Tag: Subject Positions Theory

Simone de Beauvoir: The second sex – the social construction of women and implications for wellbeing.

Simone de Beauvoir: The second sex – the social construction of women and implications for wellbeing.

 

In 1949 Simone de Beauvoir published ‘The Second Sex’, a book that was put on a ‘prohibited list’ by the Vatican. In 2015, the ideas within should also make the non-religious think again about what makes for femininity and why. Women suffering from eating disorders, or spending a great deal of money on cosmetic surgery, might wish to consider why they are doing so and who profits from it. Nurses as women, and a nurse education interested in the personal growth of its students, might profit from this analysis as they experience, almost daily, images of what the ideal body type should be. This experience is implicated in negative evaluations of body shape (e,g, anti-fat bias); evaluations that even health professionals engage in (Teachman and Brownhill 2001), and the prevalence of eating disorders (Garner and Garfinkel 2009).

 

Biology is not destiny. To begin with, the fact of female biology is an ‘is’ but should not be automatically linked to the ‘ought’ of social roles around, for example, child rearing and the plethora of social and domestic roles women have played for centuries. In 1740, the Scottish Enlightenment philosopher David Hume, in his ‘Treatise on Human Nature’, pointed out that human reasoning can so easily jump the gap between what ‘is’ and then declare that it also ‘ought’ to be. This gap between the ‘is’ of fact and the ‘ought’ of value requires examining rather than uncritical acceptance. Just because we eat meat, ought we to eat meet? For women, examining the gap between fact and values means realising that reproductive biology (an ‘is’) is not their destiny linked to a subordinate domestic role (an ‘ought’). In part 1 of the book ‘Destiny’, Beauvoir argues that the facts of biology must be viewed in the light of the ontological, economic, social, and physiological contexts in which they exist.

 

Beauvoir goes further into the nature of female sexuality and their feminine forms to suggest that notions of female beauty are socially constructed, and most often by men. In addition, women learn how to be women often in relation to male ideals. Beauvoir argued: “one is not born a woman, one becomes a woman” (book 1, part 2 ch 1). This feels counterintuitive and goes against natural thinking at the birth of a child in which the sex of the child is established by biological factors but almost immediately gender constructions begin. Sex and gender are intertwined and erroneously conceptualised as being the same thing. In western societies, the bestowal of the pink and the blue begins that process of the social construction of gender which then overlays the biological sex of the baby. Howard Garfinkel (1967) in ‘Studies in Ethnomethodology’, later described the continuous process of the social production of gender roles, whereby ‘Agnes’, born with a penis, passed as a woman.

 

In part two ‘History’ Beauvoir describes the historical subjugation of women by men for example quoting Proudhon who valued a woman at 8/27th the value of a man. The almost total subjugation of women, and their subsequent invisibility in history, results from patriarchy often underpinned by religion. Biology (the ‘is’) is invoked to put and keep them in their subordinate place (the ‘ought’). However, in the modern era, two key factors were involved in the evolution of the female role in society: 1. participation in production and 2. freedom from reproductive slavery. ‘Modern’ women, such as Rosa Luxembourg and Marie Curie, who were able to exploit these factors:

 

brilliantly demonstrate that it is not women’s inferiority that has determined their historical insignificance: it is their historical insignificance that has doomed them to inferiority” (p131).

 

Industrial, and now postindustrial capitalism as a dynamic system, has both freed women and created new forms of subjugation. Factory work, especially during war, gave opportunities for women to, en masse, demonstrate their strength and provide alternatives to lives of domestic labour. Nursing arguably began its professionalisation following these factors, and nurses themselves enjoy almost total freedom from obligatory reproductive labour secured by the contraceptive pill. Yet, new forms of subjugation have been created. Advances in cosmetic technologies and medical practices have now given women new tools to construct themselves as befitting whatever cultural artefact is now considered as beauty. We now have labiaplasty offered, not to correct genital ‘malfunction’ but as an aspect of new norms of beauty possibly in response to exposure to pornography (Davis 2011). Beauvoir pointed to the male gaze, but it now seems that women themselves are complicit in this reconstruction of the feminine.

 

In part three ‘Myths’, Beauvoir discusses such as issues as men’s ‘disappointment’ in women revolving round issues such as menstruation, virginity, copulation and motherhood. Myths about the female role abound in literature written by men, especially the ‘mystery’ of woman to man, perhaps foreshadowing Betty Friedan’s later work, ‘The Feminine Mystique’ (Friedan 1963). Friedan argued that male editorial decisions in women’s magazines, insisted on articles that showed women as either happy housewives or unhappy careerists. This was the “feminine mystique” the idea that women were naturally fulfilled by devoting their lives to being housewives and mothers. In both books there is this suggestion that men misunderstand, or perhaps even fear women, and engage in creating a simulacrum (Baudrillard n.d.) of femininity to best fit their own gendered and sexual needs. It might be that male fear of women, their lack of control of female reproduction, is at the root of ‘femicide’ – the killing of females by males because they are females (Russell and Harmes 2001).

 

Volume two of the work is also divided into 4 parts; ‘Formative years’, ‘Situation’, Justifications’ and ‘Towards Liberation’. Beauvoir describes the learning of appropriate femininity and subsequent domestic roles. Her critique of marriage and acceptance of lesbianism no doubt helped the Vatican in its decision.

 

Beauvoir assembles an historical account using examples from literature, politics and philosophy to argue that to fully understand what it is to be a women requires moving beyond biology as destiny to examining the myths of femininity, myths often created by and for men, and then towards constructing emancipatory practices.

 

Women should come to see that they are under a ‘male gaze’ which constructs who they are and that beauty itself is a social construct. It is through other people’s assumptions and expectations that a woman (sex) becomes ‘feminine’ (gender). Part of that feminization is the requirement of women to strive after beauty, defined by mens’ view of what they would like women to be. A view that denies women the capacity for action and thought, to be passive objects of the male gaze, and to use artifice in order to be ornamental, to disguise the more animal aspects of their bodies, e.g. the removal of body hair in western aesthetics. The pressure on women to become an object, to be conventionally beautiful, to diet, is intense.

 

Of course, the male gaze can be internalized by women, and it is the case that women’s magazines produced and edited by women perpetuate beauty myths (Wolf 1991). Aesthetic technologies, such as dermal fillers and botox, are often advertised by women, performed by women, performed on women. Beauvoir focused on patriarchal values and concepts as drivers for these processes, whereas and especially since the development of liquid modernity (Baumann 2000) characterized by individualism, consumerism and atomization, and by the increasing marketisation of society (Sandel 2012, Marquand 2014), consumer capitalism has also targeted men as consumers of beauty products. We have now the construction of the male body type with the ‘six pack’ as its apotheosis.

 

The creation of dissatisfaction with one’s body, be it male or female, is now a marketing tool to sell product. This process may have become a dominant ethic in contemporary society. Booth (2014) refers to a contemporary concerns with ‘mammon worship’ defined as ‘seeking satisfaction through the superficial’ while Skidelsky and Skidelsky (2012) focus on the dominance of the values of acquisition and ‘insatiability’ while societies have lost the sense of what the good life might be. If this is the case, then Beauvoir’s focus on patriarchal values and the male gaze, allied with more and more of a concern with financialisation and the creating of new markets for profit,  come together as dominant social ethics to create who we are at both emotional and physical levels.

There is resistance of course. Since Beauvoir’s publication, some have suggested that ‘second wave’ feminism (Gamble 2001) and ‘third wave’ feminism (Tong 2009) arose to address the rights of women. Resistance to the male gaze can be seen in Susie Orbach’s work (1978). For Orbach, gender inequality makes women fat; compulsive eating and being fat is one way to avoid being marketed at or being seen as the ideal woman. Orbach suggested it was some womens’ way of rebelling against powerlessness in society. More recently, the ‘Everyday Sexism’ project exists to address instances of sexism experienced by women on a daily basis. Within a health context, Hagell (1989) discussed the conceptualization of nursing work as women’s work while Aston (2011) have used feminist post structuralism (FPS) as a way of understanding obesity. Sundin-Huard (2001) used subject positions theory to illustrate how nurses in a gendered profession can be positioned into subordinate roles within hierarchical medical and managerial structures.

 

The value of returning to Beauvoir’s work is in reminding us that what seems normal and natural for women’s place in society and what seems normal in their ‘natural’ attributes as carers and nurterers, may not be normal or natural. We need to remember the ‘is’ and the ‘ought’. The pressures women experience, and the tools they use to provide an acceptably pleasing face to themselves as well as to men, are cultural artefacts bound up within systems of power. Powerlessness in the face of the social construction of feminities that lead to abject and subordinate subject positions can lead to reaction which might even be self harming. Feminist theory may not find a home in nurse education, perhaps it should?

 

 

 

 

 

 

Aston M, Price S, Kirk S, and Penney T. (2011) More than meets the eye. Feminist poststructuralism as a lens towards understanding Obesity. Journal of Advanced Nursing.

Baudrillard, J. “XI. Holograms.” Simulacra and Simulations. transl. Sheila Faria Glaser. http://www.egs.edu/faculty/jean-baudrillard/articles/simulacra-and-simulations-xi-holograms/ retrieved 20 February 2015

Baumann Z. (2000) Liquid Modernity. Polity. Cambridge.

Beauvoir, Simone de (1949 (translated 2009)). The Second Sex. Trans. Constance Borde and Sheila Malovany-Chevallier. Random House: Alfred A. Knopf.

Booth, P. (2014) Straw Mammon: An essay on Mammon’s Kingdom by David Marquand. Institute of Economic Affairs. July 2014. http://www.iea.org.uk/blog/straw-mammon-an-essay-on-mammon’s-kingdom-by-david-marquand

Davis, R. (2011) Labiaplasty surgery increased as a result of pornography. Women. The Observer 27th February http://www.theguardian.com/lifeandstyle/2011/feb/27/labiaplasty-surgery-labia-vagina-pornography

Garfinkel, H. 1967 Studies in Ethnomethodology. Englewood Cliffs, NJ: Prentice Hall.

Gamble, s. (2001) ed. The Routledge companion to feminism and postfeminism . Routledge London.

Garner, David M.; Garfinkel, Paul E. (2009). Socio-cultural factors in the development of anorexia nervosa. Psychological Medicine 10 (4): 647–56

Hagell, E (1989) Nursing knowledge: Women’s knowledge. A sociological perspective. Journal of Advanced Nursing, 14: 226–33

Hume, D. (1739-1740) Treatise on Human Nature. Section 3.1.1. Moral Distinctions Not deriv’d from Reason. http://davidhume.org/texts/thn.html

Marquand, D. (2014) Mammon’s Kingdom: An Essay on Britain Now. Allen lane. London.

Orbach, S (1978) Fat is a feminist issue. Arrow. London.

Russell, D and Harmes, R. (eds) Femicide in Global Perspective. Ch 2 p 13-14. Teachers College Press, New York.

Sandel, M. (2012) What money can’t buy. The moral limits of markets. Allen lane. London.

Skidelsky, R and Skidelsky E, (2012) How much is enough? Money and the Good Life. Other Press. New York.

Teachman, B.A.; Brownell, K.D. (2001). “Implicit anti-fat bias among health professionals: Is anyone immune?”. International Journal of Obesity 25 (10): 1525–1531

Tong, R. (2009). Feminist Thought: A More Comprehensive Introduction (Third ed.). Boulder: Westview Press. pp. 284–285, 289

Wolf, N. (1990) The Beauty Myth. How Images of beauty are used against women. Vintage. London.

Why do nurses behave as they do?

Subject Positions Theory.   Why do individual nurses behave as they do?

SPT tries to explain how ‘subjects’ will behave in certain situations. It can be used to explore what ‘positions’ we take up and what identities we either assume or refuse within a social context that is characterised by power relationships. It allows the question about how powerful ‘others’ (i.e. Health Secretaries, CEOs, Consultants, Managers) position the relatively powerless ‘subject’ (staff nurse, patient) into certain subject positions (e.g. handmaiden, passive recipient) simply through an unconscious, uncriticised and shared language, discourse and power. Objective formal power involving clear boundaries, sanctions and authority also operate in social relationships. Objective formal power needs to be called out, and its foundation clearly described as operating often on an unspoken ideology. In the current context of health care delivery, that ideology is founded upon the twin pillars of neoliberalism and managerialism. These are macro level positions, whereas SPT allows exploration of informal power at the micro level that might go otherwise unanalysed.

 

The ‘subject’ within this theory refers to the individual human being who engages in creating an identity and does so partly by being the ‘subject’ of language, discourses and power relationships. The subject position, or identity, one takes is created by language, discourse and power and in doing so also creates that identity. This operates within a set of social relationships that are characterised by differences such as ethnicity, sexuality, gender and class. These relationships are also relationships of power. They operate through and within language. Our subject positions are partly defined by others unless we recognise the process of positioning and resist it. However, a good deal of positioning by others can be successful because we take subject positions often unconsciously. We have already accepted the language, discourse and power of others. Within any social interaction, powerful ‘others’ may engage in ‘interpellation’ (Althusser 1989). They ‘call’ us into a subject position by our intersubjective acceptance of the language, discourse and power of the other.

 

When a doctor, or manager, calls upon a nurse to do something, they are often ‘interpellating’ the nurse into a subject position of obedience to a medical or hierarchical regime. This can only work if the nurse recognises and accepts the subject position of junior partner. This process of identification creates an identity. The doctor identifies the nurse and the ‘subject’ within the nurse becomes a nurse. The subjective ‘I’, which in other social situations is not identified as a nurse, now becomes one. This is not to be confused with the formal title that the qualification RN bestows upon someone. Merely having been registered with the Nursing and Midwifery council does not identify a subject as a ‘nurse’, it is merely a formal recognition of one’s status on a register. One becomes and assumes the identity of nurse through social interaction and the ‘interpellation’ of others. A nurse is a nurse only when others say so within a social context. Upon leaving the clinical setting, the subjective ‘I’ is now free to assume other identities such as mother, friend, runner or dancer.

 

When a nurse is called in this manner, it may well be the case that the nurse recognises this calling, and that the subjective ‘I’ is now the subject position of ‘me’ as nurse. This operates through the unconscious acceptance of that subject position. Through such mechanisms as ‘occupational socialisation’ the calling out of ‘me as nurse’ feels natural and in that acceptance further cements this identity. The nurse has been ‘recruited’ into that subject position and over time bonds with that identity and its underlying ideological sets of discourses and power relationships that go with it.

 

Within the occupation of nursing there may be a number of subject positions open to individual nurses. Some of those positions are overt and openly discussed, others operate within the covert, intersubjective, lifeworld of nursing. Thus, nurses assume certain subject positions, such as ‘nurse advocate’, and attempt to assume this identity to further patient care. In doing so, do other ‘powerful subjects’ may position the ‘nurse advocate’ identity into one of ‘whistleblower’ or ‘uppity nurse’, ‘non-medical care worker’ or ‘junior partner’.

 

Potential Subject Positions that might be open to nurses: they operate as binaries – one position is assumed other is an ‘abject’ position.

 

·       Advocate/Non advocate

·       Carer/patient

·       Empathiser/task completer

·       Doer/Organiser

·       Whistleblower/Compliant worker

·       Educator/Student

·       Trainer/Trainee

·       Supervisor/worker

·       Female/male

·       Good nurse/uppity nurse

·       Coper/Whinger

·       Emotional supporter/distant professional

·       Responder/avoider

 

 

‘Subjects’ have the ability to occupy and move between a variety of identities, or ‘subject positions’, within an interaction in the clinical setting but this depends on the power dynamics and context of that exchange. We can therefore try to analyse in any given interaction what those power dynamics are and what the context consists of. So, how do nurses either comply with or resist positioning for example as a ‘doer’ within a power struggle?

 

Lacan (1977) suggests we assume identities, or positions, in response to punishments or threats of punishment. In the clinical context that might include bullying, intimidation, snubbing, patronising language or lack of promotion. The fear of punishment arises out of ‘knowing’ the rules of interaction and being aware of power and the rules of hierarchy.

 

Once an identity has been assumed it is associated with a particular discourse, i.e. a stock of words, phrases, concepts, theories, that support and explain the position taken. The subject position of nurse, according, to society, should display feminine attributes based in an ethic of care. The discourse associated with this is about being a ‘good nurse’ emphasising nurturance, obedience, support, listening and helping. This recently has been given even more support through emphasising the 6 Cs. This sits in opposition to critical advocacy especially in relation to the medical profession and NHS management. The discourse available to critical advocacy emphasises challenge, assertiveness, rights, and standards. The subject position of whistleblower is similarly contradictory, at once being that of advocate and patient champion while the reality is also one of irritant, turncoat and rebel to the hierarchies of power. SPT requires a critical theory of power to move beyond analysis at the micro level to critique of power structures (be they gendered, class, managerial) at the macro.

 

Clinical decision making, such as advocating a certain course of action such as moving an older person within the hospital at night, or changing the operating list to avoid delays, or getting analgesia prescribed, operates within this matrix of subject positions involving negotiating the social order of hierarchy and power. Sundin-Huard (2001) argues the subject position of advocate is countered by the subject position of ‘good nurse’ in that in exercising advocacy the nurse threatens the identity of ‘good nurse’ and becomes the ‘uppity nurse’. A vignette illustrating this positioning is used as an exemplar. In the vignette, a neonatal nurse advocates, unsuccessfully, for analgesia as she is positioned and assumes the position of advocate and uppity nurse. In the training film ‘just a routine operation’, two nurses are similarly positioned as ‘junior without formal decision making power’ within a critical airway emergency in theatre. The resulting death of the patient in that scenario clearly demonstrates that this analysis is no mere sociological abstraction.

 

Conclusion

 

Nursing does not operate in a neutral power context. Nurses work in a gendered occupation underpinned by a range of discourses using certain languages that often position them into subordination. Those in formal power positions also understand these discourses and through language use can ‘call’ nurses into subordinate and contradictory subject positions. Hierarchies of gender, class and occupation provide the context for these positionings to take place. In order to minimise moral distress and the burden of emotional labour, nurses require an emancipatory understanding of these taken for granted power plays to enable practical resistance to develop. In this they can be aided by the discourse of humanism recognising the requirement for patient safety, comfort and cleanliness in the provision of quality care. The nurse who feels emotional and moral distress as a result of the actions and omissions of other power actors in the workplace, requires an analysis of the basis of this power relationship so that rather than turning in on oneself in defeat, a resistance can be mounted by creating alternative languages, discourses and power bases. Resilience in the face of threat in this context is not enough. Nurses need to find a language to speak truth to power and then forge political alliances with other actors, e.g. patient advocacy groups, to create alternative visions and structures to that which is advocated by neoliberals and the dead hand of managerialism.

 

 

 

 

 

 

 

Althusser, L. (1989). ‘Ideology and ideological state apparatuses’ in Lenin and Philosophy and other Essays: pp 170-186. London. New Left Books.

 

Lacan, J. (1977). Écrits: A Selection. Trans. Alan Sheridan. New York: Norton

 

Sundin-Huard D. Subject Positions Theory. Understanding conflict and collaboration in critical care. (2001). Journal of Advanced Nursing 34 (3) pp 376-382

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