Bruce C Wearne
- for further discussion please contact bcwearne@ozemail.com.au
© March 2005 (December 1995)
In this article the focus is broad but the aim is to give a theoretical description of health, illness and health care in their social context. Any one social issue has to be considered in its social context, and it is because of this that some students find sociology difficult and frustrating. A discussion in the political sociology of health care has to consider all the aspects of human experience in relation to all social institutions, organisation and relationships.
We could begin by asking a few questions. Why have those responsible for the professional training of nurses considered sociology to be an important part of the curriculum? What does a sociological understanding of health-care provide? A sociological understanding of the policy-making process for health care helps us better understand the direction in which our society is headed.
Sociological analysis cannot resolve our personal and professional uncertainties. Yet sometimes sociological discussion is very complex. Often the uncertainties about ourselves and our bodies come to a new and forceful expression in our theories and concepts, in our search for scientific insight. But do sociological theories about power and the social distribution of knowledge really matter that much? Are they integral to the nursing task or are they simply the concern of theorists?
Students sometimes suspect that sociology is part of the problem rather than being an aid to further understanding. It might be worthwhile to try to gain clarity about the structure of health care, but what can a sociological analysis of health and illness, doctors and nurses, really contribute?
Nursing is a profession; nursing students are taught by nursing educators, who contribute to nursing education because they have themselves been nurses. But what about those who teach sociology? Sociology cannot be called a health-care profession. Yet sociologists of health are involved in the health-care field.
We live in a society in which each profession seems bent on defining social reality in order to privilege itself. It is actually hard to see how, from the way this is usually done, that it is not motivated from a desire to grant itself privilege at the expense of some or all other professions. And professional ideology sometimes comes to its clearest expression in a theoretical overview, with the result that one professional self-definition becomes central to the search for truth in a general sense. Professionalism is rampant in health-care generally, and nursing in particular.
Nursing now attempts to make itself into a profession. It is often for this reason that sociology is called upon to make its contribution. After all, there are many professions in our society and if nursing is to develop itself as a profession it needs to have some means of understanding the place of professions, how they have achieved the place they have in contemporary society, and the problems which they confront in general. Nursing cannot derive this information from within its own professional arena alone. The positive and negative development of the nursing profession in our society needs to be understood in context. We gain insight by comparing occupational groups and the various professions. But how is profession to be defined? Which profession has the task of defining the general concept? This is a genuine sociological problem.
It was John Maynard Keynes (1883-1946), perhaps the most influential of 20th-century economists, who stated that debate about ideas was a most important part of social progress. He concluded his most famous work in terms which leave us in no doubt about his view of the power of ideas :
... the ideas of economists and political philosophers, both when they are right and when they are wrong, are more powerful than is commonly understood. Indeed the world is ruled by little else. Practical men, who believe themselves to be quite exempt from any intellectual influences, are usually the salves of some defunct economist. Madmen in authority, who hear voices in the air, are distilling their frenzy from some academic scribbler of a few years back. I am sure that the power of vested interests is vastly exaggerated compared with the gradual encroachment of ideas. Not, indeed, immediately but after a certain interval; for in the field of economic and political philosophy there are not many who are influenced by new theories after they are twenty-five or thirty years of age, so that the ideas which civil servants and politicians and even agitators apply to current events are not likely to be the newest. But, soon or late, it is ideas, not vested interests, which are dangerous for good or evil.
When we discuss professions and professionalism we are concerned with the "gradual encroachment of ideas". Most university students these days, and nursing students in particular, have not escaped the belief that all of life is a market place. Some believe this fervently. Challenge that idea and you will face the accusation that you are not being practical. But such a view is also a basis from which people make judgments about social life, other social actors, fellow students.
At the same time many students, particularly nursing students, complain that all this social theory is not getting them anywhere. What they usually mean by this is that it is not immediately obvious how theories help us to help others, to do our work or to make money. So they find it hard to use complex ideas and theories as they help others do their work and make their money which then helps to make sense of it all. But the relevance of social theory and sociology emerges for most students when they begin to see such abstract discussion - making comparisons among occupational and professional groups - as part of "professional development". When nursing students confront themselves as students for the purpose of becoming nursing professionals they begin to see the relevance of social theory and comparative sociology. And in this way the dogma that university training exists to train people for jobs is challenged as students begin to get out from under the domination of the market-ideology and embrace their immediate student-task as a role with its own integrity.
Criticism of government these days focuses upon that policy formulation which simply endorses the ideology that all of social reality is a market place. Such criticism is based on the assumption that market-place activity is not all that goes on in society. A wider perspective is required and hence an attempt is made to identify the underlying principles of social and public life. But when we think about it theoretically [this might be when we are confronted by a sociological argument] we realise that all of social reality indeed can be interpreted as if it is a market, but also in terms of many other metaphors besides.
Apart from being viewed as if it is a market-place, social life is a court-room, a place of judgment; it is a temple, a place of worship; social life is a hotel or a hospital, a place of welcoming and care; social life is diversion, distraction, entertainment, a stage for role-playing by cast and audience. Social life is constraint; it can be analysed as if it is a set of rules; as if it is a prison.
The use of metaphor as such, and even of the market metaphor, is not invalid, it is integral to our "everyday thinking". That should cause us to pause and reflect about the nature and character of our thinking activity. Are metaphors, as part of everyday conversation, used in a similar manner when we engage in complex theoretical argument?
The answer, as with many such questions is "Yes" and "No". Yes: conceptual argument, like all argument, requires metaphors to link our abstract logic to the processes and activities of everyday life. No: everyday conversation and reflection is not geared to an analytic and abstract goal in the way that theoretical reflection is. Yet theoretical reflection can focus analytically upon the "everyday" type of non-theoretical thinking, just as much as the distinction between theoretical thinking and everyday thinking is an abstraction.
Sociological analysis, economic forecasting and Government policies are hardly conceivable without the use of metaphoric allusions to some degree. Our everyday life, in which we make critical judgments, formulate decisions and act upon them, is filled with metaphoric allusions. We cannot avoid metaphor in our speech; in our society we also cannot avoid the use of the market metaphor. So when someone says : "Stop the theorising; be practical!" they might not be saying "just give me the money!" but rather "give me something in your analysis that I can then use in the market place!" Then we realise that here is an idea rich and overflowing in theoretical ambiguity; it may have been expressed in an anti-intellectual way but it is still deeply theoretical! Thinking abstractly is conceptualised according to this view in such a way that implies that if a formulation cannot readily indicate some immediate market place outcome as well, then it is probably not worth the effort. This is indeed part of "culture" in which pragmatism has thrived and continues to thrive.
There is a widespread attempt to use such an economic metaphor not only to explain but also to describe the way things are and to predict how things will continue to be. And this indicates that it is a theoretical view with a peculiar normative characteristic. We are always making judgments in terms of what we believe is normative but those who hold this view will probably get annoyed if it is pointed out that their view of how things have to be is a normative view. They would want assume a world-wise disposition that is simply facing up to market place realities.
In philosophical terms we say that such an argument is a metaphysical explanation or part of a meta-narrative. The problem with so-called economic rationalism is not that the market metaphor is used, but that it is used as the base-line normative (fated) consideration for all other ways of viewing complex social reality.
There is much criticism of economic rationalism and it usually implies that the market-metaphor has been absolutised, gaining an exclusive, or privileged, position in public debate, to the exclusion or subordination of other metaphors, other ways of seeing the social terrain. But if we judge that one metaphor has been absolutised, we must be referring to a standard, a criterion, by which we can not only say that "things are out of whack", but also why the given perspective is wrong. It is not only distorted, it is distorting. Still it is sometimes hard to pin our own normative judgments down.
Sometimes normative judgments are viewed as the mathematical facts - 2 + 2 = 4 or 2 X 3 X 3 = 18 or 34 = 81. Sometimes we want our judgments to be accepted like Newtonian laws of motion. Often we want our judgments to be accepted as true as if they would be so quite apart from any need on our part to say so! Immediately we run into a whole host of complex questions and problems. But in sociological thinking we also have to confront the way our public life is organised and ordered, and hence we cannot avoid social norms and normativity. This means that political discussion of public affairs has to have its own normative standpoint as well and we have to reckon with the standards which are held by people in the society under consideration. It is complex and often extremely contentious.
So where do these metaphors come from? And what is the relevance of these for health-care related professional tasks? Is there any criterion by which they should be employed and their use ordered? Indeed can metaphors be used without their being absolutised? The post-structuralist approach to social discourse implies that any one "super-metaphor" or "meta-narrative" can only be put in its place by another metaphor or metanarrative. So is it possible then to make use of the market metaphor by first of all "putting it in its place" (an inherently juridical metaphor)?
Before we can attempt an answer to such a question we have to try to gain insight into how such metaphoric allusions function in the social sciences, in particular sociology.
There is a serious problem we have to face. Sometimes students are "turned on" to this discussion about metaphor, studying society "as if". And they are so enthusiastic in their studies and in their academic talk (or discourse!) because they now have a way of talking about all the frustrations and difficulties they encounter in this society about being a student in general, and even about being a nursing student in particular. They grab hold of this discourse in a serious way, yet a fundamental logical flaw develops in the approach to social research. The analysis of social life becomes so attached to "theory", and discussing the manipulations of language in colourful ways, that the language and use of metaphors to enrich everyday work by others, particularly policy-makers and economic planners, is forgotten, or seriously misconstrued.
In our so-called post-modern condition we may attempt to engage in language games to protect our own fragile professional self-image. We might say that everyone is doing it. But another word for language games is jargon; it can be part of an image which is cool, toughing it out and giving the impression we know what the latest is even when we are tossed to and fro with inner confusion, with significant doubts and also large areas of ignorance. Sometimes as we listen to the corporate-babble, the discussions about market trends and so on, we are tempted to conclude that such decision-making ignores cultural discourse. We slip into a pseudo-critical frame of mind. But are we not failing to reckon with the fact that economics is itself cultural, that the mumbo-jumbo of balancing budgets is actually discourse, and that in this mumbo-jumbo the discourse of non-economic culture has been utilised, generalized, recognised and construed for its own particular purposes. A serious flaw will result from an erroneous privileging of our new-fangled post-modern discourse over against the seemingly mundane and mechanical reality of ledger-keeping, which should not be defined as non-discursive. Ledger-keeping is also discourse; accountants develop their own sub-cultural ways of doing things - another way of saying this is to say that accountants act as professionals. The view that metaphoric discourse pertains to a higher level of culture than the uninteresting facts of accountancy is in fact part of a mythic discourse, or more precisely a myth-making discourse. In other words, when we start to realize how language use relates to our professional education we confront the possibility that we could create as part of an attempt to establish our own elitist sub-culture in order to say that we know because we have learned a particular language, because we are training in a particular professional area.
This creates very real theoretical problems. There are very real practical problems as well. It is a problem which bedevils the medical profession, medical science, psychiatry and psychology as well. It is a problem which is beginning to trouble the nursing profession and it is this which we seek to explore in this present discussion. But it is also a problem we confront in the "issues" of every-day life.
The next question in our quest for a truly self-critical attitude is : How can one be a professional without adopting a closed and defensive elitism? This is not only a question for nursing. It relates to all professions and trades. This might seem very abstract but when we are trying to formulate theories about social life we all use metaphoric allusions. It is our ongoing use of language which ensures that this takes place. But when someone gets too abstract we say that they are over-doing it. They have gone over our heads.
Let us consider economics : on the one hand, the market-metaphor is viewed as an all-encompassing frame of reference, within which all other discussion about all other facets of cultural life can be accommodated.
I was confronted
by a young man the other day who came up to the Arts Faculty at 4.30pm during
examination week on his way home. He claimed to have been self-employed as a
salesman for 15 years and wanted a new challenge. He had achieved what he had
wanted in selling his products, and now he said he wanted to move into the
products of the mind. All people in our society have something to sell, he
said. Being human is marketing your own product. I engaged him further;
courtship, marriage, raising a family, even going to church were all viewed in
terms of the same metaphor: it was all a matter of what we produce, and from there we move on to selling our products in
marketing exercise. Yes, he said, finding the right girl was a matter of
advertising, raising children was marketing yourself to your children as
parents and so on. And he was keen to move into a new line of products, the
marketing of ideas. Thus, he said, he wanted to study psychology! I surmised
that he had succeeded with what he thought was "objective reality";
now what he wanted was to succeed in the "subjective" realm. I am
sure that such speculative reflection by plumbers, electricians, police and
shop assistants can all construe reality metaphorically; as poetry this might
be imaginative and recreative. But all of life is not pipes and drains,
changing a fuse, keeping the peace or serving customers, even for those who
work in these areas. The occupational metaphors are useful and powerful as long
as we remember that. Attend to the fact that they are part of the non-logical concepts of our
pre-scientific, pre-theoretical every-day life.
How do we order our account of reality to keep the various metaphors in their place? The point is that if one of the metaphors is absolutised it has become, in fact, the leading idea, an appeal to an order of reality within our thinking. Reality then will have to find its place in relation to the metaphor, rather than the metaphor being useful to help us orient our thinking via an idea of the lawful coherence of reality. It is this coherence from which the variety of metaphors are derived. Metaphors may allow us to engage in elementary theoretical comparisons. We make these comparisons all the time : a teacher is in loco parentis; a sibling is a good friend; we belong to mother Church; we seek to return to the Fatherland; this battle is the mother of all wars; school is a prison and so on.
There are also many other discourses as well which we confront in our social life, some of which are of an abstract and theoretic character. The problems arise when one such discourse is turned into a basic frame of reference for all other metaphors; when all subsidiary metaphors are derived from one major metaphor.
We have to keep in mind that when we are using metaphors we are not talking about the full concrete reality, but rather how that reality is presented to us in a variety of aspects. After all, there is discourse about (the meaning of) discourse. This is why criticism of economic rationalism is in order. Lyotard, in his classic statement, bases his report on his conclusion that postmodernism involves an incredulity toward all metanarratives. There is certainly something to be said for the observation that economic rationalism, which has been the dominant Government policy in this country for almost 25 years, tends to be a kind of metanarrative - a metaphysical frame of reference beyond criticism. But then the post-modernist intellectual disposition may also affix itself to this same economic rationalism as the most efficient myth for the effective running of our daily lives. In this way economic rationalism can be as much a cause, as a consequence, of the confusion we encounter when as students we are called upon to study our society in all its complex and differentiated detail.
Pusey (1991) attempts to answer the question of the priority of the economic mode of discourse in the political decision-making of Canberra bureaucrats by recourse to an historical reconstruction of how such a social construction came about. When he investigates the mind of the administrative revolution to determine how the new economically dominated reality was constructed, he argues as if the Canberra public officials were acting as one person, with one mind. His argument therefore is that this was a revolution in social vision, as much as it was an idealistic attempt to implement a full and consistent rationality in that arena of society we call the `economy'. But his explanation is an historical and sociological account of how such a revolutionary mind has taken hold. We are still left to ponder how it is that human culture can be so thoroughly shaped by the absolutisation of a theoretical and socially constructed concept.
It is to that question, which this present discussion seeks to find an answer, namely, how is it possible for an absolutisation of social metaphors to take on formative significance in cultural life, private and public? Why is it that the metaphors of medicine seem to have such a power upon the way in which health care is managed and nursing is organised? And then we will be in a position to ask: Once the absolutisation has taken place what are the consequences?
To attempt an answer to this questions I propose first to look briefly at the manner in which students/thinkers are swimming in the currents of post-modern sociology.
Among students there is widespread confusion, apprehension and uncertainty about the nature of theory. I suspect that it is possible to understand why students get lost in their sociological quest but we need to look carefully at the way theory is presented right at the start of their university studies, and probably before.
Introductory courses in sociology embody the prejudice that students need to come to terms with what are called Sociological Perspectives
The student is told "If you are going to study society you will need to adopt a theoretical perspective" or "since all of our everyday concepts are socially constructed you will not be able to develop a critical perspective unless you adopt a particular sociological stance" or, more naively, that "you will need to develop a sociological imagination". Such advice may be well intentioned, directed at how the student should view herself in the study of society, but for it to be constructive one has to have a clear idea of what a theoretical perspective is, or how imagination is to function within a scientific point of view.
So how do we then define the "core business" of the university student? Is it to be in terms of a task? Is the task for the student at a University level to learn to reflect abstractly, forming an integrated conceptual explanation of the various aspects of human society and how these aspects together cohere in the totality of the human condition? I believe so because it is also from the order of these cohering aspects, in their diversity and totality, that the powerful metaphors we referred to above can be derived. And thus we have a point of orientation to creatively interpret our experience while also discovering ways in which these issues can be addressed. The serious student, as she starts out on her student vocation, must become aware of what is being done by her in her own study of society. She is beginning to construct a theoretical overview of human society. By engaging in theoretical analysis the student begins to construct argument in which metaphor and allusion has an important place. She becomes aware of the basic concepts she needs if she is to think theoretically in a positive and non-reductionistic way
But in my opinion it is another thing entirely to therefore say, as Pusey says, following Thompson and Schutz, that such `systems' ipso facto acquire characteristics of facticity, independence, objectivity, impersonality and autonomy. At the very least the student must be encouraged to investigate such philosophical notions as these, to determine how these leading characteristics are derived and what they presuppose.
Various philosophical approaches will all seek to account for this reality. Post-modernist accounts of the dependent nature of theory are an attempt to come to a (post-Enlightenment) understanding of the structure of such reflection but are by no means the one and only account. In so far as those who hold the post-modern perspective assume that post-modernism is constituted by putting theory in its rightful place, then post-modernism becomes a meta-metaphor, implicitly proscribing the structural condition for all thinking ie this is the era of the problematic meta-narrative - the narrative that asserts we have all "moved on" so that we no longer view meta-narratives as credible. At this level post-modernism's avowed partial, fragmented and eclectic approach is not only ambiguous and self-contradictory it is self-performatively destructive of its own avowed position.
The view taken here is that the theoretical overview of the social scientific task and of human society, must be a philosophical viewpoint, theoretical in character, based upon its own (religious) presuppositions. which comes to expression in a particular world-view with its own view of the meaning, coherence and totality of our experience.
Very often students are told to "get an overview" in pragmatist terms. Better to act and get moving than to stand still pondering the meaning of it all. Pragmatism, like its latter-day step-children swimming in the currents of post-modernism, is an intellectual strategy which tries to avoid an uncritical viewpoint by thinking about its own theoretical reflection. But it finds itself stymied by its (not-yet post-modern) convention of piercing through the crust of philosophical convention.
Under pragmatism, the call to "get a viewpoint" sounds very much like a call to adopt one's own subjective dogmatic approach. Supposedly, if one admits one's dogmatic prejudices, then this, as if by magic, allows the thinker to set forth a more objective case. We might well admit that an open statement of one's prejudices is to be preferred to a closed attitude which doesn't even admit that one's work is clothed with the garb of subjectivity. But something in our tradition of sociological reflection, and the teaching thereof, leads teachers and students away from the self-critical task of investigating pragmatism's assumptions, as if such an investigation has very little, if anything, to do with genuine sociological understanding.
Listen carefully to academic talk about sociological theory and you will very often hear sociological reflection discussed as if the noun (sociology, theory, society) somehow has priority over the verb (research, theorising, acting socially). Sociological thought, in this formal way of thinking about it, is what is contained in the books (text-books) on the subject. Theory is therefore the ideal form of the subject. It is the problematic for sociology. it needs to be operationalised, put into empirically relevant terms so that it can function in the scientific market place. This problematic view derives from an academic tradition which considers that responsible professionalism in academia means merely abstract talk. Meanwhile theorising is the human act, talking abstractly, developing an argument in words, a humble attempt to attain to this ideal. Is it any wonder that students come to view sociology's re-presentation of society as merely the imposition of jargon in an academic discourse; society is rendered in static terms which thereby uncritically ascribes intentionality and agency to structures?
Some of these typical statements go like this : "Society forces this custom upon us" or "Society does not like deviants" or "Society has not yet learned to accept this change but it is in the process of dong so" or "As much as we make society, society also makes us." This kind of inexact speech might not be entirely wrong as part of everyday conversation; but as part of a theoretical account of social order such speech is the harbinger of many problems. Moreover, the humble student (by that I mean the student who is critical of her own conceptual constructions) will have an exceedingly hard time of it if she doubts such Theory (n.)!
Consider further the typical advice of text-books, lecturers and teachers to sociology students : "One needs to have a theory." "Theory is the core of sociological reflection." "There has to be a large theory component in any course which wants to introduce the student to the discipline." These statements are made out of respect for Theory (n.); they show little or a diminished appreciation for critical discussion about the character and structure of theorising (v.) itself. They show even less respect for the pedagogical fact that theorising as schooled human thinking activity, has to be learned, and that such learning can never be programmed into the exact time-frame requirements of semesters and terms, of essay deadlines and examination questions.
But theory is not a commodity in the way that our use of language often leads us to conceive of it. By transposing all the knotty questions into problems which derive from its uncritical use as a noun - eg what is the definition of this thing called theory? - we are in danger of developing our sociological insight in terms of a confused linguistic problematic. Surely theory can be itself analysed, and in so far as this is so it can be treated as a thing; yet it is a thing like other human acts are things - it is not a thing like a potato or a flower, a dog or a rock; it is a thing more akin to a handshake or an international treaty.
And so what do students actually confront? Laid out before them is a choice between various competing theories. Marxist ideology confronts Weberian social science, which in turn confronts functionalisms' professionalism, and symbolic-interactionistic aesthetic criticism, phenomenological reductionism and feminist iconoclasm. Meanwhile, post-structural semiotic de-construction claims to unveil all previous jargon(s). These are received as mutually-distinct standpoints - theoretical overviews of general significance for particular studies - from which the student must make her own choice. It is a bit like the super-market shelf. But unlike the supermarket students simply have no choice; they must choose. Before their claim to be students (ie those engaged in theoretical reflection) can be considered genuine, they have to show which product they are favouring. And so it is that mass-produced sociology courses, for all their critical aspiration and appeal, accommodate to the tyrannies of the market metaphor. Sociology prepares the way for the dominance of the post-modern metaphor in higher learning.
But deeper insight can result when these theory-options are viewed within a framework of alternative or competing metaphors. The field upon which this competition takes place is scientific reflection; theoretical reflection is the "common denominator". In this way we move away from meta-narratives and meta-metaphors and reckon with the fact that theoretical reflection requires its own account of the structure and conditions which make theoretical thought itself possible. Such an account will include within it a conceptual armoury allowing us to develop theoretic understanding of the way various metaphoric allusions operates in scientific discourse.
This is why I say that a focus upon the set of predominant metaphors, re-presenting society in various images, might help students better understand their choice of theory.
When we consider the totality of our experience, analysing it from the standpoint of one or other aspect, we confront in our theorising the phenomenon of analogical re-presentation of structures. This is integral to the complex task of scientific reflection, and it constitutes our scientific language.
In society we see the differential development of language in the different social spheres. One of these is concerned with science and scientific language is itself differentiated between the various scientific disciplines. In this we distinguish between analogy (structural concepts) and metaphor (literary and comparative concepts). We can say that an organisation has a life of its own (biotic analogy), it needs to get a feel (psychic analogy) for its place (spatial analogy) in the local community. These (life, feeling and place) are used analogically. But when we say that the cheer squad is like a choir, that football is religion, that the choir is the church's cheer squad, the statements are linguistically and culturally richer and they go beyond abstract analogy. Often such metaphors are explicitly ideological.
In sociological analysis our theorising will involve us in using one social setting to try and gain (comparative) insight into other structured settings. The number of resultant possible metaphors is very large as are the possibilities which derive from mixed metaphors. But the mixing of metaphors in theoretical reflection is not merely an anti-systematic, eclectic approach. In fact it may be the derivative of a attempt to develop a more disciplined and scientific approach to social research. Some of these basic metaphors have had a long and enduring currency within the discipline of sociology. They can be approached as if society (or one institution, organisation or relationship) :
- is a field of battle; the focus is upon the strategy of the captains of the troops; what are the two or three major contending sides?; who is fighting whom for what? etc.
- is a market place; a domain where interests and possessions are exchanged; products made, bought and sold; producers organised and capital invested.
- is a stage or a novel with a developed plot with themes, characterisation, roles, scripts and individual variations.
- is the playing out of a time-honoured ritual, communicating some symbolic idea from one sector of professionals to the non-professionals.
- is a biological organism with organs (structures) joined by processes and sub-systems; it could be viewed as a womb in which the future is born out of the past.
- is a gas bottle or a machine where energy/power is conserved and utilised in a fixed mechanical way according to a mechanical plan for the integration of the various component parts of a mechanical whole.
- is a language; a court-room, place for judgement; a place of worship; a sporting venue or a game.
The student under the current scheme of theory-options easily sees herself as a somewhat helpless consumer who has to take a risk in the psycho-historical market-place of sociological ideas. The predominant academic "market forces" are simply beyond her horizon. Somehow the theory which she might be drawn to accept is a function of the hidden hand of the ideological market-place.
The character of her choice is not easily specified; her direction seems to have been set by mysterious forces which transcend her understanding. What adjective should we use to characterise this choice?
Is it ideological, aesthetic, religious, historical, political or economic? Is it a choice made in the context of a battle? a market place? or is it a choice made in terms of one's contribution to a game? the development of one's own imagination? a symbolic contribution to a traditional ritual? Or is it simply the development of a preferred language?
I do not think that it is possible to reduce the contributions of the various theoretical schools to these basic metaphors - but these basic metaphors can be used to characterise the complex debates in sociological theory. But the important question is : how can this be done without reducing theory to literary allusion? It is therefore wholly appropriate, as the post-structuralist trend in critical theory has emphasised, to reappraise the manner in which logic is developed, argument is framed and narrative is constructed in its historical context.
The characterisation of any one theoretical strategy is not an easy task; explaining the meaning of theoretical debate between various schools is also complex. Clarification can be enhanced by use of a classification of theoretical positions that makes use of metaphoric allusions to characterise social theories. But only if it is understood that the classification scheme is not neutral with respect to the various theoretical options it re-presents. A classification of theories will also have to (self-critically) locate itself in relation to the basic parameters it spells out for all other theoretical approaches. Such a classification is a pedagogic first step when introducing students to the perceived state of play in social theory.
A metaphoric explanation of sociological theories is useful when trying to illustrate how ideas are translated into policies, elucidating how society is shaped, and to a degree they provide students with a means by which they can evaluate the strengths and weaknesses of the various sociological schools of thought. An analysis of public policy which openly faces the theoretic character of the (theoretical and critical) metaphors are more critically aware than those analyses which simply try to replace the multi-faceted reality with their own metaphor ie reduction. If one is to adopt an anti-reductionist strategy then one has to face the theoretic and abstract utilisation of the metaphor used. But the question remain : How is this to be done? We need to formulate a logical concept of the metaphor
It is also possible to start with each of the metaphors and develop insight into the strengths and limitations of each resultant account of human society in all of its aspects, in all of its institutions, organisations and relationships. In this way the teaching of sociology can begin to encourage the development of the student's own overview - not rejecting the theoretical tradition, nor the genuine analogical insights that the various sociological metaphoric traditions have bequeathed to us. The task of developing a theoretical overview of human society is placed within reach; it is not equated with in-depth specialist understanding of the historiography of sociology. Rather, the conceptual character of the scientific task comes alive, calls forth imaginative argument and systematic application is encouraged.
But there is another aspect here which we should briefly comment upon. By highlighting how the different theoretical traditions gain coherence and analytic leverage through one or other metaphoric allusions (ie the battle-field of Marxist social theory or the physiological homeostasis implicit in functionalism) we still confront difficulty when we try to account for the way in which one theoretical tradition incorporates the valuable aspects and insights from other theoretical traditions and make them work in their own frame of reference. We should keep in mind that the field of competing metaphors is also a pedagogic device and as such introduces us to the problem of developing a theoretical overview. It does not, indeed it cannot, provide more than a set of creative starting points for an internal critique of the structure and leading ideas of the various "metaphorical" schools.
We began with a discussion of the critical use of metaphors in public debate. We now ask : need the absolutisation of one metaphor be an inevitable consequence of thinking theoretically? And if it is what does that say about the possibility of engaging in a critical and self-critical social theory? If it is not how are we to develop a systematic approach to the scientific study of society?
These questions go to the heart of what we understand by theory. It seems as if our choice is between an artificial integration of our theory of society - based upon the exclusive and monopolistic use of one metaphor - and an aversion to systematic social theory as our social science is replaced by separate and discrete descriptions with no inner connection between them. But we have also made a distinction between metaphor and analogy. We do not simply deal on the level of metaphor, as if metaphoric allusions are to be equated with theoretical analysis of empirically existent situations. We do not seek to reduce theorising to metaphor, and thereby equate metaphor with analogy. Rather we work with metaphor as a teaching aid on the assumption that theoretical reflection confronts a multi-faceted reality, and that a field of competing metaphors is one way to begin to think about the theoretical discourse which confronts us in sociological research. In social theory metaphors are useful because they help to elucidate the nature and character of theoretical concepts, which are ana-logical in character. They do this because they are inherently comparative.
(It would also be worthwhile to compare and contrast the pedagogical traditions of the various academic disciplines, particularly in terms of how teaching practise embodies answers to these basic questions of the variety of schools of theoretical reflection in any one discipline. In the teaching of current 'theory' there will always be, implicitly if not explicitly, explanation of how some preferred approach is related to some other (less than satisfactory) alternative. As well today's approach will also be explained in the discipline's historical context.
But even if one metaphor is chosen to the exclusion of all others, we still have to account for the other possible metaphors. Is theory to be reduced to a choice of metaphor? How then would we construe the population of metaphors? If we decide that the metaphors exist in some kind of society of allusions, then will we conclude that our definition of the term society should structure our understanding of the order among the metaphors? Or will this word society only function in a metaphoric way?
Further, if we defer to a society of allusions our viewpoint will necessarily be normative : we still have to decide how this term is to be defined and how this society is to be ordered. A democratic vision of society in which all metaphors are equal requires a choice for the candidate of chief executive metaphor; but the democratic criterion is not quite the same as an aristocratic vision in which the status of the metaphor is pre-eminent; a federation of metaphors might imply a lawful order, whereas an imperial power will rule a kingdom of metaphors. And so on and so on. But whichever definition is accepted, our questions about the character and structure of metaphoric debate is not lessened but deepened. Society becomes its own metaphor - a reality sui generis - and the study of society, intrinsically a part of social life, is viewed as the autonomous motor of societal interaction. If we follow this route then we conclude that the rules which govern all societies, including the society of metaphors in social scientific discourse, are in some sense self-regulating and self-determining. The distinctive integrity of the society itself, is determined by the kind of society it is.
We should also consider that viewpoint which says that the order within which metaphors function is an economic ordering, a market-place of trading and exchange, giving and taking - the best metaphor is the one which is the most economic, the one which returns most profitability in terms of theoretical insight and control over everyday life. But you will notice here the circularity in the viewpoint : is not the metaphor that works best under the regime of the market metaphor always the one which is most economic?
The order of metaphors can itself be seen in literary terms. A prevailing post-structuralist approach which considers society as a structure of ongoing discourses. The social critique in this view is essentially following the lead of the literary critique. The metaphors are indicative, they are signs, which place the participants in the discourse in a universe of language and communication about the meaning of things. As much as a discursive focus upon metaphors enriches theoretical discourse, previously dominated by "dry as dust" utilitarianism and positivism, so also we need to reckon with the fact that our experience is always much richer than our theoretical construal of it no matter how discursive we may become.
With each of these (meta-metaphoric) ways of approaching the use of metaphor in social theory we witness the subtle tendency toward reductionism again and again. Post-modernist concern with metaphors is diagnostic and therapeutic. First, the diagnosis focuses attention upon the reduction of social and cultural life to economics. The analysis of ideas and words concerns how power is traded and exchanged in discourse - and the resultant economism then fails to reckon with the domination of the market metaphor. The metaphor is made into something much larger than it really is. The metaphor replaces reality.
The therapeutic direction, takes its leave from the way in which marketing has a tendency to reproduce all of life to its manufactured gloss, resolving to present an alternative marketing strategy for an alternative metaphor, which is in fact the metaphor of language and allusions. But therapy itself can be metaphorically utilised. In Rorty's post-pragmatist philosophy it becomes the prime metaphor to understand the history of ideas and the task of philosophy. It is reduced to being a matter of experimenting to discover what works best to solve our problem.
Critically, it might be observed that the therapeutic direction simply leads to a situation where a post-modern myth confronts a previous myth based in the market metaphor. But the latter claims to confront metaphoric allusion with metaphoric allusion; the market absolutists confront reality with their metaphoric allusion (their myth) and forget the conceptual character of their metaphor.
In contradistinction to both modern realism and post-modern iconoclastic nominalism, the position adopted here maintains that social theory requires a systematic analysis of metaphor in terms of a prior structural analysis of the contribution of analogies to theoretical thinking per se. This requires a critical investigation of the structure of theoretical reflection and concept making. It needs a clear articulation of the place of theoretical thinking in the everyday reality of social policy-making. In this way we begin to deepen our insight in the structure of theoretical discourse and answer the question : how is it possible that one analogy/metaphor begins to dominate in our thinking about social life? What is theoretical thought that it can be undertaken in a way that leads to its subservience to its own analogical constructions? It is questions such as these that require attention. The post-structuralist tendency in post-modern scholarship usually moves away from this question into a semiological consideration of the meaning of signs and how social power and theoretical knowledge are linked in systems and strategies of domination. But why does it take that turn away from the critical investigation of theoretical thought as such? To answer that question we need to take our consideration of post-modern outlook one step further.
What does post-modernism mean? Let us look at post-modern feminism as an example. On the one hand we confront arguments to the effect that the category woman has been deconstructed - post-structural concern with discourse has revealed that the category woman has been constructed as part of a strategy of gendered domination. But if, for example, woman is no longer a meaningful category, how is it that another abstract concept (say discourse or post-modernism) can be taken to suggest something meaningful at all? The de-constructing approach is indeed a reaction against the idea that reality must be transformed into the rational construct of the Cogito, but what prevents the notion of deconstruction being subject to sharp critique. How is it that men and women may be constructed and deconstructed but the discourse of post-modernism seemingly goes on forever? Where is the deconstruction of the mythic concept of fate? We would have to conclude that the academic capitulation to post-modernism, and its reduction of all things scientific and scholarly to the dogmas of discourse must count as one of the most spectacular retreats into the ivory tower that we have seen since the Enlightenment. The retreating discoursists will counter with the view that their deconstruction is simply highlighting the social construction of all domination - including the theoretical tyrannies of metaphoric absolutisation - but the therapy is simply a matter of retreat into explicit mythology within which, seemingly, it claims it is happy to acquiesce in its own construction of relativism, negation or mere passionate passivity. This is the all too comfortable pose of post-modern 'theory'.
We therefore ask : Is post-modern thinking a reductionist approach? Does it not reduce the horizon of human responsibility to that which adapts to the universe of language, signs and symbols? Has not the will to de-construction to discern the power and hierarchy which control all things, assumed that all things are constructs to begin with? My point is this : if you disallow the concept man or woman why allow the concept power, or knowledge, or language, or freedom, or gender?
Post-(modern) feminism is more akin to the arguments of those who wish to be part of a public majority, but who discovering that a majority cannot be constructed in the conventional way, decide to take a route which also appears to be philosophical ie it says it avers constructs such as women, but what it is really concerned about is that there is no general consensus, particularly about the meaning of gender. It therefore aims to use its professional power to be on the side of the consensus, whatever that consensus may turn out to be. It is an approach that wants to be involved in the study of the social world but does not want to be labeled by "others".
What I have tried to do above therefore is to unravel the particular form of reductionism in sociology which seems to reduce the study of social reality to a decision about where to stand and how to pitch one's analysis in terms of the pre-existing matrix of theories. This may be a modified reductionism; it shifts the emphasis away from a reduction of all of reality to one or other aspect, but it still reduces the fullness of the task of theoretical engagement - often by reference to choice and the application of the market metaphor beyond strictly economic matters. But how are we to theorise about this state of affairs and move towards an adequate explanation of the place and contribution of sociology?
The post-modern tendency in the social sciences has begun to direct attention to the ways in which various professional groups shape their own reality through the discourse they develop and adopt. In nursing education, for example, there is a strong tendency toward "discursive analysis" as a central part of the task of developing the nursing profession's sense of professionalism. The historiographic task of identifying the discursive tendencies within the universe defined by the "medical model" coincides with the attempt to historiographically recount the development of "nursing discourse" in the history of health care. By documenting the typical ways in which nurses have referred to themselves, their task and their place in health care, it is proposed that insight can be gained concerning how nurses have accommodated to the medical view of health care, whilst also gaining moral strength from a deepened awareness of how nurses have tried to develop and maintain their own professional autonomy. Such an approach to nursing education and "nursing theory" is part of an attempt to build a distinctive body of nursing knowledge. But a critical question remains : Is such an approach to building nursing as a profession for nursing only? Should it not involve a challenge to the entire architectonics of professional training in the health-care arena including medicine? Is not the question parallel to the question concerning the place of economic science once the economism of the absolutisation of the market metaphor has been exposed? In other words, once it has been shown that the absolutisation of the medical metaphor leads to an improper control and domination over the professional training and knowledge of the other health-care professions, are we not now left with the question of the right and proper place of medicine within the health-care field. Having arrived at this point we have built a platform, a philosophical basis from which a next step can be taken to consider the crucial (normative) contribution of the medical profession to health-care, in terms of a norm which governs medicine but also ensures the professional and vocational integrity of all other legitimate health-care professions?
We might therefore come to some surprising conclusions as in the case of the definition of medicine as a legally qualified and technically trained form of nursing. The full implications of this view in terms of an institutional and organisational analysis will have to wait for another occasion.
This article has discussed the place of theory, social theory and sociological investigation in professional nursing education. It has addressed itself to the contemporary debate about "post-modernism" with special reference to the theoretical reflection of metaphoric understanding. Social scientific understanding is indeed an important part of professional education in nursing and health-care. But as professional thinkers and thinking professionals we need to self-critically examine our understanding of theoretical thought lest we lapse into patterns of thought which undermine our wonder for the order, coherence and meaning of reality with our concepts and theories. A close examination of the metaphors we use in theoretical argument coincides with our attempts to develop such self-critical attitude, which must be a central part of any professional viewpoint. Our human imagination will be enhanced when theoretical thought finds its own vocation.
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