A new review article out in the journal of BiosemioticsAnd the Flesh in Between: Towards a Health Semiotics,” by Devon Schiller takes Jonathan Hope and my edited volume as an opportunity to review the history of medical semiotics and health semiotics. Our book, Food and Medicine: A Biosemiotic Perspective (2021), deals with the question of how food becomes glossed as food and medicine becomes seen, used, and healing as medicine, according to the different bodies of living beings. As medicine is the birthplace of semiotics, with diagnosis (being able to decide between different possible diseases, and then having some idea of how to treat it – assuming you have diagnosed correctly), it is fitting that semiotics returns to these questions.

Schiller’s article contextualizes our book and the chapters by different authors therein according to a Hippocratic context, in a semio-historical approach much deeper than our book focuses on. While we discuss briefly the medical origins of semiotics and I in particular rely on Eugen Baer’s foundational Medical Semiotics, Schiller forcefully argues the explicit links between applied semiotics (especially to the realms of public health and medicine) and semioethics, a topic I have also written on previously, with Morten Tønnessen and Jonathan Beever, in the Zeitschrift für Semiotik.

Schiller makes extensive citation of contemporary semioticians to reveal it’s history on these topics:

To establish the connection between contemporary biological semiotics and classical medical semiotics, Italian semiotician Susan Petrilli states, “implies a great responsibility for the semiotician,” because doing so goes beyond theoretical reason into “practical reason,” thereby conferring upon the study of signs “a commitment that is of an ethical nature [because it] concerns the health of life

That the health of life be the primary font of semiotics reveals the biosemiotic character of all semiotics, as well as sets up the stage for Jakob von Üexkull’s Umwelt concept applied to disease. Such a perspective

…recognizes how diseases do not “exist in rebus Naturae,” that is, in things of nature, and are neither “Platonic realities” nor “universals ante rem,” that is, timeless entities independent from the signs used to represent them, just out there, waiting to be discovered. Rather… [we can] consider[] “disease-concepts” to be constructed through “general references” as a matter of “mental convenience”

The implications of this are enormous for medical classification, taxonomies, as well as bearing epidemiological consequences and tarrying with the terrain theory of health and disease.

In other words – the disease always spills over the confines of our semiotic Umwelt, or the sphere of our reference. Disease exists not just within the confines of our perceptible, measurable, knowledge; but often what we are able to perceive are mere symptoms of the real disease, existing for the most part out of the realm of normal apperception (yet affecting us just the same).

This is a major topic that could be fleshed out, in Schiller’s words, much more, constituting a substantial research program. Not just for physical disorders, but also mental ones (psycho-social-emotional ones). The biopsychosocial model of disease arrives closer at understanding the implications of this diagnosis of health and disease as overspilling our Umwelt into a just as real Umgebung a/effecting us just as totally, touching on the point that it is impossible to derive, measure, or pin down exactly the causation of disease in terms of sequence or contravening factors through taking only a biological, or psychological, or social approach; but indeed to get anywhere near understanding, diagnosing, and treating the full onslaught of the disease requires attending to the gestalt of all of these factors put together. Such attention begins to subtend on the event horizon of our Umwelt, letting us peer into the many causes of disease.