WPR, Foucault and Nominalist Critique, Part 2

Content

In the last entry I introduced a way to think about the operation of Foucault’s nominalist critique as a political stratagem for producing a particular kind of analysis. As Rajchman (1983-84) points out, once you put the existence of “universals” (or “constants”) into question, it becomes necessary to focus on the multitude of factors and practices that lead “things” to “become something” (“devenir quelque chose” (Senellart 2008: 19). Genealogy describes the history of that multitude of factors and practices. 

In this entry, I’d like to show how Foucault’s nominalism leads to his focus on practices and on problematization. Afterwards, I’ll examine briefly the implications of this stance for conceptions of “power”, “the state” and “man”. In each case it is useful to think in terms of challenging these “things” as simply existing (“exister”), focusing instead on how they have come to be something (“devenir quelque chose”). I emphasize how Foucault’s efforts to displace unitary conceptions of “the State” are linked to his development of the concept of governmentality.

As seen in the last entry Foucault clearly connects his challenge to the existence of universals to practices. He highlights the “conjunctions” made by “a whole set of practices”, “real practices” (Senellart 2008: 19). But what are these practices? In two previous Research Hub entries (30 Nov 2019, 31 Dec 2019) I pursued this topic, indicating the need, at the very least, to consider the plurality of approaches in the “turn to practice” which continues to characterize contemporary social theory. I mention there that Foucault evades the temptation to start from a definition of practices by referring to practices as “places” (see previous Research Hub entry on the refusal of definitions in poststructuralism). As he explains, practices are places where “what is said and what is done … meet and interconnect” (Foucault 1991: 75). This starting point allows Foucault to focus on what he calls the juridicative and veridicative components of practices – how they establish and apply norms and render them as “true” or “false”. It follows that practices are not simply the “actions” of individuals, as can appear to be the case in some developments in the “turn to practice”. The distance between thinking of practices as simply what people do and what Foucault has in mind is clear in the examples of practices that he mentions – i.e. “the sequestration of the insane, or clinical medicine, or the organization of the empirical sciences, or legal punishment” (Foucault 1991: 79)

To see how practices are involved in making “things” come to be something, requires a focus on the ways in which they problematize those “things”. For example, it is through examining how “the mad” are dealt with (the practices involved in their “sequestration”) – “how madmen were recognized, set aside, excluded from society, interned, and treated” (Foucault 1969 in Eribon 1991: 214) – that we can see how they were “problematized” and conceptualized, and “trace how they have come to be translated into specific kinds of ‘problems’ and objects of government” (Pienaar et al. 2018: 188). 

In “Why study problematizations?” I (2012: 1) consider how the term “problematization” has two meanings in Foucault. One meaning uses “problematization” as a verb to refer to the mode of critical analysis Foucault calls “thinking problematically” (Research Hub entries 9 July 2018, 23 July 2018). The second meaning, a noun form, is tied to the “historical process of producing objects for thought”, which we need to remember do not simply exist (exister). Here “problematizations” are the “somethings” produced through this historical process, captured in Foucault’s nominalist genealogies – “the forms of problematization themselves” (Foucault 1986: 17-18).  In WPR I call these “objects for thought” or forms of problematization “problem representations” (Research Hub entry 11 June 2018). Through the study of problematizations, therefore, it is possible to reflect critically on the multitude of factors and practices that lead “things” to “become something” (“devenir quelque chose”) (Bacchi 2017).

I now comment briefly on three universals that Foucault sets out to displace – “power”, “the state” and “man” – to illustrate where his nominalist critique takes us. This trio of concepts formed the basis of much theoretical discussion in the middle to latter half of the twentieth century when Foucault wrote. They also, of course, continue to feature prominently in contemporary theoretical speculation. 

The tendency to think about “power” as something people possess is ubiquitous. We continue to talk about people “having” power – often understood as having power over others. To challenge this position, Foucault at times writes “Power” in scare quotes, a nominalist strategy deployed to take distance from analytical concepts (Alasuuarti 2010: 407). “Power”, he specifies, is “not an institution, and not a structure”. Rather, it is (simply) “the name that one attributes to a complex strategical situation in a particular society” (Foucault, 1980[1978]: 93; emphasis added).

Importantly, Foucault’s notion of strategy, as in “a complex strategical situation”, does not require a conscious strategist (Alasuuarti 2010: 406). The analytic focus shifts therefore from “actors” intentionally deploying power to the “strategic situations” in which power “is produced from one moment to the next, at every point” – a “micro-physics of power” (Foucault 1980: 93). Rather than “actors” having“power”, subjects are constituted in and through power relations (see comment on “man” below), a process described as “subjectification” (Bacchi and Goodwin 2016: 49-51). 

Foucault brought this same nominalist focus on “complex strategic situations” to his study of governing (Alasuuarti 2010: 411-412). His primary objective is to point to the limitations of thinking about governing in terms of a grand theory of something called “the State”.  

“The State” in Foucault is a “mythical abstraction” (Rose and Miller 1992: 173), an anchor point for myriad strategic relations that merge in specific political forms, rather than an entity with a presumed essential necessity or functionality. Rather than talking about “the State” as a “thing”, we need to see the term (simply) as a way to talk about a particular form of governing. “The State”, therefore, needs to be decomposed into practices and relations.

Foucault coins the term “governmentality” to mark out this research agenda. Governmentality studies investigate the minutiae of routine and mundane practices of governing. Categories and concepts are “denaturalised, made specific and their governmental implications revealed” (Larner 2008: 23).

This intervention has important political effects. It broadens the focus of our studies from political institutions (“The State”) to encompass numerous sites, agencies and “ways of knowing” that interrelate to shape social rules (Bacchi 2017: 7). In tune with the poststructural refusal to offer definitions of “things” (see previous Research Hub entry) “governmentality” is not given a firm definition. As Valverde (2010: 52) explains, governmentality is not a concept; it is a “dynamic abstraction deployed strategically”. 

“Man”, of course, is another presumed universal in much contemporary social theory and political analysis. There are repeated references to “human nature” and to “man’s” instincts. Consider for example behavioural economics, nudge theory (Haydock 2014) and situational crime prevention (Bacchi and Goodwin 2016: 49). In two previous Research Hub entries (30 Sept. 2019, 31 Oct 2019), I explored Foucault’s challenge to the humanist, Enlightenment subject who is presumed to be fixed, autonomous and a reliable source of knowledge (Scott 1991: 782). Here, I wish only to emphasise how nominalism disrupts established categories of thought and analysis, including “man”, opening up new avenues of research and thinking. 

What does all this mean for our research practices? First and foremost, there is the obligation to examine the categories of analysis we adopt as presumably fixed and meaningful. As Barbehon (2020) notes, the classifications we use to describe “reality” (including “reality” itself of course) are social artifacts. It does not serve us well, therefore, to treat our categories of analysis as simply existing (“exister”), as fixed and hence useful “things”; rather, it is incumbent on us to consider how these categories have “come to be” something (“devenir quelque chose”). Moreover, since research practices, alongside other practices, produce “realities” (see previous entry), there is an obligation to consider the “realities” our analytic categories produce (elaborated below). 

This stance points to an important distinction between Foucauldian poststructuralism and much realist sociology. Foucault (Senellart: 2) made this clear in the Birth of Bioethics where he listed some of the concepts put into question through his nominalist starting point: “notions such as the sovereign, sovereignty, the people, subjects, the state, and civil society, that is to say, all those universals employed by sociological analysis, historical analysis and political philosophy in order to account for real governmental practice”. On these grounds the postrstructuralist scholar, Wendy Larner (2008), questions the “realist governmentality” produced by Stenson (2008), pointing out how his analysis treats terms such as “knowledge economy”, “welfare dependency”, “white flight” and “communities at risk” as “self-evident descriptors of the terrain being analysed”, instead of the “names” bestowed on “things”. I suggest similar objections can be made to the reliance on presumed fixed categories of social analysis in critical realism (Research Hub 1 Feb 2019) and in uncritical ethnography (Research Hub 28 Feb 2019, 31 March 2019).

In line with this position, the Foucauldian scholar, William Walters (2009: 495) cautions against the tendency to ontologize our spatial concepts. He asks: what is a region? a zone? a territory? a network? an area? With Larner, he suggests that policy analysts need to become “much more nominalistic about the diversity of global spaces” (Larner and Walters 2004: 16). Remembering that research practices produce “realities”, the use of common spatial concepts needs to be seen in political terms as reinforcing the “existence” of those things that do not exist (as essences). For example, when analysts and researchers deploy concepts such as “nation-state” unproblematically, they actively support and entrench the “reality” of “nation-states”, reinforcing current geopolitical power relations (Law 2004: 144; Mol 2002: 136). 

A number of WPR applications usefully interrogate commonly accepted analytic categories, which feature prominently in governing practices. In a recent critical commentary on the NDIS (Australia’s National Disability Insurance Scheme), Horsell (2020) opens to contestation “fixed concepts and categories (such as fixed and homogeneous conceptualisations of disability) that shape policy formulation”. In tune with this analysis, Barry Allan (2018) puts in question the notion of “impairment” and its reliance on a “medical perception of normality”. Along related lines Marley (2018) uses WPR to investigate the conditions fundamental to the “existence” of ADHD (Attention-deficit/hyperactivity disorder). 

Step 7 in WPR emphasizes the importance of self-problematization as part of any WPR analysis (Bacchi and Goodwin 2016: 24). This Research Hub entry helps to explain its importance. The undertaking to apply the WPR questions to one’s own proposals (which is what Step 7 entails) is intended to alert researchers to the danger in simply accepting and deploying common analytic categories such as “nation-state”, “impairment” and so many others, and to the benefit of becoming more nominalistic about such terms. 

My hope in this entry and the previous one is to indicate the usefulness of bringing a nominalist lens to our research. In my view, it accomplishes several important things. First, it encourages the kind of critical deconstruction of established categories that WPR is commonly used to achieve. And second, it reminds us of the need to apply this same critical approach to our own categories of analysis. Finally, by highlighting that “things” are created in practices, it opens up the possibility for researchers to create new “things”, to engage in ontopolitically-oriented research practices (Fraser 2019), a topic pursued next time.

References

Alasuutari, P. 2010. The nominalist turn in theorizing power. European Journal of Cultural Studies, 13(4): 403-417.

Allan, B. 2018. Foucault’s nominalism. In S. Tremain (ed.) Foucault and the government of disability (first published in 2005). University of Michigan Press.

Bacchi, C. 2012. Why study problematizations? Making politics visible. Open Journal of Political Science, 2(1): 1-8. 

Bacchi, C. 2017. Drug Problematizations and Politics: Deploying a Poststructural Analytic Strategy. Contemporary Drug Problems, 45(1): 3-14.

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

Barbehon, M. 2020. Reclaiming constructivism: towards an interpretive reading of the “Social Construction Framework”. Policy Sciences, https://doi.org/10.1007/s11077-020-09370-7 

Foucault, M. 1969. Pamphlet submitted to Professors of the Collège de France. Cited in D. Eribon (1991) Michel Foucault. Trans., B. Wing. Cambridge, MA: Harvard University Press.

Foucault, M. 1980 [1978]. This History of Sexuality Vol 1: An Introduction. NY: Vintage Books.  

Foucault, M. 1986 [1984]. The use of pleasure. The history of sexuality. Trans. R. Hurley. London: Viking Press.

Foucault, M. 1991 [1981]. Questions of method. In G. Burchell, C. Gordon, P. Miller (Eds.), The Foucault effect: Studies in governmentality. Chicago: University of Chicago Press.

Fraser, S. 2019. Doing ontopolitically-oriented research: Synthesising concepts from the ontological turn for alcohol and other drug research and other social sciences. International Journal of Drug Policy, https://doi.org/10.1016/j.drugpo.2019.102610 

Haydock, W. (2014). The rise and fall of the ‘‘nudge’’ of minimum unit pricing: The continuity of neoliberalism in alcohol policy in England. Critical Social Policy, 34, 260–279.

Horsell, C. 2020. Problematising Disability: A Critical Policy Analysis of the Australian National Disability Insurance Scheme, Australian Social Work, DOI: 10.1080/0312407X.2020.1784969  

Larner, W. 2008. Comments on Kevin Stenson’s “Governing the Local: Sovereignty, Social Governance and Community Safety”, Social Work & Society: International Online Journal, 6(1).

Larner, W. and Walters, W. 2004. Introduction: Global governmentality. In W. Larner & W. Walters (Eds) Global governmentality: Governing international spaces. NY: Routledge. 

Law, J. 2004. After Method: Mess in Social Science Research. NY: Routledge.

Marley, C. 2018. A Foucauldian-inspired ethnographic investigation: The emergence of the everyday social practice of ADHD. PhD thesis, University of Queensland, School of Education. 

Mol, A. 2002. The Body Multiple: Ontology in Medical Practice. Durham and London: Duke University Press.

Pienaar, K., Murphy, D. A., Race, K. and Lea, T. 2018. Problematising LGBTIQ drug use, governing sexuality and gender: A critical analysis of LGBTIQ health policy in Australia. International Journal of Drug Policy, 55: 187-194. 

Rajchman, J. 1983-84. The Story of Foucault’s History. Social Text, 8: 2-24.

Rose, N. and Miller, P. 1992. Political power beyond the state: Problematics of government. The British Journal of Sociology, 43(2): 173-205.

Scott, J. 1991. The Evidence of Experience. Critical Inquiry, 17(4): 773-797.   

Senellart, M. (ed.) 2008. Michel Foucault, The Birth of Biopolitics: Lectures at the College de France, 1978-79. Trans., Graham Burchell. London: Palgrave Macmillan.

Stenson, K. 2008. Governing the Local: Sovereignty, Social Governance and Community Safety. Social Work & Society, 6(1).

Valverde, M. 2010. Specters of Foucault in Law and Society Scholarship. Annual Review of Law and Social Science, 6: 45-59.

Walters, W. 2009. Europe’s borders. In C. Rumford (Ed.) The Sage Handbook of European Studies. London: Sage

WPR, Foucault and Nominalist Critique Part I

Content:

This entry and the one to follow are prompted by a question I received about the place of nominalism in Foucault’s thinking. In Part 1 I describe how nominalism informs Foucault’s critical analysis. In Part 2 (entry in a month’s time) I illustrate how starting from Foucault’s nominalism opens up his work in useful and accessible ways, considering topics such as “power”, “the state”, “man”, “sexuality”, “madness”, etc. Starting from nominalism helps explain important connections among several concepts that feature prominently in Foucault’s political analyses, e.g. practices, genealogy, “a history of the present”, objectivizations, governmentality, and problematization. Throughout I will signal how WPR engages with these understandings.

“Nominalism” comes from the Latin word nominalis meaning “of or pertaining to names”. As a philosophical position it has a long history. Debates about the relationship between nominalism and realism go back to the Middle Ages (Rodriguez-Pereyra 2015). Distinctions have been drawn between nominalists who wished to challenge the existence of universals, as in Plato’s “forms”, and those who questioned the existence of abstract objects (as opposed to concrete objects). For our purposes it is adequate to think of nominalism in Foucault as an analytic intervention designed to disrupt assumptions about general categories of “things” (“objects” and “subjects”) through a focus on what we “call” (or name) them.

A good place to start is Foucault’s comment in the Birth of Biopolitics (Senellart 2008: 3): “Let’s suppose that universals do not exist”. I suggest that we need to focus on the words: “Let’s suppose”. In my view, such wording indicates that Foucault is not interested in engaging in philosophical debates about the meaning of nominalism; rather, he wants to suggest that assuming there are no universals opens up political analysis in useful ways – that taking such a position allows us “to know how and to what extent it might be possible to think differently, instead of legitimating what is already known” (Foucault 1990: 9).  My hope is, in this and the subsequent Research Hub entry, to illustrate just what he intends to accomplish through this analytic strategy. To illustrate my argument, I draw upon a number of theorists who have made useful contributions on the topic of Foucault and nominalism. 

Oksala (2012: 28) helps us to draw a clear distinction between nominalism and natural realism.  She explains how, in Foucault, there is a need to see “things” not simply as “existing” (“exister”) – the realist position – but as “becoming something” (“devenir quelque chose”) – the nominalist position. In the latter the focus of study becomes how specific “things”, such as “the domains we call sexuality”, “have been formed”, how they come to be something (Foucault in Mort and Peters 2005: 12-13; emphasis added). 

In the Birth of Biopolitics (Senellart 2008: 19), Foucault elaborates this position, indicating how his nominalist starting point shapes his studies of madness, disease, delinquency and sexuality. He distinguishes his stance from accounts that speak of these “things” as “hidden before finally being discovered” or as “wicked illusions or ideological products to be dispelled in the [light] of reason”. Rather, in his account, 

“It was a matter of showing by what conjunctions a whole set of practices – from the moment they become coordinated with a regime of truth – was able to make what does not exist (madness, disease, delinquency, sexuality, etcetera), nonetheless become something, something however that continues not to exist.” (Senellart 2008: 19; emphasis added)

The last point here is important and needs to be read through the distinction between “exister” (as essences) and “devenir” (becoming). Foucault clarifies that this position is not anti-realist: “It [e.g. sexuality] is not an illusion since it is precisely a set of practices, real practices, which established it and thus imperiously marks it out in reality” (Senellart 2008: 19). As Dean (2015: 359; emphasis added) explains, Foucault “seeks not the real, but the effects in the real of how we think about or ‘name’ the real”.  

Returning to Oksala we can describe the two positions, “exister” and “devenir” (existing and becoming), as contrasting ontologies (see Bacchi and Goodwin 2016: 15). Recognizing that “all thinking necessarily relies on ontological commitments of some kind”, Oksala (2012: 18-19) emphasizes the need to reflect upon the political implications of the ontology one adopts – how for example seeing “things” simply as “existing” tends to install them as “truth”, making it difficult to initiate change.  By contrast, in an ontology of becoming (the nominalist stance), one tends to stress the practices and processes that shape “subjects”, “objects”, “places” and “problems”, opening up opportunities for modifications (Bacchi and Goodwin 2016). 

For example, as seen in a previous Research Hub entry (10 Dec. 2017), starting from a nominalist ontology of becoming, Annemarie Mol (1999; 2002: 155) stresses how research practices shape specific realities, a proposition she describes as “ontological politics”. Pellizzoni (2015: 75 ff) elaborates the distinction between “political ontology” – the argument that all ontological stances are political, as in Oksala – and “ontological politics” – the argument that researchers are involved in shaping realities through their research practices, as in Mol (see also Fraser 2019).

Above, I suggest that Foucault is less interested in philosophical debates about nominalism than in what such a stance can do in terms of political analysis. This stance is clear in his claim that “knowledge is not made for understanding; it is made for cutting” (Foucault 1977: 88). As Rose (2000: 58) explains, the goal is “to disturb that which forms the very groundwork of our present, to make the given once more strange and to cause us to wonder at how it came to appear so natural” (see also Osberg 2010). To this end, as Valverde (2010: 45) describes, concepts (in Foucault) have no fixed meaning; rather, they are “tactical weapons” or tools for political change. Nominalism frees us up to use concepts in this way since they are not presumed to describe “essences” while it encourages critical interrogation of accepted “universals” or “constants” in valorised knowledges. 

It is often noted that Foucault uses several concepts in different ways at different times. In other work, together with co-authors, I point out how he uses “discourse” in at least three ways (Bacchi and Bonhan 2014: 178), and both “problematization” (Bacchi 2012) and “governmentality” (Bacchi and Goodwin 2016: 41) with two different meanings. The point to make here is that this practice is not an indication of fuzzy thinking; rather, it illustrates the political usefulness of a nominalist way of thinking – how nominalism frees up the researcher’s ability to mobilise concepts for political effect. 

This stance explains why it is inappropriate, in poststructuralist analysis, to give precise definitions of “things”. “Words are just that: words. They do not capture, reflect, mirror or correspond to an external reality” (Merlingen 2013). Mol, Moser and Pols (in Mol et al. 2010: 84) assist here. They point out that, if you offer a definition of an apple, you will proceed to see as “apples” only those things that match that definition. To open up thinking in useful ways we need to refuse assigned and assumed categories. In Care in Practice (Mol, Moser and Pols 2010) Mol and her co-editors refuse to stipulate what “care” is. Relatedly, they point out the stumbling block created by trying to specify the precise meaning of “practices”: 

“… the quintessence of the practice turn is to study practices – not to define the term. It is to follow objects and/or processes, like autonomy, subjectivity, respect, killing, tagging, buying, tasting, filling in forms, using a webcam, and so on, without beforehand fixing what these things and activities are.” (Mol et al. 2010: 85)

In this view, “words are tools within a practice rather than labels that can be firmly circumscribed” (Mol et al. 2010: 85; see also Bacchi 2005: 198-199).

To repeat the key argument developed in this entry, nominalism (as used by Foucault) accomplishes two things: first, it opens up a critical strategy to interrogate commonly assumed “things”, including “subjects” and “objects”; and second, it allows us to think in terms of deploying concepts for political purposes – in other words, to engage in “ontopolitically-oriented research” (see Fraser 2019). If “things” do not simply “exist” (as the nominalist contends), attention must be paid to how they have “come to be” and how they function politically. On these grounds it becomes crucial to interrogate the assumed categories (or “field assumptions”; see Research Hub entries 31 May 2020, 30 June 2020) in the “methods” we adopt for social analysis. This point will be pursued in the next entry.

For now, let us see how Foucault’s nominalism – the view that “things” do not simply “exist” but “come to be” – flows through into Foucault’s political analysis. Lemke (2011: 31) describes Foucault’s “nominalist critique” as a two-step process: first, questioning universals; second, investigating the “system of acceptability” that allows these “things” to “come to be” acceptable.

The latter goal requires us to reconstruct the “conditions of possibility for the presence of phenomena” (Keller 2017: 59). To this end we analyse the multiplicity of factors and practices involved in the coming to be of “things” – the network of “connections, encounters, supports, blockages, plays of forces, strategies and so on, that at a given moment establish what subsequently counts as being self-evident, universal and necessary” (Foucault 1991: 76). 

Foucault adopts several terms to capture this sense of multiplicity – including “assemblage”, “dispositif” and “discursive practices” (see Bacchi and Bonham 2014). In this way Foucault (1991: 33) effects “a sort of multiplication or pluralization of causes” that illustrates “a micro-physics of power” (Foucault 1979: 26; see next entry).  This stance helps makes sense of Veyne’s (1997: 160) contention that “There are no natural objects. … There are only multiple objectivisations (‘population’, ‘fauna’, ‘subjects under law’), correlatives of heterogeneous practices”: “The object is only the correlative of the practice: prior to the practice there exists no eternal governed that could be targeted more or less accurately.” (Veyne 1997: 155-156). Correlatives are terms paired to perform a single function (e.g. “both/and”, “either/or”). 

Foucault describes himself as a “historical nominalist” (Foucault 1980: 56; see also Flynn 1989). He sets out to trace the history, or genealogy, of “things”, to show precisely how they have “come to be”. “The role of genealogy”, he tells us, is to record “the history of morals, ideals, and metaphysical concepts, the history of the concept of liberty or of the ascetic life” (Foucault 1977: 1). He describes the specific form of history he produces as a “history of the present” and an “effective history”:

“Instead of criticising the past in terms of the present, the Foucauldian histories criticise the present by reflecting upon the ways the discursive and institutional practices of the past still affect the constitution of the present.” (Tamboukou 1999: 205)

Rajchman (1983-84: 10-14) elaborates four nominalist arguments or tropes developed in Foucault’s writings. The first, “argument by dispersal”, refers to the emphasis in Foucault on multiplicity and heterogeneity (see above). His goal is “to ‘disperse’ what is presumed to be essentially whole”, accomplished in his nominalist genealogies.  

The second trope – “argument by reversal” – sets out to trace the “objectification” (or objectivization; see above) of those “things” historians take as “objectively given” (Foucault 1980: 55). For example, in his work on the history of madness, Foucault (2006) rebukes historians for using psychiatric categories to understand, for example, witchcraft or magic in pre-psychiatric societies. He reverses this approach and asks about how the object “mental illness” was produced. This thinking highlights the need to interrogate the assumed categories of analysis in our research and writing (pursued in the next entry). Rajchman (1983-84: 12) emphasises that this practice of reversal is meant to be “politically consequential”. It operates as a form of criticism “of the preconditions and foundations of our own present’s intellectual habits” (Valverde 2010: Abstract).

Rajchman (1983-84: 12) characterizes the third nominalist trope as “argument by critical exposure of current practice”. This argument refers to Foucault’s style of nominalist history, his “history of the present” described above.  As Rajchman elaborates, Foucault uses the past to criticize the present “under the assumption that the past still informs the present in ways and with consequences we don’t recognize”. These influences need to be exposed and questioned. Importantly, there is no assumption that “our situation is the lawlike outcome of previous ones”. Rather, Foucault “tries to make our situation seem less ‘necessitated’’ by history, and more peculiar, unique, or arbitrary” (Rajchman 1983-84: 12). 

Rendering our current practices “arbitrary or contingent” opens them to criticism and change. The emphasis on contingency produces the fourth nominalist trope – “argument to singular enlightenment”. This trope provides a link to Foucault’s well-known scepticism concerning the “universalism of the Enlightenment” (see next entry). On this point, Rajchman (1983-84: 5) emphasises that, while Foucault uses these arguments to open up consideration of alternative social arrangements, his nominalist history is not about the alternatives themselves. As Foucault (1988: 197) explains: 

“My position is that it is not up to us to propose. As soon as one “proposes” – one proposes a vocabulary, an ideology, which can only have effects of domination. What we have to present are instruments or tools that people might find useful.”

WPR is offered as one such instrument (Bacchi WPR CHART). It deploys the four nominalist arguments outlined above. Embracing Foucault’s nominalist genealogies, it emphasizes the pluralizing (or dispersal) of factors producing “realities” (Questions 3 and 6) alongside a critical analysis of current practices (Question 5). WPR also encourages the continual questioning of governmental categories and of our categories of analysis, or “field assumptions” (Question 2). And while encouraging consideration of alternative problematizations (Question 4), it insists on continual reappraisal of those alternatives (Step 7 on self-problematization). 

The next entry offers some examples of how Foucault’s nominalism helps to explain his positions on “power”, “the state” and “man”. 

References

Bacchi, C. 2005. Discourse, Discourse Everywhere: Subject “Agency” in Feminist Discourse Methodology. NORA: Nordic Journal of Women’s Studies, 13(3): 198-209.

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

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

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

Dean, M. 2015. Neoliberalism, Governmentality, Ethnography: A Response to Michelle Brady. Foucault Studies, 20: 356-366.

Flynn, T. 1989. Foucault and Historical Nominalism. In H. A. Durfee and D. F. T. Rodier (Eds) Phenomenology and Beyond: The Self and its Language. Kluwer Academic Publishers.

Foucault, M. (1977) [1971]. Nietzsche, genealogy, history. In D.F. Bouchard, (Ed.), Language, counter-memory, practice: Selected essays and interviews. Ithaca: Cornell University Press.

Foucault, M. 1979. Discipline and punish: The birth of the prison. Trans., A. Sheridan. NY: Vintage/Random House. 

Foucault, M. 1980. L’impossible prison. Paris: Seuil. 

Foucault, M. 1988 [1977]. Confinement, Psychiatry, Prison. In L. D. Kritzman (ed.) Michel Foucault: Politics, Philosophy, Culture: Interviews and Other Writings, 1977-1984. NY: Routledge. 

Foucault, M. 1990 [1984]. The use of pleasure. Volume 2 of  The History of Sexuality. Trans. R. Hurley. NY: Vintage Books. 

Foucault, M. 1991 [1981]. Questions of method. In G. Burchell, C. Gordon, P. Miller (Eds.), The Foucault effect: Studies in governmentality.Chicago: University of Chicago Press.

Foucault, M. 2006 [1961]. History of Madness. Ed. J. Khalfa. Trans., J. Murphy. NY: Routledge. 

Fraser, S. 2019. Doing ontopolitically-oriented research: Synthesising concepts from the ontological turn for alcohol and other drug research and other social sciences. International Journal of Drug Policyhttps://doi.org/10.1016/j.drugpo.2019.102610

Keller, R. 2017. Has Critique Run Out of Steam? – On Discourse Research as Critical Inquiry. Qualitative Inquiry, 23(1): 50-60.

Lemke, T. 2011. Critique and Experience in Foucault. Theory, Culture & Society, 28(4): 26-48. 

Merlingen, M. 2013. Is Poststructuralism a Useful IR Theory? What About its Relationship to Historical Materialism? E-International Relationshttps://www.e-ir.info/2013/05/08/is-poststructuralism-a-useful-ir-theory-and-what-about-its-relationship-to-historical-materialism/

Mol, A. 1999. Ontological politics: A word and some questions. In J. Law and J. Hassard (Eds) Actor network theory and after (pp. 74-89). Oxford and Malden, MA: Blackwell Publishers. 

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

Mol, A., Moser, I., Piras, E. M., Turrini, M., Pols, J. and Zanutto, A. 2010. Care in Practice: On Normativity, Concepts, and Boundaries. Technoscienza, Italian Journal of Science and Technology Studies, 2(1): 73-86.

Mol, A., Moser, I. and Pols, J. (Eds) 2010. Care in Practice: On Tinkering in Clinics, Homes and Farms. Columbia University Press.  

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Oksala, J. 2012. Foucault, Politics and Violence. Northwestern University Press.

Osberg, D. 2010. Knowledge is Not Made for Understanding: It is Made for Cutting. Complicity: An International Journal of Complexity and Education. 7(2): iii-viii.

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

Rajchman, J. 1983-84. The Story of Foucault’s History. Social Text, 8: 2-24.  

Rodriguez-Pereyra, G. 2015. Nominalism in Metaphysics. Stanford Encyclopedia of Philosophyhttps://stanford.library.sydney.edu.au/entries/nominalism-metaphysics/

Rose, N. 2000. Power of Freedom: Reframing political thought.Cambridge, UK: Cambridge University Press. 

Senellart, M. (ed.) 2008. Michel Foucault, The Birth of Biopolitics: Lectures at the College de France, 1978-79. Trans., Graham Burchell. London: Palgrave Macmillan.

Tamboukou, M. 1999. Writing Genealogies: an exploration of Foucault’s strategies for doing research. Discourse: Studies in the Cultural Politics of Education, 20(2): 201-217.

Valverde, M. 2010. Specters of Foucault in Law and Society Scholarship. Annual Review of Law and Social Science, 6: 45-59.Veyne, P. 1997. Foucault revolutionizes history. In A. I. Davidson (Ed.), Foucault and his Interlocutors, C. Porter, Trans., Chicago: University of Chicago Press

WPR and “social flesh”

CONTENT:

This entry is prompted by an article which applies WPR to the UK’s “Safeguarding Strategy: Unaccompanied asylum seeking and refugee children” (Rigby et al. 2019), a policy produced by the Home Office in 2017 (see ref. below). I have selected this article because it provides a useful illustration of what can be accomplished in terms of critical analysis through exploring problematizations, a task facilitated through applying WPR. The article also shows the potential of adopting “social flesh” as a new ethico-political imaginary to reflect on important political issues (though the article by Rigby et al. does not adopt the term “social flesh”).

I have mentioned “social flesh” in two previous Research Hub entries (30 June, 31 July 2020). Together, Chris Beasley and I have produced several articles offering “social flesh” as a critical analytic concept to rethink the ways in which governmental practices conceptualize bodies (Bacchi and Beasley 2002, 2005; Beasley and Bacchi 2000, 2005, 2007, 2012). Specifically, we wish to challenge a dominant conceptualization which sets “vulnerable” bodies against other bodies. “Vulnerable” bodies, we argue, reflect a view that people are controlled by their biology, that they are (so to speak) at the mercy of their bodies. This view is contrasted to a perceived autonomous rational actor who keeps the body in line (see Horsell 2020 in relation to conceptions of “disability”). While this dichotomy may appear to be familiar, mapping onto fleshly women versus cerebral men, we show that these conceptualisations do not always map directly onto gender categories (Bacchi and Beasley 2002). To our minds, it follows that there is a need to consider the politics that produces these contrasting ontologies. Our hope is that “social flesh” might serve to disrupt the current dominant neoliberal ethic that privileges autonomous, rational actors who are held responsible for their lives and health. It does this by drawing attention to shared embodied reliance, mutual reliance, of people across the globe on social space, infrastructure and resources (Beasley and Bacchi 2007).

Beasley and I also developed “social flesh” in order to engage with the expansive feminist literature on care, vulnerability and precarity, and the attempts in these developments to contest neoliberal premises about “atomistic individualism” (see McCormack and Salmenniemi 2016, and Koivunen et al. 2018). Our concern with these literatures highlights two points: first, the tendency in some accounts to fall back on presumed individual characteristics (generosity); and second, the often, inadvertent acceptance of a hierarchical relationship between those who can care versus those who need care (e.g. “the vulnerable”).

The article by Rigby et al. provides a useful illustration of our thinking. I will firstly outline how they apply WPR and then focus directly on their contribution to debates around care and caring. Of particular interest is the way in which care enters the analysis through the application of WPR.

Rigby et al. start by discussing how unaccompanied asylum seeking children (UASC) are represented and hence produced in specific ways in media reports. They then explain the focus of their analysis: “how the issue is discursively constructed within the policies that have been proposed to ‘address children’s needs’” (Rigby et al. 2019: 3-5; emphasis in original).

Accepting that WPR is “not a formula per se”, a point I have made previously (Bacchi and Goodwin 2016: 24; Eveline and Bacchi 2010: 155), the authors decide to focus on Questions 1 and 4 of a WPR analysis “as a conceptual checklist for our critical reading of the policy document” (see Bacchi WPR CHART). They adopt Keller’s (2013) term “statement-events” as their starting point, which in their careful analysis works well to identify what I call “proposals” and “proposed solutions”. In my view, the latter terms are preferable starting points for two reasons: first, a focus on “proposed solutions” turns the analysis immediately to problematizations – the key to a Foucauldian analysis of governing practices (by seeing what is proposed it is possible to understand what is produced as the “problem”); and second, such a focus also indicates that what is of interest are underlying knowledges rather than language (see Bacchi and Bonham 2014). Rigby et al. (2019: 8) make this very point: “With the ‘refugee crisis’ continuing to evolve, the WPR approach provides a way to open up the knowledges surrounding it and the effects of knowledge production by considering how UASC are constructed and represented in a key policy document”.

The authors begin by identifying problem representations within the “Safeguarding Strategy” (Home Office 2017). They note several underlying assumptions (“field assumptions”; see Research Hub entry 31 May 2020), specifically the distinction drawn between “legal” and “safe” routes of arrival on one side, and “clandestine” and “dangerous” routes on the other. They note how this distinction operates to “make up” (see Hacking 2007) categories of children as less or more deserving of “assistance”, at the same time producing the children as “responsibilised subjects with agency” (Rigby et al. 2019: 8):

‘By emphasising the different routes of arrival, the policy effectively creates an ontological register for the children who are portrayed as exercising their agency in “choosing” to either enter the country legally or illegally’. (Rigby et al. 2019: 13)

The article proceeds to apply the concept of nesting from WPR (Bacchi 2009: 21) to explore how the issues are characterized in relationship to notions of risk. Specifically, the authors argue that a “dividing practice” (see Bacchi and Goodwin 2016: 49-53) operates in the “Safeguarding Strategy” “with profound implications for how children are governed”: “When they face risks, they are just children, but when they embody risk, they are UASC” (Rigby et al. 2019: 10). Those who “embody risk” are associated with clandestine routes of entry and potential radicalization. In terms of governing, to be labelled “at high risk” compared with others “is to be singled out as requiring expert advice, surveillance and self-regulation” (Lupton 1993: 61 in Rigby et al. 2019: 15).

It is through considerations of risk that care enters the analysis. As Rigby et al. (2019: 12) elaborate: “Within this context of embodied risk, care is arguably constituted inter alia as charity and generosity provided by benevolent British individuals”. Emphasis is placed on one-to-one caring relationships, “on micro levels, rather than on care as a macro social practice with institutional and governing implications”.

To the extent that governmental practices are deemed relevant, care of UASC is constituted a moral responsibility of the Government, rather than a human right. This “call to morality” ascribes “safeguarding UASC” to “voluntary moral norms, rather than to its [the Government’s] formal and legal obligations”. In terms of effects (Question 5 in WPR; seeBacchi WPR CHART),

“Representing the Government’s responsibility on the grounds of morality, rather than on the grounds of human rights and international conventions delimits the question of the obligations towards unaccompanied asylum seeking and refugee children to resettlement.”

It also silences (Question 4 in WPR Bacchi WPR CHART) what happens to the refugees “who will remain unsettled”: “The government’s moral responsibility disappears as soon as the unsettled children are beyond the UK border” (Rigby et al. 2019: 12).

Within these practices, “asymmetrical and hierarchical power relationships are discursively formed between the carer and the beneficiary, the ‘needy’ and those attending to their needs, who are depicted as generous and beneficent” (Rigby et al. 2019: 13). Beasley and I (2007: 293) characterize this relationship as displaying “the residues of noblesse oblige”, effectively denying the socio-political relations that constitute this hierarchy. Rigby et al. (2019: 15 check) drive home the point: “prescriptive understandings of altruism within already hierarchical societies hide alternative, more expansive conceptions of a just and interconnected community, either national or international”. Beasley and I (2007: 279) offer “social flesh” as one such expansive conception, underpinning a profoundly levelling perspective, a radical politics.

The analysis here of how UASC are produced as particular kinds of subjects in the distinction drawn between “legal” and “clandestine” routes of entry maps onto worldwide debates about the legality of adult refugees (Rigby et al. 2019: 13; see Jörgensen 2012, and Wikström and Sténs 2019). In this problematization, care is constituted beneficence, and hence made voluntary and reversible.

In a recognition of social flesh, the shared reliance of embodied humans on social space, infrastructure and resources challenges this characterisation. The “problem” of “care” is recast in ways that raise important questions about the “political responsibility that governments have globally to help this group of children” (Rigby et al. 2019: 15; emphasis added) and other refugees. At a time when governments worldwide are narrowing their purview of political obligations to their “local citizens” (see Gibson and Moran 2020), a call to recognize “social flesh” offers a timely intervention. As Georgia Tacey (Adelaide Advertiser 22 August 2020), consortium director for Save the Children, argues:

‘… if COVID has taught us anything, it’s how interdependent we are on one another both nationally and globally … It’s a false choice to think we can concentrate on Australia’s health. … As our borders will open up sooner rather than later, we need to ensure that the Australian Government continues to strengthen the health systems and livelihoods of other countries.’

REFERENCES

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

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

Bacchi, C. & Beasley, C. 2005. The Limits of Trust and Respect: Rethinking Dependency. Social Alternatives, 24(4): 55-61.

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

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

Beasley, C. & Bacchi, C. 2000. Citizen Bodies: embodying citizens—a feminist analysis. International Feminist Journal of Politics, 2(3): 337-358.

Beasley, C. & Bacchi, C. 2005. The Political Limits of “Care” in Re-imagining Interconnection/Community and an Ethical Future. Australian Feminist Studies, 20(46): 49-64.

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

Beasley, C. & Bacchi, C. 2012. Making politics fleshly: The ethic of social flesh (with Chris Beasley). In A. Bletsas & C. Beasley (Eds.), Engaging with Carol Bacchi: Strategic Interventions and Exchanges. Adelaide: University of Adelaide Press, pp. 141-56.

Eveline, J. and Bacchi, C. 2010. Power, Resistance and Reflexive Practice. In C. Bacchi and J. Eveline (eds) Mainstreaming Politics: Gendering Practices and Feminist Theory. Adelaide: University of Adelaide Press. pp. 139-161.

Gibson, J. and Moran, A. 2020. As coronavirus spreads, “it’s time to go home” Scott Morrison tells visitors and international students. ABC News, 4 April. Available at: https://www.abc.net.au/news/2020-04-03/coronavirus-pm-tells-international-students-time-to-go-to-home/12119568

Hacking, I. 2007. “Kinds of People: Moving Targets”. Proceedings of the British Academy 151: 285-318.

Home Office. 2017. Safeguarding Unaccompanied Asylum Seeking Children. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/656425/UASC_Safeguarding_Strategy_2017.pdf.

Horsell, C. 2020. Problematising Disability: A Critical Policy Analysis of the Australian National Disability Insurance Scheme, Australian Social Work, DOI: 10.1080/0312407X.2020.1784969

Jörgensen, M. B. 2012. Legitimizing policies: How policy approaches to irregular migrants are formulated and legitimized in Scandinavia. Nordic Journal of Applied Ethics, 6(2): 46-53.

Keller, R. 2013. Doing Discourse Research: An Introduction for Social Scientists. London: Sage.

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.

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.

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

Rigby, P., Fotopoulou, M., Rogers, A. Manta & Dikaiou, M. 2019. Problematising separated children: a policy analysis of the UK “Safeguarding Strategy: Unaccompanied asylum seeking and refugee children”, Journal of Ethnic and Migration Studies, DOI: 10.1080/1369183X.2019.1694407

Wikström, E., and Sténs, A. 2019. Problematising refugee migrants in the Swedish forestry sector, Transfer, 1-18. DOI:10.1177/1024258919827133

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

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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

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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.