Category: C Wright Mills

Why do we do what we do?

Photo by Alvin Mahmudov on Unsplash

Why do we do what we do?

 

“The powers of ordinary man are circumscribed by the everyday worlds in which they live, yet even in these rounds of job, family, and neighbourhood they often seem driven by forces they can neither understand nor govern. ‘Great changes’ are beyond their control, but effect their conduct and outlook none the less. The very framework of modern society confines them to projects not their own, but from every side, such changes now press upon the men and women of mass society, who accordingly feel that they are without purpose in an epoch in which they are without power” (Wright Mills 1956).

 

In common talk, we hear and read a great deal about ‘taking individual responsibility’ for example ‘for health’, or the need for ‘helping people to make better choices’  and we hear explanations for ill health based on people’s choice of unhealthy lifestyles. Papers like the Daily Mail like to focus unhealthy working class ‘chav’ cultures in a bid to promote outrage and to garner support to reduce the Welfare State. Every New Year, gym membership rises, dry January is embarked upon and resolutions to quit smoking are made. Failure often follows. The UK population is getting fatter, it drinks excessively and takes little exercise. We are also a nation consuming antidepressants as if they were smarties. Some individuals of course are ‘paragons of virtue’ in terms of health and the question is asked “if they can do it, why don’t the rest of us?”  Often this is framed within personal success stories as “I did it, so you can too (you fat lazy bastard)”. Celebrities are often promoted as role models for a “leaner, fitter, healthier you”.

The same goes for individual success. The advice is “work hard, take your opportunities, be focused, dedicated and determined”. If you fail, it is only down to you.

Most people probably know that eating well and taking more exercise is better for health. Most people probably accept that hard work and dedication is a necessary condition for achievement.

So why do we see continuing patterns of chronic ill health, early deaths, and deprivation? These patterns show social class differences, i.e. the  ‘social gradient’, and unequal health outcomes. Those in the lower socio economic groups die younger, experience more chronic illness and have fewer disability free years.  Is it really all down to individual moral failure?

The question is posed in common discourse:  ‘why don’t millions of us get up off our fat arses, do something positive and take responsibility for health and success’? Why don’t we as a population or as individuals always exercise our agency to act for better health? After all, we are all ‘free autonomous sovereign individuals ’ able to choose courses of action unconstrained by social conditions. If the individual is poor or unhealthy then it is probably a result of the decision making of that individual or so the extreme version of the narrative goes.

I would argue that we are free to be critically reflexive about our socially structured conditions and thus to a degree free to change circumstances, but that we are also products of our biology, psychology and social circumstances. Our actions are highly structured (e.g. by class structures) but not structurally determined.

The complete freedom to think and act may be more complicated than adherents of the ‘autonomous sovereign individual’ may have us believe. The model of the ‘free sovereign individual’, so beloved by libertarians, neoliberals and most hues of conservatism in their political stances, is a flawed and incomplete model of human behaviour. It is a model of human behaviour that arose in Enlightenment modernity, and results in the creation of ‘homo economicus’, the free instrumentally rational being, who weighs up the pros and cons of action independently of social or cultural influences or internal psychological drivers, and is 100% responsible therefore for the consequences of their action. The adherents of this model of the human are often in adversarial and vehement denial of the ‘social’ and the cultural, they deny completely that there just might be a social reality or cultures in which our individual agency operates. Many have a visceral loathing of concepts such as gender, ethnicity and class affecting life chances.

 

To better understand this mode of thinking which underpins beliefs about human action, it is necessary to root it in its history of social relationships and cultures. Max Weber, along with Emile Durkheim, Karl Marx, Auguste Compte, and many others, for example, C Wright Mills (1956, 1959) attempted to do just that. Currently, Roy Bhaskar and Margaret Archer have further expounded on ‘Agency, Culture and Structure’. But to keep it simple, Weber’s contribution sheds some light on ways of thinking that lead to action.

 

Max Weber introduced the word ‘Verstehen’ (German for understanding, perceiving, knowing) to describe the sociologists’ attempt to grasp both the intent and context of human action. The 18th century’s Enlightenment ‘man of modernity’ was seen to be increasingly using instrumental rationality to guide action and becomes a model explanation for human behaviour.  During this period, Enlightenment philosophers thought that the main basis for authority and legitimacy in social affairs should arise from the exercise of reason in opposition to authoritarian monarchy or religion. Hence concepts such as liberty, progress, tolerance were emphasised along with science and reductionism (understanding something by reducing it to its parts). These ideas arose alongside the rise of mercantile and then industrial capitalism.

 

Weber, in trying to understand why capitalism succeeded in Europe even though its conditions elsewhere in the world could have given rise to it, wanted to consider ideas and ways of thinking (e.g. the Protestant Ethic) that underpinned action.

 

He described 4 ‘types’ of social action and the thinking behind it:

 

  1. Zweckrational – means/ends rationality
  2. Wertrational – values based rationality
  3. Affective action – emotion based
  4. Traditional action – based in custom and practice.

 

In short, the Enlightenment was emphasising ‘zweckrational’ alongside developing a model of humanity as an autonomous rational being. This idea is still core to much of current ‘common sense’ orthodoxy. Today, many ignore or forget the other 3 types while focusing on ‘zweckrational’, assuming that this is our only way of thinking.

 

We know from experience and research however, that we choose courses of action not because they always meet a certain goal, but because of a mixture of all 4 types of reasoned action. Many also think about these types (if at all) as existing independently of society. They do not want to consider, or fail to consider, that the human actor is actually not an autonomous individual existing separate from society and culture from which they spring, but are social and relational. They do not want to consider that personal agency operates within society and culture which has a reality “behind our backs”.

 

Weber’s insight was to link these types to changing social conditions. He argued that modern societies differed from those of the past because of the shift to zweckrational thinking rooted in the growth of bureaucracy and industrialism. This might explain why today, in bureaucratised, industrialised societies, that instrumental, technical, means ends thinking came to dominate. The error for many is that the ‘is’ of the dominance of zweckrational becomes the ‘ought’, the only way to think and it becomes the assumed method of human thinking. I suggest that those trained in scientific, technical and logical (means-ends) occupations are apt to think using ‘zweckrational’ but assume that is how everybody else does and ought to think. They then become one dimensional in their own thoughts, unable to grasp the complexity of human decision making.

 

The social theorist Margaret Archer describes this ‘man of modernity’ as “a being whose fundamental constitution owes nothing to society” (2000 p51) and who is increasingly driven by instrumental rationality or ‘means-ends’ thinking. This is the ‘ready-made man’ who turns up out of nowhere to impose his own order on the world and applies rational thought to social concerns. It is a view of humanity that believes that our ‘self’, our individuality,  exists totally separate from society, that it is not constituted at all by society or culture. The free acting self is an independent of society and culture free thinking and rational being. We will hear echoes of this man’s voice when we hear such statements as “only the individual should and can take responsibility for health”, “there is no such thing as society, just individuals and families”. Any idea of social structure, culture or social forces is completely denied. In this view there are no social mechanisms operating ‘behind our backs’ that might be guiding free choices.

 

This model of the self assumes the primacy of agency devoid of social structure or cultural or language contexts. It not only assumes the primacy of agency, but elevates it into a core aspect of the political project (neoliberalism) to reduce any action on poverty or welfare beyond that of individuals, families and charities. If there is no society, then there is nothing society can or should do.

 

Those who adhere to this model might think that obese and overweight people merely freely choose to eat more than they need, that their inability to lose weight is down only to their weak moral character and lack of will power. The obese should “just say no” to a second pork pie. Against this I suggest that they eat and move within the structures and cultures of the ‘obesogenic environment’ (Foresight 2007) and within cultural practices around food that becomes aspects of who they are, that they build into their self-concept. Veganism for example has been seen as the preserve of a slightly effete (?) minority and for many men especially, just cannot be built into their own notions of self as ‘red meat eating males’. Their self-concept as a man excludes this food choice as viable. They are of course free to act as a vegan but the structural and cultural context militates against men many doing so. Some men will be able to draw upon their material, psychological, biological, social, cultural, spatial and symbolic assets to exercise their agency to become vegan. Many others will not be able to exercise the same degree of freedom to do so. Some men will be critically reflexive of their meat eating and will easily see it as a cultural construct not a biological imperative. Many others will not do so because meat eating is too intertwined with their own unreflexively criticised ideas of masculinity and their social group feels exactly the same way. They of course will offer up superficial reasons such as taste and protein to justify eating meat but will downplay its symbolic value (its ‘sign value’), its ubiquitous availability and price and finally they ignore or forget as irrelevant that there are huge vested interests in keeping the link between meat and masculinity alive.

 

There is not the space to fully explore this idea of the ‘free, pre-existing, independent from society’ view of self, other than to suggest that extricating human agency and the ‘self’ completely out of the effects of language, culture and social structure is erroneous. I emphasise however, the pernicious persistence of this idea in current culture, politics and health policy as it underpins much understanding of, and pronouncements about, human behaviour towards health and individual success in capitalist social structures.

 

I also suggest that those whose knowledge is non-existent, or superficially grounded, in philosophy, the humanities or social sciences cannot exercise their agency to begin to understand this argument. Their ‘ways of knowing’ and sense of self  is in violent opposition to it. They will be so embedded in certain social structures and cultural assumptions and values that the self they experience is unable to grasp the concepts. They will read the words but will feel an instant visceral hatred of the challenge to sovereign individuality because it shakes the very foundations of who they think they are and the basis for success and failure. Current ideal types would be Boris Johnson, Peter Thiel the PayPal billionaire, Rupert Murdoch, Donald Trump, many in Silicon Valley and the alt-right. In fact most of the powerful world leaders might fall into this category including Putin, Erdogan and Modi. They may well feature varying degrees of narcissism, ‘alpha male’ ideology and the assumptions of what Graham Scambler calls the ‘Greedy Bastards’.

 

The Sociological Imagination.

Part of the answer to understanding why we do what we do,  will be found by exercising our sociological imaginations (Wright Mills 1959) to gain a fuller understanding of human behaviour. We need to think beyond the action of an individual, to consider the wider actions of society and culture that provides the context for individual choices at this point in history.

Take the choice to eat insects. In the UK we are free to do so. We could exercise our ‘free agency’ as sovereign individuals. There is no biological reason why we don’t. There is no legal barrier to doing so. There is no trade barrier, tariffs or taxes in importing insects as food. What prevents us eating insects is a combination of cultural barriers with a lack of social institutions that values eating insects and no social institutions providing access to insects. Psychologically we might think that the eating of insects is not part of our ‘self-concept’, there is no social learning going on because no one is doing it, the mental short cuts bypass rational appraisal and go straight to the ‘yuk’ factor. We live in an obesogenic environment and not an ‘insectivorous’ environment.

Why do fat people eat pork pies? Why don’t thin people eat insects?

Graham Scambler in wishing to establish a theory of agency in sociology argues:

 

Humans…are simultaneously the products of biological, psychological and social mechanisms while retaining their agency…socially structured without being structurally determined

 

I think this means that if you want to know why some people can resist eating the pork pie and most in the UK resist eating insects, you have to think holistically rather than individualistically. You have to avoid the temptation to be reductionist and instead think ‘systems’.

A biologist would focus on physiological processes and raise the importance of body chemicals such as leptin, dopamine, serotonin and endorphins in stimulating behaviour. They might acknowledge the physiological role of sugar and processed carbohydrates in providing very satisfying, but unhealthy, eating habits. This is perhaps the first hurdle that ‘will power’ has to overcome.  ‘Willpower’ is of course the ‘go to’ mechanism for those with individualist understandings.

A psychologist might explain eating patterns from a variety of perspectives: cognitive psychology might outline the role of mental short cuts that bypass rational thinking; behavioural psychology emphasising the conditioned nature of responses; social psychology which asks us to consider the power of social learning upon choices and psychodynamic psychology which would raise deep seated emotions as drivers for behaviour e.g. food playing the ‘comfort’ role to compensate for deep seated painful emotions. All have explanations that down play the power of technical instrumental rationality (zweckrational). Key concepts within psychology which could be linked to why we eat as we do include:

  • Self-Efficacy.
  • Body Image.
  • Locus of Control.
  • ‘What the hell’ effects.
  • Future Discounting.
  • Classical/Operant Conditioning.
  • System 1 and System 2 thinking.
  • Self and self-awareness.
  • Adult, Child, Parent Ego States.

 

Both biology and psychology examine the individual body and mind. They seek explanations for human agency within ourselves. For some people, that is enough. Yet both disciplines cast huge doubt on the idea of ‘free thinking sovereign individuals’ who use rational thought, and the exercise of sheer willpower in achieving their aims.

If you have not eaten for three or four hours, and you pass a shop selling freshly baked bread or pasties, or foodstuffs you very much enjoy, your will power to lose weight is severely challenged first by your biology as the body reacts to sight and smell of delicious food and then by your psychology as the ‘what the hell effect’ kicks in supported by ‘future discounting’. Your future self as a slim lean athlete is discounted by your immediate self’s need for food.  As you go through your day you are immersed in social and cultural invitations and opportunities to eat and to eat too much. Against this is will power, unless you can actively design your social and cultural environment every single day to support will power, you may well crack. Do you have the material, psychological, social, cultural, spatial and symbolic assets to do this day after day after day for years? For the rest of your life? Some also have poor biological health assets in this regard as in utero processes may well have pre-set a certain weight for you that your body will always want to get to.

We are not completely free autonomous agents beloved of neoliberal ideology. Our lives are highly structured, but not structurally determined. We are the result of a complex interplay of our biology, our psychology and the social. Underpinning much of the common discourse in our media is the idea of the ‘liberal human self’, and failures to live healthy lifestyles are to be found in the individual. This belief, and it is a belief not a scientific fact, often leads to a ‘Moral Underclass Discourse’ (MUD) to explain health inequalities. The MUD focuses on cultural and behavioural explanations, rather than sociological, for health inequalities. It is a discourse that leads easily to victim blaming.

We need to think a little more critically about this explanation, particularly as it has a great deal of political and social force in terms of policies we design to tackle health. We need to bring the social (structure) to the individual (agency). We need to ask to what degree are we free agents who can take 100% responsibility for our lives, we need to examine what social structures exist in which that agency operates.

Margaret Archer has published a series of books on this central problem of structure, culture and agency, i.e. the relationship between our personal actions as free agents and the societies and social structures we are born into.

We know that smoking is linked to illness and disease, we also know there are patterns to smoking which show prevalence is not spread equally across class or age. If we want to more fully understand smoking behaviour we require not only the sociological imagination but also why people as ‘free agents’ continue to smoke despite knowing the consequences. The answer is of course complex, situated in and mediated by a matrix of the biological, social and psychological. Smoking occurs in a social context in which people are enabled or constrained in their behaviours by the structures of society and mediated by their and others’ ‘reflexive deliberations’ and to a degree, their biology (the ‘substance’ (nicotine) theory of addiction).

Archer’s theory suggests that our individual actions are predated by the existence of social structure of, for example, class relationships. Class structure, and the culture associated with it, are transmitted to individuals. In smoking’s case, the culture of smoking was once widespread across all social classes and therefore to take up the habit was not to be seen as a social pariah. Quite the opposite. George Orwell in both ‘Homage to Catalonia’ and ‘The Road to Wigan Pier’ describes vividly the valued place of tobacco in people’s lives. Today however, smoking has a class characteristic to it, the middle classes apparently are more open to health warnings than those lower on the social scale. This ‘predates’ any individual coming into puberty today. The ‘cachet’ associated with smoking, or its status as a rite of passage, has to be factored in to understanding why some people shun the habit while others embrace it. In addition, the short term comfort smoking brings in the face of immediate precarity, insecurity and adverse social conditions, also has to be factored in.

Weber’s ‘Affective Action’ comes into play at this point as we realise the part feelings play in decision making.

The smug middle classes may easily shun chavs for their  smoking and drinking habits but they are unable to grasp what poverty does to one’s feelings.

Orwell again clearly describes this process.

“…it is altogether curious, your first contact with poverty….you thought it would be terrible, it is merely squalid and boring. It is the peculiar lowness of poverty that you discover first…the shifts it puts you to, the complicated meanness, the crust wiping.

 You discover, for instance, the secrecy attaching to poverty…you dare not admit it, you have to pretend that you are living quite as usual.

 You discover what it is like to be hungry…everywhere there is food insulting you in huge wasteful piles…a snivelling self pity comes over you at the sight of so much food.

 You discover the boredom…you discover that a man who has gone even a week on bread and margarine is not a man any longer, only a belly with a few accessory organs…

 …but you discover the great redeeming feature of poverty: the fact that it annihilates the future…

 And there is another feeling that is a great consolation in poverty. It is a feeling of relief, almost of pleasure, at knowing yourself at last genuinely down and out. You have talked so often of going to the dogs – and well, here are the dogs, and you have reached them, and you can stand it. It takes off a lot of anxiety”.

(Chapter 3, Down and Out in Paris and London 1933)

In this context. Smoking is not quite so bad.

 

Archer however does not wish to over emphasise how such social structures affect action, rather there needs to be a focus on how agents respond and act to those circumstances. There is a causal efficacy to agency, we are not automatons responding to class structures, poverty or obesogenic environments. We can make choices to act in certain ways to not buy the pork pie.  We do so by having internal conversations which are mediated by our ‘mode of reflexivity’ which at this point in history is particularly salient.

You and I are confronted in our daily lives by social circumstances, and we have a choice of action. We bring to that choice of action our own priorities, our ‘projects and concerns’. What we then do is mediated by the type of internal conversation, or reflexive deliberation. Archer’s thesis is that in the past social structures were such that little self reflexivity occurred. We ‘knew our place’, we knew what our role was and what status we had.  This was Weber’s ‘Traditional Action’.

However, as societies modernised, cultures and structures confronting us are far more open to change and critique, and are so by the actions of the people involved. The use of ‘Zweckrational ‘replaced’ ‘Traditional Action’. Women for example, no longer took for granted that their place was to rear children and to engage in unpaid domestic labour. They thought about the franchise and employment and some decided to act differently to ‘break the mould’. Why do some act to challenge social structure and why do others conform and thus replicate social structures?
 

The subjective powers of reflexivity mediate the role that objective structural or cultural powers play in influencing social action and are thus indispensable to explaining social outcomes’ (Archer, 2007: 5).

In other words, your inner voice is confronted by the facts of the obesogenic environment or of social class or of gender relationships in the workplace, but you can be reflexive upon that fact and so it can be acted upon. Action can be, for example, fatalistic towards that circumstance or instead might confront it in an attempt to overcome any perceived or actual disadvantage. You might engage your zweckrational, your affective rationality, your values based rationality and/or act based in tradition, custom and practice. In short, you exercise critical reflexivity, or not!

Agency and Context

Yet Agency is necessarily contextualized, it occurs in a context of social structure and culture characterised by power differentials. That is the objective fact the people confront every day. For example, an objective social fact that predates your existence is the social structure of education in the UK. Exercising personal agency towards financial and material success is a lot easier if you are born into a wealthy family and are sent to one of the prestigious English public schools and Universities.

Archer’s (1995, 2003, 2007) way of articulating this is in terms of a three-stage model.

  • Structural and cultural properties objectivelyshape the situations that people confront involuntarily; the structural and cultural possess powers of constraint and enablement in relation to
  • People’s own constellations of concerns, as they define them.
  • Courses of action are produced through the reflexive deliberationsof subjects who subjectively determine their practical projects in relation to their objective

 

Think about the social structures that produce, advertise and market and then distribute food  – how that this currently characterised by the industrial production of delicious, tasty and cheap foodstuffs packed with sugar, salt and calories. The objective cultural context might include aversion to walking and cycling as we perceive these as impractical, dangerous or too slow.  Think about the culture of eating food and the sociability that surrounds certain foodstuffs. What role currently does wine play in the cultural life of many women, and what about beer for men? These objective conditions provide ‘enablements’ to eating easily too many calories. It is made easy to do so. What constraints do we have in eating too much? Well, against the above we have health injunctions not to do so, we have body images that emphasise thinness with attractiveness. If the various constraints to eating too much are not as strong as the enablements, then the individual has to work hard  on clearly identifying their ‘concerns’ – one of which is to lose weight. This has to be turned into a project, something that they focus on every day to combat the many opportunities to fail at achieving the goal. People will tell themselves if the daily project of losing weight is achievable given the reality of their working and social lives. They will draw upon their health assets to help them do so. If their health assets are very poor across the board success is not impossible (they are after all free agents) but it will be harder.

 

Agency operates within certain social and cultural contexts, so consider how agency is operated by an A list actress and a struggling in debt mother. What social ‘forces’ propelled them into two very different circumstances and how much is down to personal achievement, luck or circumstance? Consider they now give birth to daughters. What are the chances of either girl using personal agency to radically alter their circumstances. Yes, it happens (e.g. Oprah Winfrey) but who will have the easier path?

 

The following table are ideal types to illustrate just some of complexity of the interplay between biology, psychology and sociology in understanding health choices and health outcomes. These factors are not be thought of as a simple cause effect relationship, there are feedback loops and emergent properties from the whole. Nothing is predestined, all is possible. The list is not exhaustive either. There may be other confounding variables that will change outcomes. The actress may develop a cocaine habit, Vicky may become an ‘Educated Rita’.

 

Health Asset A list celebrity Actress Vicky Pollard “yeah but no”
Biological Ectomorph

Non variant FTO gene

No chronic illnesses

Endomorph

Variant FTO gene

Type 2 Diabetic

Psychological High self-efficacy

High self esteem

High body image (body reality matches body ideal

Internal locus of control

Emotional and sexual support

Depression free

Positive outlook

Low self-efficacy

Low self esteem

Poor body image (body reality far from body ideal)

External locus of control

Emotional and sexual abuse

Bouts of depression

Suicidal ideation

Social Similar looking thin peer group

‘Network effect’ is positive

Social support for domestic needs

Child care easily affordable

Food prepared by nutritionist

Supportive parents and spouse

Socially popular

Wealthy successful peers

The 0.01% Global elite

Private School and Drama School paid by parents

Similar looking fat peer group

‘Network effect’ is negative

No social support for domestic needs

Child care expensive

Food prepared by Greggs

Parents both dead, absent partner

Social pariah

Poor just about managing peers

The local Precariat

Left at 16 with no qualifications.

Cultural Ambitious

Health high priority

Non Smoking

Gym Membership

Non Violent

Survivalist/Fatalist

Health discounted

Smoking

Daytime TV

Emotional, verbal and physical violence is common/expected

Spatial Beverly Hills, Sunshine, Sea View and palm trees Concrete high rise, Rain, Industrial Units and burned cars
Symbolic ‘A’ list celebrity Demonised Chav
Material

This asset is paramount as it feeds into the others

High Net worth

 

In debt.

 

 

Conclusion.

It is complicated.

The data clearly, for example in ‘Fair Society, Healthy Lives’, shows social patterns for a whole range of indicators from educational achievement to premature death. These patterns are characterised by the ‘social gradient’, i.e. the lower down on the socio-economic scale you are, the worse your outcomes are likely to be across the board. These patterns are further complicated by intersections of ethnicity and gender, but the most salient is social class. Your individual success or failure at anything is down to luck: primarily who your parents are (determines your class, ethnicity, geographical location and you’re your access to education, networks, supportive cultures and material well-being).

The period of history you were born in is also crucial. The post war baby boomers in the UK benefitted from an explosion in middle class and managerial white collar jobs, the expansion of educational opportunities,  the breaking down of class barriers and status, well paid industrial employment and cheap credit, mortgages and house price affordability. To be born white, male, middle class in the UK in 1955 was a huge privilege. To be born black, male, poor in Alabama in the 1920’s could see you lynched on the Courthouse lawn.

Biology plays its part but is by no means determines your destiny. Hard work, focus and determination are also key but they operate in this wider context.

That is why your life is highly structured but not structurally determined. You are not a free autonomous rational individual even if it feels that way. ‘Poor boy done good’ does not validate the system it merely shows it is complex. This narrative can also be used to justify the status quo as meritocratic, a concept in practice which is largely mythical.

The political issue that arises then is one of whether you see the status quo and just accept it as inevitable, or whether you think something can be done. I suggest that many of the ‘Greedy Bastards’ (with notable exceptions) take the former, it is not in their interests to change anything at all.

 

 

 

Graham Scambler, emeritus professor at UCL, has written a series of blogs based on the work of Margaret Archer. His work can be found here: http://www.grahamscambler.com/sociological-theorists-margaret-archer/.

Archer,M (1995) Realist Social Theory: The Morphogenetic Approach. Cambridge; Cambridge University Press.

Archer,M (1998)  Realism in the social sciences. In Eds Archer,M, Bhaskar,R, Collier,A, Lawson,T & Norrie,A: Critical realism: Basic Readings. London; Routledge.

Archer,M (2003) Structure, Agency and the Internal Conversation. Cambridge; Cambridge University Press.

Archer,M (2007) Making our Way Through the World. Cambridge; Cambridge University Press.

Archer,M (2012) The Reflexive Imperative in Late Modernity. Cambridge; Cambridge University Press.

Archer,M (2014) The generative mechanism re-configuring late modernity. In Ed Archer,M: Late Modernity: Trajectories Towards Morphogenetic Society. New York; Springer

 

See also C Wright Mills (1959) The Sociological Imagination. Oxford University Press. Oxford. Chapter 1 ‘The promise’.

C Wright Mills (1956) The Power Elite. Oxford University Press. New York.

 

 

 

The Task….

It is the political task of the social scientist — as of any liberal educator — continually to translate personal troubles into public issues, and public issues into the terms of their human meaning for a variety of individuals”.

C Wright Mills. The Sociological Imagination (1959).

This statement is the reason for a good deal of my work. I was first introduced to the book ‘The Sociological Imagination’ way back in 1983 when it was the very first text given to us undergraduates. I admit the full force of the book’s meaning was understood only later and after reading various sociological theories and research studies did this ‘quality of mind‘ begin to flourish.

The sociological imagination enables us to grasp history and biography and the relations between the two within society. That is its task and its promise

In everyday conversations, and on social media, we speak about any manner of things that excite us, annoy us, amuse us. We complain and comment. All too often however we do not engage in the ‘quality of mind’ that is the sociological imagination and thus we fail to fully understand the issue. This does not matter for the trivial issues, but it does for wider social and political issues. Our lack of critical understanding, our lack of an historical context , our lack of imagination, leads all too often to views and actions that are stupid, racist, dangerous and callous. In so called democratic societies we end up voting for stupid, racist, dangerous and callous political leaders.

At best, this lack of an imagination leads to policy that is woefully lacking. In a previous post I outlined the complex and multifarious nature of the obesogenic environment.

Those struggling with weight gain are all too familiar with the stigma that follows overly simplistic explanations and policy makers are all too readily drawn to lifestyle drift response to weight gain.  Lifestyle drift refers to the phenomenon whereby policy makers accept that there are wider determinants to health issues such as weight gain, but drift towards lifestyle responses as the key interventions. This results in the insanity of accepting the ‘obesogenic environment’ but then advocating individual behaviour change as the policy response.

It is necessary for me and others like me to point out that your personal trouble is to be understood not only, or just, as a result of your personal decision making. It is to show that your personal decision making occurs in a society in which there are powerful individuals, organisations, corporations, technologies and social structures who have a vested interest in the decisions you make, and who then collectively spend billions in product development, marketing with ‘sign values‘, demand management, and dissatisfaction manufacturing to make a profit. Claims of ‘corporate social responsibility‘, or ‘creating shared value‘, have to be taken with huge truck loads of salt in far too many examples.

The sociological imagination links your individual decision to drink coca cola with the vast network that lies behind the point of delivery of that can into your hands. Your ‘personal biography’ which includes “I drink coca cola” is linked to this point in history in which there exists a multi billion dollar corporation with a vested interest in you drinking its product. The sociological imagination takes this relationship between can and corporation and investigates what this means. It does not say “Thou shalt not drink coca cola”. It does however provide information about what that simple act means socially and politically so that we come to see drinking a can of coke as a social and political act as well as a thirst quenching one.

The Sociological Imagination

“The sociological imagination enables us to grasp history and biography and the relations between the two within society. That is its task and its promise” C. Wright Mills

Photo by Lance Anderson on Unsplash

This is a key work in the sociological literature and provides a way of thinking about our experiences as individuals in society at any given point in time. The argument is that to fully understand ourselves we have to apply the ‘sociological imagination’ to our ‘personal troubles’.

The relevance for health is that this takes us beyond making overly simplistic analysis of our health behaviours, experiences and decisions. If our analysis is too simplistic then we come up partial answers to health care issues at best and irrelevant, judgemental or dangerous answers at worst.

C Wright Mills wrote:

‘…men (sic) do not usually define the troubles they endure in terms of historical change…’ (p3).

So, what is a ‘trouble’?  That might be an episode of illness.

 

 

Personal troubles:

 

  • Having type 2 diabetes and thus having to manage that condition
  • Living alone
  • Being overweight
  • Worries about changes in the benefits system

 

 

We may not consider that our issues (as personal troubles) are better or more fully understood as being linked to living in the 21st century, or that the roots may lie in current society. We are

‘…seldom aware of the intricate connection between the patterns of their own lives and the course of world history.’ (p4).

We do not

‘…possess the quality of mind essential to grasp the interplay of man and society, of biography and history…’  (p4).

In addition we:

‘…cannot cope with their personal troubles in such ways as to control the structural transformations that lie behind them.’  (p4).

What ‘structural transformations’ might be behind living alone, diabetes, weight gain and money worries?

What is a ‘structural transformation?’

If we think of society has having ‘structures’, which vary from society to society and which varies within the same society over time (history), we may begin to understand that society is but the outcome of individuals, groups, communities and populations deciding to act out their relationships one with another. In doing so they create (and are created by) society and its social ‘structures’. We have family structures, gender role structures, work organisation and employment structures, educational structures, health care delivery structures, food manufacture, marketing and delivery structures, economic structures…..  A commonly experienced social structure today is the baking or buying and eating of cake and coffee as a social event. In response to, or perhaps to encourage this, we now have both small businesses in town centres and global corporations (Nestle, Starbucks, Costa Coffee) oriented to selling us high calorie non essential  food and drink.

Relationships between people evolve as humans live their lives and develop their capacities and these relationships then act as structural patterns for others to follow. This process of ‘evolution’ and ‘pattern’ changes over time and between societies. An individual thus is both shaped by these (structural) patterns of living, and in living their lives they in turn shape the patterns (structures). Our lives are thus ‘structured’ but not determined by these structures.

What social structures are there and what are those structures that lie beneath the personal troubles outlined above?

To help answer that question Wright Mills argued that

 

what they need…is a quality of mind that will help them to use information and to develop reason in order to achieve lucid summations of what is going on in the world and of what may be happening within themselves… this quality…(is) the sociological imagination.” (p5).

 

What information do we have about Type 2 diabetes – its rate, prevalence, risk groups, epidemiology, aetiology, and the wider determinants? To fully understand why anyone now has Type 2 we need to get this information and consider for example that:

 

We might be ‘overweight’. What exactly does that mean and how much of an issue is it? The fact that we might now have type 2 diabetes suggests that previous diet, levels of exercise and lifestyle may have contributed. What do we know about weight gain and the link to diabetes?

Our personal story of being overweight is linked to various structural and technological changes in society over our lifetime. These changes include the abundance of fossil fuels to use for energy (a technological change) instead of food, so that cars replace cycling/walking. Active travel is replaced by driving, while the social meaning of driving and car ownership underpin our unwillingness to cycle, walk to the bus stop or railway station.

So, to what degree are we responsible for gaining this weight? Many of us have lived through a time when the public’s understanding of diet was perhaps rudimentary, constrained as it was by rationing and availability and the social norms that construct a ‘healthy’ diet. Many of us experienced ‘socialisation’ which involves learning the values, norms and beliefs of our culture regarding what is appropriate food. To what degree is  vegetarianism, veganism or the mediterranean diet, popular and or promoted as healthy option?

We need to consider what a healthy diet is and how the public get to know. Currently the eatwell plate is a suggestion, but to what degree do the public know about it, how much are they guided by it and what is the evidence base for it? We might want to consider if there are any vested interests in selling us high calorie, sugar dense foodstuffs?

Exercising a sociological imagination also asks what social changes occurred so that we have now an abundance of sugar in the form of high fructose corn syrup?

Our early lives would have been guided by social norms and what shops could provide, as well as cost. the ‘personal trouble’ is weight gain but it is also a public issue as the whole UK population has gained weight. So we need to connect changes in social structures and historical events to the personal story that is a diagnosis of diabetes, to fully understand current health.

The role of sugar in the diet is an issue, what is the history of the dietary advice regarding fat and sugar? We may well have been consuming sugar in amounts that seems normal and indeed is hidden. This could be part of what is called an ‘obesogenic environment’ in which we are immersed and have been for several decades. What do we believe and think about sugar in the diet? To what degree does rational thinking about the risk to weight from eating a ‘normal’ UK diet, feature in buying, cooking and meal preparation decisions?

 

The sociological imagination enables its possessor to understand the larger historical scene in terms of its meaning for the inner life….’ (p5).

This is what Wright Mills refers to when he argued that:

The first fruit of this imagination…is the idea that the individual can understand his own experience and gauge his own fate only by locating himself within his period, that he can know his own chances in life only by becoming aware of all those individuals in his circumstances’ (p5).

 

Wright Mills outlines:

‘The personal troubles of milieu and the public issues of social structure’. (p8).

Troubles:

These occur within the individual’s immediate experience and relationships. They relate to the individual self and to those areas of social life of which the individual is immediately, directly and personally aware. The description of what the trouble is and what the solutions are, come from the individual and within the scope of their ‘social milieu’. A trouble is a private matter; they are values that we feel are threatened.

One of our personal troubles may be feeling and living alone and feeling that whatever we does makes no difference (learned helplessness). The value being threatened here is the value of social relationships being missed.

 

 

Learned helplessness is a state of mind which results in the inability or the unwillingness to avoid negative experiences as a result of thinking that those experiences are unavoidable (even if they are avoidable). This arises because one has learned that one does not have control over the situation. Learned helplessness theory is the view that clinical depression and related mental illnesses may result from a perceived absence of control over the outcome of a situation.

 

Public Issues:   

These are matters that go beyond the local environment of the individual and their inner life. They result as an ‘organisation’ of many such situations into the structure and institutions of society. The countless individual social milieux (i.e. ‘all the lonely people’ in the UK) overlap and create society at points in history. An issue is a public matter; issues threaten values held by the public. When this happens there may be public debate about what that value is and what really threatens it. There is some evidence that loneliness is becoming a public issue as the scale of the issue becomes clearer and its health effects become known.

One of Wright Mill’s examples to explain the use of the sociological imagination is unemployment:

‘When…only one man is unemployed, that is his personal trouble, and for its relief we look to the character of the man, his skills and his immediate opportunities. When…15 million…are unemployed, that is an issue, and we may not hope to find the solution within the range of opportunities open to any one individual. The very structure of opportunities has collapsed. Both the correct statement of the problem and the range of possible solutions require us to consider the economic and political institutions of society and not merely the personal situation and character of a scatter of individuals’. (p9).

What the individual unemployed man (out of the 15 million) experiences is often caused by the structural changes in society. When global economics means that steel can be produced more cheaply in a foreign country (a structural change) then a UK steel works shuts down. To be aware of the idea of social structure and to use it, is to be able to trace links among a great variety of individual social milieu which, as Wright Mills’ states, ‘…is to possess the sociological imagination’ (p11).

There is more than one person who lives alone, is overweight, struggling with diabetes and has money worries. Therefore these personal troubles are also public issues of society if we use the sociological imagination.

To fully understand our life means understanding how society has changed and the opportunities and threats to health that arise as a consequence. It means understanding that our personal agency, the freedom to act, operates within particular social structures that constrain action as well as providing enablements. So, what constrains our action, what enables us to take control of our lives?

Understanding obesity using the sociological imagination links the personal trouble of weight gain with the public issue of whole population shifts in BMI within the context of the obesogenic environment. A fuller understanding of ‘fatness’ goes beyond overly simplistic calculations of calories in = calories out type equations, and simplistic exhortations to “eat less move more”.

Implications:

Health and illness is to be thought as arising from social structure as well as, if not more than, biology. The knowledge that diabetes results not just from the individual’s choice of diet, but also from the social environment, should indicate a  public health and socio-political role. Health education is not just an individually focused issue, based on a biomedical understanding. Health itself has social origins. The concept of an ‘obesogenic environment’ suggests just that.

Therefore strategies that will assist people to move towards health must take into account the social and political context in which they live. Society has to change as much as the individual. Individualised models for change that ignore this will have less chance of success.

Understanding that illness, although at first may seem self-inflicted and out of free will, may result from the social milieu of the individual.  Victim blaming of the unpopular patient, the obese, the self-harmer, the drug addict, the alcoholic, is not only poor practice but is theoretically myopic. That is to say it does not understand the wider determinants of health. This realisation should change the language around health into a more open, less judgemental stance towards the people. For example, the label alcoholic implies the trouble lies within the individual when the roots may also be social.

To summarise: 

  • Health and Illness both derive from socially structured human agency, societal as well as biology.
  • The patterns, experience and causes of health and illness has to be understood in the context of history and culture.
  • The meanings that people attach to health and illness not only are built by social structure but go towards creating social structures.
  • Professionals need to acknowledge the complexity of health and illness and adopt a more open, non judgmental viewpoint.
  • There is a social/political and public health role.
  • Models for change have to go beyond individualised biomedical understandings of health and illness, realising that ‘education’ is not a universal panacea.

 

Benny Goodman      September 2017

 

Hunt’s agenda

The ideology of health care provision.

 

 

Amid the junior doctors strike of 2016, the health secretary Jeremy Hunt was embroiled in a conflict with the BMA over doctors’ contracts designed to address a 7day NHS. This is the surface issue but sits upon a deeper ideological conflict, one that many of the doctors will be unaware of but will suspect, especially if they have read Alysson Pollock’s works on the privatisation and corporatisation of the NHS. Hunt argued he has a ‘mandate’ to introduce a 7 day NHS and perhaps realises that if this policy cannot be introduced, the balance of power over the future of the NHS will swing back towards the BMA and other health professional groups. The irony is that the BMA opposed the introduction of the NHS back in 1948 but now is one of the strongest supporters. Since 2012 however, the NHS has been dismantled and been replaced with privatised and corporatized service provision, with ‘patient choice’ and ‘patient safety’ being used as the ideological veil which masks the corporate face. People have not noticed this detail because so far ‘free at the point of delivery’ is still in place, but this principle, along with universal and comprehensive cover, is under threat. The government remain the almost monopoly purchaser of health services on our behalf but for how long? The care home crisis points in the direction of travel. This will be withdrawal of state funding and reliance on private provision which will not be ‘free at the point of delivery’.

 

 

 

In 2005 ‘Direct Democracy – an agenda for a new model party’ was published, the authors include the current health secretary Jeremy Hunt. It is not government policy and does not represent the full range of conservative views. The Tory party itself is home to those of a ‘one nation’ persuasion who mix ideas of ‘noblesse oblige’ with a modicum of a social welfare, safety net, public service ethos. It is also home to ‘neoliberalism’ rooted in anti State sentiment based on freedom of the individual and free market economics. This ideology can be clearly seen in the 2012 book ‘Britannia Unchained – Global lessons for growth and prosperity’ which argues for further free market economics based on a bonfire of employment laws. The book suggests:

 

“The British are among the worst idlers in the world. We work among the lowest hours, we retire early and our productivity is poor. Whereas Indian children aspire to be doctors or businessmen, the British are more interested in football and pop music.”

 

This one quote conveys the disdain neoliberals have in general for those less well paid, less “successful” and less powerful than themselves. Boris Johnson’s speech in 2013 on the impossibility of equality being based on differences in IQ, implied some people are too stupid to get ahead. This individualises issues, while ignoring structures of class, gender, ethnicity and privilege. He said:

 

And for one reason or another – boardroom greed or, as I am assured, the natural and god-given talent of boardroom inhabitants – the income gap between the top cornflakes and the bottom cornflakes is getting wider than ever. I stress: I don’t believe that economic equality is possible; indeed, some measure of inequality is essential for the spirit of envy and keeping up with the Joneses that is, like greed, a valuable spur to economic activity.”

 

Two ideas are core here: that the working class and the poor are so because they are more lazy and stupid than the ruling class, and that the answer to this is to increase competition and to use inequality as incentives for personal improvement. Of course said like that to the electorate, it would seriously threaten voter support. Instead the discourse of market efficiency, effectiveness and choice is used to justify privatization and corporatization of public services. The message to the public is clear: take responsibility for education, health, social care and housing. It is down to individuals and families to provide by working hard and being prudent.

 

The arguments over the NHS have to be seen within this wider context. At heart, many in the current Tory party viewed the state run NHS as anathema. As such they have succeeded in dismantling the post war structure of the NHS following the Health and Social Care Act 2012. This allowed for private providers to bid for the provision of health services but keeps in place, for now, principles such as ‘free at the point of delivery’.

 

According to Alysson Pollock, the Health and Social Care Act 2012:

 

  1. Removed the duty of the Secretary of State for health to secure and provide health care for all.
  2. Introduced US style insurance schemes.
  3. Gives the secretary of state legal powers to create a market, allows providers to pick and choose which patients will get care, services to be provided and what will be charged for.

 

A market has been introduced into health service delivery, and markets operate through risk selection and appraisal resulting in fragmentation of provision. That is to say a market provider needs to pick and choose which patients are profitable in competition with other providers. We now have clinical commissioning groups modelled on insurance based lines. Those with high risk or multiple needs will be expensive to provide care for.

 

The ‘NHS’ is now fragmented in which:

 

  1. Services are broken up and put out to tender to commercial companies.
  2. Commercial shareholders have new legal powers to decide who gets care, what the get and what they pay for.

 

This current state of affairs is not enough for neoliberal thought. So what is the vision of this group of neoliberal Tories? How did this happen?

 

Direct Democracy argues:

 

“Several other countries operate political systems based on localism and direct democracy. Two outstanding examples – one much smaller than the United Kingdom and one many times larger – are Switzerland and the United States. In their different ways, both states respect the principles of the dispersal of power, the direct election of public officials and the use of the referendum as a legislative tool. Our proposals for the devolution of power directly to the citizen – notably in the fields of education and health care – have also been successfully trialled abroad, often in unlikely places. No less corporatist a state than Sweden has introduced a form of school voucher, while almost every state in Europe, at least since the fall of the Berlin Wall, now provides for an element of health insurance”.

 

This goes to the heart of the matter, note how the US and the Swiss are held up as models. The principles of localism and direct democracy are invoked as justifications hiding their argument and belief about market mechanisms. The United States is a beacon for the dispersal of power? One cannot expect anything other than this nonsense from neoliberals, wilfully ignorant as they surely must be of the work of C Wright Mills, Herbert Marcuse, Jurgen Habermas, David Harvey, Thomas Picketty, Graham Scambler, and Yanis Varoufakis? This also ignores the literature on social inequalities and inequalities in health and the social and political determinants of health. At this point we must also point to the wealth of feminist and post-colonial literature on ‘power’. In short it is an invocation of bourgeois patriarchal perspective on the exercise of power which blinds them to actuality.

 

As for Switzerland, the OECD reports that compared to the UK’s 9.3 % of GDP, the Swiss pay 11.4%. The UK used to pay under 6% but has seen a rise, not totally due to actual health spending but to cater for administration and profit for private companies. The US spends 16.9% (OECD 2014) and has introduced ‘Obama care’ to address the plight of uninsured americans. Obama care is an outcome of class struggle which has been hotly contested in the ‘land of the free’.

 

 

 

‘Direct Democracy’ claims to hold to three principles:

 

  1. Decisions should be taken as closely to the people they affect.
  2. Law makers should be directly accountable.
  3. The citizen should enjoy maximum freedom from state control.

 

 

On the face of it who would argue with that? Certainly not anarchists, socialists or libertarians. The problem is that these principles exist within a social and historical context, one characterised by imbalances of power along class, gender and ethnic lines and this cannot deal with the reality on the ground. Hunt et al are blind to the context in which ‘men of wealth buy men of power’, a world in which the capitalist class executive and the political power elite exercise a new class/command dynamic which neoliberal ‘reforms’ ushered in since about the 1980’s especially in the US and UK.

 

Yanis Varoufakis (2016) clearly discusses the effects of such things as the “Nixon Shock’ on the post war global financial settlement, the outcome being that the ‘strong do what they can and the weak suffer what they must’. Global health corporations need new markets and looked to the UK’s NHS as a source of rich pickings. This is the context in which Hunt’s bourgeois democracy operates.

 

  • Decisions about who provides health care, what health care looks like and where it is provided are taken by unelected clinical commissioning groups operating within a profit driven market context.
  • Patients do not have an electable secretary of state who has a statutory obligation to provide health care services.
  • Freedom from state control for health service provision has morphed into control via corporate decision making.

 

 

Direct Democracy (2005) argues:

 

‘The problem with the NHS is not one of resources. Rather it is the system remains centrally run, state monopoly designed over half a century ago’ (p74).

 

Clearly this is a statement that ‘the system’ needs to go. The resource issue in the context of increasing demands and costs is brushed aside. This remark now looks questionable at best in 2016.

 

“We should fund patients either through the tax system or by way of universal insurance, to purchase health care from the provider of their choice. Those without means would have their contributions supplemented or paid for by the State.” (p74).

 

Holding on to a notion of ‘free at the point of delivery’ implied here, it is clear that private provision is to be introduced. The language is anodyne, context free, taking no notice of what private provision might look like, who would provide it and what the consequences of the inevitability of a market might be. The State at least has a role in providing for the poor. The writers of this document are part of the political power elite, or may wish to be, and the coherence of interests with the corporate/capitalist class executive are hidden. Those who sell insurance have not been lobbying for this change then? A bit of research into who benefits from this change might prove insightful. Are there links between corporate interest and the politicians who are driving the changes?

 

Hunt et al feared the NHS would only be second to the US in terms of % of GDP spent. This has not occurred. They report a study ranking the UK 18 of 19 countries. This is selective in the extreme, and is now way out of date.

 

Many of the critiques they evoke of the NHS are a result of the rise of new public management, or ‘managerialism, introduced into the system by previous governments both New Labour and Tory. For about three decades managerial control, targets and distrust of professionals have eroded the ability of the NHS to be the best in the world.  The judgment about the efficiency and effectiveness of health services partly depends on what criteria are being used to judge them. The % spend of GDP is a crude figure as it hides a plethora of costs and profits.

 

Other measures of success could include universality of access, comprehensiveness of cover, mortality and morbidity outcomes, and the publics’ safety and satisfaction.

 

Mark Britnall has written ‘In search of the Perfect Health System’ (2015) of the complexity of comparing health systems. Britnall is no Tory ideologue and describes his approach as more brown mud than blue sky thinking:

 

He also wrote in 2011 before the 2012 Act:

 

“[o]f course, the vast majority of care – quite rightly in the UK context – will always be provided by public sector organisations (currently, about 95% of it) and will be paid out of taxation” and “[t]he issue of competition, which now seems to be conflated with privatisation, is unhelpful and misleading and, at best, only a small part of reform. Competition can exist without privatisation and the NHS can maintain its historic role in funding care while dealing with a richer variety of providers – public sector, social enterprise and private organisations”.

 

This 2011 comment predated the 2012 Act and can be seen as a statement of intent than actuality on his part. In 2010 there was some controversy over his statements in the US about private provision.

 

One area in which private provision is facing severe challenges is the care home sector.

 

Roy Lilley, writes a daily blog, and has considerable experience in the health service and with private sector organisations. He is no left wing radical. He writes in ‘They don’t matter’ (3rd May 2016) that success in private provision in the community has been ‘patchy’, citing Circle’s loss of £5 million and the paying of another £2 million to get out of the Hinchinbrooke contract, while SERCO and Bupa ‘bailed out’ of provision leaving Virgin clinging on. He argues that the private sector can be nimble and quick to adapt, but of course needs to make a profit.

 

However, the largest care home provider, Four Seasons, is in talks to ‘restructure its debt’ as they face a 39% drop in profits. Most of their ‘customers’ have their fees paid by social services. This amounts to some local authorities paying £385 per week which is just not enough. The living wage is also an issue for them, they have over 30,000 staff but with no way of adjusting prices to pay for the increase and with no operating surplus. It has a debt of £510 million. If Four Seasons go broke they have 450 care homes at risk.

 

The bottom line is that health and social care costs money. There is not enough money in the system to pay for the care required. Some private families are paying £1,250 per week. Company Watch data which covers 20,000 homes, indicates that there is a funding black hole of half a billion pounds. This is market failure due to inadequate funding by design. It is almost as if the government is deliberately forcing people to find the money themselves either through savings, insurance or property while state funding through local authorities is slowly wound down.

 

Mark Britnall’s approach is scholarly, based in experience managing health care organisations and a deep knowledge and overview of many health systems. However, is Britnall sufficiently aware of the political economy of neoliberalism and its agenda for health?  Roy Lilley’s highlighting of the care home crisis clearly shows the political, austerity driven nature of the issue.

 

‘Direct Democracy’ and ‘Britannia Unchained’ are ideological approaches to health and social care. Whether Hunt has the temper for addressing Britnall’s insights or whether he still stands by the document he co-wrote is anyone’s guess. However, I know where the smart money would go. His face down of the doctors is more to do with power and who exercises it rather than the future of the health service as we knew it. If the neoliberals can get away with it, then free at the point of delivery will be severely challenged perhaps using spurious arguments stigmatising drug users, alcoholics, smokers, the obese, self harmers, self inflicted sports injuries, prostitutes, the promiscuous and Johnson’s ‘stupid’ as a wedge driven between the deserving and the undeserving ill. The care home crisis indicates that older people are ignored and the costs increasingly privatised as the state withdraws, or should we say abdicates, support. The NHS was to socialise risk, to spread its cost across the whole population. Instead we are rapidly moving towards individualising risk and private insurance based provision as the state withers away.

 

Choose your parents

Alejandro Nieto.

Bernal Heights. San Francisco.

What has the death of a young man, shot by four police officers in a park in California got to do with with understanding health outcomes in the United Kingdom?

Mary Sue and Miriam. Two women born at similar times whose grandparents came from the same small town in the United States. One will be going to an Ivy League University while the other struggles with drugs and hopelessness writing on her Facebook page ‘Love hurts, Trust is dangerous’.

What links them is that Alejandro and Mary Sue ‘chose the wrong parents’, while Miriam chose wisely, a Harvard professor for a grandfather (Robert Putnam), and University educated parents.

Their cases illustrate that health and well being is ‘structured but not determined’, that to truly understand their life chances we have to consider the transformations in society that impact on the choices made and opportunities open to individuals and their families.

Alejandro was born to Mexican immigrants who came to San Francisco in the 1970’s. His mother worked all her life while his father took on most of the child care duties. San Francisco has a history of immigrants from other parts of the US as well as from elsewhere. Being Hispanic in California is ‘normal’ but not to the white, male, educated tech engineers from Silicon Valley who have moved to the area en mass ushering in gentrification and myopia. Alejandro was described to the Police as probably ‘foreign’ who had a gun, his red jacket marking him out as a gang member. All of this was supposition and assumption. Alejandro had lived in Bernal Heights all of his life, the gun was a taser, carried because he worked as a security guard. His red jacket was a sports jacket, the colour of the local sports team the 49’ers. Those doing the describing were white tech engineers making assumptions about behaviour. Indeed, Alejandro was holding a taser, but he had just been harassed by a dog barking and jumping up at him to get at his chips. The dog owner was 40 feet away, distracted by a ‘jogger’s butt’ and unable to keep his dog under control.

The police arrived, and shot him, one unloading over 20 bullets and had to reload.

Alejandro, Mary Sue and Miriam live at a time when the United States is experiencing growing inequalities in wealth, segregation in its communities, family instability and a collapse of both good working class jobs now being followed by a squeeze on middle class opportunities. While the wealth of the 1% has increased based on their increased share of wealth being created – they are getting an even bigger slice of the pie, working class incomes have stagnated. Mary Sue’s grandfather used to have a decent income from a solidly working class job, now gone leaving ‘flexible’, low paid insecure work.

As economies restructure, as cities adapt to new social conditions, people experience changing social structures that enhance or diminish their chances. The white Ivy League tech engineers are likely to know only other white Ivy Leaguers, to come from Ivy League parents, went to the same schools and know only their own kind in a networked bubble of privilege, social myopia and self satisfying smugness. They don’t know the ‘other’ and can thus label a sports fan as a gang member with in this case lethal consequences.

Perhaps representing their views:

“I know people are frustrated about gentrification happening in the city, but the reality is, we live in a free market society. The wealthy working people have earned their right to live in the city. They went out, got an education, work hard, and earned it. I shouldn’t have to worry about being accosted. I shouldn’t have to see the pain, struggle, and despair of homeless people to and from my way to work every day.”

 

So ‘free market society’ justifies the breakdown of community, segregation, inequality, fear and mistrust. Wealth is ‘earned’ rather than a result of circumstances (right time, right family, right ethnicity, right gender, right neighbourhood, right education, right opportunities and often the inheritance of not only financial but social and cultural capital). Indeed, no one should have be be accosted, no one should see pain and struggle and despair, but don’t blame the victims of unjust social, political and economic systems. Don’t blame the dog for barking when someone’s kicked it.

Alejandro’s ‘personal trouble’ (being shot) is now a public issue. When only one young man is shot by police, we might consider the character of the man and look to him as an individual for reasons and solutions. When hundreds of young men are being shot by police this individual analysis is no longer useful, we must look to social structures, to link personal stories to this point in time in this particular society.

Miriam can look forward to a bright future, she experienced great parenting, great education backed up of course by well resourced material assets. Mary Sue, is a single parent with no education, self harm, a drug habit and abusive partners. Her child will very probably not go to Harvard. Alejandro made the mistake of being born Hispanic and thus a potential threat to the White denizens of a newly gentrified neighbourhood.

If you are struggling to apply this to the UK context, you don’t know the truth and you lack the ‘sociological imagination’.

Alejandro’s story is in Rebecca Solnit ‘Death by Gentrification’. Opinion. The Guardian. March 22nd 2016.
Mary Sue and Miriam’s story is in a talk by Robert Putnam to the RSA in London, March 2015, on ‘Inequality and the Opportunity Gap’. https://www.thersa.org/discover/videos/event-videos/2015/10/robert-putnam-on-inequality-and-opportunity/#

The missing two C’s – commodity and critique

http://tinyurl.com/the-missingtwoCs   This is the link to the published article in the Journal of Research in Nursing.

This discussion paper argues for understanding nursing care as a commodity within capitalist relations of production, ultimately as a product of labour, whose use value far exceeds its exchange value and price. This under recognised commodification of care work obscures the social relationships involved in the contribution to the social reproduction of labour and to capital accumulation by nursing care work. This matters, because many care workers give of themselves and their unpaid overtime to provide care as if in a ‘gift economy’, but in doing so find themselves in subordinate subject positions as a part the social reproduction of labour in a ‘commodity economy’. Thus they are caught in the contradiction between the ‘appearance’ and reality. A focus on the individual moral character of nurses  (e.g. the UK’s 6Cs), may operate as a screen deflecting understanding of the reality of the lived experiences of thousands of care workers and supports the discourse of ‘care as a gift’. The commodification of care work also undermines social reproduction itself. Many nurses will not have tools of analysis to critique their subject positioning by power elites and have thus been largely ineffectual in creating change to the neoliberalist and managerialist context that characterise many healthcare and other public sector organisations. The implications of this analysis for health care policy and nursing practice is the need for a critical praxis (an ‘action nursing’) by nurses and nursing bodies, along with their allies which may include patient groups, to put care in all its guises and consequences central to the political agenda.

 

“The University in Ruins”

Constructing the Paraversity using the web.

 

Introduction

Higher Education institutions across the globe are changing and changing fast. Several writers have expressed dismay, as well as seeing opportunities to move in different directions, in response to what has been called the ‘University in Ruins’ (Readings 1996).

 

Gary Rolfe (2013), picking up on Reading’s work addressed ‘scholarship in the corporate university’ and suggested that academics must ‘dwell in the ruins’ in an authentic and productive way through the development of a community of philosophers who will dissent, subvert and challenge the ‘corporate university’ from within. Tools for subversion are at hand. Social media, blogging, open access journals and the development of new academic websites such as Researchgate and academia.edu, give academics new ways to reach students, and indeed anybody, way beyond the physical confines of their campus. Accepting that there are issues of peer review and hence quality, these tools allow free access and may facilitate dialogue in ways unheard of just few years ago. This paper explores the ruins, argues for critical dissensus, and shares one experience of using such tools and suggests that this might then assist in building Rolfe’s ‘community of philosophers’ or what Slavoj Žižek has called ‘liberated territories’ (Žižek 2008).

 

Following a note on pedagogy and addressing what the purpose of education  might be,  the idea of the Paraversity will be outlined, and importantly a central notion of dissensus highlighted. Why nurse educators and student nurses should engage in dissensus, as well as professional training, is a point to be debated. To do so, I will refer to the work of C Wright Mills’ on ‘intellectual craftsmanship’. Secondly, an example of constructing this Paraversity will be shared, not that this is a paradigm case, but as only one way to do so, a way that of course may prove fruitless as we acknowledge the variety of approaches and uncertainty of any outcomes. Indeed ‘outcomes’ themselves may be part of the language of a certain mindset that is antithetical to the Paraversity.

So, what follows is a thesis, which may draw forth an antithesis resulting in a new synthesis, which in turn can be challenged. Consensus and agreement is not the point; dialogue is. This paper is overtly political; drawing upon Freire’s ‘pedagogy of the oppressed’, Marx and the heirs of Marx, to argue that nursing is locked into a matrix of social systems that are oppressive and marginalising, and that Higher Education itself, in the guise of the ‘University of Excellence’ is increasingly commodified, and losing its way as it tries to meet the needs of the ‘Knowledge Economy’ in the production of ‘Cognitive Capitalism’.  I argue we need to revisit the question ‘what is education for’?

 


 

A note on Pedagogy

 

Paulo Friere’s first premise concerns a humanistic value base, upon which a pedagogy should be constructed. The human being is a ‘subject’, rather than an ‘object’ ready for construction by oppressive forces. Our ‘ontological vocation’ is towards ‘humanization’; to be able to engage in ‘conscientização’   which is learning to perceive social, political and economic contradictions and to take action against the oppressive elements of reality.

Stephen Sterling (2001) later argued that we need a paradigm shift away from transmissive forms of education towards transformative forms of education. Transmitting an education that ensures graduates are better equipped to perform clinical skills is first order learning.  However it is a partial education at best. First order learning takes place within current educational boundaries and philosophies. It is adaptivelearning, e.g. the acquisition of skills and knowledge to assist in adapting to new roles as registered nurses.

 

Education ought to be a process of transforming individuals so that base values, assumptions and paradigms are taken into account and challenged  – this is what Sterling calls second and third order learning.

 

Second order learning involves critically reflective learning. This is about examining the assumptions that underpin first order learning.

Third order learning is transformative learning and allows us to change perspectives and paradigms. It is creative, is a ‘shift in consciousness’, and involves a ‘deep awareness of alternative world views’ (Sterling 2001 p15).

 

Education in this sense is for humanity rather than just the transmission of knowledge, skills and values for the corporate, or employment, sphere. The Paraversity could be such a space in which this pedagogy operates. Thus, the process of education is as important, if not more important, than the end product. However, this is an issue for nurse education – to what degree is the product more important than the process? Do certain professional values, regulation and the needs for an NHS workforce outweigh the experience of a critical pedagogy? If so, are we constructing the student as passive object, who also self governs, rendering them unable to engage with countervailing voices against a one dimensional political hegemony in which the ‘market is king’?

We need to challenge pedagogical assumptions because, contrary to what many would have us believe, history has not ended, business can’t be ‘as usual’ and this is not ‘the best of all possible worlds’:

“The truth is that many things on which our future health and prosperity depend are in dire jeopardy….this is not the work of ignorant people. Rather it is largely the results of work by people with BAs, BScs, LLBs, MBAs and PhDs.” (Orr 2004 p.7)

The global financial crisis of 2007-8 was not caused by blue collar workers, nurses or teachers, but arose out of the activities of very clever people recruited from so called elite universities, many of whom studied economics mired in orthodoxy, rendering it unable to foresee the systemic risk building up within finance capital.

Jihadist social movements have gained ground in part to the ideologically based bumblings of Yale, Harvard and Oxbridge Educated elites, who with characteristic hubris and with appalling lack of insight, declared ‘mission accomplished’, and are now fretting about ‘radicalisation’ while doing little to address the socio-political causes of jihadist ideological narratives that drive young men and women into armed conflict.

Older people, their families, and those with mental health problems, in contemporary capitalist societies are experiencing crises in health and social care provision as successive governments have failed to put the interests of people before profits and capital accumulation.

With a few exceptions, for example Michael Burawoy’s (2004) notion of ‘public sociology’ or Paul Hawken’s notion of the ‘Blessed Unrest’, we have largely failed to produce enough countervailing voices, or a new vision of care that is fit for the 21st century. There is little in the way of critical guiding philosophies in operation for nursing beyond individualised biomedically dominated notions of ‘care and compassion’ in the context of instrumentally orientated curricula obsessed with competence – ‘doing rather than thinking’. This is not to deny the existence of critical voices in the literature, just to acknowledge the often ahistorical, apolitical and anti theoretical nature of what passes for scholarship in and for clinical practice.

This might seem irrelevant, idealistic, utopian and antithetical to professional nursing practice. Nonetheless, it is a notion that can be discussed within the paraversity as an element of dissensus.


 

What is the ‘paraversity’? (Rolfe 2013).

Gary Rolfe  suggest that the ‘paraversity’ runs alongside the visible University, going unnoticed or unseen. The paraversity is a ‘mental space’ of dissensus, seeking no unity of thought or acceptance of any grand narrative. As such, the Paraversity may well throw up an antithesis to this thesis. It is invisible, subversive and a virtual institution. It is not owned by corporate interests, it is not influenced directly by research bodies, funding streams or research programmes or corporate management strategies. The national student survey is irrelevant to its continuance. There will be no physically identified building or faculty – it exists in the form of a community of philosopher scholars exploring and deconstructing and reconstructing ideas.

In the paraversity there is no need to arrive at consensus or agreement or a system of unified thought. It does not exist to fulfil the corporate university’s aims and objectives, it is the ‘pursuit of difference’ to keep open debate and discussion and not to shut it down. It also operates to call the corporate university to intellectual account.

In this aim, it fosters countervailing voices to critique one dimensional thought and implicitly evokes the critical theory of Herbert Marcuse, Theodore Adorno and Louis Althusser, but is of course not merely the intellectual heir to such thought as if the matters regarding ontology, epistemology and philosophy were settled. This uncertainty of certainty could be potentially unsettling for nursing thought and practice which seeks certainty and truth in professional practice.

 

What are Universities for?

“In a world characterised by complexity and uncertainty, our long term survival lies…..in our willingness to bend the rules in unforeseen circumstances and even operate beyond our level of knowledge as we make our world view” (Paul Vare p2).

Vare acknowledges that the problems besetting the world require thinking differently, acting differently and challenging many long held assumptions. Academic disciplines which cannot evolve their thinking will produce graduates who will engage in ‘business as usual’ chasing fewer and fewer ‘plum’ jobs as they join the precariat (Standing 2011) as ‘graduates with no future’ (Mason 2012) .

 

The ‘University of Excellence’.

It might be argued that within the ‘Enlightenment’, the historic missions of Universities focused on ‘truth’ and ‘emancipation’. Docherty (2014) writes

“In 1946, the political theorist Hannah Arendt received a copy of The Idea of the University, which was written by her mentor, Karl Jaspers. Jaspers had revised the book, originally published in 1923, for the post-war context, when German universities needed to recover from explicit institutional and ideological conformism to Nazism. He advances a reconfiguration of academic freedom that, today, is everywhere threatened again, thanks to a failure of political will – and of leadership – that allows intellectual freedoms to be sacrificed to financial priorities. Writing to Jaspers on receipt of the book, Arendt firmly expressed the view that, given the cost of the higher education system, it must be state-funded. But it was vital that the professoriate should not thereby become tacitly politicised “civil servants”. Academic freedom meant that universities should be governed by intellectual demands, without improper political interference”.

Now, this narrative has been replaced with that of the neoliberal capitalist narrative of efficiency and profitability, i.e. the narrative of the market. Readings (1996) argued that the ‘pursuit of excellence’ within this narrative is a legitimising idea. However, ‘excellence’ refers more to administrative processes in which ‘excellence’ is a unit of measurement, devoid of qualitative content, which we now measure through such metrics as attrition, the number of firsts, impact factors, the number of research grants awarded and student perception questionnaires. An excellent nursing degree is one with low attrition, satisfied students, high employability and high numbers of firsts. Who would disagree with that?  Rolfe (2013) suggests this view of excellence is one of quantity rather than quality and brings us into the realms of ‘efficiency, profitability and administration’ (p9). He goes on to argue

“The vision and mission of the University has shifted from the production and dissemination of thought and ideas to the generation and sale of facts and data” (Rolfe 2013 p 81).

This suggests that the role of Universities now is often that of contributing to the local and national economy and to train graduates for the job market, and I would suggest that in many nursing departments that is the sole ‘raison d’etre’.

This instrumental orientation to nursing education (Goodman 2012) is evidenced by the dominance of competency based education, fit for practice, fit for purpose curricula, based on the NMC’s educational standards. The student nurse or graduate registrant who questions and critiques the ontological, political, ideological and epistemological assumptions upon which care is designed, delivered and evaluated would not be that welcome in clinical practice and perhaps only marginally tolerated in many nursing modules based on the transmission of facts and theories for clinical practice, grounded as many are in the assumptions of positivist and empiricist science. Nursing theory, let alone feminist or critical theory, may have disappeared from nurse education.  We may now be less able within nursing curricula to question the basis of social knowledge and care practices from critical perspectives that seeks to illuminate the subject positioning of women and the marginalisation of older people as unproductive burdens on society.

What is being lost is the notion of ‘intellectual craftmanship’ in favour of the search for empirical certainty, data and hard facts to guide practice. Indeed, evidence based practice education can be reduced to issues of methodology rather than issues of epistemology, philosophy and ontology. Perhaps many nurse scholars themselves have lost the ability to engage in this activity, and thus to be role models, buckling under the pressure to deliver clinical skills and other diverse teaching while also delivering empirically based research which provides facts and answers to practical questions. Many of course will have been schooled in the biomedical sciences and thus would not have had the critical epistemological enquiries and paradigms of social science. What we end up with is the pressure to produce ‘denotative’ writing – the telling and informing process through powerpoints and scientific reports as the dominant discourse of knowledge production and dissemination.  This is the ‘University of Excellence’.

 

What are academics for in the ‘University of Excellence’?

 

Brock (2014) asked “what is the function of the social movement academic’? However I would rephrase this and ask “what is one of the functions of the nurse academic? I would respond, as Brock does, with the suggestion that it is partly “to debunk the knowledge on which the powerful rest”.  One of those notions being peddled currently is that the NHS and society will not be able to afford care for older people,  that free at the point of delivery will no longer be possible, and that expensive external monitoring and inspections are worth the money spent on them. All the while corporates lobby behind the scenes for bits of the profitable NHS pie; see this list by Andrew Robertson on his site ‘social investigations’.

To engage in debunking requires ‘intellectual craftsmanship’ and is important for critical enquiry in the paraversity. What might that look like?

 

On Intellectual Craftsmanship  (C Wright Mills 1959).

 

In the appendix to ‘The Sociological Imagination’ Wright Mills outlined his view on ‘doing’ social science in which he suggested that ‘Scholarship’ is more important than empirical research for the social scientist. He considered that Empiricism was the ‘mere sorting out of facts and disagreements about facts’. Wright Mills’ critique of abstract empiricism contained in ‘The Sociological Imagination’ is that argument made manifest. Rules of method and arguments on methodological procedures and validity are just so much navel gazing which Wright Mills wished to avoid if he could possibly do so:

 

“Now I do not like to do empirical work if I can possibly avoid it” (p205) and “there is no more worth in empirical enquiry as such than in reading as such” (p 226).

 

The task of social science is thus to critically engage in the real world, joining personal experience and intellectual life through critical reflective reason as the

 

“advance guard in any field of learning” (p205).

He argued:

“It is the political task of the social scientist — as of any liberal educator — continually to translate personal troubles into public issues, and public issues into the terms of their human meaning for a variety of individuals. It is his task to display in his work — and, as an educator, in his life as well — this kind of sociological imagination. And it is his purpose to cultivate such habits of mind among the men and women who are publicly exposed to him. To secure these ends is to secure reason and individuality, and to make these the predominant values of a democratic society” (p187).

The personal trouble of obesity is a public issue not a personal moral failing of weak willed individuals. We must look to the role of fossil fuels instead of food, in providing energy; we must look at the marketing and distribution activities of the food industry; we must look to portrayals of the body in the media;  we must look to the structures od sedentary employment…..

Nurse educators might read this and think, actually, no it is not my political task at all!  Nurse students do not need to think about their personal lives and the lives of others as they relate to wider social and political issues…they need to be able to deliver care – to provide pain relief, comfort and explanations to vulnerable people, to interpret cardiac rhythms and administer medications, to assess wounds and decide upon management plans….that is the stuff of nursing and the rest of this is mere frippery. This is a view I have heard expressed by students as they cry “when are we going to learn proper nursing?”

In this they might be supported by the Corporate University which, in response to the demands of its customers, industry, commerce and the economy, has shifted the emphasis of the role of the academic from raising questions to providing answers, from problematizing to problem solving. Many nursing students want answers, not to raise questions. Thus empiricism and the tenets of positivistic science have been dragooned to support this mission. This is in opposition to many notions regarding personal and social transformation.

 

Michael Burawoy argued:

“The original passion for social justice, economic equality, human rights, sustainable environment, political freedom or simply a better world, that drew so many of us to sociology, is channeled into the pursuit of academic credentials. Progress becomes a battery of disciplinary techniques—standardized courses, validated reading lists, bureaucratic ranking intensive examinations, literature reviews, tailored dissertations, refereed publications, the all-mighty CV, the job search, the tenure file, and then policing one’s colleagues and successors to make sure we all march in step. Still, despite the normalizing pressures of careers, the originating moral impetus is rarely vanquished, the sociological spirit cannot be extinguished so easily”.

Can we replace sociology with nursing in this paragraph? Can we say our original passions have been channeled into pointless mindnumbing bureaucratically led education programmes that do nothing to challenge or change the context of care in which currently we are facing major issues in mental health and the care of older people with long term conditions?

Antonio Gramsci’s (1971) archetypal theory of the intellectual may also be illuminative and raises questions about what we are here for. Gramsci described two types of intellectual: the ‘traditional’ and the ‘organic’. The traditional is the academic who secures the status quo and the organic as the activist whose function it was to ‘construct a transformative historical bloc’, an alternative basis of consent for social order (Cresswell and Spandler 2012 p4). Although written many decades ago, this archetype may well be seen within the corporate university which supports and encourages the traditional and ignores the activist.

Nursing, and nurse academics, have a question to address. Are we engaged in the development of a practice based discipline interested only in the ‘sorting out of facts and the disagreements of facts?’ Are we traditional and/or organic academics? Is there room for both, either as separate individuals or as two roles within the same person? Justification for the ‘discovery of facts’ may be founded on its usefulness for policy and clinical practice and of course should be foundational knowledge for clinical nursing practice, after all we do not want the wrong drug to be administered because we have not sorted out the ‘facts’.

However, empirical research does not take place within a political vacuum and it would be a mistake to see the relationship of research to policy and practice as a simple linear relationship. The purist model of ‘research-policy relationships’ which takes for granted that research informs policy action by generating knowledge, or the problem solving model whereby research is driven by the need for a policy answer, do not adequately describe the process and is a far too narrow a focus for scholarship. It just does not address some of the fundamental questions underpinning human health and well-being which are as much to do with human agency and social structures within certain political economies, as to do with biomedical processes.

Research and policy then is a political activity. Wright Mills in arguing for craftsmanship in intellectual life implicitly acknowledges in the Sociological Imagination the need to go beyond simple empirical knowledge in forming policy action when he enjoins social scientists in a political and intellectual task to clarify the contemporary causes of “uneasiness and indifference to personal troubles and public issues” (p13). The social scientist is not to merely describe the contemporary elements of social life, but to engage in it.

The use of the word ‘craft’, undefined by Mills, appears here to differentiate the activity from that of (mere?) mastery of elaborate discussions of research method and ‘theory-in-general’, which would quickly make one “impatient and weary” (p195). A craft suggests development of skill by diligent constant practice, honing one’s technique by reference to finished products and products in the process of being to evaluate their flaws and strengths and then adjust accordingly. This is reflexive practice in that the work as it continues is being constantly worked and reworked as required. It suggests leaps of imagination and intuitive thinking and practice in the creation of a project. It calls for a departure from strict adherence to a rigid structure of routines, methods and frameworks. It also suggests a measure of artistry in thinking.

The scholarly craftsman is his work as his craft develops alongside who he is. Scholarly craftsmanship then is a state of being not only doing:

When Wright Mills argued that:

“admirable thinkers…do not split their work from their lives” (p195), he also argued

“Scholarship is a choice of how to live as well as a choice of career” (p196).

And:

“Scholarship is writing”.

To undertake this craft he asked students and social scientists to keep a journal to enable the development of the intellectual life, of the craftsmanship of social science. This should consist of ideas, personal notes, excerpts from books, bibliographical items and outlines of projects. He suggests that journals should record ‘fringe thoughts’, snatches of conversation and even dreams. This will also include the taking of copious notes from books and this needs developing into a habit.

Since Wright Mills outlined notes on journal keeping there has been the explosion onto the scene of information technologies, elearning and web 2.0. These are now new tools that were unavailable to Wright Mills. However the essential nature of scholarly activity should not be lost in any infatuation with new technologies, rather these gateway technologies could facilitate critical enquiry, journal keeping and the connection of a community of philosopher scholars engaged in dissensus and critique through a process of what Paolo Freire called dialogics.

To assist in this process, scholars need to write, and to write essays or blogs and not just research reports; to engage in discussion and not just to tell; write to invite commentary, to clarify one’s thoughts, to learn about oneself as well as to explore ideas and investigate one’s area of interest. Nursing is a socio-political activity and not just an applied set of techniques; and as such requires critique, understanding, discussion, reflexivity and transformation. The corporate university may not be interested in these ‘outcomes’, fixated as it may be on contracted commissioning targets, workforce development, league tables, SPQ results, attrition rates and ill defined notions of the ‘student experience’. The early career nursing academic will be faced by a host of external constraints on their intellectual development and their ‘success’ or performance development reviews may rest on targets and values not of their own making. What may be ignored by ‘impact metrics’ is any of their writing, which is createdover and above the research ‘write up’ focused on answering an empirical question according to a matrix of methodological imperatives. Graham Scambler (2014), as a now retired academic,  makes the point that he benefitted from the freedom to engage in intellectual activity unchained from the demand s of the Corporate University chasing its position in league tables:

“I was rarely during my career forced onto the back-foot, obliged to define achievement in terms of research revenue generated or publications in high-impact journals.”

And…

“I have encountered several ‘young’ sociologists whose expertise by far exceeds mine and who have played significant roles in facilitating as well as contributing to virtual networking and innovation but whose pioneering expertise in social media remain institutionally unrecognized and unrewarded” (my emphasis).

 

Karl Marx, C Wright Mills, Antonio Gramsci, Paulo Freire, Pierre Bourdieu, Michael Burawoy,  recognized that intellectuals can play a crucial role in ideological warfare against the dominant classes. The Paraversity may assist in this by creating

 

“havens of thinking into which thinkers can migrate and from which thoughts can proliferate and social change can reify” (Žižek 2008).

 


 

What might the Paraversity begin to look like?

 

The examples below are not definitive, it is up to the community of scholars to construct the Paraversity and if it is based on dissensus, it may look very different and take on a dynamic nature. If the idea is to create dialogue, to share ideas, to critique, to go beyond the physical confines of the Corporate University, the web 2.0 technologies might assist in this process.

 

1. Social Science and Nursing

2. Graham Scambler

4. Benny Goodman’s blog

5. Researchgate

6. Academia.edu

7. Facebook

8. Twitter

 

The links above will provide examples of critical thought and the sharing of ideas accessible by anyone anywhere and at anytime. They provide platforms for commentary and feedback, both synchronously and asynchronously. Their credibility may be built upon already established reputations and research outputs and/or by the clarity and force of the arguments. They will stand or fall by the readership wanting to engage and share and the commitment and enthusiasm by the creator.

 

Conclusion

 

Human health and wellbeing depend on many things. Critical education and challenging taken for granted assumptions are part of the foundations for human progress, if we still believe in progress. Universities may not provide the fertile soil for critical enquiry and discourse, but we do not have to wait for this to occur. We can right now live in the ruins of the University and engage in scholarship that is subversive, critical and potentially engaging and do so in the full knowledge that traditional rewards and recognition may not be forthcoming. That makes it risky. That also makes it fun.

References

Brock T (2014) What is the function of the Social Movement Academic? The Sociological Imagination. http://sociologicalimagination.org/archives/15545

 

Burawoy, M. (2004) Public Sociologies: Contradictions, Dilemmas and Possibilities. Social Forces, 82(4), 1603-1618.

 

Cresswell M. and Spandler H. (2012) The Engaged Academic: Academic Intellectuals and the Psychiatric Survivor Movement, Social Movement Studies DOI:10.1080/14742837.2012.696821.

 

Docherty T (2014) Austerity canard stymies funding debate. THES. July 7th  http://www.timeshighereducation.co.uk/story.aspx?storyCode=2014367

 

Goodman B (2013) What are nurse academics for? Intellectual craftsmanship in an age of instrumentalism. Nurse Education Today 33: 87-89

 

Gramsci, A. (1971) Selections from the Prison Notebooks. Lawrence and Wishart. London

 

Mason, P. 2012 The graduates of 2012 will survive only in the cracks of our economy. The ‘Graduate without a future’ series. http://www.guardian.co.uk/commentisfree/2012/jul/01/graduates-2012-survive-in-cracks-economy

 

Orr D. (2004) Earth in Mind. On Education, Environment, and the Human Prospect. Island Press, Washington.

 

Rolfe G (2013) The University in Dissent. Routledge. London

 

Readings B (1996) The University in Ruins. Harvard University Press. Cambridge. MA.

 

Scambler, G. (2014) A 100th Blog: A reflexive interlude.http://www.grahamscambler.com/a-100th-blog-a-reflexive-interlude/#respond

 

Standing, G. (2011) The Precariat: the new dangerous class. Bloomsbury. London

 

Sterling S (2001). Sustainable Education – Revisioning Learning and Change, Schumacher Briefings 6. Green Books, Dartington.

 

Vare P (2014) Sustainability Literacy: role or goal? (online) http://arts.brighton.ac.uk/__data/assets/pdf_file/0010/6202/Sustainability-Literacy-Blewitt-and-Vare.pdf in Stibbe A (2014) Handbook of Sustainability Literacy http://arts.brighton.ac.uk/stibbe-handbook-of-sustainability

 

Wright Mills C (1959) The Sociological Imagination. 40th Edition. Oxford University Press  Oxford.

 

Zizek S (2008) Violence. Profile. London.

 

On Intellectual Craftsmanship (Mills 1959)

On Intellectual Craftsmanship  (Mills 1959)

In the appendix to ‘The Sociological Imagination’ Mills outlines his view on ‘doing’ social science in which he suggests that ‘Scholarship’ (scholarship is writing) is more important for the social scientist than empirical research (the ‘mere sorting out of facts and disagreements about facts’). Mills’ critique of abstract empricism contained in ‘The Sociological Imagination’ is that argument made manifest. Rules of method and arguments on methodological procedures and validity are just so much navel gazing which Mills wished to avoid if he could possibly do so, (“Now I do not like to do empirical work if I can possibly avoid it” p205). The task of social science is thus to critically engage in the real world, joining personal experience and intellectual life through critical reflective reason as the ‘advance guard in any field of learning’ (p205).

Justification for the ‘discovery of facts’ may be founded on its usefulness for policy. However, empirical research does not take place within a political vacuum and it would be a mistake to see the relationship of research to policy as a simple linear relationship. The purist model of ‘research-policy relationships’ (Booth 1988) which takes for granted that research informs policy action by generating knowledge or the problem solving model whereby research is driven by the need for a policy answer do not adequately describe the process and in Mills’ understanding would be  far too narrow a focus for scholarship. An enlightenment model emphasises the role research plays in framing ideas while acknowledging that the relationship between research and policy is nuanced, and that research creeps into action through ‘osmosis’ over time. Research merges with other forms of knowledge as policy action accretes. This however under acknowledges the political dimensions of research-policy whereby ideology shapes research questions, methods and interpretations, application and what types of evidence is accepted (Carlisle 2001). Research and policy then is a political activity. Mills in arguing for craftsmanship in intellectual life implicitly acknowledges (in the Sociological Imagination) the need to go beyond simple empirical knowledge in forming policy action when he enjoins social scientists in a political and intellectual task to clarify the contemporary causes of uneasiness and indifference (p13) to personal troubles and public issues. The social scientist is not to merely describe the contemporary elements of social life but to engage. 

The use of the word ‘craft’ (undefined by Mills) appears here to differentiate the activity from that of (mere?) mastery of elaborate discussions of research method and ‘theory-in-general’, which would quickly make one “impatient and weary” (p195). A craft suggests development of skill by diligent constant practice, honing one’s technique by reference to finished products and products in the process of being to evaluate their flaws and strengths and then adjust accordingly. This is reflexive practice in that the work as it continues is being constantly worked and reworked as required. It suggests leaps of imagination and intuitive thinking and practice in the creation of a project. It calls for a departure from strict adherence to a rigid structure of routines, methods and frameworks. It also suggests a measure of artistry in thinking.

The (scholarly) craftsman is his work as his craft develops alongside who he is. Scholarly craftsmanship then is a state of being not only doing,  “Scholarship is a choice of how to live as well as a choice of career” (p196). When Mills states that “admirable thinkers…do not split their work from their lives” (p195), he preconceives notions of lifelong learning that are to follow. Nursing practice (if it were to take this concept on board) may then have to consider a break away from a  wage based employee model (where a nurse works for 37.5 hours per week) to a salaried professional/intellectual model whereupon the nurse would continue to critically reflect on issues pertinent to speciality and patient group outside of NHS contracted hours. Given the current context of the NHS and clinical practice this seems highly unlikely for clinically based nurses.

To undertake this craft he asks students and social scientists to keep a journal to enable the development of the intellectual life, of the craftsmanship of social science. This should consist of ideas, personal notes, excerpts from books, bibliographical items and outlines of projects. He suggests that journals should record ‘fringe thoughts’, snatches of conversation and even dreams. This will also include the taking of copious notes from books and this needs developing into a habit. However the reading of whole books is not necessary but the reading of parts of many books is.

Since Mills outlined notes on journal keeping there has been the explosion onto the scene of information technologies, elearning and web 2.0. These are now new tools that were unavailable to Mills. However the essential nature of scholarly activity should not be lost in any infatuation with new technologies, rather these gateway technologies (for example the ipad) could facilitate critical enquiry and journal keeping.

Mills’ work thus calls for the development of scholarship as a core intellectual activity. Scholarship within nursing is under threat both in practice and in Universities (Morrall 2010, Goodman 2011, Shields et al 2011). There is a need to rediscover it.

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