach to seemingly non-medical phenomena of everyday life. For example, in the fall, Princeton senior Elektra Alivisatos, a student in "History of Medicine," researched prenatal yoga and the history of yoga in the West. She went to one of the yoga studios in Princeton to interview the participants, and produced an oral history. She then turned her research into a five-minute podcast that included snippets from her interviews.
如今，醫學具有相當大的文化權威性。不只是人類生命的始末都在醫學場域中，醫學也遍及人類生命歷程的各處。如此權威造成了各方不滿，舉目所見有為數不少的倡議及文化習俗被視為是對現代生物醫學的反動及對抗手段。這表示醫療史的範疇不再停留在醫院及醫師辦公處，學生們也發現日常生活中一般不被視為與醫學有關的現象對醫療史更具有揭示性。舉例來說，今年秋天，修習醫療史課程的普林斯頓大學四年級生Elektra Alivisatos研究了有關了瑜珈在西方世界的緣起及發展。她到普林斯頓一間瑜珈館裡和教練進行訪談，並且編纂口述史。而後她將訪談摘錄成五分鐘的廣播放在播客上。
What are goals for the graduate course "Freud to fMRI?"
「從佛洛伊德到功能性磁振造影」的課程目標是什麼？
The mind sciences seem to me an exemplary case of the ways in which scientific and cultural perspectives are entangled. Few fields make such strong claims about human subjectivity, and the imprint of broader cultural assumptions is particularly clear in the mind and brain sciences. In the course we are discussing questions like: What forms of subjectivity do the mind and brain sciences promote, and what ideas about the self do they reflect?
對我來說，心智科學對於揭示科學和文化如何交互作用具有示範性意義。很少有學科對人類主體性有那麼強的主張，而且心智科學及腦科學留有豐富的文化假設痕跡。在課堂上我們討論的課題則像是：心智科學及腦科學增進了什麼樣形式的主體性發展？他們反映了什麼樣的自我概念？
In the present, as the neurosciences dominate the study of the mind and brain, a further question is raised: What impact has neuroscience had on broader society? And what impact should it have? We are witness today to the rise of several neuro-hyphenated disciplines like neuro-ethics and neuro-economics. Their existence is testament to a profound optimism that neuroscientists will be able to redefine existing bodies of thought. But in my opinion modern neuroscience has often been insufficiently attentive to the way in which it draws on psychological categories, and to the types of subjectivity that it produces. We need to think carefully through these relationships to recognize the potential of the neurosciences, but also to understand their limitations.
在神經科學主宰心智及腦研究的今日，更深一層的疑問浮現──神經科學對於廣大社會的影響是什麼？而它應該造成什麼程度的影響？我們正見證以神經此一元素為指導原則的世道，諸如神經倫理學、神經經濟學等。神經的存在成為神經科學家得以樂觀地重新定義舊有身體想像的證據。但以我來看，現代神經科學並未充分留意其自身利用心理學的分類的狀況以及自身所產生的主體性類型。我們必須順著這層關係慎思，不只為了發掘神經科學的潛力，也是為了理解它的侷限性。
Guenther explains that the "tense interplay" between the "psy" and "neuro" disciplines can particularly be investigated in the work of Freud, whose study of neurology laid the groundwork for the development of psychoanalysis. Guenther translated Freud's 1887 book, "Critical Introduction to Neuropathology," which includes this drawing by Freud of the spinal cord, nuclei of the posterior tract and cerebellum. (Freud illustration courtesy of Psychoanalysis and History, Vol. 14 No. 2, 2012)
甘瑟解釋，尤其從那些佛洛伊德為往後心理分析奠下根基的神經學研究來看，心理和神經兩個概念彼此是緊密交織的。甘瑟翻譯了佛洛伊德寫作於1887的專書「批判神經病理學導論」，上圖即為佛洛伊德在專書中描繪脊髓、脊髓小腦徑和小腦的關聯插圖。(佛洛伊德的插圖取材於《心理分析及歷史》，第十四冊2012年第二期)
How do these ideas play out in your own research?
這些概念在你的研究中扮演什麼樣的角色？
If we look at the history of the mind and brain sciences, and this is central to my research, we can see a tense interplay between the "psy" and the "neuro" disciplines (psychology, psychiatry and psychoanalysis, in contrast to neurology, neurosurgery and the neurosciences). Nowhere is this clearer than in the work of Sigmund Freud. When I was conducting research for my book at the Library of Congress in Washington, D.C., I came across a short book manuscript written by Freud in 1887. It was a very exciting find. There are very few major Freud texts that haven't been published, and this one seemed especially important. In his letters to his fiancée from the time he described the project as a particularly "bold" one. He worried that the ideas he expressed there were too radical to gain traction, which in part explains why he never published it. Together with colleagues in Tübingen, Germany, the Freud scholars Albrecht Hirschmüller and the late Gerhard Fichtner, I edited the manuscript, and translated it into English.
如果我們翻閱有關心靈和大腦科學的歷史(這段歷史正是我研究的重心)，我們可以看到心理和神經兩個概念彼此緊密交織(心理學、心理治療和心理分析對應神經學、神經外科學和神經科學)。沒有任何得以比西格蒙德‧佛洛伊德的研究更能闡明這個現象的了。當我在華盛頓特區的國會圖書館為我的著作找尋文獻時，我偶然發現佛洛伊德寫作於1887年的專書原稿殘篇。這是個令人興奮的發現。佛洛伊德的文本在當時幾乎都已出版，因此這份原稿顯得格外重要。在他那時寫給未婚妻的信裡提到，這項寫作計畫對他來說是非常大膽的嘗試。他擔憂如此基進的想法難以得到人們的支持，這也一部份說明了他為何從未出版此書的原因。我和在德國圖賓根的同事──研究佛洛伊德的學者Albrecht Hirschmüller以及已故的Gerhard Fichtner*，一同校訂這份原稿，並且翻譯成英文。
*Gerhard Fichtner: 1932~2012，http://www.euppublishing.com/doi/abs/10.3366/pah.2012.0116。
What is most fascinating about the text is that it was deeply embedded within the German neurological tradition. Freud gave it the title "Critical Introduction to Neuropathology." In an article that appeared last year in Modern Intellectual History, I show how his radical re-reading of neurology laid the groundwork for the development of psychoanalysis. Freud's new theory of the mind was dependent upon his close engagement and working through of the neurological tradition.
最有趣的莫過於其內容深植於德國傳統神經學概念。佛洛伊德下了這樣的一個標題「批判神經病理學導論(Critical Introduction to Neuropathology)」。在一篇去年發表在《現代思想史》期刊的研究**中，我試圖呈現佛洛伊德如何透過根本地重新閱讀相關神經學文獻，進而建構心理分析得以發展的根基。佛洛伊德對於心智的新學理是仰賴他和神經學傳統的契合而發展出來的。
** "The Disappearing Lesion. Sigmund Freud, Sensory-Motor Physiology, and the Beginnings of Psychoanalysis," forthcoming in Modern Intellectual History, Fall 2013.
In a similar way, in my recently completed book manuscript, I look at how different notions of the nervous system promoted different ideas of the self. I tell a history about these competing visions that gives context to what some historians have called the modern "cerebral subject," according to which we identify ourselves fully with our brains. When we understand this history, recognize its complexity, I think it allows us to look afresh at modern neuroscience, to welcome its contributions, but also to be wary of its limitations in understanding the world in its historical complexity.
同樣地，在我最近完成的專書草稿中，我聚焦在不同神經系統的概念如何影響人們對於自我概念的發展。我揭示了一群歷史學家稱之為「以大腦為主體」的今日，意即完全以腦作為指認我們自身存在依據的今日，是如何在這些相互競逐的舊有觀點間，有今天這樣的發展脈絡。當我們更加了解這段歷史，更加釐清其中的複雜性時，我認為這將讓我們對於現代神經科學有更不同的認識：除了一味地讚揚它的貢獻，也得以使我們警覺在歷史複雜性之下，有什麼樣的限制影響我們對於這個世界的認識。
原文網址：http://www.princeton.edu/main/news/archive/S39/56/89K93/index.xml?section=featured
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