WPR and Medicine Part II

Content:

In the last entry I examined some applications of WPR that highlight the need to consider underlying presuppositions and “field assumptions” in medical practices – to make explicit what is implicit in clinical medicine – and their “broader implications” (de Vries 2002: 161). I continue this analysis here (see also Research Hub entry 31 May 2020 on “field assumptions”).

The work by Illife and Manthorpe (2018) on “dementia-friendly cities” picks up themes introduced in the preceding entry. They draw on WPR to analyse proposals for “dementia-friendly cities” in the UK – with links to the movement for “age-friendly cities”. They point out how these proposals appear to be informed by a social rather than a biomedical view of “ill health” but they are concerned about the limited nature of the proposals offered. In particular they note that the narrative does not incorporate a sensitivity to inequalities and hence stands to increase them (see Table 1 and page 8). Beyond this limitation in the proposals, they want to emphasize the need to probe underlying circumstances that harm all people, such as pollution, rather than constituting dementia as a disability (Iliffe and Manthrope 2018: 11; see discussion on models of disability in Murano 2020 and on social flesh in Beasley and Bacchi 2007 in preceding entry).

Ijaz (2020) draws on WPR to examine conceptions of risk in the Ontario (Canada) government’s 2006 Regulated Health Professions Act (RHPA), “under which the province’s homeopaths would ultimately be regulated in 2015”. Her analysis emphasizes that “While the RHPA is an epistemically-inclusive piece of legislation that governs biomedically-trained providers as well as T&CM (traditional and complementary medicine) professionals (e.g., Chinese medicine practitioners, naturopaths)”, the legislation is not epistemically neutral, with biomedical epistemology constituted as normative (Ijaz 2020: 8). Risk conceptions in conventional biomedicine, argues Ijaz, are substantially rooted in principles of scientific materialism, echoing the implicit biomedical underpinnings evident in Ontario’s broader legislative context, and sit in contrast to the vitalist principles of many T&CM systems.

Ijaz (2020: 3) elaborates that “scientific materialism” relies upon a mechanistic “epistemic construct of the human organism” as an “essentially physical entity”. In contrast, “Vitalist epistemologies generally hold that a ‘vital’ or functional living principle underpins and interacts with the material structures of living systems (including human beings)”. She makes the case that vitalist explanatory models may incorporate “mechanistic observations (about risk and otherwise)”, while a scientific materialist stance by definition excludes vitalist perspectives. Importantly, homeopathy-specific risk conceptions extend “beyond materialist constructions of adverse events and clinical omission to address potential harms from homeopathic ‘proving symptoms’, ‘aggravation’ and ‘disruption’”, considerations omitted in the risk management strategies ultimately mandated for practitioners. It follows that “to optimally preserve patient safety”, regulators need to actively “negotiate paradigm-specific conceptions [of risk] from both biomedicine and the occupation under governance”.

The notion of “paradigm-specific risk conceptions” opens up the topic of risk in medical practice in innovative ways. It reminds us: first, to notice how we are governed through categories of “risk” (Bacchi 2009: 63); and, second, to pay heed to incommensurable epistemic principles in the model of medicine we take for granted as “truth”. Both of these topics could be explored productively in relation to COVID-19.

Alongside WPR’s emphasis on the “embedded knowledges” in medical practices that constitute what is produced as “real” and “true” there is a commitment to consider the implications (or effects) of these modes of rule (see discussion in Research Hub entry 31 May 2020). Here we look at research that highlights the subjectification effects of policy affecting medical practices. Subjectification, as discussed elsewhere (Bacchi and Goodwin 2016: 49-53), challenges the view that policies simply act upon self-contained subjects. Instead it looks to the processes by which subjects are produced as particular types of subject by governmental problematizations. In this view, the “subject” is “an effect of politics, always in process” (Bacchi and Goodwin 2016: 49).

Cui, Lancaster and Newman (2019) look specifically at how select pieces of mental health policy in Hong Kong, China, and in New South Wales (NSW), Australia, produce mental health “subjects”. Illustrating the benefits of employing WPR in comparative analyses (Bacchi 2012: 6), they find that, while both policies constituted subjects as “unwell individuals”, “subjectivities were shaped by distinctive cultural and socio-political contexts” (2019: 740). In Hong Kong, subjects were constituted as “patientised” individuals, “encouraged to depend on professionals” to help them reintegrate into the “normal” community. In contrast, in New South Wales mental health subjects are produced as “traumatised” individuals “expected to take responsibility to guide the delivery of mental health care and respected as a part of diversity in community settings”. The strong emphasis on consumer choice and individual responsibility in NSW signals a connection with neoliberal premises, a theme developed in Pringle (2019; see preceding entry). Cui et al. conclude that, “Unfortunately, both representations [i.e. the “patientised” and the “traumatised”] make it difficult to draw attention to the influences of broader social conditions in the causation of MHIs [mental health issues], for example social exclusion and inequality” (2019: 746).

Bazira’s (2017) thesis on medical education in the UK draws attention to the individualist assumptions in the 2015 regulations produced by the UK General Medical Council (GMC). Specifically, he highlights how the regulations represent the “problem” of “patient safety” in terms of individual doctor’s or organization’s behaviours/practices rather than in terms of the responsibility of the state to provide conditions conducive to good health. “Safety” is understood to be synonymous with the absence of adverse effects or errors rather than in terms of welfare. This problematization illustrates “the implicit reductionism of medical practice to a definable set of skills and competencies” (Bazira 2017: 84). It further embraces a neoliberal focus on individual responsibility (2017: 135).

A particular concern in Bazira (2017: 132) is how these discourses interact to produce particular subjectivities in the learners, doctors, educators and organisations that are governed by means of this policy. The production of “patient safety” as the result of individual and organizational practices, with a focus on omissions and errors, privileges the practice of “evidence-based medicine”, which emphasizes “measurable competencies” (2017: 80). According to Bazira, this approach effectively excludes those aspects of medical education that require interpretation and interpretive practice (see discussion in Research Hub entry 31 May 2020).

In Bazira’s (2017: 79) view, rethinking and re-representing the problem in an effective manner requires a change in healthcare focus from therapeutic medicine to preventive public health (2017: 79). There is a need to challenge the now taken for granted focus in medical education, and the medical profession as a whole, on making ill people better, replacing this objective with an emphasis on societal health and the prevention of illness in the first place (2017: 90).

It could of course be argued that in the current pandemic we have excellent examples of “preventive public health”. Surely, you may say, “social distancing” and “contact tracing” highlight key elements of a “public health” response aimed at “prevention” of infection. Epidemiology, however, is not the form of prevention Bazira has in mind in his references to “societal health”. I pursue this topic below.

Together the arguments in Bazira (2017) and in Cui, Lancaster and Newman (2019) alert us to the possible subjectification effects of policies introduced to “combat” COVID-19 – the kinds of subjects being produced through the sorts of interventions promoted to “manage” the pandemic. I have already mentioned the distinction drawn between “vulnerable populations” and “socially responsible” others (see preceding entry). Clearly, in any such analysis, attention needs to be paid to the specifics of particular sites and proposals. For example, what kind of subject is produced by the Australian government’s tracing app (https://www.health.gov.au/resources/apps-and-tools/covidsafe-app) and how does this compare with South Korea’s tracing technologies (https://jamanetwork.com/journals/jama/fullarticle/2765252)? More broadly, what kinds of subjects are produced in the experimental approach to “managing” the crisis described in a previous entry (30 April 2020)? What does it mean to be/come an “epidemiological” “subject”?

Riemann (2018) assists us with this topic. He deploys WPR to critically interrogate the USA based violence prevention initiative, Cure Violence (CV). This initiative frames violence as a “public health” issue. More precisely, it “maintains that violence is an actual disease, which can be controlled and contained via epidemiological methods and strategies applied in disease control” (Abstract). Riemann explains the three-pronged approach of an anti-epidemic strategy (with which we are now all too familiar) – identification, interruption, and behavioural change, outlining how the approach is applied in CV. By concentrating on the need to identify “high risk” individuals, CV reduces violence to individual pathology, with the line between the “normal” and the “pathological” associated with race (2018: 7). Riemann describes the CV initiative as depoliticizing, separating socio-economic inequalities from the analysis of violence. The goal, to produce self-governing subjectivities, promotes “the production of neoliberal subjects that understand themselves as reflexive health entrepreneurs” (2018: 4) – a description that resonates worryingly with the current focus, in Australia at least, on “social responsibility” and “self-governance”.

Mabhala et al. (2020) draw similar conclusions about the limitations of epidemiological approaches; however, significantly for the current pandemic situation, their target is infectious diseases. They share Riemann’s concern that epidemiological approaches are depoliticizing and for similar reasons, that they ignore the social and political conditions promoting contagion. Using WPR as one of their analytic tools, the authors emphasize that most interventions to do with infectious diseases create such diseases as biomedical conditions. In their view, such a problematization ignores the need in southern countries to tackle socioeconomic determinants of health: “infectious diseases in low-income countries are an indication that these conditions cluster wherever poverty is widespread”.

Along related lines, Sandset (2020) uses WPR to provide a content analysis of academic articles on phylogenetic analysis for HIV transmission. Noting ethical concerns raised by such analysis, he points out that a focus on genetic transmission networks can lose sight of “structural drivers, cultural aspects and economic disparities” (2020: 6). The relevance of this critique to the increased use of phylogenetic testing in COVID-19 cases is worth considering.

The Mabhala et al. paper was published in January 2020 and hence does not include COVID-19. However, their argument provokes useful rethinking about the current pandemic. Responses to COVID-19 are almost exclusively biomedical. The focus is the disease and treatments or vaccines to bring it “under control”. “Social” distancing is also biomedical since its goal is to reduce infection rates. Michael Marmot has tried to alert people to the ways in which the disease and the responses to it can exacerbate health inequalities (https://www.abc.net.au/radionational/programs/healthreport/social-equity-and-covid-19/12189450)

To borrow a much overused and abused metaphor, the playing field is not level. “Social distancing” and WFH (“Working from Home”) is much easier for some people than for others. The emphasis on hygiene and handwashing creates unreasonable expectations for populations where water is scarce. The impact of COVID-19 on African-Americans has been “extraordinary and disproportionate”. Nearly one-third of those who have died across the USA are African-American, although they represent only 13 percent of the US population (https://www.nationalgeographic.com/history/2020/04/coronavirus-disproportionately-impacts-african-americans/)

African-Americans are also anticipated to bear the brunt of COVID-19’s economic impact (https://www.theguardian.com/us-news/2020/apr/28/african-americans-unemployment-covid-19-economic-impact).

A social flesh political imaginary, introduced in the previous Research Hub entry, may prove useful in highlighting the unequal burden of infectious diseases through insisting on the shared embodied reliance of people across the globe on social space, infrastructure and resources (Beasley and Bacchi 2007). This imaginary may become all the more necessary as “countries”, “states”, “regions” become self-managing, insular entities (O’Hagan 2020: 25). A turning inwards to protect “one’s own” may prove to be both inadequate and a “risk” to life on the planet. On this point consider how the Australian Government’s recent decision to spend Aust.$270b building larger military to prepare for a “poorer, more dangerous” world produces the “problem” (https://www.abc.net.au/news/2020-06-30/australia-unveils-10-year-defence-strategy/12408232). Consider also how the virus is exposing the inequalities and exploitation that characterize contemporary work relations. As one example, in Melbourne, Victoria, there is the disturbing “discovery” that something called “insecure work” leads to increased case numbers due to people’s inability to self-isolate without paid leave (think also of the underpayment of Victoria’s hired security guards in the contentious quarantine hotels debacle and the underpayment of workers in aged care facilities). (https://www.news.com.au/finance/work/at-work/insecure-work-is-no-good-dan-andrews-blames-casual-jobs-for-victorias-second-wave/news-story/fe58e2da479cac7fb7f7d328a2561fb2)(https://www.theage.com.au/national/victoria/hotel-quarantine-security-done-on-the-cheap-via-subcontractors-says-guard-20200724-p55f1t.html)

In the conclusion to Analysing Policy (2009) I describe WPR as a “problem”-questioning rather than a problem-solving approach. The articles in this and the previous entry (30 June 2020) suggest some areas where questioning may be needed in reflections on “the conditions of possibility of medical experience in modern times” (Foucault 1973: p. xix). By targeting what is taken-for-granted – what is implicit – in medical practices, ethical guidelines, medical education, models of health, and so on, we create the opportunity to rethink what medicine is, how it heals and how it shapes ways for us to be.  We have some work to do!

References

Bacchi, C. 2009. Analysing Policy: What’s the Problem Represented to be? Frenchs Forest: Pearson Education.

Bacchi, C. 2012. Why Study Problematizations? Making Politics Visible. Open Journal of Political Science, 2(1): 1-8.

Bacchi, C. and Goodwin, S. 2016. Poststructural Policy Analysis: A Guide to Practice. NY: Palgrave Macmillan.

Bazira, P. J.2017. Medical Education in the United Kingdom: A post-structural critical policy analysis. PhD Thesis, Doctor of Education, Faculty of Social Sciences, School of Education, The University of Sheffield, England. [Abstract available at: http://www.eurjanat.com/web/paper.php?id=180211gf]

Beasley, C. and Bacchi, C. 2007. Envisaging a new politics for an ethical future: Beyond trust, care and generosity – towards an ethic of “social flesh”. Feminist Theory, 8(3): 279-298.

Cui, J., Lancaster, K. and Newman, C. E. 2019. Making the subjects of mental health care: a cross-cultural comparison of mental health policy in Hong Kong, China and New South Wales, Australia. Sociology of Health & Illness, 41(4): 740-754.

De Vries, G. 2002. Pragmatism for Medical Ethics. In J. Keulartz, M. Korthals, M. Schermer and T. Swierstra (Eds) Pragmatist Ethics for a Technological Culture. Springer-Science+Business Media, B. V. pp. 151-165.

Ijaz, N. 2020. Paradigm-Specific Risk Conceptions, Patient Safety, and the Regulation of Traditional and Complementary Medicine Practitioners: The Case of Homeopathy in Ontario, Canada. Frontiers in Sociology, doi 103389/fsoc.2019.00089

Iliffe, S. and Manthorpe, J. 2018. Muddling along in the city: Framing the cityscape of dementia. Dementia DOI: 10.1177/1471301218817451

Mabhala, M.A., Yohannes, A., Massey, A., Reid, J.A. 2020. Mind your language: Discursive practices produce unequal power and control over infectious disease: A critical discourse analysis. International Journal of Preventive Medicine, 11:37.

Murano, M. C. 2020. A Disability Bioethics Reading of the FDA and EMA Evaluations on the Marketing Authorisation of Growth Hormone for Idiopathic Short Stature Children. Health Care Analysis https://doi.org/10.1007/s10728-020-00390-1

O’Hagan, Angela. «Introduction. “A critical practice of thinking otherwise”: Bacchi, gender and public policy analysis». En Feminismo/s, 35 (junio 2020): 13-28. Monographic dossier / Dossier monográfico: A critical practice of thinking otherwise: Bacchi, Gender and Public Policy Analysis, coord. Angela O’Hagan, DOI: 10.14198/fem.2020.35.01

Pringle, W. 2019. Problematizations in Assisted Dying Discourse: Testing the “What’s the Problem Represented to Be?” (WPR) Method for Critical Health Communication Research. Frontiers in Communication 4 (article 58). doi: 10.3389/fcomm.2019.00058

  Riemann, M. 2018. Problematizing the medicalization of violence: a critical discourse analysis of the “Cure Violence” initiative. Critical Public Health. DOI: 10.1080/09581596.2018.1535168

Sandset, T. 2020. The ethical and epistemological pitfalls of translating phylogenetic HIV testing: from patient-centered care to surveillance. Humanities and Social Sciences Communications, 7: 19. https://doi.org/10.1057/s41599-020-0522-4

WPR and Medicine Part I

CONTENT:

This entry is prompted by SARS-CoV-2 (the virus) and COVID-19 (the disease), at least indirectly. The challenges of managing and arresting a global pandemic inevitably places a priority on biological pathogens and “population” health. This priority is clear in the dominant role played by doctors and epidemiologists in current news reporting. How, one may be tempted to ask, can WPR be deployed in this setting? What does WPR offer to those contending with “real-world” “disease”?

To engage with these questions, it is helpful to begin with some discussion of how a Foucauldian analysis approaches medicine. The starting premise of WPR is that “problems” are not pre-existing states or conditions but that they are produced in proposals. That is, proposals about what to do (how to conduct conduct) have implicit problem representations (Bacchi and Goodwin 2016: 19). The focus therefore is on the social and epistemological conditions that allow these problematizations to emerge. The goal is to draw attention to “the way we, under certain conditions, experience and articulate our ‘problems’ as well as our ‘solutions’” (Zwart 2002: 39). In a previous Research Hub entry (30 April 2020) Jennifer Bonham and I reflected on how the “problem” of “uncertainty” has been produced as a guiding premise in responses to COVID-19.

Turning to medical practice, a focus on how “problems” are produced as particular sorts of problems rejects a history based on the “consciousness of clinicians” in favour of determining “the conditions of possibility of medical experience in modern times” (Foucault 1973: p. xix). In this account, “What the ‘realist’ takes for (medical) ‘reality’ is a time-specific conception that is meaningful only on condition that the practice known as ‘clinical medicine’ is already in place” – that is, a practice that includes “a specific conception of disease, a particular relation to the body, diagnostic and therapeutic instruments and procedures, as well as institutionalized professional standards as key-elements” (De Vries 2002: 157).

“For example, when a physician tells a patient that his (sic) complaints about fatigue are symptoms of arteries in bad shape and that an operation is advised, this statement is meaningful only within the rules of the game we know as clinical medicine. … Two centuries ago “arteries in bad shape” was not a medical condition”. (De Vries 2002: 160; emphasis added).

The reference to “rules of the game” relates to Foucault’s position on “truth” and “truth games”. For Foucault (1985), telling the truth is like playing a game because, as in a game, there are no outside criteria by which to judge its content; “truth” is shaped by internal rules or “field assumptions” (see Research Hub entry 31 May 2020). The task then is to devise ways to tease out these “rules of the game” and to place their production “at the heart of historical analysis and political debate” (Foucault 1980: 47 in Castell 1994: 238). Annemarie Mol (2002: 50) develops this insight to emphasize how specific medical practices rely upon “embedded knowledges” to produce particular realities.

WPR undertakes the examination of the production of medical knowledge, including the conditions of its emergence, insertion and functioning, through a study of problematizations. Its seven forms of questioning and analysis (seeBacchi WPR CHART) draw attention to how medical “problems” are conceptualized and produced, drawing particular attention to the assumptions and presuppositions (the “field assumptions”) upon which such conceptualizations rely, to the uneven course of their development, and to their possible implications for how governing takes place. This form of analysis has a political goal – to enable us to consider how epistemological and ontological assumptions shape our “realities” and with what effects. To quote De Vries (2002: 161): “The success of Foucault’s analysis in making explicit what is implicit in clinical medicine may help us see what is implied in the practice that is under construction in current medicine”. Zwart (2002: 39) elaborates:

“By studying the conditions that allow certain problems and solutions, as well as certain principles and concepts, to emerge, we may become more aware of the factors that actually guide our thoughts and actions in the present. And this may prepare us for making our own concrete choices with regard to the present …”

Here and in a subsequent Research Hub entry I offer examples of WPR applications in the field of medical practice, indicating how these applications contribute to understanding the rules of the game of clinical medicine. I also suggest how the insights produced by these applications provoke lines of thinking that may encourage useful research on COVID-19 developments.

Murano et al. (2018) put in question the “problem-oriented approach” to growth hormone treatment for children with idiopathic short stature (ISS), which refers to children who are considerably shorter than average without identified medical reason. The authors characterize a “problem-oriented approach” as centrally focused on the “possible psychosocial disadvantages or problems of short stature and quantifiable height”, which, they argue, operates “at the expense of first-hand lived experiences of short stature and height as a lived phenomenon”. Their particular concerns are the ethical implications of such an approach.

Murano (2020) proceeds to use WPR to interrogate the contrasting ethical premises of FDA (US Food and Drug Administration) and EMA (European Medicines Agency) guidelines on the marketing of recombinant human growth hormone (hGH) for ISS. As Murano (2020) explains, she is not looking for errors or fallacies in the reasons advanced for or against approval of the drug but rather for norms, values and assumptions that underpin those rationales. We have here an apt illustration of WPR thinking, which looks to identify and question presuppositions that shape “problems” or, to borrow De Vries’ (2002: 161; see above) phrasing, to make explicit what is implicit in clinical medicine.  And, as with WPR, the objective is to reflect on the “broader implications that policies’ formulations might have on society”.

Usefully Murano draws on critical disability studies to interrogate the arguments/proposals she identifies. She explains how the FDA response illustrates a medical model of disability in which ISS is characterized as “a functional impairment or limitation, and as a problem inherent to the individual”. She shows that the EMA decision illustrates a similar epistemological approach: “it is not merely to treat short stature, but there is or might be a kind of short stature that might benefit from treatment”. Murano contrasts these positions to a relational model of disability, where “short stature should be understood not as an intrinsic problem of the individual (either in terms of height measurement or psychological well-being), but as a problem contingent on social discriminations and/or disadvantage”. In this stance, disability is not a fixed state or individual characteristic, but a process influenced by multiple external and internal factors: “This model takes as its starting point a human development model applicable to everyone and stresses the fact that development happens over time through a dynamic and complex process”.

This relational model, in which disability is constituted within a continuum of human experience, “reveals the many contributions that disability brings to the world and shows that medical intervention to change it or eliminate might not be justified” (see Garland-Thomson 2017). This stance on human development is taken up in work I have produced with Chris Beasley on “social flesh”, about which more will be said shortly.

Pringle (2019) brings WPR to an examination of Canada’s Assisted Dying legislation, supporting themes advanced in Murano’s work. She shows how the legislative framing of MAiD (Medical Assistance in Dying) in Canada fixated on a “reasonably foreseeable” death as a condition of its legal permissibility, “a gesture which was intended to protect vulnerable individuals from having their lives cut short by accessing assisted dying”. Such a proposition, argues Pringle, “inadvertently reifies the view that good healthy living necessarily excludes any kind of dependence or vulnerability”. As with Murano, then, in Canada’s assisted dying legislation, human development is underpinned by the “view that we are (or should be) autonomous and invulnerable throughout life, that a good healthy life is contingent on this invulnerability”. This autonomous healthy person could be seen to be linked to a form of neoliberal subjectivity with an emphasis on a moral responsibility to stay healthy (see Metzl and Kirkland 2010).

Currently in much feminist theory there is an emphasis on vulnerability and precarity (see McCormack and Salmenniemi 2016, and Koivunen et al. 2018). Pringle’s analysis raises qualms about the implications of identifying specific vulnerable groups and so reifying a human norm of invulnerability. Brown and Wincup (2019) deploy WPR in their analysis of the UK’s 2017 Drug Strategy to draw attention to the presuppositions and potential effects of being labelled (or not) as vulnerable. They argue that

“alongside bolstering targeted support, the problematisation of vulnerability in English drug policy supports the operation of subtle disciplinary mechanisms to regulate the behaviour of those deemed vulnerable, underplaying the role of material inequalities and social divisions in the unevenness of drug-related harms.”

Chris Beasley and I show how selected Australian policies rely upon a distinction between perceiving people as either controlled by their bodies (and hence vulnerable), justifying forms of regulation and constraint, or as in control of their bodies (and therefore robust, rational decision-makers/consumers, independent of government oversight) (Bacchi and Beasley 2002). Our examples (abortion, surrogacy, cosmetic surgery) all involve medical interventions, and hence provide important insights into the relationships between medicine/science and governing practices. We point to the deleterious implications of the “controlled by”/ “control over” dichotomy and offer social flesh as a new political imaginary.

Social flesh draws attention to shared embodied reliance, mutual reliance, of people across the globe on social space, infrastructure and resources. Insistence upon this shared reliance, we argue, underpins a profoundly levelling perspective, a radical politics (Beasley and Bacchi 2007), reopening vital debates about appropriate distribution of social goods, environmental politics, professional and institutional power, and democratic processes. It would be useful, I suggest, to explore the ways in which COVID-19 is commonly linked to “vulnerable populations” alongside the imperative for “autonomous” individuals to demonstrate “social responsibility”, and to consider how social flesh might disrupt these categories. Additional reflections on the implications of social flesh for the politics of COVID-19 follow in the next entry.

References

Bacchi, C. 2012. What Study Problematizations? Making Politics Visible. Open Journal of Political Science, 2: 1-8.

Bacchi, C. and Goodwin, S. 2016. Poststructural Policy Analysis: A Guide to Practice. NY: Palgrave Macmillan.

Bacchi, C. and Beasley, C. 2002. Citizen bodies: Is embodied citizenship a contradiction in terms? Critical Social Policy, 22(2): 324-352.

Beasley, C. and Bacchi, C. 2007. Envisaging a new politics for an ethical future: Beyond trust, care and generosity – towards an ethic of “social flesh”. Feminist Theory, 8(3): 279-298.

Brown, K. and Wincup, E. 2019. Producing the vulnerable subject in English drug policy. International Journal of Drug Policy, https://doi.org/10.1016/j.drugpo.2019.07.020

Castel, R. (1994). “Problematization” as a mode of reading history. In J. Goldstein (Ed.), Foucault and the writing of history (pp. 237-252). Oxford, UK: Blackwell.

De Vries, G. 2002. Pragmatism for Medical Ethics. In J. Keulartz, M. Korthals, M. Schermer and T. Swierstra (Eds) Pragmatist Ethics for a Technological Culture. Springer-Science+Business Media, B. V. pp. 151-165.

Foucault, M. 1973 [1963]. The Birth of the Clinic: An Archaeology of Medical Perception. NY: Pantheon Books.

Foucault, M. (1980b). Iimpossible prison: Recherches sur le système pénitentiare au XIXe siècle. In M. Perrot (Ed.), Paris: Seuil.

Foucault, M. 1985. Discourse and truth: The problematization of parrhesia. In J. Pearson (Ed.), Evanston, IL: Northwestern University.

Garland-Thomson, R. 2012. The case for conserving disability. Bioethical Inquiry, 9: 339-355.

Koivunen, A., Kyrölä, K. and Ryberg, I. (Eds) 2018. The Power of Vulnerability: Mobilising affect in feminist, queer and anti-racists media cultures. Manchester: Manchester University Press.

McCormack, D. and Salmenniemi, S. 2016. The Biopolitics of Precarity and the Self. European Journal of Cultural Studies, 19(1): 3-15.

Metzl, J. M. and Kirkland, A. (Eds) 2010. Against Health: How Health Became the New Morality. NY: NYU Press.

Mol, A. 2002. The body multiple: ontology in medical practice. Durham: Duke University Press.

Murano, M. C., Slatman, J. and Zeiler, K. 2018. How sociophenomenology of the body problematises the “problem-oriented approach” to growth hormone treatment. Medical Humanities.  Doi: 10.1136/medhum-2018-011548.

Murano, M. C. 2020. A Disability Bioethics Reading of the FDA and EMA Evaluations on the Marketing Authorisation of Growth Hormone for Idiopathic Short Stature Children. Health Care Analysishttps://doi.org/10.1007/s10728-020-00390-1

Pringle, W. 2019. Problematizations in Assisted Dying Discourse: Testing the “What’s the Problem Represented to Be?” (WPR) Method for Critical Health Communication Research. Frontiers in Communication 4 (article 58). doi: 10.3389/fcomm.2019.00058

Zwart, H. 2002. Philosophical Tools and Technical Solutions: Comments on L. Hickman. In J. Keulartz, M. Korthals, M. Schermer and T. Swierstra (Eds) Pragmatist Ethics for a Technological Culture. Springer-Science+Business Media, B. V. pp. 37-40.

WPR and Covid-19: Comparing research approaches

Content:

This entry is prompted by a recent article by Kayi and Sakarya (2020) which states that it uses “Bacchi’s framework” (commonly known as the WPR approach) to analyse government responses to COVID-19 in 13 countries (United States, UK, Netherlands, Sweden, Denmark, Norway, Germany, Italy, Turkey, South Korea, Singapore, Japan and China). The article offers a survey of the arguments for and against the two main policy responses to COVID-19: suppression and mitigation.

While the paper is useful, it does not to my mind engage the level of analysis I associate with WPR. Clearly, I cannot and do not wish to “manage” how WPR is deployed. At the same time, I feel that it is worthwhile to consider the research approaches that appear in various WPR adaptations. I use the term “approach”, in line with Ozga’s (2019) account, to signal a focus on the “theoretical resources” drawn upon in forms of analysis.

On this point it is important to recognize that WPR is used in a variety of ways and in combination with other theoretical approaches (van Toorn and Dowse 2016; Van Aswegen et al. 2019). In other Research Hub entries, I have queried the possibility of some of these combinations, specifically on attempts to produce hybrids of WPR with CDA (Critical Discourse Analysis) or with critical realism (14 May 2018; 1 Feb. 2019).

Kayi and Sakarya (2020) describe their approach as interpretive, an approach they link to studies of representation and frames/framing. They refer to Browne et al. (2019: 3, 8) who offer interpretivism as a broad rubric encompassing WPR alongside other qualitative approaches that focus on “how meaning is created” in policy texts and interactions, and on how “different stakeholders represent policy problems”.

In a previous entry (4 March 2018) I emphasize one key distinguishing factor that separates WPR from other interpretive approaches: that interpretive analyses tend to focus on the rationales or perspectives advanced by policy actors or “stakeholders” whereas WPR, alongside other poststructural approaches, analyzes deep-seated presuppositions within governmental texts (see also Bacchi 2015 Bacchi The Turn to Problematization).  Importantly, “governmental” is understood broadly to encompass the many rules, agencies, professional bodies, etc. that shape conduct, while texts go beyond written documents to include all practices of signification (see for example “Buildings as Proposals”, Research Hub entry 14 Jan. 2018; Bacchi and Goodwin 2016: 18). The objective is to examine critically the “grounds of the system’s possibility” (Johnson 1981: xv) and the politics involved in its making.

In their introduction to WPR, Kayi and Sakarya ask: “What is the problem represented to be in the debate between defenders of mitigation and suppression strategies?” (2020: 31). This declared intention to identify problem representations in debates between defenders of mitigation or suppression strategies indicates a distance from the WPR objective of interrogating problem representations in governmental texts (see above). As a result, the authors fail to select proposals within governmental texts as starting points for asking the WPR questions, a key step in applying the framework (see Bacchi and Goodwin 2016: 16, 19). What we are offered instead is an analysis of “points of view” or “commonly articulated reason[s]” (Kayi and Sakarya 2020: 32).

It appears, then, that the research approach in this analysis – that is, the  theoretical resources drawn upon (see Ozga above) – contrasts with the WPR research project. Alvesson and Sandberg (2013: 53-56) offer a useful way to distinguish among analytic approaches, focusing specifically on the kinds of assumptions that researchers target for interrogation (or problematization). They produce five categories of assumptions: in-house, root metaphor, paradigmatic, ideological and “field assumptions”, associating the last with the work of Foucault.  Studies that question “in-house assumptions” tend to work within the frames of reference accepted in their field, whereas Foucauldian-influenced research puts these terms of reference into question. Alvesson and Sandberg offer the example of “trait theory” in research on leadership. Those who dispute (only) the criteria for characterizing leadership retain the background assumption that leadership abilities depend on certain traits and hence tacitly accept the premise of “trait theory”.

Kayi and Sakarya (2020) produce analysis at the level of “in-house” assumptions, whereas WPR works at the level of “field assumptions”. They do not query the terms of reference (the “in-house” assumptions) marshalled in the debates about responses to COVID-19. That is, their approach stays within the framework of accepted medical and epidemiological categories. The goal becomes (simply) to highlight “fallacies” or missing information in relation to those terms of reference. For example, they spend some time pointing out that efforts to achieve herd immunity are compromised by the lack of a vaccine for “high-risk” groups (Kayi and Sakarya 2020: 36). And they note that: “The challenge with the simulation models is the need for input variables which are uncertain or absent” (Kayi and Sakarya 2020: 35).

A WPR approach, by contrast, raises questions about the categories of analysis (the “field assumptions”) that feature in governmental “responses” (see Bacchi and Goodwin 2016: 62-63), e.g. “risk categories” (see Lupton, 1993; Dean, 1999: Chapter 9; Rose 2000), “modelling” (see Rhodes and Lancaster 2020), “immunity” and “distancing”. Such categories are seen as “contingent historical creations, human constructions, that need to be interrogated rather than enshrined as ‘truth’” (Bacchi and Goodwin 2016: 5; emphasis in original).

In WPR, Question 2 probes the ontological and epistemological presuppositions that make those categories of analysis possible – for example, presuppositions about the nature of disease, “the body” and “human nature” (Bacchi and Goodwin 2016: 21).  Spivakovsky and Seear (2017: 458, 463) usefully refer to these presuppositions as “pervasive cultural logics” and “dominant cultural imaginaries”. They offer agency, capacity, disability and crime as examples of categories in the field of legal research that require critical interrogation at the level of deep-seated assumptions. By contrast, assumptions of this kind are, in general, rendered unremarkable in Kayi and Sakarya.

This tendency to work within accepted (“in-house”) terms of reference is clear in Kayi and Sakarya’s (2020: 40) enthusiastic promotion of evidence-based research. By contrast, the WPR framework encourages researchers to probe the ways in which conceptions of “evidence” rely on epistemological assumptions about “true knowledge” and ontological assumptions about a fixed “reality” (Bacchi 2009: 252-254).

In the article, the adaptation of Question 5 (in WPR; see Bacchi WPR CHART) also clearly illustrates the distance between Kayi and Sakarya’s research approach and WPR-related thinking – that is, how they stay within the terms of reference of mainstream policy analysis. While they pose the question “What effects are produced by the representations of the problem?” they describe their goal as assessing “outcomes” of the contrasting strategies. In their account, “effects” (“outcomes”) refers to the specific details of implementation. For example, here are the “outcomes” they observe in Sweden:

“Sweden maintains its mitigation approach: most places are open, only work hours are reduced, primary and secondary schools are open, people over 70 are particularly encouraged to stay at home, more than 50 people are prohibited from being together, and social distance rules are applied.” (Kayi and Sakarya 2020: 37)

Diagrams indicating the number of cases and deaths reported in the analysed countries also serve as “outcomes”.

By contrast, Question 5 in WPR identifies three kinds of interconnected effects (or implications): discursive effects, subjectification effects and lived effects. Discursive effects highlight the limits imposed on thinking and analysis by working within accepted terms of reference. Subjectification effects consider how specific policy “responses” affect how subjects “come to relate to themselves and others as subjects of a certain type” (Rose 1998: 25). For example, the focus on individual responsibility in social distancing rules – a policy proposal that crosses over the suppression/mitigation distinction – produces subjects who self-regulate in domains and practices that invite critical scrutiny. Finally, lived effects focus on how discursive and subjectification effects translate into everyday lives. Together, these three “kinds” of effects broaden our understanding of “outcomes” to consider how lives are shaped through governmental practices, “how social relationships are set up and [for] how subjects are positioned within policy and discourse” (Cui et al. 2019: 2). None of these issues is raised by Kayi and Sakaryi.

The WPR approach also emphasizes the need for researchers to practice self-problematization as a part of the research exercise (see Step 7 in Chart Bacchi WPR CHART). In the Covid-19 example, this step would involve researchers questioning their positioning in debates about, for example, containment strategies, “outcomes” and “evidence”.

As I mentioned at the outset, I have no desire to “police” how WPR is deployed. However, I would encourage researchers to pay more attention to the different levels of analysis produced in contrasting applications – if only to debate their potential usefulness. In the next two entries, I introduce several WPR applications in the field of medical practices to illustrate further what it means to query “field assumptions” and to suggest the political implications of such analyses.

I would like to thank Sue Goodwin and Anne Wilson for comments on an earlier draft of this entry.

References

Bacchi, C. 2009. Analysing Policy: What’s the Problem Represented to be? Frenchs Forest: Pearson Education.

Bacchi, C. 2015. The Turn to Problematization: Political Implications of Contrasting Interpretive and Poststructural Adaptations. Open Journal of Political Science, 5: 1-12.

Bacchi, C. and Goodwin, S. 2016. Poststructural Policy Analysis: A Guide to Practice. NY: Palgrave Macmillan.

Browne, J., Coffey, B., Cook, K., Meiklejohn, S. and Palermo, C. 2019. A guide to policy analysis as a research method. Health Promotion International, 34: 1032-44.

Cui, J., Lancaster, K. and Newman, C. E. 2019. Making the subjects of mental health care: a cross-cultural comparison of mental health policy in Hong Kong, China and New South Wales, Australia. Sociology of Health and Illness, doi: 10.1111/1467-9566.12851

Dean, M. 1999. Governmentality: Power and Rule in Modern Society. London: Sage.

Johnson, B. 1981. Translator’s Introduction. In J. Derrida, Dissemination, B. Johnson, trans. Chicago: University of Chicago Press.

Kayi, I. and Sakarya, S. 2020. Policy Analysis of Suppression and Mitigation Strategies in the Management of an Outbreak Through the Example of COVID-19 Pandemic. Infect Dis Clin Microbiol, 2(1): 30-41.

Lupton, D. 1993. Risk as Moral Danger: The Social and Political Functions of Risk Discourse in Public Health. International Journal of Health Services, 23(3): 425-435.

Ozga, J. 2019. Problematising policy: the development of (critical) policy sociology. Critical Studies in Education, DOI: 10.1080/17508487.2019.1697718

Rhodes, T. and Lancaster, K. 2020. A model society: Maths, models and expertise in viral outbreaks. Critical Public Health,doi:10/1080/09581596.2020.1748310

Rose, N. 1997.  Inventing Our Selves: Psychology, Power, and Personhood. Cambridge: Cambridge University Press.

Rose, N. 2000. Government and Control. British Journal of Criminology, 40(2): 321-339.

Spivakovsky, C. and Seear, K. 2017. Making the abject: problem-solving courts, addiction, mental illness and impairment. Continuum, 31(3): 458-469.

Van Aswegen, J., Hyatt, D., and Goodley, D. 2019. A critical discourse problematization framework for (disability) policy analysis: “good cop/bad cop strategy”.  Qualitative Research Journal, https://doi.org/10.1108/QRJ-12-2018-0004

Van Toorn, G. and Dowse, L. 2016. Policy claims and problem frames: a cross-case comparison of evidence-based policy in an Australian context. Evidence & Policy, 12(1): 9-24.

Governing through experimenting: “They are treating my childcare centre like a petri dish”

PreambleThe challenges of bringing a critical theoretical perspective to current developments in local, national and international politics are immense. There is a tendency to be overwhelmed by the minutiae of daily case counts and the on-the-ground adaptations of “travel bans” and “social distancing”. To step back, to gain some perspective on developments, requires a sharing and questioning of taken-for-granted assumptions and views. And so I am grateful to Jennifer Bonham for co-authoring this current Research Hub entry. Jennifer is Senior Lecturer in the Department of Geography, Environment and Population, University of Adelaide. She and I have written together on Foucault’s concept “discursive practices” (Bacchi and Bonham 2014) and have collaborated on the development of PIA (Poststructural Interview Analysis) (Bacchi and Bonham 2016). Jennifer’s most recent book is entitled Cycling Futures (Bonham and Johnson 2015). It is available as a free download from the University of Adelaide Press website (https://www.adelaide.edu.au/press/).

Commentary contrasting responses to the HIV epidemic of the 1980s and the COVID-19 pandemic today is perhaps inevitable. Australia’s terrifying public advertising campaign saw the Grim Reaper knock down people of all ages, walks of life and genders like so many ten pins in a bowling alley (Padula 2006). Medical researchers understood HIV was transmitted via blood and blood products and anyone who contracted the disease would die. HIV was understood to be prevalent among gay men and drug users but the advertising campaign targeted the entire population. Every single Australian was deemed to be at risk so everyone needed to take care. While one reading of the ad was that the Grim Reaper became associated with gay men it is unclear whether this was a pervasive interpretation.

Fast forward to 2020 with many of us watching in disbelief as news footage emerged of people collapsing in Wuhan’s streets. Hospitals were overwhelmed, entire populations were locked down and confined to their apartments, temperatures were taken of people venturing into public places and “suspected” COVID-19 sufferers were hunted down, bundled into vans and taken to hastily erected “hospitals”. But Wuhan was a world away and despite the early blocking of flights from China, there was no sense of urgency in the statements from Australian authorities (politicians in all levels of government, departmental heads, or health officials) or the media reports covering the growing epidemic. Posters began appearing on protocols around coughing, washing hands, touching one’s face and greeting others (no hugging or shaking hands) but it seemed this would be enough. Information on how the virus spread focused on droplets associated with coughing and sneezing and there weren’t any real people in these advertisements – they were line drawings. The virulence of the disease, ease of surface spreading or the role of ordinary people touching ordinary objects like the door handle, keyboard or bench top did not begin appearing in the traditional media until April 2020 – several weeks after the 100 cases milestone.

Our goal is not to make a detailed analysis of responses to the HIV epidemic and COVID-19. Our purpose is to draw on Luigi Pellizzoni’s Ontological Politics in a Disposable World (2015) to recommend a line of inquiry that foregrounds an emerging mode of governing. Pellizzoni’s book critically examines the links between intellectual shifts in the biophysical sciences, the ontological turn in the social sciences and the rise of neo-liberalism. Beginning in the 1970s, each of these domains has moved away from concepts, or goals, of stasis, and increasingly constituted existence in terms of flux and flows. In this context, interventions by scientists, managers, economists and other authorities are not (or should not be) concerned with ensuring stability but they are manipulations toward producing something new. The uncertainties inherent in the flux and flow of existence together with the uncertainties of our manipulations have become opportunities to be celebrated. Pellizzoni questions the implications of hailing this uncertainty:

“Burdened with imperfect foresight, we take a chance, hoping to be excused from moral blame [let alone liability, added by Pellizzoni], if it can be demonstrated we did not have sufficient knowledge of the future consequences of actions at the time: that these could not have been ‘reasonably foreseen'”. (Owen et al 2013 cited in Pellizzoni, 2015, p. 24)

On the face of it, this new approach to intervening in the world, aligns with the Australian government’s response to COVID-19 and might be seen as an example of “governing through experimenting”.

State experiments are nothing new but, as Bulkeley and Broto (2012) and Jones and Whitehead (2018) argue, they are becoming more widely used. Not-withstanding their critiques of such experimentation, the examples they provide describe controlled and limited experiments. In contrast to these authors, we are using the phrase “governing through experimenting” to refer to authorities trialling novel interventions and, crucially, embracing the uncertainty of their outcomes. Regardless of those outcomes, the experiment provides an opportunity for the production of new knowledge (Pellizzoni, 2015, p. 29).

Like politicians and health officials across most of the world, the Australian Prime Minister, Scott Morrison, and the Chief Medical Officer, Brendan Murphy, appear on the nightly news to talk about “flattening the curve”. We couldn’t “let the virus rip”, although this idea was endorsed in some quarters (e.g. the UK), but we could “flatten the curve”. In fact, ALL we could do was try to flatten the curve. As an exercise in “problem-solving”, “flattening the curve” was not a matter of politics but a matter of technical expertise (Bacchi Problem Solving ojps_2019123016255521). This strategy aimed at dampening the daily count of people contracting the disease in order to reduce the demands on the health care systems and minimise the death toll. As the Prime Minister stated a number of times “there will be deaths” and the acceptability of these deaths was supported with the analogy of war. Indeed, the certainty of deaths was the only thing we could count on in a moment of uncertainty where “there are no guarantees” and the “virus writes its own rules” (Melbourne Age, Saturday 4 April 2020, p. 6).  We had to understand it wasn’t possible to eradicate the virus – until New Zealand’s Prime Minister, Jacinda Ardern, offered New Zealanders an alternative. Her Government’s goal was precisely that, to eradicate the disease. Most recently (7.30 Report, ABC, 16 April 2020) Morrison speculated that Australia might yet achieve “eradication” as a “by-product” of its current approach to suppression. Experimenting, it seems, is a useful intervention.

The significance of this motif of governing is clear in the parallel development in the world of finance and management. In Radical Uncertainty: Decision-making for an unknowable future (2020) John Kay and Mervyn King celebrate the human instinct to adapt to an environment that people understand only imperfectly. As Pat O’Malley (2004: 3-5 in Pellizzoni 2015:63) identifies, this outlook reflects “an extensive and immensely influential managerial literature appearing since the 1980s” that “celebrates uncertainty as the technique of entrepreneurial creativity … the fluid art of the possible”.

In this task environment, “proper calculations of risk are seen as the exception, while reasoned bets on unpredictable futures are regarded as the rule” (Pellizzoni 2015: 63) – with “betting on the future” a hallmark of decision-making by the Morrison government at the moment.

In this motif of governing, flux and flows are productive of innovation. The more unstable and unpredictable the world, the more manageable (Pellizzoni 2011), “as long as the market, as a blind mechanism of co-ordination, ensures ex-post the overall soundness of choices” (Pellizzoni 2015: 66-67). Here we would emphasize the insistence by Morrison that “lives and livelihoods” are inextricably linked.

In this motif of governing, “scenarios and expectations play a growing role in policy-making” (Pellizzoni 2015: 63). And so, the focus in Australian planning for COVID-19 is on modelling and curves. The wonders of mathematics and science are hauled out to give sense to an “unprecedented” “crisis”, all the while heralding that there are “no guarantees”. People become ciphers in a scientific experiment. As one childcare worker noted when reflecting on the Morrison decision to provide childcare free – commonly perceived to be a progressive intervention – “they are treating my childcare centre like a petri dish”.

We are not suggesting here that a version of the Grim Reaper would have been preferable to the regime of measurement and “guesstimates” currently shaping Australian lives. Rather, we are suggesting the need to step back from the kinds of questions COVID-19 commonly provokes – for example, do authoritarian or democratic governments “handle” the crisis better? Or how are we to explain the turn to the “left” of Australian conservatives (the Liberal Party)? Instead, we suggest that a broader shift in governance styles needs to be traced, a shift towards a mode of “governing through disorder” (Pellizzoni 2011) and an “entrepreneurial desire for uncertainty as an engine of enterprise” (Ericson 2005: 659).

REFERENCES

Bacchi, C. & Bonham, J. 2014. Reclaiming discursive practices as an analytic focus: Political implications. Foucault Studies, 17 (March): 173-192.

Bacchi, C. & Bonham, J. 2016. Poststructural Interview Analysis: Politicizing “personhood”. In C. Bacchi and S. Goodwin (eds) Poststructural Policy Analysis: A Guide to Practice. NY: Palgrave Macmillan.

Bacchi, C. 2020. Problem-Solving as a Governing Knowledge: “Skills”-Testing in PISA and PIAAC. Open Journal of Political Science, 10: 82-105.

Bonham, J. and Johnson, M. (eds) 2015. Cycling Futures. Adelaide: University of Adelaide Press.

Bulkeley, H. and Broto, V. C. 2012. Government by experiment? Global cities and the governing of climate change. Transactions of the Institute of British Geographers.

Ericson, R. 2005. Governing Through risk and uncertainty. Economy and Society, 34(4): 659-672.

Jones, R. and Whitehead, M. 2018. “Politics done like science”: Critical perspectives on psychological governance and the experimental state. Environment and Planning D: Society and Space, 36(2): 313-330.

Kay, J. and King, M. 2020. Radical Uncertainty: Decision-making for an unknowable future. NY: W. W. Norton and co.

Padula, M. 2006. “The AIDS Grim Reaper Campaign”. The Australia and New Zealand School of Government, 2006-90.1. Case Program. https://www.anzsog.edu.au/preview-documents/case-study-level-1/192-aids-grim-reaper-campaign-the-a-2006-90-1/file

O’Malley, P. 2004. Risk, Uncertainty and Governance. London: Glasshouse.

Owen, R., Stilgoe, J., Macnaghten, P., Gorman, M., Fisher, E. and Guston, D. 2013. A framework for responsible innovation, in Responsible Innovation: Managing the Responsible Emergence of Science and Innovation in Society, edited by R. Owen, J. Bessant and M. Heintz. Chichester: Wiley, 27-50.

Pellizzoni, L. 2011. Governing through disorder: Neoliberal environmental governance and social theory. Global Environmental Change, 21(3): 795-803.

Pellizzoni, L. 2015. Ontological Politics in a Disposable World: The New Mastery of Nature.Surrey: Ashgate.

WPR and “affectivity”

Content:

I mentioned “affect” briefly in the last entry. Given its prevalence in contemporary social theory, I felt it worthwhile to introduce the concept more fully.

Leys (2011) identifies a two-fold foundation: first, the “dominant paradigm in the field of emotions”, associated with Silvan Tomkins, in which “the affective processes occur independently of intention or meaning”; and second, Spinozist-Deleuzean ideas about affect. To these, I would add the uptake of “affect” by some governmentality scholars, discussed later.

The Tomkins’ perspective (2008), described as a “Basic Emotions paradigm” (Leys 2011: 439), conflates “emotion” and “affect”, a trend identified as problematic in the last entry. Some in the Spinozist-Deleuzean tradition, most importantly Massumi (2002), insist that “emotions” and “affect” are separate phenomena. Massumi claims a distance from “received psychological categories such as emotions”, describing “affect” as “irreducibly bodily and autonomic” (Massumi 2002: 28; see Shouse 2005). “Affect” is a prepersonal “intensity”, “the human power or capacity to affect and be affected” (Kristensen 2016: 17). In this account, “affects” bypass reason and criticality and seize “the body at the level of neural circuits, the nervous system, the endocrine system or other systems assumed to work independently of cognition” (Blackman 2012: xi).

This view of “affects” as “irreducibly bodily” appears in the work of the geographer, Nigel Thrift, and the policy researcher, Paul Hoggett. According to Thrift (2004: 59), “It has become increasingly evident that the biological constitution of being … has to be taken into account if performative force is ever to be understood, and in particular, the dynamics of birth (and creativity) rather than death.” Along similar lines, Hoggett (2000: 144; see also Thompson and Hoggett 2012), argues that “the body is the original site of the affects and emotions, and that these saturate consciousness”. Emotions, in his view, exist “on the boundary between the psyche and the soma”. For researchers, says Hoggett (2000: 144), it follows that, “With affect, quantitative considerations are dominant, whereas with emotion the qualitative dimension is much more important”.

This (re)turn to the body can be explained as, in part, a reaction against both “rationalist models of the human subject” and post-structuralist and Foucauldian perspectives. The latter, argues Hoggett (2000: 142), provides “us with no adequate way of theorizing agency”. “Agency” here aligns with the intentional, autonomous subject, put in question in a previous Research Hub entry (31 Jan. 2020). Along similar lines, Schaefer (2016; see also Shaefer 2015) argues that “affect theory helps us evade the ‘linguistic fallacy’”, while Sedgwick and Frank (1995 in Wetherell 2013: 352) see it as a counter to “routine anti-biologism and anti-essentialism”.

Its broader appeal can be linked to an attempt to “take a more encompassing view of social action … redirecting attention to the ‘somatically sensed’ body” (Wetherell 2013: 352). It reflects an effort “to offer a dynamic alternative to scientific thinking that highlights stasis” (Kristensen 2016: 12). We can see links here to what is described as the “new materialism” (Fox 2015). Wetherell (Beer 2014) also identifies connections to feminism “which made the ‘personal’ and the process of ‘being affected’ a core social topic”.

A number of theorists query what they perceive to be a presumption of a biological substrate operating in Massumi-associated understandings of “affect”. Leys (2011), for example, sees strong links between Massumi and a Basic Emotions paradigm. Wetherell (Beer 2014) considers “versions of ‘affect theory’ that posit affect as a pre-personal extra-discursive force hitting and shaping bodies prior to sense making” to be “simply unsustainable”. Clarke et al. (2015: 58) are equally wary of Massumi’s (2002) idea of affect as somehow “pre-social”, describing it as “psychologistic or biologistic essentialism”.

Some of these critics have produced adaptations that attempt to avoid “affective determinism” (Kristensen 2016: 11). Notably Wetherell (2013) describes “affect” as a “practice” and develops an affective/discursive variation. Here there are links to discursive versions of “emotions”, seen in the last entry. On this development, note that a decision to characterize “affect” as “practice” leads necessarily to the complex task of theorizing practices (see Research Hub entries 30 Nov. 2019; 31 Dec. 2019).

Clarke et al. (2015: 59) offer what they describe as a “somewhat promiscuous approach to thinking analytically” that can “weave the attention to affect/feeling into our repertoire, rather than succumbing to them”. In this approach they refer to the “danger” of borrowing “the languages of emotions and affect without them making any difference to how actors, processes and relationships are conceived”, leading to interesting questions about their conceptions of “the subject”.

Ahmed (2004: 119) develops the notion of “affective economies”. Her primary target is “emotions”. However, in her account, emotions are not “psychological dispositions”; they do not “reside in a given subject or object”. She describes emotions as “economic” because they circulate “between signifiers in relationships of difference and displacement” (Ahmed 2004: 119).

Ahmed focuses on narratives of fear in the creation of notions of crisis. She gives as an example the fear of the “bogus asylum seeker” and how “words generate effects: they create impressions of others as those who have invaded the space of the nation, threatening its existence” (Ahmed 2004: 122-123). Fear, in this instance, “does not involve the defense of borders that already exist”; rather “anxiety and fear create the very effect of borders” (Ahmed 2004: 128, 132).

Ahmed’s argument leads us directly into, and allows a contrast with, the ways in which “emotions” and “affects” have been linked to studies of governmentality. Bigo (2010), introduced in the previous entry, shares Ahmed’s interest in borders. However, in Bigo’s account, fear does not create borders; rather, borders create fear and “unease”. The key point of differentiation from Ahmed is the emphasis on how governmental technologies (here “borders”) produce “subjects” as particular kinds of subject, described as “subjectification”. There is no “fearful” “subject” prior to the governmental practice of “bordering” (Bacchi and Goodwin 2016: 100).

A significant group of theorists include consideration of “affect” in their reflections on subjectification.  Fannin (2013: 278) focuses on “transformations of governmental power in the realm of reproduction” to “incorporate the affective and psychological dimensions of birth”. Fortier (2010) targets “community cohesion” as a form of “governing through affect”, aimed at “designing people’s behaviours and attitudes in the public domain”. Carol Johnson (2010: 495) argues for the importance of a concept of “affective citizenship” which explores “(a) which intimate emotional relationships between citizens are endorsed and recognised by governments in personal life and (b) how citizens are also encouraged to feel about others and themselves in broader, more public domains.”

Other theorists argue that governing practices do more than produce particular “subjects”; governing involves “affects”. Clough (2007a), and Parisi and Terranova (2000), draw upon Deleuze and Foucault to examine the shift from discipline to control as a mode of governing. Says Clough, “Control is a biopolitics that works at the molecular level of bodies, at the informational substrate of matter”:

“The target of control is not the production of subjects whose behaviors express internalized social norms; rather, control aims at a never-ending modulation of moods, capacities, affects, and potentialities, assembled in genetic codes, identification numbers, ratings profiles, and preference listings, that is to say, in bodies of data and information (including the human body as information and data).” (Clough 2007: 27) – dramatised perhaps in the ongoing Covid-19 pandemic.

Clough et al. (2007: 62, 74) identify a “rationality of affectivity” that governs through “pre-individual capacities to affect and be affected”.

While recognizing the appeal of this argument, I remain uncomfortable with references to “capacities” and “moods” as if these exist outside of signification. For similar reasons, I am “unhappy” (so to speak) with “affect”.

I mentioned in the previous entry (29 Feb. 2020) that neither Foucault nor Deleuze engaged with “emotions”. “Affect” is clearly associated with Deleuze but not with Foucault.

“Affect” in Deleuze is directly connected to his concept of “desire” (see Gilliam 2018: 192). Foucault explicitly distanced himself from the term “desire” because it seemed to “evoke a psychoanalytic idealism of lack and repression (contra his reversal of the repression hypothesis in the first volume of The History of Sexuality)” (Gilliam 2018: 192). The point in Foucault was not to “liberate” “desire” but to create “pleasures”, a term Deleuze criticized.

Gilliam (2018: 194) argues that the dispute between Foucault and Deleuze over “desire” versus “pleasures” was a matter of semantics. That may indeed be the case. Foucault admitted that “desire” in Deleuze was not used with its conventional meaning. Still he continued to avoid the term. He explained why:

“Deleuze and Guattari obviously use the notion in a completely different way. But the problem I have is that I’m not sure if, through this very word, despite its different meaning, we don’t run the risk, despite Deleuze and Guattari’s intention, of allowing some of the medico-psychological presuppositions [prises] that were built into desire, in its traditional sense, to be reintroduced.” (Foucault 2011: 389)

I have similar qualms about “affect” and on grounds Gilliam (2018: 209) clearly explains:

“Language exists in a discursive network after all, particularly conceptual language. Thus, despite any internal conceptual subversions, the use of a word entails a subtle network of power-relations capable of invoking and/or inviting un/intended misuse.”

Choosing to adopt a specific theoretical language is a fraught exercise, as numerous earlier Research Hub entries illustrate. My aversion to “problem/s” and to “agency” rests precisely on long-standing traditional uses of these terms, uses entrenched in power-relations that concern me. On the same grounds the commonplace view of “affects” as pre-existent bodily capacities leads to my decision to avoid the term.

REFERENCES

Ahmed, S. 2004. Affective Economies. Social Text, 22(2): 117-139.

Bacchi, C. and Goodwin, S. 2016. Poststructural Policy Analysis: A Guide to Practice. NY: Palgrave Macmillan.

Beer, D. 2014. The future of affect theory: An interview with Margaret Wetherell. Theory, Culture and Society, Available at: https://www.theoryculturesociety.org/the-future-of-affect-theory-an-interview-with-margaret-wetherall/Accessed 28 October 2019.

Bigo, D. 2010. Freedom and Speed in Enlarged Borderzones. In V. Squire (Ed.) The Contested Politics of Mobility: Borderzones and Irregularity. NY: Routledge.

Blackman, L. 2012. Immaterial Bodies: Affect, Embodiment, Mediation. London: Sage.

Clarke, J., Bainton, D. Lendvai, N. and Stubbs, P. 2015. Making Policy Move: Towards a Politics of Translation and Assemblage. Chicago: University of Chicago Press.

Clough, P. T. 2007a. Introduction. In P.T. Clough and J. Halley (Eds) The Affective Turn: Theorizing the Social. Durham, N.C.: Duke University Press.

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