龔鵬程對(duì)話海外學(xué)者第八十四期：在后現(xiàn)代情境中，被技術(shù)統(tǒng)治的人類社會(huì)，只有強(qiáng)化交談、重建溝通倫理，才能獲得文化新生的力量。這不是誰(shuí)的理論，而是每個(gè)人都應(yīng)實(shí)踐的活動(dòng)。龔鵬程先生遊走世界，并曾主持過(guò)“世界漢學(xué)研究中心”。我們會(huì)陸續(xù)推出“龔鵬程對(duì)話海外學(xué)者”系列文章，請(qǐng)他對(duì)話一些學(xué)界有意義的靈魂。范圍不局限于漢學(xué)，會(huì)涉及多種學(xué)科。以期深山長(zhǎng)谷之水，四面而出。

S. 洛克蘭·珍教授（Professor S. Lochlann Jain）

美國(guó)斯坦福大學(xué)人類學(xué)教授、倫敦國(guó)王學(xué)院全球健康和社會(huì)醫(yī)學(xué)客座教授

龔鵬程教授：您好。您的《惡性：癌癥如何成為了我們》一書(shū)中，您討論了癌癥對(duì)社會(huì)的影響。醫(yī)療事故在您著作中是一個(gè)重要的話題。正如您所指出的，醫(yī)生是人，醫(yī)療失誤是不可避免的。但社會(huì)如何處理這些失誤，將對(duì)患者的健康產(chǎn)生巨大的影響。您認(rèn)為社會(huì)該如何應(yīng)對(duì)醫(yī)療事故?

S. 洛克蘭·珍教授：龔教授，您好。關(guān)于系統(tǒng)和個(gè)人錯(cuò)誤的問(wèn)題很吸引人，特別是在醫(yī)療事故這種情況下，風(fēng)險(xiǎn)可能很高。一些研究發(fā)現(xiàn)，醫(yī)療事故是美國(guó)最大的單一死因，但它作為一個(gè)公共衛(wèi)生問(wèn)題卻幾乎不為人知。

醫(yī)生在復(fù)雜的醫(yī)療系統(tǒng)中工作，同時(shí)與經(jīng)濟(jì)系統(tǒng)與社會(huì)系統(tǒng)相關(guān)聯(lián)。幾個(gè)關(guān)鍵的事實(shí)使問(wèn)題復(fù)雜化：醫(yī)學(xué)是一個(gè)地位高、利潤(rùn)高的經(jīng)濟(jì)領(lǐng)域，不幸的是，這往往意味著，否認(rèn)醫(yī)療事故是一個(gè)結(jié)構(gòu)性的問(wèn)題，其中有重大利害關(guān)系。例如，病人不可能知道外科醫(yī)生犯了多少錯(cuò)誤（記錄根本沒(méi)有保存），甚至不可能知道自己的手術(shù)過(guò)程中發(fā)生了什么（外科醫(yī)生寫(xiě)了記錄，但病人是無(wú)意識(shí)的）。即使病人確實(shí)對(duì)他們的醫(yī)生的質(zhì)量有一個(gè)準(zhǔn)確的描述，他們的保險(xiǎn)在看病的人找醫(yī)生方面，可能也不會(huì)給他們太多的選擇。

有許多歷史上的例子表明，利潤(rùn)勝過(guò)了醫(yī)療事故，成為公共衛(wèi)生問(wèn)題。例如，在20世紀(jì)60年代和70年代，乙型肝炎是美國(guó)血液供應(yīng)中流行的一種病毒。醫(yī)院沒(méi)有使用現(xiàn)有的方法來(lái)減少病毒的傳播，而是辯稱提供更清潔的血液供應(yīng)并不符合“當(dāng)前的醫(yī)療標(biāo)準(zhǔn)”，從而避免了訴訟。由于法院接受了這一推理，病人在接受手術(shù)時(shí)別無(wú)選擇，只能承擔(dān)感染乙型肝炎的風(fēng)險(xiǎn)。同樣，只是在過(guò)去的十年里，一些醫(yī)院才找到了鼓勵(lì)醫(yī)生定期洗手的方法，并設(shè)計(jì)出了更難以在給藥過(guò)程中犯錯(cuò)的系統(tǒng)。關(guān)鍵是，雖然犯錯(cuò)是人之常事，但人類所工作的系統(tǒng)可能更容易犯錯(cuò)、更容易否認(rèn)或更容易彌補(bǔ)錯(cuò)誤。

否認(rèn)錯(cuò)誤符合醫(yī)院的經(jīng)濟(jì)利益，而病人幾乎沒(méi)有追索權(quán)時(shí)，很難看到前進(jìn)的道路。因?yàn)槌俗類毫拥陌咐?，這些失誤幾乎不可能被證實(shí)。然而，應(yīng)對(duì)錯(cuò)誤的方法是認(rèn)真對(duì)待它們，讓獨(dú)立機(jī)構(gòu)對(duì)每一個(gè)錯(cuò)誤的經(jīng)濟(jì)、心理、設(shè)計(jì)、社會(huì)和結(jié)構(gòu)因素進(jìn)行全面分析——換句話說(shuō)，首先把它們理解為結(jié)構(gòu)性問(wèn)題，而不是個(gè)人責(zé)任問(wèn)題（盡管在某些情況下確實(shí)是這樣）。這些調(diào)查可以在各機(jī)構(gòu)之間共享，以確定改善系統(tǒng)和機(jī)構(gòu)的方法。

The question of systems and personal errors is fascinating, and particularly in cases of medical error where the stakes can be high. Some studies have found medical error to be the single largest cause of death in the US, and yet it is virtually invisible as a public health issue.

Doctors work within complex medical systems that are both economic and social. They are also materially designed. A few crucial facts complicate the issue: medicine is a high-status and high profit area of the economy, which has tended to mean, unfortunately, that there are large stakes in disavowing medical error as a structural concern. For example, it would be impossible for a patient to find out how many mistakes a surgeon has made (records are simply not kept), or even to know what has happened during their own surgery (the surgeon writes the notes, the patient is unconscious). Even if a patient did have an accurate account of the quality of their doctor, their insurance will probably not give them much choice as to which doctors they can see.

There are many historical examples of situations in which profits have trumped medical error as a public health issue. For example, hepatitis B was a virus endemic to the American blood supply in the 1960s and 1970s. Rather than using established ways to reduce the circulation of the virus, hospitals protected themselves from litigation by arguing that it was not the “current medical standard” to provide a cleaner blood supply. Since the courts accepted this reasoning, patients had no choice but to take the risk of getting hepatitis B when they underwent surgery. Similarly, only in the last ten years have some hospitals found ways to encourage physicians to wash their hands regularly and devised systems to make mistakes in drug delivery more difficult. The point is that while to err is human, humans work in systems that can make errors more and less easy to make, to deny, or to compensate for.

It's difficult to see a way forward when disavowal of mistakes is in the financial interests of hospitals and patients have little recourse since mistakes are practically impossible to prove except in the most egregious cases. Still, constructive ways to respond to mistakes would be to take them seriously and have independent agencies provide a thorough analysis of the economic, psychological, design, social, and structural elements that have gone into each – in other words, to understand them first as structural rather than as a question of individual blame (although it some cases it certainly is that). These investigations could be shared across institutions to identify ways of ameliorating the systems and institutions.

龔鵬程教授：在您的《傷害》一書(shū)中，您討論了美國(guó)的傷害文化。什么是美國(guó)傷害文化？它是如何影響美國(guó)人的生活方式的？

S. 洛克蘭·珍教授：我的書(shū)《傷害》對(duì)美國(guó)人身傷害法的具體歷史和作用進(jìn)行了分析。我的目的是描述在整個(gè)20世紀(jì)，美國(guó)的產(chǎn)品責(zé)任和侵權(quán)法是如何與圍繞消費(fèi)品的監(jiān)管（往往是由于相關(guān)監(jiān)管的缺乏）結(jié)合在一起出現(xiàn)的。這一領(lǐng)域的法律平衡了制造商的利益（為了利潤(rùn)，他們可能會(huì)出售未經(jīng)充分研究和測(cè)試的市場(chǎng)產(chǎn)品）和個(gè)人的利益（他們可能沒(méi)有能力做所有的研究來(lái)尋找合格的產(chǎn)品）。

在汽車發(fā)展史上，關(guān)于安全帶的爭(zhēng)論中可以找到一個(gè)很好的例子來(lái)說(shuō)明這個(gè)說(shuō)法的變化。幾十年來(lái)，人們知道安全帶每年可以挽救成千上萬(wàn)的生命，這些生命都是在“低速”撞擊中喪生的。制造商沒(méi)有增加安全帶，而是聲稱 "安全帶不賣(mài)"，車禍?zhǔn)怯捎谒緳C(jī)的錯(cuò)誤造成的。法院在很大程度上支持這些主張。受傷的原告認(rèn)為車禍?zhǔn)强梢灶A(yù)見(jiàn)的，因此在設(shè)計(jì)汽車時(shí)應(yīng)該考慮到潛在的傷害，但這種論點(diǎn)一直被駁回。隨著民權(quán)和消費(fèi)者權(quán)益運(yùn)動(dòng)的興起，這種觀點(diǎn)在20世紀(jì)60年代發(fā)生了根本性的改變。到1968年，法院認(rèn)為制造商應(yīng)該設(shè)計(jì)出在低速撞擊中保護(hù)車內(nèi)人員的汽車。

我想，這種構(gòu)建公共衛(wèi)生的方式不僅是美國(guó)特有的，而且被大多數(shù)人誤解。因此，美國(guó)人很容易被操縱，使他們的利益與企業(yè)捆綁在一起。

我認(rèn)為這種將公共衛(wèi)生視為司法問(wèn)題而非監(jiān)管問(wèn)題的思維方式，會(huì)產(chǎn)生廣泛的影響。美國(guó)人面臨著巨大的不安全感，因?yàn)橐淮蝹涂赡艽輾麄兊姆e蓄和身心健康。即使是那些有保險(xiǎn)的人，受傷也需要和保險(xiǎn)公司打幾個(gè)小時(shí)的電話。

My book,Injury, offers an analysis of the specific history of and role played by personal injury law in the United States. I aimed to describe a very particular way in which product liability and tort law emerged throughout the twentieth century in the US in conjunction with- and often because of the dearth of – regulation around consumer products. This area of law balances the interests of manufacturers (who in the interests of profit may sell products that have not been adequately researched and tested on the market) and the interests of individuals (who may not be able to do all the research required to find save products).

A good example of the shifting terrain of this equation can be found in the history of automobility with the debates about seatbelts. For decades it was known that seat belts could save thousands of lives a year, lives that were lost in low-speed collisions. Rather than add seatbelts, manufacturers claimed that “seatbelts don’t sell,” and that crashes were due to driver error. The courts largely stood behind these claims, and so injured plaintiffs’ arguments that crashes were foreseeable and that therefore cars should be designed with potential injuries in mind consistently failed. This view radically changed in the 1960s with the rise of Civil Rights and Consumer Rights movements. By 1968, courts found that manufacturers should design cars to protect occupants in low-speed collisions.

I suggested that this way of framing public health was both particular to the United States, and peculiarly misunderstood by most people. Therefore, Americans could be easily manipulated to ally their interests with corporations rather than with themselves as susceptible to injury.

I think the effects of this way of thinking about public health as a judicial rather than a regulatory issue has broad effects. Americans face tremendous insecurity since one injury can destroy their savings and well-being. Even for those with insurance, an injury will requires hours on the phone with insurance companies.

龔鵬程教授：圖像在您的書(shū)中發(fā)揮了重要的作用，最近您寫(xiě)了一本名為《藝術(shù)之物：充滿迷人好奇心的圖像動(dòng)物園》的繪畫(huà)小說(shuō)。該書(shū)比您的其他作品更通俗易懂，因?yàn)槿魏稳硕伎梢蚤喿x并學(xué)到一些知識(shí)。您創(chuàng)作這本書(shū)的目的是什么？它是否比您的其他作品更能吸引更廣泛的觀眾？您是如何選擇書(shū)中不同的主題的？

S. 洛克蘭·珍教授：《藝術(shù)之物》比我的其他書(shū)要短，它是以一系列的圖畫(huà)和幾篇短文的格式組成的。我對(duì)這個(gè)項(xiàng)目有兩個(gè)想要達(dá)成的目標(biāo)。首先，我想對(duì)形式進(jìn)行實(shí)驗(yàn)，其次，我想更好地理解收藏背后的政治。

我在整個(gè)系列中使用了一種非常具體的格式：每一頁(yè)都包含一個(gè)標(biāo)題和下面一些帶標(biāo)簽的繪圖。這種繪畫(huà)集合的形式與圖片明信片、植物色板、棒球交易卡相呼應(yīng)，每張圖片都與標(biāo)簽相呼應(yīng)，因?yàn)槊繌垐D片解釋了標(biāo)簽上的名稱，而標(biāo)簽標(biāo)明了圖像的名稱。書(shū)名提供了一個(gè)元標(biāo)簽，使整個(gè)信息結(jié)構(gòu)形成一個(gè)閉環(huán)。動(dòng)物園、博物館和其他教育機(jī)構(gòu)在提供信息時(shí)就采用了這一框架。

我想嘗試使用一種想當(dāng)然的形式，將其解構(gòu)為“從內(nèi)部”構(gòu)建意義的項(xiàng)目。當(dāng)我們收集東西的時(shí)候，我們會(huì)賦予它們一種相似的結(jié)構(gòu)，也會(huì)對(duì)什么東西應(yīng)該放在哪里做出判斷。誰(shuí)屬于“美麗”的范疇？這些結(jié)構(gòu)是偶然的和可變的；然而沒(méi)有它們，我們就無(wú)法正常工作。

但是，作為一個(gè)混合種族、混合性別、混合國(guó)籍的人，我一直在掙扎并質(zhì)疑這種安置模式。

這個(gè)項(xiàng)目是作為一個(gè)游戲提出來(lái)的，一種例如我在等公交車的時(shí)候可以打發(fā)時(shí)間的方式。在早期階段，我可能會(huì)隨機(jī)地問(wèn)自己：有哪些東西是綠色的？我可以把一件什么意想不到的東西扔在那里？例如，回憶一下古老的謎語(yǔ)：“什么東西是黑色白色的，和紅色組成的：報(bào)紙”或者更可怕的答案是是“一只被打傷的企鵝”。當(dāng)我繼續(xù)畫(huà)這些畫(huà)時(shí)，我意識(shí)到這種形式可以做幾件事。我玩起了怪異的歷史（復(fù)活溺水者的方法）和突出某些物體（武器）的方法。我用這些作品來(lái)思考更抽象的符號(hào)概念，如否定和修辭。在某些內(nèi)容中，我提供了元評(píng)論，例如藝術(shù)運(yùn)動(dòng)（即帶有標(biāo)簽的內(nèi)容）。

換句話說(shuō)，我?guī)缀跏请S機(jī)地發(fā)現(xiàn)了一種方法，我可以用一種可辨認(rèn)的形式來(lái)解讀形式本身，我發(fā)現(xiàn)這相當(dāng)有趣，并在業(yè)余時(shí)間繼續(xù)研究它。當(dāng)多倫多大學(xué)出版社表示有興趣在他們的EthnoGraphics系列中出版它時(shí)，我非常高興。

Things that Art is shorter than my other books, and it is written as a series of drawings accompanied by several short articles. I had two intertwined goals with the project. First, I wanted to experiment with form, and second, I wanted to better understand the politics of collection.

I used a very specific form across the series: each page consists of a title and a number of labeled drawings underneath. This form of a drawn collection echoes the picture postcard, the botanical color plate, the baseball trading card in that each image illustrates the label and the label names the image. The title offers, if you will, a meta-label such that the whole informational structure forms a closed loop. Zoos, museums, and other educational institutions adopt this scaffold in their informational offerings.

I wanted to experiment with using a taken-for-granted form to deconstruct it as sense-making project “from the inside”. When we collect things, we impute a structure of similarity to them, and also a judgement about what belongs where. Who belongs in the category of “beautiful”? These structures are contingent and mutable; and yet without them, we can’t really function. Still, as a mixed race, mixed gender, mixed nationality, etc., person, I’ve always struggled with and questioned this mode of placement.

The project stated as a game, a way of filling empty time as I waited for bus, for example. At the early stages I might have asked myself, randomly: What are a few things that are green? What is an unexpected thing I could throw I there, recalling, for example, the old riddle“what is black and white and red all over: a newspaper.” Or more gruesomely, “a mauled penguin.” As I continued to make of these drawings, I realized that this form could do several things. I played with bizarre histories (ways to resuscitate the drowned) and ways to highlight certain facets of objects (things that are weapons). I used the works to contemplate more abstract semiotic notions such as negatives and figures of speech. In some I offer a meta commentary on, for example, art movements (things that are labelled, things that are not a pipe).

In other words, I nearly randomly came upon a way that I could use a recognizable form to unpack the form itself, and I found that quite fun and continued to work on it in my spare time. When the University of Toronto Press showed interest in publishing it in their EthnoGraphics series I was quite chuffed.

You ask about capturing that elusive thing we call a“broader audience.” For that I think a series of elements have to magically come together for that to happen: it’s about marketing, personal connections, book design and writing style, timing – and of course it’s also about how one’s book fits into the categories already in place. Two of the best books I’ve ever read never found a publisher, let alone a broad audience, whereas some authors unexpectedly find themselves with six figure advances. In other words, as with everything, there is a lot of chance to this business and it isn’t something I’ve become terribly invested in.

龔鵬程教授：您目前正在進(jìn)行一個(gè)關(guān)于肺和空氣的歷史的漫畫(huà)小說(shuō)項(xiàng)目，這聽(tīng)起來(lái)很吸引人。您能介紹一下這部作品嗎?

S. 洛克蘭·珍教授：在繪制《藝術(shù)之物》時(shí)，我對(duì)以不同的形式認(rèn)可、促成、鼓勵(lì)思想和感受這方面產(chǎn)生了興趣。學(xué)術(shù)界很清楚：經(jīng)濟(jì)學(xué)家使用不同于哲學(xué)家的認(rèn)識(shí)論框架，因此對(duì)類似問(wèn)題有不同的“答案”。這一概念還可以進(jìn)一步推廣：圖表、照片和獎(jiǎng)?wù)乱彩菢?gòu)建和表達(dá)社會(huì)問(wèn)題的方式。

我目前正在積極從事的項(xiàng)目，是一部關(guān)于溺水的文化史，包括散文和藝術(shù)作品，名為《肺是一只鳥(niǎo)和魚(yú)》。

溺水，在十八世紀(jì)中期成為一種顯著的意外死亡形式。這種“顯然是被淹死的”尸體，在生與死之間搖搖欲墜，呈現(xiàn)出恐懼、厭惡和迷戀的對(duì)象。到了18世紀(jì)后期，人道協(xié)會(huì)在歐洲各地如雨后春筍般涌現(xiàn)，倡導(dǎo)城市設(shè)計(jì)改革，包括照明、護(hù)欄、獎(jiǎng)懲制度和沿河警衛(wèi)。與此同時(shí)，雖然有大量的溺水復(fù)蘇方法，但仍然無(wú)效；甚至在19世紀(jì)，歐洲海員普遍不會(huì)游泳。雖然助產(chǎn)護(hù)士廣泛使用人工呼吸來(lái)挽救新生兒，但在18世紀(jì)中期被認(rèn)為是“粗俗的”并被禁止。

隨著海上貿(mào)易的興起、沉船事件的增多，以及繪畫(huà)和文學(xué)中對(duì)水的描繪的繁盛，溺水也成為歐洲文學(xué)、藝術(shù)和生活中的一種癡迷。位于塞納河岸邊的巴黎停尸房被稱為“溺水者博物館”，每天吸引了數(shù)千名游客。

這本書(shū)將這段以歐洲為中心的歷史與一系列平行的、更黑暗的歷史進(jìn)行了追溯，比如奴隸在“中央航道”溺亡和非洲移民試圖前往歐洲。

總的來(lái)說(shuō)，“肺是一只鳥(niǎo)和魚(yú)” 表明，人們所說(shuō)的或爭(zhēng)論的內(nèi)容，無(wú)法與它的呈現(xiàn)和交流方式區(qū)分開(kāi)來(lái)，藝術(shù)成分是該項(xiàng)目的核心。每一種形式（報(bào)紙文章、法律文件、廣告、照片）都體現(xiàn)了不同形式的權(quán)威，并強(qiáng)調(diào)或否認(rèn)任何研究項(xiàng)目不可避免的分歧、空白和不確定性。

因此，繪畫(huà)的目的不是為了說(shuō)明所附的文字，也不是為了以不同的形式呈現(xiàn)一個(gè)相關(guān)的思想。相反，我想把繪畫(huà)作為一種獨(dú)立的認(rèn)識(shí)論來(lái)思考：在繪畫(huà)中而不是在學(xué)術(shù)論文中排列源材料，會(huì)產(chǎn)生哪些不同的思維和感受模式？

通過(guò)這種方式，我的目標(biāo)是可以略微取代學(xué)術(shù)寫(xiě)作理想中的權(quán)威作者，并考慮一種通過(guò)圖像來(lái)回應(yīng)社會(huì)現(xiàn)象的方式。

In drawingThings that Art, I became interested in the ways in which different forms allow, enable, encourage directions of thought and feeling. Academics know this: economists use different epistemological frameworks than philosophers, and thus have different “answers” to similar questions. This notion can be pushed further: charts, photographs, and medals are also ways to frame and express social issues.

The project I’m actively working on at the moment is a cultural history of drowning consisting of both prose and artworks calledThe Lung is a Bird and Fish. Drowning emerged as a notable form of accidental death in the mid-eighteenth century. “Apparently drowned” bodies, teetering between life and death, presented objects of fear, revulsion, and fascination. By the late 1700s, Humane Societies sprung up across Europe to advocate for urban design reform including lighting, guard-railing, systems of rewards and penalties, and watchmen along waterways. Meanwhile, drowning resuscitation methods, while plentiful, remained inefficacious and European seafarers generally could not swim even through the 19th century. Mouth-to-mouth resuscitation, while widely used by mid-wives reviving neonates, was deemed “vulgar” and banned by the mid-1700s. With the rise of maritime trade, increasing shipwrecks, and an effloresce of representations of water in painting and literature, drowning also became a virtual obsession in European literature, art, and life. The Paris Morgue, located on the bank of the Seine and dubbed“a museum for the drowned,” drew thousands of visitors a day. The book traces this Euro-centric history against a series of parallel, darker histories such as drownings among slaves in the Middle Passage and African migrants attempting to travel to Europe.

Overall,“The Lung is a Bird and a Fish” suggests that what is said or argued cannot be distinguished from how it is presented and communicated, and the art component is central to the project. Each form (a newspaper article, a legal document, an advertisement, a photograph) embodies different forms of authority and highlights or disavows the ambiguities, gaps and uncertainties that are an ineluctable aspect of any research project. The goal in the drawings is thus not to illustrate the accompanying text, nor to present an allied thought in a different form. Rather, I want to think about drawing as a separate epistemology: what different modes of thought and feeling altogether emerge from ordering source materials in a drawing rather than in an academic essay? In that way I aim to slightly displace the sovereign author required by academic writing and consider a way to respond to social phenomena in and through images.

龔鵬程，1956年生于臺(tái)北，臺(tái)灣師范大學(xué)博士，當(dāng)代著名學(xué)者和思想家。著作已出版一百五十多本。

辦有大學(xué)、出版社、雜志社、書(shū)院等，并規(guī)劃城市建設(shè)、主題園區(qū)等多處。講學(xué)于世界各地。并在北京、上海、杭州、臺(tái)北、巴黎、日本、澳門(mén)等地舉辦過(guò)書(shū)法展?，F(xiàn)為中國(guó)孔子博物館名譽(yù)館長(zhǎng)、美國(guó)龔鵬程基金會(huì)主席。