Marcus A. Doel

Attending to the world: Competition, cooperation and connectivity in the world city network

World Cities are acknowledged to be a key aspect of globalization. In many accounts, these cities are depicted as rivals in a global marketplace, their economic success a result of their competitive advantage. However, what has not been fully acknowledged is their connectivity and, in addition, the time and effort taken by specific ‘attendants’ to produce the World City network. Accordingly, this article aims to advance understanding of World City network formation by developing a conceptual model that focuses on four major attendants (firms, sectors, cities and states) that enact network formation through two nexuses —‘city-firm’ and ‘statesector’— and two communities —‘cities within states’ and ‘firms within sectors’. The utility of this model is demonstrated by drawing upon interviews conducted in offices of 39 advanced producer service firms in banking and law. These interviews were undertaken in three World Cities (London, New York and Singapore) in the wake of the East Asian financial crisis, an event that challenged the consistency of the World City network. Showing how attendants sought to maintain and transform the World City network at this key moment of crisis, we conclude that studies of city competitiveness ultimately need to focus on the cooperative work that sustains global networks.

Beyond belief? Consumer culture, complementary medicine, and the dis-ease of everyday life

The increasing popularity of complementary and alternative medicine (CAM) in the West raises profound questions for social scientists, not least because it is as much about consumerism as it is about health care. Although the sociology of CAM is well developed, its geography remains almost wholly unexplored. In this paper we argue that one of the main reasons for this neglect is the fact that (post)medical geography has found it extremely difficult to come to terms with the disconcerting fusion of health care and consumer culture, and its dispersion across a vast array of materials and practices that are often far removed from the established concerns of the subdiscipline. Accordingly, in this paper we approach the dispersed geography of CAM through two key sources of consumer information: a range of ‘popular’ health-related magazines produced for the UK market, contextualized in relation to a sample of twenty-four British-based patient support groups. Specifically, we consider three critical issues that are shaping the mass mediation of CAM: the displacement of efficacy; the abrogation of authority; and the cultivation of anxiety. The paper concludes with a brief consideration of a profoundly geographical problem: the difficulty of constructing effective pathways through a profusion of disparate materials and practices in a context that is literally beyond belief.

Disturbing geography: obsessive‐compulsive disorder as spatial practice

This paper explores the spatial practices of obsessive‐compulsive disorder (OCD). It begins by introducing the key elements of the disorder: obsessions and compulsions. It then concentrates on obsessions and compulsions relating to fears of bodily contamination. Such fears necessitate the formation of psycho‐social boundaries in ways that are similar to agoraphobia and other mental‐health problems. Avoiding bodily contamination also involves complex spatial orderings to prevent the illicit movement of contaminants. The vital importance, yet fragile nature, of these spatial formations means that negotiating social space and interactions can be immensely fearful, and the OCD sufferer may retreat to the relative safety of home. However, the domestic is a space of ambivalent safety. Everyday objects become saturated with fear, transforming the experience of ‘home’. Boundaries and spatial orderings are transgressed in the movement of people and objects. Thus, the OCD sufferer is driven to (re)order space constantly, and in doing so often uses everyday materials in inventive ways. We critique the depiction of OCD as irrational and excessive, and set the creative practices of OCD in relation to the ‘slippage’ of Michel de Certeaus distinction between spatial strategies of domination and the art of tactical living.

1a. Qualified quantitative geography

The rapprochement of humanism and structuralism on the one hand, and quantitative and qualitative approaches on the other hand, has not addressed an implacable difficulty which continues to haunt both spatial science and ‘critical’ human geographies. That difficulty concerns the ontological and ethical status of numbers, and their relationship to concepts, events, and sensations. The paper engages with this difficulty through a combination of theoretical and literary writings, most notably Woody Allens film Deconstructing Harry, Samuel Becketts play Not I, and Derridas work of Dissemination. Insofar as ‘one’ lacks consistency—by disavowing difference, alterity, and innumerable numbers—its deployment is invariably unbecoming, repressive, and ill-mannered. The ethical response is to divine ‘another way of working with numbers’, as Derrida once intimated; to prevent some ones from taking hold. The outcome is a form of poststructuralist geography that takes flight from all kinds of pointillism. After an opening scene that lays out the general setup of quantification and its qualification, the first section of the paper employs the notion of a soft ontology in order to prepare the way for ‘another way of working with numbers’ that is occasioned by a sensitivity towards the ontological buzzing and solicitation that accompanies processes of subjectification, objectification, identification, and enumeration. The paper concludes with an affirmation of a ‘disturbing geography’ that leaves everything in perpetual suspense.

Eleven themes of patient-centred professionalism in community pharmacy: Innovative approaches to consulting

Objectives  The study aimed to clarify patient‐centred professionalism within and across community pharmacy settings; position that knowledge in a modern‐day environment, accessing the opinions and experiences of patients and professionals; inform the literature on the value of consultation workshops within this context; and develop a template of positive and challenging exemplars of patient‐centred professionalism within these contexts.

Convenient space or "a tight squeeze": insider views on the community pharmacy

This paper presents research aimed at identifying the extent to which pharmacy spaces are aligned to good professional practice, enhance a professionals sense of self and meet the demands of the public. Findings from a novel, qualitative, mixed-methods approach employing biographic and photographic techniques indicate that UK pharmacy spaces are less accessible than intended by the Department of Healths pharmacy contract. Pharmacists escape to the dispensary to preserve their professional self-identity and to avoid the expectations of a demanding public. Recent innovations such as consultation rooms lack clarity of intent amid the multiple functions that a busy community pharmacy demands.

From manila to monitor: biographies of general practitioner workspaces.

This article presents a study that explores how general practitioners (GPs) reflect on their workspaces and what that tells us about how professional practice is enacted. The study employed biography as its data collection method to enable three pilot and nine other GPs from the Swansea Region in the UK to write about their consulting rooms. Thematic analysis of biographies, employing individual and group analysis sessions, revealed eleven themes of GP workspace. These indicated that although a minority of the group were totally satisfied with their environments, most of the group spent time and energy finding ways of creating environments of ‘best fit’, thus enabling lack of function to become part of their daily routine.

Obtaining consensus regarding patient-centred professionalism in community pharmacy: nominal group work activity with professionals, stakeholders, and members of the public

Objectives The aim of this study was to develop a ranked thematic list encompassing the positive and negative exemplars of patient‐centred professionalism in community pharmacy.

Narrating uncertainties about treatment of mental health conditions.

BackgroundIntegration of patient views in mental health service planning is in its infancy despite service provision being clearly dominated by narratives from professional consultations and medical records. We wished to clarify perceptions of uncertainty about mental health conditions from a range of provider and user perspectives (patients, carers, parents, mental health service providers) and understand the role of narratives in mental health research.Aims(1) To explore the utility of qualitative research methods, particularly narrative content analysis in mental health research, and (2) identify aspects of uncertainty in mental health service users and providers.MaterialFour hundred and six free text responses were considered as one element of an existing questionnaire about uncertainties about mental health treatments, collected from mental healthcare users and providers through charities, the Mental Health Research Network in Wales, health professionals and websites. Free text responses were analysed using narrative content analysis, an elaborate and rigorous research technique that involves groups of analysts working independently and together over extended group sessions.FindingsThree main themes emerged across respondent groups: “medication and treatment options”, “objectification and marginalisation of patient” and “integrity of service delivery”. Within these, patients embraced the opportunity to write about their illness at length, whilst carers’ and parents’ main concerns were about how patients were dealing with their illnesses, the services they were getting and the side effects of treatments. Carers and patients’ parents perceived themselves to be the ‘go-between’, carrying messages between patients and professionals, in order to enable services to function. Mental health service providers and professionals considered uncertainties surrounding medication and treatment from an ‘evidence-base’ perspective, concentrating on medication choices and the adoption of new approaches to care rather than patient need and expectation. Patients wanted to know what alternatives were available to the drug regimes they were on and felt their opinions were rarely listened to. As a consequence patients felt marginalised by the health systems there to support them and by society as a whole.ConclusionsNarrative content analysis can help distil large amounts of free text data and enable their successful interpretation. Listening to patients’ voices should become an integral part of routine service evaluation and may help bring patient expectation more in line with service organisation and delivery towards an optimal delivery of care.

Miserly Thinking/Excessful Geography: From Restricted Economy to Global Financial Crisis

Against the horizon of Earthly depletion and social exhaustion, miserly thinking is once again on the ascendancy, catching hold of critical and radical thought as well as the popular and conservative imagination. Whatever its ethicopolitical inflection, miserly thought enjoins one to conserve, constrain, and sustain. It is consumed by scarcity: specifically, the inability of the world to accommodate itself to the insatiable demands that are placed upon it. Faced with lack, miserly thought advances its ethic of restraint, the target of which is everything that would exceed the paucity of means placed at our worlds disposal. Pitching itself against miserly thinking, the paper unfolds a form of thought animated by excession rather than immiseration, by a world given as excess rather than as privation. This is accomplished in four parts, the first of which dislodges the grip of miserly thinking by recourse to Georges Batailles notion of general economy. The paper then considers arguably the best-known form of excessful thinking: Marxian political economy, as rendered by David Harvey. Nevertheless, while this successfully reveals how social formations are animated by surplus rather than by scarcity, its desire to restitute excess remains mired in miserly thinking. Consequently, the third part of the paper considers the fate of excess once it suffuses the whole of existence. With its ontology of association, Bruno Latours actor-network theory has gone the furthest in this regard. However, this ontology runs aground upon an inconsistent excess held in reserve: plasma. The final part of the paper addresses the limitations of Latours actor-network theory by way of Alain Badious ontology of subtraction. In the final analysis, the sequence of ‘lack’, ‘surplus’, and ‘association’ gives way to the constellation of ‘multiplicity’, ‘situation’, and ‘event’, which is illustrated with reference to the global financial crisis of 2008 and 2009.