Justin Cruickshank

A critical realist approach to understanding and evaluating heart health programmes

Secondary prevention programmes for Coronary Heart Disease (CHD) aim to reduce cardiovascular risks and promote health in people with heart disease. Though programmes have been associated with health improvements in study populations, access to programmes remains low, and quality and effectiveness is highly variable. Current guidelines propose significant modifications to programmes, but existing research provides little insight into why programme effectiveness varies so much. Drawing on a critical realist approach, this article argues that current research has been based on an impoverished ontology, which has elements of positivism, does not explore the social determinants of health or the effects on outcomes of salient contextual factors, and thereby fails to account for programme variations. Alternative constructivist approaches are also weak and lacking in clinical credibility. An alternative critical realist approach is proposed that draws on the merits of subjectivist and objectivist approaches but also reflects the complex interplay between individual, programme-related, socio-cultural and organizational factors that influence health outcomes in open systems. This approach embraces measurement of objective effectiveness but also examines the mechanisms, organizational and contextual-related factors causing these outcomes. Finally, a practical example of how a critical realist approach can guide research into secondary prevention programmes is provided.

A tale of two ontologies: an immanent critique of critical realism

In this article is it argued that critical realism has two mutually exclusive definitions of ontology. Ontology is defined as both a fallible interpretation of reality and as a definitive definition of a reality beyond our knowledge claims. A slippage in meaning occurs from the former to the latter, as critical realists try to justify the claim that their ontology ought to supply the terms of reference for all scientific research. Rather than defend an alternative ontology, it is argued that ontology needs to be defined in terms of fallible interpretations of social reality. This necessitates the revision and replacement of ontological theories in the course of an ongoing critical dialogue about reality, and precludes the use of one fixed ontology to supply the terms of reference for the sciences. 2

Positioning positivism, critical realism and social constructionism in the health sciences: a philosophical orientation

Positioning positivism, critical realism and social constructionism in the health sciences: a philosophical orientation This article starts by considering the differences within the positivist tradition and then it moves on to compare two of the most prominent schools of postpositivism, namely critical realism and social constructionism. Critical realists hold, with positivism, that knowledge should be positively applied, but reject the positivist method for doing this, arguing that causal explanations have to be based not on empirical regularities but on references to unobservable structures. Social constructionists take a different approach to postpositivism and endorse a relativist rejection of truth and hold that the task of research is to foster a scepticism that undermines any positive truth claim made. It is argued that social constructionism is a contradictory position.

Critical Realism and Critical Philosophy

ritical realism is becoming increasingly influential in the social sciences, with critical realist ideas being used as underlabouring precepts. That is to say, critical realist ideas are used to guide empirical research, with critical realism being a meta-theory that informs the construction of specific theories in the course of empirical research. A meta-theory is necessary, critical realists argue, because all research is guided by certain assumptions. The most important of these assumptions are ontological assumptions concerning how the social context influences individuals and how individuals may act back and change the prevailing social context. This means that researchers need to be explicit about their ontology to avoid arbitrariness, and that the ontology of social reality developed needs to resolve the structure-agency problem, to explain how individuals’ agency is both enabled and constrained by social reality. Critical realists argue that defining social structures as emergent properties resolves the structure-agency problem and so the meta-theory of social reality that empirical researchers need to adopt is one of structures as emergent properties.

Knowing Social Reality: A Critique of Bhaskar and Archer's Attempt to Derive a Social Ontology from Lay Knowledge

Critical realists argue that the condition of possibility of the sciences is that they are based on a correct set of ontological assumptions or definitions. The task of philosophy is to underlabor for the sciences, by ensuring that the explanations developed are congruent with the ontological condition of possibility of the sciences. This requires critical realists to justify their claims about ontology and, to do this, they turn to ontological assumptions that are held to obtain in natural scientific knowledge and social agents’ lay knowledge. A number of problems with this approach are discussed and a problem-solving alternative is advocated.

Anti-Authority: Comparing Popper and Rorty on the Dialogic Development of Beliefs and Practices

For many, Rorty was a postmodern relativist and Popper was a positivist and Cold War liberal ideologue. The argument developed here rejects such views and explores how Rorty’s work is best understood from a Popperian problem-solving perspective. It is argued that Rorty erred in seeking justification for beliefs, unlike Popper who replaced the search for justification with criticism. Nonetheless, Rorty’s arguments about post-Nietzschean theory and reformism function as important updates to Popper’s arguments about methodological essentialism and piecemeal social engineering, respectively.

Structures, Agents and Criticism: Assessing Bhaskar's Fact-To-Value and Value-To-Fact Arguments

Most discussion about critical realism concerns the concepts of structure and agency. This neglects Bhaskars arguments about facts and values. Bhaskar argues that we can move from facts to values with ‘explanatory critiques’ and from values to facts with ‘descriptively adequate’ accounts of ‘value impregnated’ events. The argument in this article is that both of Bhaskars arguments are untenable and that the alternative is the value-to-value argument.

Overcoming Essentialism: Notes On The Underclass Debate

According to the ideological individualism that accompanied the laissez-faire policies of the nineteenth century, a ‘free market’ allowed individuals to realise their ability to make wealth and, conversely, poverty was to be explained in terms of individuals’ failures to ‘get on’. When confronted by large scale economic hardship the response, though, was not to say that large numbers of working people were ‘feckless’. Instead, the response was to modify the individualist conception of the economy, by making a distinction between (a) the ‘deserving poor’ who were poor because of a difficult situation, and who would eventually work their way out of poverty; and (b) the ‘undeserving poor’, who brought poverty upon themselves, by being unable to work in gainful employment. Thus the notion of a class ‘under’ the working class developed as a way to explain long-term poverty in terms which blamed the individuals concerned. Whilst it was recognised that capitalism (or at least the form of capitalism operating at the time) may create economic distress for individuals who did work hard, the belief in laisssez-faire could be defended by saying that individuals who were not feckless would escape poverty, whilst the feckless would always be in self-inflicted poverty. So, for the working class/deserving poor, poverty would be caused by capitalism, and overcome by individuals, whereas for the underclass/undeserving poor, poverty would be caused by individual failings, and would be impossible to overcome. In which case laissez-faire could be justified along the lines that individuals were ultimately responsible for their fate, and if nascent welfare were increased then this would only support a feckless underclass. These views can be illustrated by turning to the works of two nineteenth century commentators, viz. Mayhew and Booth. Mayhew, in the mid-nineteenth century, talked of a ‘substratum’ which was distinct from the working class. After recognising that casual and sweated labour in London would create conditions whereby work was insecure and gruelling, Mayhew made a distinction between casual labourers and vagrants. The former may experience poverty but could work their way out of this, whilst the latter brought poverty upon themselves. This latter group were innately feckless: the vagrants, i.e. the substratum, could could not support themselves because they were a biologically inadequate sub-race. In trying to distinguish such a group, Mayhew listed some physical and social traits, such as ‘high cheek bones and protruding jaws’, ‘slang language’, ‘repugnance to continuous labour’, and ‘love of cruelty’ (Mayhew in Himmelfarb, cited in Morris 1994:17). Similarly, in the late 1880s, Booth carried out a survey of London which found that one third of the population lived in poverty, including members of the labouring poor. This could have challenged any notion of an underclass of feckless individuals, as it would seem that economicstructural factors were the cause of poverty. However Booth drew a different conclusion. He argued that there existed a ‘residuum’ constituted by feckless individuals who would corrupt workers. He described the residuum as ‘[o]ccasional labourers, street-sellers, loafers, criminals and semi-criminals [... who] degrade whatever they touch and as individuals are incapable of improvement’ (Keating cited in Morris 1994: 21-2). The notion of a biologically distinct underclass persisted into the twentieth century, although by the 1960s and 1970s biology was replaced by ‘culture’. In the USA the debate turned upon the notion of a ‘culture of poverty’, whilst in the UK the debate turned upon the notion of a ‘cycle of deprivation’. In both cases the argument was that poverty was caused by a situation whereby children were socialised into ‘deviant’ norms. The argument was that children would be brought up by single mothers who could not discipline the children, or in dysfunctional families; the children would be socialised into expecting welfare support instead of supporting themselves through work; and given the lack of any sense of self-responsibility (from supporting oneself via work), the children might turn to crime when older. Such a view was famously championed by Keith Joseph, who described how there was an ‘intergenerational transmission of poverty’, caused by inadequate socialisation leading to unemployment and unstable families, which continued the dysfunctional rearing of children (Bagguley and Mann 1992:121). The purpose in making such arguments was not now to distinguish a deserving from an undeserving poor because, whilst there were still poor people, it was assumed that modern welfare had removed extreme poverty. Indeed, it was thought that such ‘generous’ welfare had encouraged the development of an underclass. In which case, the purpose of the culturalist arguments was to argue for reduced welfare and increased policing of benefits, together with a ‘crackdown’ on crime, to prevent young underclass men using crime to avoid work. In other words, the culturalist arguments supported new right politics, based on the neoliberal emphasis on ‘markets’ and the neo-conservative emphasis on law and order.

Dialogue and the development of ideas in the political and social sciences: from critical realism to problem-solving via Colin Hay and the rejection of the epistemic fallacy

Colin Hay’s extensive work on politics helps illustrate that ideas can have significant traction of their own which inhibits change. Therefore, accounts of conceptual development in the political a...

Book review: Interpretation and Social Knowledge: On the Use of Theory in the Human Sciences

of instability for men as it is performed through these films, rather than mapping social change onto film performance. The model of ongoing instability is more resonant than the unnecessary drama of the language of ‘crisis’ and is certainly more effective for dealing with the internal struggles dramatized in many movies. In turn, one wonders whether angst might be open to women as well as men, why American cinema tends to suggest otherwise, and why the characteristic presentation of male uncertainty suggests not an alliance with women but either blank incomprehension or outright hostility. Though these are not questions with which Peberdy’s book is centrally concerned, her achievement is to require us to ask these questions in a way that takes account of performance, in all its registers. In a developing area of critical work, she offers a fresh and rich perspective, one which acknowledges the cinema as a medium bound by history but which insists on the complexities of filmmaking and film performance.