Nick J. Fox

New materialist social inquiry: designs, methods and the research-assemblage

This paper discusses issues of research design and methods in new materialist social inquiry, an approach that is attracting increasing interest across the social sciences as an alternative to either realist or constructionist ontologies. New materialism de-privileges human agency, focusing instead upon how assemblages of the animate and inanimate together produce the world, with fundamental implications for social inquiry methodology and methods. Key to our exploration is the materialist notion of a ‘research-assemblage’ comprising researcher, data, methods and contexts. We use this understanding first to explore the micropolitics of the research process, and then – along with a review of 30 recent empirical studies – to establish a framework for materialist social inquiry methodology and methods. We discuss the epistemological consequences of adopting a materialist ontology.

Health identities: from expert patient to resisting consumer

This article explores the formation of ‘health identities’: embodied subjectivities that emerge out of complex psychosocial contexts of reflexive modernity, in relation to data on health and illness practices among groups of people and patients using medical technologies including weight-loss drugs and the erectile dysfunction drug sildenafil (Viagra). We examine a range of health identities, from the ‘expert patient’ - a person who broadly adopts a biomedical model of health and illness, to a ‘resisting consumer’, who fabricates a health identity around lay experiential models of health and the body. The understanding of health identities is developed within a theoretical framework drawing on previous work on body/self and the work of Deleuze and Guattari. It is concluded that the constellation of health identities reflects the diversity of relations in an industrialized, technology-driven, consumer-oriented and media-saturated society.

GPs in cyberspace : the sociology of a virtual community

It has been argued that on-line networked communication can enable the establishment of ‘virtual communities’. Empirical data from an electronic discussion group for general medical practitioners (GPs) are used to evaluate these claims, and to explore the similarities and discrepancies between on-line and face-to-face interactions. A distinct social order for this ‘community’ is reported, and the strategies to establish this order in a textual environment are discussed. Participants went through a cycle of integration into membership, and some generated distinctive virtual identities or personae. The notion of a ‘virtual community’ is critically discussed. Participants interacted as if they were part of a community, but it is suggested that the interactions on the list are best understood as extensions of the wider social relations of general practice. The study of virtual communities may thus have relevance for wider issues of social inclusion and citizenship. The paper also includes reflections on ‘cyberethnography’, and suggestions for further research are offered.

Refracting 'health': Deleuze, Guattari and body-self

This article considers ‘health’ and issues of embodiment through the prism of Deleuze and Guattari’s framework of theory. Deleuze and Guattari speak of an embodied subjectivity, a ‘body-without-organs’ (BwO), which is the outcome of a dynamic tension between culture and biology. This BwO – or ‘body-self’– is a limit, the outcome of physical, psychological and social ‘territorialization’, but which may be ‘deterritorialized’ to open up new possibilities for embodied subjectivity. The question ‘what can a body do?’ is posed to address issues of health and illness. The physical, psychological, emotional and social relations of body-self together comprise the limit of a person’s embodied subjectivity, and as such delimit its ‘health’. ‘Illness’ is a further limiting of these relations, while health care may offer the potential to de-territorialize these relations, opening up new possibilities. This model suggests the importance of a collaborative approach to illness, health and health care.

Boundary Objects, Social Meanings and the Success of New Technologies

Boundary objects are entities that enhance the capacity of an idea, theory or practice to translate across culturally defined boundaries, for example, between communities of knowledge or practice. This concept thus has potential to both explain and predict technology adoption; however, it remains sociologically under-theorized. This article assesses, by recourse to a historical case study of innovations in surgical sterility, how boundary objects work and their relationship to social meanings within communities of practice. It is concluded that not only are there positive and negative boundary objects, but that technological devices or processes may themselves act as facilitative or inhibitory boundary objects during innovation. The approach set out here has potential as a sociologically informed model of improving adoption of technologies and policies by managing the positive and negative social meanings of technology objects.

Postmodern perspectives on care: the vigil and the gift

This paper explores the perspectives which postmodernism and post- structuralism bring to an understanding of care, particularly in the writings of Jacques Derrida, Michel Foucault, Hélène Cixous and Stephen White. It is suggested that care is paradoxical. On one hand it is a tech nology of surveillance which, as a consequence of the professionalisa tion of caring, constitutes the vigil. But although this technology is one of control and supplies the authority for profession care, it is also possible to recognise an alternative caring, which is about love, generosity, and a celebration of otherness. This gift of care seeks to enable the cared-for person, and resists the discourses of the vigil. The paper examines the issues raised for practitioners by this dual character of care.

What are health identities and how may we study them

This paper draws together findings from studies of health and identity to develop a model of health identities, based upon Deleuze and Guattaris approach to understanding the relationship between self, body and society. The model is used to inform a methodology for the empirical study of identities in relation to health and the body. Using a sample interview transcript, the methodology of analysis is demonstrated. The application of the model and the methodology for studying health identities are discussed.

Foucault, Foucauldians and Sociology

Abstract This paper considers the application of Foucauldian perspectives within sociology. While Foucault’s epistemology has generated novel historical and philosophical interpretations, when transposed to sociology, problems arise. The first of these concerns the association of knowledge and power, and the concept of ‘discourse’. Foucault suggested that there are ‘rules’ of discursive formation which are extraneous to the ‘non-discursive’ realm of ‘reality’. This formulation is consequently both deterministic and incapable of supplying explanations of why some practices become discursive which others do not. This determinism is reflected in some sociological analyses of embodiment, offering a model of the ‘body’ which is passive, and incapable of resisting power/knowledge. Secondly, Foucault’s notion of the ‘self’ moves to the other extreme, inadequately addressing the constraints which affect the fabrication of subjectivity. Sociological accounts do not always recognise the ambiguities which consequently result from efforts to use Foucauldian positions. It is argued that post-structuralists other than Foucault may offer more to sociology.

The Ill-Health Assemblage: Beyond the Body-with-Organs

Abstract The ill-health assemblage comprises the networks of biological, psychological and sociocultural relations that surround bodies during ill-health. The paper argues for health sociology to reject an organic body-with-organs as its unit of analysis of health and illness, and replace it with an approach to embodiment deriving from Deleuze and Guattari’s ontology. I set out the three key terms: the body-without-organs (BwO), assemblages, and territorialisation. These concepts will be applied to health and illness, to develop an understanding of an ill-health assemblage. I contrast this with the biomedicalised body-with-organs, and explore the shaping of the ill-health assemblage in a case study.

Postmodernism, rationality and the evaluation of health care

This paper examines the logic of evaluation of health care services, calling into question the possibility of assessing the extent to which medicine and health care systems are ‘rational’ or ‘irrational’ The paper analyses and rejects claims to rationality made in discourses on evaluation and in particular economic evaluation, by recourse to Webers distinction between formal and substantive rationalities. The rationality claimed by evaluation is a value-laden and therefore substantive rationality. Similarly, the claims of the rational actor model are seen to over-simplify the ways actors interact in the market. This leads to a postmodernist perspective rejecting the idea of a single rationality, which if it can only be grasped enables the achievement of Truth, and substituting the position of contingent and fragmentary discourse, brought into being to serve the interests of particular groups in determining knowledge and power. With regard to the evaluation of health services, whereas the modernist assumes that the Enlightenment metanarrative of rationality has imbued the provision and delivery of health care, and that the evaluation by another discipline within this metanarrative, for instance health economics, can fine-tune this rational system for efficacy and efficiency, and suggest changes, the postmodern position recognises that both are distinct discursive perspectives, constituted for local reasons. This position is then applied to a case study of the management of surgical services based on ethnographic work conducted by the author. Deconstruction of the ethnography derives an understanding of the disruption of surgery as being a consequence of the arrangements for clinical advice in the committee structure of management.