There is a certain sigh of relief—a sense of coming home—when encountering a concept that deeply reinforces a scholarly path that you have been on for over a decade, especially when that concept is better articulated than anything you have ever produced yourself. It was that home that I found in Vinciane Despret’s Living as a Bird. My mind perked up when I read, “if we are to sound like economists, there is also a price to be paid,”Footnote ¹ and then really connected with a sentence where she explains that in addition to being particularly punishing to read, studies of bird territories and territorialization, which are rooted in a clean, quantitative economics approach, have certain things that fail to be said, due to an “element of negligence.”Footnote ² Finally, she turns to a quotation by Bruno Latour that rang wonderfully true with a sense of where I have lived over the last several years:

This thinking is squarely aligned with my critique of the dominant economic approach of surgical outcomes that marginalizes nearly every patient and discourages the introduction of new methodology that might resolve it.Footnote ⁴ Despret’s focus on territorialization and the finding of elisions between actor-network theory (a conceptual and richly philosophical approach to the world that considers the ever-shifting network of relationships between the social and the natural) and concepts from Gilles Deleuze (specifically the ontological work, territoriality, and the notion of the assemblage) has set a new challenge for the trajectory of my work.

Living as a Bird is a book about birds, and it will be a joy to read for anyone who knows the entire Audubon Guide but finds themselves wanting more. More importantly, it is also about the bird-loving (or even bird-hating) folks interested in territorialization. It is a virtuosic demonstration of her own territorial position among the scientists as a philosopher of science, as well as among the contemporary others who concern themselves with the same topic, successfully bridging ornithology with contemporary epistemological and social worlds.

By focusing the book on “territorialization” and not just on “behavior,” Despret portrays the assemblage of birds, backyards, fields, migratory patterns, trees, and, indeed, scientists, all with the focal point of territorialization. Territory, she warns, “is by no means an innocent term.”Footnote ⁵ We are taken on a tour of the topic. Across the span, territory is a bird “headquarters,”Footnote ⁶ “a sustainer of function,”Footnote ⁷ “any defended area,”Footnote ⁸ “a site of display and spectacle,”Footnote ⁹ and is “musical scores.”Footnote ¹⁰ She celebrates (in a way that the reader can celebrate along with her) the moment where territory studies shifted away from fragmentary research that lacked theoretical structure to methods that focused on the life of birds. This structured approach to science—an Enlightenment-era strategy that she introduces early on—gives way to a heavy critique of it later in the book. The Anthropocene epoch, which can be said to have a milieu that is dazzlingly complex, simply calls for something more than science-as-usual: Approaches to science that remove the human observers (as if our presence and observing make no impact to the world around us) are shown to be utterly insufficient.

Despret tells us in the first few pages that her work on bird territorialization is not meant to only refer to birds but that the work has implications beyond birds, beyond science. She means to show, too, just how well territorialization is embedded in contemporary thinking. Despret is looking for a better world. She writes, “I am convinced … that this multiplication of worlds can make our own world a better place to live in. Creating such worlds means learning how to respect different ways of inhabiting a given space, identifying and itemizing what animals do and how each of them has developed its own way of being.”Footnote ¹¹

Despret sketches an alternative to economic analysis when she writes, “Perhaps I am drawn more to stories than to numbers, and maybe I am not sufficiently susceptible to the beauty of graphs, to colourful pie charts and to the choreography of curves which set out costs and benefits.”Footnote ¹² She takes Isabelle Stengers’ view that Kant’s sapere aude—daring to know—be restored to its original meaning (attributed to the Roman poet Horace): “daring to taste.” She writes, “Learning to know something … [m]eans learning to discriminate, learning to recognize what matters, learning how differences count, and learning all of that, in the context of the encounter with all its attendant risks and consequences.”Footnote ¹³ It is not simply a matter of taste or predilection here, however, though taste is at the origin. Despret sets out in the rest of the book to show just how what has been neglected, oversimplified, and externalized might be taken into consideration, not only in bird science but also in human life.

In a key moment, for example, Despret considers a passage from Maylis de Kerangal’s novel, The Heart, in which she describes Hocine, a young man who traps and sells goldfinches in Algiers, as recognizing just how the songs of the goldfinches were manifestations of their various territories (valley, city, mountain, forest, hill, and stream), which brings “a landscape to life”Footnote ¹⁴ that inspires rethinking of how we see the world. “Take, for example, the case of those females who were said to have chosen a territory and not a male. But the ‘and not’ here is already superfluous, it is no longer possible to be in an ‘either … or’ situation, as the song, courtship display, colours, poses, territorialization and territory could somehow be dissociated.”Footnote ¹⁵ To truly comprehend the reality before us, we must take in all of its interrelatedness.

The work has immediate application to my justice-oriented project in surgery. The evolution of surgical outcome science was necessitated, constrained, and tuned by the fact that the double-blinded, randomized controlled clinical trials are impossible for almost all researchers of surgery. Blinding, for example, is not feasible, since surgeons must know specifically what they are doing. The “placebo” in surgery, called a “sham operation,” often involves at least an incision that is ethically questionable since it is harm-inducing. Starting in the 1990s, an econometric approach was instituted instead, bringing surgical outcomes science from a loose affiliation of cottage industries and anecdotal reports to a sophisticated system that relies primarily on large databases (e.g., Surveillance, Epidemiology, and End Results Database; the National Surgical Quality Improvement Project [NSQIP]; the National Trauma Databank). These approaches tend to venerate the central tendency of data sets and ignore the marginal cases in them—there is no science of the plurality. These approaches create what I have deemed “data normates” that I argue are worthy of critique by advocates of the social model of disability. This critique was inspired by Rosemarie Garland ThomsonFootnote ¹⁶ and later work by Aimi HamraieFootnote ¹⁷ that critically engages contemporary views on disability, and especially the way that contemporary environments tend to actively exclude marginalized people.

The econometric approach in surgery has been remarkably valuable in its ability to show a measure of surgical quality. The approach originated at the Veteran’s Affairs (VA) hospitals and owes its birth to a 1985 US Congressional act that was prompted by concerns that surgical quality at the VA was not on a par with that of the private sector.Footnote ¹⁸ The law requires that VA hospitals compare their results with national averages on a yearly basis. A problem with its implementation was that a science of outcomes had to be invented to do such a comparison. The program, which involves creating a statistically stable database of preoperative risk factors and postoperative outcomes of hundreds of thousands of patients in order to develop risk models that allow comparisons from hospital to hospital, was remarkably successful. The American College of Surgeons estimates that the program was responsible for a 47 percent drop in postoperative mortality and a 43 percent drop in morbidity rates in VA hospitals from 1991 to 2006.Footnote ¹⁹

In its contemporary manifestation, it is possible to show, using a similar econometric approach, where an individual hospital lies along a chart of all participating hospitals with regard to its surgical outcomes in a process called “benchmarking.”Footnote ²⁰ Valuable population studies can be performed showing a panoply of important results across bariatric surgery, inflammatory bowel disease, and the influence of risk factors and lifestyle choices.Footnote ²¹

The problem with the program’s success and vast dominance is that it has unintentionally created an environment in which there is hardly space for any alternative empirical methods to evaluate surgical quality. The econometric approach relies on studies that often include quantitative data from hundreds of thousands of rigorously datafied patients. The big data approach achieves a level of epistemic fidelity that rivals that of randomized trials but does a handy job of “shunting to the outside.”Footnote ²² In it is a deviation from justice that goes largely unrecognized in surgical circles. A science that proceeds by anonymizing and quantifying data in a striving for scientific validity relies heavily on creating a “data normate”: a highly averaged, and very much cis-gendered and able-bodied, white, middle-class quantitative representation of a human that appears neutral and serves as a “template” for future work. As Aimee Hamraie has pointed out, such templates diminish justice by serving as “a system of exclusion that segregates spaces and people along the axes of disability, race, class, and gender.”Footnote ²³ Patients who are marginalized along any axis tend to be so excluded, and in surgery it matters, for surgery makes permanent changes to human bodies that go to the root of human well-being.

What Despret calls for is just what surgery should be calling for—a system that does not focus exclusively on the quantifiable. A system without, as Latour puts it, “calculated negligence” and one that is as sensitive to territory as Despret’s entire book is by staying with and caring for the subject. In other words, an investigation of birds by “living as a bird.” As one reads, it becomes apparent that Despret’s phenomenological approach can help with many of the hard empirical problems. Despret points to and gives form to future work in so many scientific fields, and not least among them, surgery.

In order for surgery to address hard problems, such as disparities in outcome by race, investigation should proceed by methods that explore not just the fungible and anonymous quantitative data that lends itself to statistical analysis, but also data that involve the relationships between natural and social worlds of surgery. A science of the central tendency has been established—what is needed is a science of the periphery.

The magic of this book is that it takes the granular particularities of territoriality studies in bird science and develops a theory that has import for all empirical projects, and probably nonempirical ones as well. Despret’s main conclusion is that we should “take care that, when new light is thrown on a situation, it does not then end up obliterating everything under the harsh spotlight of the explanation,” and that we “have softer, subtler lights instead.”Footnote ²⁴ Nowhere is this admonition more apt than in surgery, where a uniform and relatively homogeneous explanation machine that runs on big data chugs along as fast as the electrons in the integrated circuits will permit. Blinding in its dominance, the levels of statistical validity achieved in the NSQIP studies portrayed earlier, as well as those of other similar big data projects in surgery, vastly outclass those of any other approach in surgery.

For Despret, the blinding dominance comes about when such a rapid rate allows recognized similarities to be celebrated only when any differences have been ignored. Such emphases might be acceptable if they are considered aesthetic choices, but in too many scientific projects, aesthetics are not at the root, but simple carelessness seems to be.

She furthermore sees the attractiveness in complicating matters—a response to the complexity of the matter itself. This invitation to complexity is also intriguing and inspiring for my project of rethinking scientific validity in surgery. The impetus to greater complexity runs contrary to conventional science that, as Deleuze and Guattari have argued, goes so far as to carve out a homogeneous system in order to make a scientific study possible.Footnote ²⁵ Homogeneous systems are by design simple, and the introduction of complexity is unwanted. Not only is it more difficult to proceed in science when matters become more complicated, but also the very concept of conceptual progress often involves simplification. Despret warns that the ideological biases of the researchers guide simplification, striping elements that are essential to a fuller understanding.

Despret’s work draws from Haraway, Latour, Deleuze, Stengers and fits comfortably among other criticisms of naïve empiricism (e.g., observations are objective and quantifiability lends legitimacy). Territoriality, of course, plays a fundamental role in the thought of Deleuze and Felix Guattari. A rich Deleuzian “open system” that is ontologically characterized by its process consists of coding, stratification, and territorialization wherein coding takes matter and organizes it into bodies; stratification creates hierarchy among those bodies. Territorialization has the role of ordering those bodies into assemblages, emergently creating the consistency of all that presently is.Footnote ²⁶ Despret similarly manages to show the assemblage of birds, bird territoriality, and bird scientists as an open system. Living as a Bird is about as rhizomic and decentered as a contemporary philosophy of science work can get. The assemblage here is so carefully revealed, and perhaps even deterritorialized and reassembled, so as to show the world in a particularly new light—a world in the process of realizing itself through modes of existence, and our particular moment, shared between beings on this planet.

This book belongs better between Baker’s The Peregrin and The Blue Fox by Sjon than Haraway and Latour. It shines as a work of philosophy of science, but its aesthetic qualities are of equal brilliance. The clever manner by which Despret titled and structured her chapters subtly illustrates the rich and fascinating interplay between birdsong and music. “Counterpoint,” “First Chord,” “Second Chord,” and “Polyphonic Scores” evoke Messiaen, Janequin, Delius, Ravel, and Saint-Saëns and the whole history of French music that counts birdsong as its muse.

In the end, I wanted something a bit more teleological, and not just about the construct of the world and a deep demonstration of our shared mode of existence with nature. Despret does a virtuosic job of showing that most contemporary science fails when it comes to discovering knowledge that satisfies contemporary needs, and somewhat less showing just how this better knowledge would figure into a better world. Completely lacking is much discussion about what a better world consists of (e.g., peace, equality, and justice). This is only a minor detriment for me, though (an agenda might have diminished the aesthetic). With this book as an example, I look forward to seeing goal-directed normative work emerge—with softer lights, greater nuance, daring to taste, and living as the subject matter.