anthropology, history, sociology, philosophy and psychology, feminist studies, ..... The materialism advanced by Marx and Engels: historical materialism,.
How to Place Material Things From essentialism to material-semiotic analysis of sociotechnical practice∗
Finn Olesen & Randi Markussen One can start from the idea that the world is filled, not in the first instance, with facts and observations, but with agency. The world I want to say, is continually doing things, things that bear upon us not as observation statements upon disembodied intellectuals but as forces upon material beings. (Pickering Mangle of Practice 1995: 6)
In the last few decades, a fruitful body of boundary-crossing research has developed in creaks in the walls between traditional science and technology research.
Representatives
from
various
professional
disciplines,
like
anthropology, history, sociology, philosophy and psychology, feminist studies, cultural studies, information studies, etc. now investigate science and technology as cultural expressions rather than timeless, rational activity. There are several reasons why this turn has come about, as has been narrated in various publications (Pickering 1992; Callebaut 1993; Biagioli 1999). In this paper, however, we will focus only on one aspect of the new approach to science and technology studies. It has to do with the way we study things around us as part of learning about human practice. One may study things as if they are somehow pre-given objects with certain known qualities, or they may be studied as if they are dynamic elements in a continuous flow of activities. In ∗
This paper is the outcome of a talk at the conference 'Doing Things with Things' at Copenhagen University in September 2001. The conference was organized by professor Ole Dreier and professor Alan Costall. 1
this paper we will investigate the relationship between the things we (can) say about things, and the stance from where we are able to say such things. First, we will discuss some philosophical peculiarities tied to the concept of things, then we will challenge a number of established notions about materiality on basis of the writings of the science study scholar Donna Haraway, and finally we will tie this understanding to findings from a field study we did at a large Danish hospital in the fall of 2000. The basic claim throughout this contribution is that if the researcher work from an inelastic sense of the material reality, this may hide the effectual doings of things. But let us open up the subject by meditating on the concept of a thing, to see how far a principled, conceptual analysis will bring us.
1. Thinking about things Is there more to a thing than the sum of its qualities? One reason to assume this is that we apparently use one kind of concepts to describe the qualities of things, and another kind of concepts to describe, or refer to a thing in itself. It seems that we individuate things all the time in various ways, so what are we actually able to say about them? Two issues come to the fore. First, is a thing, say a car, the sum of its parts, and if so, when will it lose its unitary status? Is the car a wheeled vehicle? Is it still a car when the wheels are removed, and are the wheels not now seen as new things in their own right? Hence, before there was the original unified thing, the car, but now there are five independent things with their own, unique qualities. The problem turns into a puzzle. When do we talk about a thing, and when do we talk about a context? Does, for example, the teapot act as context for the teapot lid? Is the tea tray context for various comestible things. - The puzzle has obviously to do with classifications, and one may wonder if there is an infinite number of
2
things in the world, so that no classification scheme whatsoever may be able to exhaust the essence of a thing (Mary Douglas 1994, Hacking 1991). Second, if we disregard the puzzles about the possibility of an infinite number of things in the world - and all those questions, following from that, regarding classification as such and the risk of making arbitrary separations we may return to the speculations about a thing as the sum of its parts. This, however, raises another and just as important, philosophical question about the relations between a thing, and the properties we assign to it. A car may be identical with the totality of its parts, but that does not account for the relation between the car and its properties, such as colour, shape, weight, and size. At the manufacturing plant the individual car is build by combining parts in a certain planned fashion, but it is not possible to build a car in that material sense by combining its properties. So what is the ontological difference between the properties and the parts of a thing? (Quinton 1973). Is it perhaps the context that yields properties to the thing? The situatedness? Seen in this abstract light there seems to be good reason to claim that there is more to a thing than its properties, simply because properties are not immanent to things, rather they are transcendent. The same properties can apply to indefinitely many individual things, because to ascribe some properties to a thing is to classify it and compare it with other things that resemble it in certain ways due to some shared properties. While the car has the property 'red' in common with a lot of other things, it has the property 'car-shaped' in common with a number of things, which are only partly compatible with red things. Also, the colour and weight properties of a car will relate it to a lot of other things, as there will be a number of additional overlaps between other properties of these things. The actual qualities of a car will limit the number of qualities it has in common with other things, because there are fewer things in
3
the world that have both red colour, car shape, car weight and car size in common, than things, that have only some of these properties in common. It follows, that it can only be contingently true, that the sum of properties of a thing is sufficient to individuate this thing from other things. There will be numerous other things that have these properties, too. It will thus be extremely difficult, if not impossible, to produce a complete specification of the properties of a thing. Neither is it feasible to claim that a particular list of specifications is final. So we are back at the opening questions: How do we individuate things, so that we may claim that this thing is what it is because it has these properties, and that these properties are uniquely belonging to it? It is in this entanglement that the problem of individuation lies: The total amount of properties ascribed to a particular thing does not guarantee that this thing necessarily has been individualised. If the total amount of properties belonging to a thing is indefinite, it follows that the presumed qualitative identity between two things is inductive, and, as we have learned from David Hume long ago, such knowledge about the world may be refuted in the light of tomorrows insights. In short, the unique, individual quality of a thing must be something else than its properties. But what might that be, then? - It was hinted in the above that the researcher can benefit from studying the context of things. Talk about a context implies talk about people, too, since the term 'context' suggests linguistic relationships between various entities. 'Context' literally means 'the framework in which a word or a phrase is used'. Relationships are established by us as an ongoing practice of linking things in certain fashions to bring order into our world.1 Hence, in the next sections we will investigate some 1
We do not intend this to be an anthropocentric or speciecist argument, since other species also appear to operate from ordering their world through contextualisations. But here it seems relevant to emphasize the relations between things and lingual beings like ourselves as the term 'context' implies, strictly speaking. 4
consequential ideas about the relationship between people and things with a focus on the material fabric of the world. On the face of it, it would seem that the material world is the most stable point of departure if one wishes to learn about things and their contexts. As will be evident, however, we may well have to develope new ideas about the materiality of things in order to talk about their practical, but slippery nature.
2. The material world In the beginning of her book: Modest_Witness@Second_Millennium. FemaleMan©_Meets_OncoMouse™ – Feminism and Technoscience from 1997 Donna Haraway claims the following: "Challenging the material-semiotic practices of technoscience is in the interest of a deeper, broader, and more open scientific literacy, which this book will call situated knowledge" (Haraway 1997: 11). Below we wish to pursue her challenge to traditional conceptions of science and technology in order to get a fresh perspective on how to do things with things. As a first step to understanding Haraway's concept of material-semiotic systems (or fields, worlds, practices, bodies, knots) we find it productive to move somewhat deeper into the details of some influential ideas about the concepts involved, i.e. 'material' and 'semiotic'. This start makes it possible to relate to the kinds of understanding of being and knowledge production that Haraway wishes to transcend. It will appear that her understanding of materialsemiotic entails a challenge to established philosophical ideas, which have been built into well-working, modern scientific narratives about 'objective' reality.
5
2.1. Materialist stances Let us continue by trying to answer a straight-forward, solid question: What is materiality and materialism? First materiality. - The concept is rooted in the latin materia, meaning 'matter or substance'. The latin word is derived from the Greek hyle, meaning 'wood', but not wood in general, though, only the specific kind of wood that is being used by the carpenter to build from. In that sense, matter is related to form from the very beginning; it is the carved wood that is implied in the concept of hyle. Matter and form are tied together in our conceptions and our experience (Flussel 2000). If one conceives of matter as the stuff things are made from, it follows that things are assigned certain qualities, e.g. spatial and temporal extension, mass, mobility, divisibility, masurability. Often such properties are labelled as 'quantitative', because they tell about size and weight. Aristotle, who lived some 2300 years ago, saw raw matter as form-less or indetermined, while the form of a things is that, which will actualise it and make it real. With the natural philosophers in the 17th century, matter is conferred many of the basic meanings familiar to us moderns, not least through the development and teachings of experimental science. The unique power of claims coming from natural science about reality has to do with the unique possibilities of scientific institutions to make controlled measurements of such natural processes. The results can be circulated and compared with other results from similar measurement to develop stable determinations of natural behaviour, i.e. natural laws. It will become obvious below, how not least Marxist conceptions of reality have criticized this understanding to be too rigorous, not providing a fair picture of the complexity of the world. What about materialism, then? If one by 'materialism' points to a stance from where the world is seen as the sum of physical matter, we are immediately led back to an understanding developed in the midst of 17th century empiricism
6
and taken over by enlightenment philosophy. This understanding was, however, already expressed in the theory of atoms by the Greek philosopher, Democritus, some 2400 years ago: Materia is what is given in knowledge about nature; there is no basic power or spirit intervening in the processes of nature. What exists is the extended, material reality that can be measured. We are in other words at the mercy of our senses, that is, natural knowledge is limited to what can be observed without interference from speculative phenomenon and concepts. Even if there is no intention in the spiritless, material nature, things do not happen by accident. On the contrary, everything follows the clear laws of nature. Also, mental processes and states can be reduced to material reality due to the atomic structure and material fabric of all things. Already Democritus had talked about the soul as made out of especially smooth and round 'soul atoms'. In mechanical philosophy, introduced by British empiricist in the 17th century and further developed in the 18th century by materialist philosophers, the interior of the soul was precisely investigated on experimental-material grounds. In the same period inventors like Baron von Kempelen and Vaucaunson produced mechanical dolls that were not just expressions of mechanical enthusiasm and skills. These automatons also symbolised a basic mechanical-material conception of reality: We do not need the cartesian 'double-ontology' that not only contains calculable matter, but also slippery soul substance of a very speculative nature! In this firm rejection of body-mind dualism one finds, however, an important recognition of the soul stuff or mentality as the distinct other in contrast to the material reality. As we well know today, this rigid contrast between mind and matter did not stay uncontested in philosophical discourse. In the middle of the 19th century, materialism got a different meaning, much in conflict with the mechanical materialism. 'Material' was interpreted 7
dialectically by Karl Marx and Friedrich Engels, who would seek for the developmental principles behind the empirical, sensual world. It is no coincidence that the young Marx wrote his academic dissertation on Democritus and Epicure, arguably the two foremost materialists of antiquity. It has been pointed out that Marx never offered a straight-forward answer to the question: What kind of a philosophical materialism is yours? (Witt-Hansen 1973). He would talk about materialism and idealism through aphorisms or in peripheral remarks in his social analyses. He does say, in opposition to Hegel, that the ideal is nothing but a mental transformation and translation of the material. This act of transformation and translation is what Marx calls spiritual production. By emphasizing human productivity Marx distances himself from Feuerbach and other materialists. In the first thesis on Feuerbach he criticizes him for ignoring the role played by human sensorial activity in practice, i.e. in history, politics and economy. Instead, Feuerbach stays satisfied with a contemplative materialism that yields a passive, observing role to human beings. The distinctive mark of Marx' materialism is that he not only accepts the claim made by contemporary materialists that people are products of their material conditions, but he adds that because we are productive beings we will also actively change our material and spiritual environments. His philosophical anthropology is thus much more generous to our participation in the world. The materialism advanced by Marx and Engels: historical materialism, would reject mechanical materialism, or 'vulgar materialism', of the kind described above, because of its basic claim that only physical bodies in motion exist as the basic building blocks in the universe. For Marx and Engels, on the contrary, it is necessary to investigate reality on separate ontological levels, where each level has its own reality in accordance with dialectic laws of historic development. This assumption makes it very sensible to talk about historical materialism. While historical materialism does not presume reality to
8
be just extended matter, it presupposes that reality is developing, or built, on top of a material foundation. But in the same way that a building is not reducable to its foundation, so is reality not just extended matter. The interior of the world does also embrace social, political, cultural, aesthetic phenomena. The concepts of 'basis' and 'superstructure' made it possible for Marx and Engels to point out dialectic tensions between the material and the sociocultural levels of any society. They thereby offered a different, much more dynamic, conception of materiality and materialism. It is true that higher levels of reality depends on lower levels, i.e. the social superstructure depends on the basic material and economical conditions. At the same time one should not aim at reducing the moral, religious, or philosophical institutions to some basic material structures. Furthermore, there are constant interchanges between the various levels. When reality is thus parted into several ontological levels, each with its own kind of existence, the physical reduction presupposed by mechanical materialism is totally misleading. Reality is much too complex for that understanding to be final. The strong political dimension, central to historical materialism, has set its mark on a large number of subsequent positions, trying to come to grips with our practical, shared existence, both as endorsements, and as attempted refutation of this dynamic mode of materialism. Marx and Engels' materialistic, political arguments and philosophical anthropology will consequently also be found in those positions. This observation allows us to move several steps further to Haraway's stance on material reality. As will be evident she attempts to dissolve a number of strong tensions between philosophical anthropology and contemporary, sociotechnical reality in which not everything is what it seems to be.
2.2. Material-semiotic stuff 9
Donna Haraway has acknowledged that she is "... something of an unreconstructed and dogged Marxist", who remains "... very interested in how social relationships get congealed into and taken for decontextualized things" (Haraway 1997:8). Like Marx, she rejects simple, scientific attempts to reduce social reality to 'congealed' objects in a mechanical-material grid. She disbelieves in any straight-forward, cartesian contrast between subject and object reality. Rather, she prefers to study sociotechnical alliances and relations, which she takes to be preconditions for scientists and philosophers, who mistakenly substitutes frozen images for social life. While Haraway willingly subscribe to Marx' determination to demonstrate how objects and nature is full of social process and work - "... even if many current science scholars have forgotten his priority here" (Haraway 1997: 43) she disagrees on his basic assumption about the given, human nature and its privileged role, or rather, she disagrees on seeing work and practice as exclusive human characteristics. Marx has expressed such views in relation to the anthropocentric interpretation of technical change through history. To him, the technical-scientific development represents a progressive, dialectic process in which human beings have emancipated themselves from nature's constrains in attempts to realise their own nature. The history of technology has in other words served as an argument to demonstrate the human desire for emancipation, i.e. the progressive humanisation. This makes it sensible to claim that Marx' thinking was based on a positive view on technology for the good of humanity (Siggaard & Skovsmose 1986). Similar anthropocentric conceptions are found in influential Marx readings from the 20th century. Not least in Adorno and Horkheimer's historicophilosophical social research one finds similar ideas about the privileged position of us humans. Based on the young Marx' philosophical writings they have described the transition from natural to societal constraints. Humans toil 10
to free themselves from the constraints of nature through technical mastering, but they remain unfree because reason fails to see that also humans are natural beings. Hence, reason itself is being governed, and as such it is reduced to instrumental reason, i.e. to a utensil to forward technical manipulation, objectification, and ruling of the world - not least human societies. Only when reason begins to reflect on its own natural foundation is the continued emancipation possible. Such thoughts are also found in Habermas's social philosophy, not least expressed through the well known term 'technical knowledge interests'. Other Marx-inspired traditions like activity theory and critical psychology seems to presuppose this principal, ontological separations between human agency and non-human things and phenomena. This is where Haraway detach herself from the marxist tradition, or perhaps better, tries to carry over the tradition to let it become a post-humanist social theory in accordance with contemporary social life: But unlike Marx, and allied with a few prominent and deliberately crazy scolars in science studies, with armies of very powerful and paradigmatically sane scientists and engineers, and with a motley band of off-the-wall ecofeminists and sciencefiction enthusiasts, I insist that social relationships include nonhumans as well as humans as socially (or, what is the same thing for this odd congeries, sociotechnically) active partners. All that is unhuman is not un-kind, outside kinship, outside the orders of signification, excluded from trading in signs and wonders (Haraway 1997: 8). It follows that if we wish to understand social reality on Haraway's terms we must (at least) be willing to bend Marx in two significant ways. First, historical materialism needs to include the non-human actors; and second, as indicated at the end of the quote, their status as actors must include the handling of signs
11
and other non-material work. That leads to the semiotic dimension of Haraway's conception of reality.2
2.3. Semiotics In the Western culturale we have built a basic idealistic conception of words as something hovering over the paper. Just think of Plato's philosophy of the real world of ideas, or the role of the word in the judean-christian tradition. In this tradition there is a deep gap between the practice of putting letters, words, and sentences to paper or to harddisk, and the cultural understanding of words as transcending their material context. Gradually, e.g. with the replacement of hand-written books by mass-produced, printed type volumes in the renaissance, and with the hermeneutic-humanist interest of modernity in trying to grasp the hidden meanings behind our written utterances, there has come to be a culturally accepted separation between the materiality of the written words and its meaning. A separation between things and signs. Words are often taken to be representations of the essence of human being, that is, reason; and language has in paradoxical ways gained status as our connection to eternity, not least through religious and cultural practices. Whether language represent God or Nature, it points beyond the specific, social and material context, in which it was first expressed. That seems to be a special property of language: the ability to free itself from its original context, from its own history. Due to this (and for other reasons, as well) we do not, in our cultural imageries, expect to find significant bonds between words and their contexts of productions, to paraphrase Marx. We have, more precisely, gotten into the habit of making deep, meticulous analysis of the numerous, symbolic representations of our unique, mental essence, and of the emancipating and/or In Haraway's writings 'semiotic' should be taken in a broad sense of the term to express the textual and symbolic dimensions of the world as they are woven into fields of practice. 2
12
limiting effects of materiality on our life. Typically, we presuppose a boundary between these two reality domains, whether it is a cartesian sign-thing ontology, or it is a more advanced, vertical understanding of reality as in Marx and Engels. In a sociotechnical culture it may not be enough, however, to see nuances through the lenses of dialectic materialism. They are not, so to speak, grinded to show the continuous transitions between the material and the semiotic dimensions of reality. We need to find a different stance from where to investigate the relationship between humans and things. Not a radically different one, as should be obvious by now, but one that is able to overcome the culturally born dichotomies between humans and things, and between signs and matter. Donna Haraway, together with the French sociologist Bruno Latour (Latour 1988, 1993) and others, has demonstrated the merits of trying to dissolve absolute ontological boundaries between material and symbolic dimensions of sociotechnical practices. She has identified figures and figurations as explicit expressions of "... the tropic quality of all materialsemiotic processes, especially in technoscience" (Haraway 1997: 11). By that she wishes to point out that a figuration is not just a figurative beautification of literal speech. Neither are pictural utterances 'just' images or symbolic expressions of literal meaning. Rather, we live with and through such figurations. The famous cyborg-figure is arguably a special sign of a sociotechnical culture's transgression of any subject-object dichotomy, of any fixed material-mental boundary-work (Haraway 1991). But there are many other such figurations, she insists (Lykke, Markussen & Olesen 2000a). Figurations are performative images that one may dwell in. She assumes that all language is figurative, and even if they are not mentioned specifically in Modest Witness, Haraway is aligned with the two writers on metaphor, Georg Lakoff and Mark Johnson, on this view about language. In a number of books, 13
the latter describe how we literally live through metaphors (Lakoff & Johnson 1980, Lakoff 1987, Johnson 1987). Our social life is characterised by projections of basic, experiential knowledge into abstract conceptions of the world. For instance, our personal, physical experiences of learning how to stay in an upright position may be projected into abstract ideas about the difficulties in living a balanced life in society. A discussion may be seen as a fight, or the memory as a container, etc. In Haraway’s use of images, literal and figurative modes are always intertwined (Bartsch et al. 2001). It entails that rhetorical practices are also in effect political practices. This goes for scientific practices too. To talk about the conquering of extended, lifeless nature in the 17th century, or historically developing, material world divided into manifest levels of reality, are two examples of political practices. Both bring into life a number of figurations that are embodied and thus able to perform sociotechnical work as such on top of human, verbal practice. This brings us back to the initial quotation: "Challenging the materialsemiotic practices of technoscience is in the interest of a deeper, broader, and more open scientific literacy, which this book will call situated knowledge." With her concept of material-semiotic reality Haraway makes it possible to challenge a number of 'hard' facts about nature's eternal, invariant atomic structures. Her conception also invites us to point out those rhetorical devices by which material and semiotic reality apparently is ordered in mutually fixed, static arrangements. 'Modest Witness' is a figure that was formulated in the 17th century by the famous British natural philosopher Robert Boyle in a setting of experimental science. His intention was to create a neutral, direct connection between the scientific matter of fact and Nature without intervention of human intermediaries (Shapin & Shaffer 1985, Olesen 1995). The experimental 14
scientist is precisely a modest, almost invisible figure, and due to this arrangement the scientist also becomes a political figuration. First, the modest witness is more or less equal to a British gentleman with special moral obligations and standings, i.e. women or poor people cannot be in a position to become modest witnesses to the basic processes of nature. Second, Boyle and other experimentalists succeed in establishing a unique moral order, which is still considered exemplary to scientific and non-scientific social practice. Basically, this order demands of its members that they are morally committed to endorse the experimental results they have witnessed in the laboratory. Third, nature and human society are arranged in a strong dichotomy, and natural scientists are, in a sense, commissioned as administrators to determine possible relations. Finally, the modest witness stands as the figure who deals with context-free, non-situated knowledge - not least due to his special moral standing. For all these reasons the modest witness is a political figure, who will influence the way we live. Not least is the idea of the scientist as a modest, neutral observer of natural processes a translation of ideas about masculine identity, which excludes the feminine gender from culturally significant interaction with nature. Haraway is able to demonstrate such political issues by dissolving rhetorically founded, and very solid walls put up by moderns between material and semiotic reality. It is a point in Haraway's reading practice that she lets the modest witness, as a figure, carry more than seem fair. This is a premeditated, characteristic aspect of her overall strategy as a social scientist. The strategy deserves some comments.
2.4. Paranoid Reading Practice Donna Haraway applies in recent work what she calls a 'paranoid reading practice' to create an intended, exorbitant interpretation of the text, thereby 15
placing the reader and the content at the edge between well known and strange territories. By doing so, a seemingly banal, or straight-forward thing might be turned into a eye-opening joke. As she puts it: "... Jokes are my way of working, my nibbling at the edges of the respectable and reassuring in technoscience and in science studies" (Haraway 1993: 154). When an exaggerated interpretation has succeeded in destabilising the meaning and significance of a modern figure, the context may then appear as a topic to reflect and act on. By characterizing this as a 'quasi-method' we wish to signal that a paranoid reading practice is not a straight-forward, off-the-shelf tool for the designer or sociologist who wishes to get a (better) grasp of a given human practice. To investigate, e.g. the concrete reality of a work-practice is also to deliberately invest oneself, thereby recognising that all knowledge is situated in some way or other (Markussen & Olesen 2003). As Haraway has stated it: Also, I am at least as invested in the continuing need to stabilizing contingent matters of fact to ground serious claims on each other as any child of the Scientific Revolution could be. [...T]he stories of the Scientific Revolution set up a narrative about ‘objectivity’ that continues to get in the way of a more adequate, self-critical technoscience committed to situated knowledge. The important practice of credible witnessing is still at stake (Haraway 1993: 33). The attempt to apply Haraway's concept of a paranoid reading practice does involve an acceptance of, and a commitment to the situatedness of our knowledge. Hence, whatever we tease out of studying a concrete work practice through an exorbitant, or joking reading practice is, in a sense, a function of our own investment in the knowledge that may be gained from that practice. If the intention is just to learn, e.g. how to make more efficient use of a technical system, the application of a paranoid reading practice is far from what Haraway (and like-minded people) wishes for. That knowledge may be in line with
16
scientific objectivity, but it is not embedded in some situation, in which the knower self-critically asks about the roots, reasons and politics of the knowledge harvesting. If, on the other hand, one intends to achieve embedded knowledge of a sociotechnical practices, the intentions will be more in concert with Haraway's ideas. In a sociotechnical lifeworld like ours we are woven into countless material-semiotic networks of mixed genealogies. Hence, there is no innocent or detached position from where, e.g. the technologist can study a sociotechnical work practice in order to improve some technical region of our life. On the contrary: "Reality is the fruit of intra-action, where material and semiotic apparatuses cannot be separated; and which material and semiotic apparatuses will be in play are at stake" (ibid. p. 116). If the student of social reality wishes to take part in the intra-action, it has to be as a stakeholder. And by performing some situated version of a paranoid reading practice the designer may contribute to improved, overall stakes. By appointing a figuration, like the modest witness, as the representative of a category or a species, Haraway creates an setting in which to disclose some features that may demonstrate the political dimensions of human practices. Also, this setting may show the socio-material embeddedness of the figure and what it represents. The material aspects of reality are never 'just material' as has been argued. Materiality, too, embeds fictional constructions. This playful, politically motivated excavation in the field of tension between what is literal and figurative is typical of Haraway's work. But it will remain hidden for the reader, who does not look for semiotics in material reality, and who is not able to see the materiality of semiotic figurations. To exemplify these reflections on the embedded, situated materialsemiotic arrangements of knowledge and things, let us turn to some empirical
17
findings from a plastic surgical ward in a large Danish Hospital, where we studied the successful incorporation of a digital device into daily work life. 3. Reconfigured medicine In the fall of 2000 we studied the incorporation of an electronic medication module (EMM) at a hospital ward. Inspired by Haraway and the French science studies researcher, Bruno Latour, our field study was centered on how, not least, medicine and writing were translated and transformed in order for the EMM to become a useful part of the ward's work routines (Markussen & Olesen 2002a, 2002b, 2003). Here we will focus on only one aspect of our study, the situated practices of dealing with medicine after the introduction of the electronic medication system. The management on the ward decided to implement the EMM, which till then had been an unused module in an electronic patient record developed for this ward. As part of the new arrangement it was decided that from October 2nd 2000 the doctor, who makes the prescription, has also to write it down in the EMM. At the same time the nurses must refrain from copying the prescriptions to charts and forms, and instead use the doctor's prescription on printed lists as basis for their drug administering. As we will demonstrate, this also transformed the material-semiotic conditions of writing. From now on the writing of medicine was no longer about a nurse using a ball pen to write down the name, dose, etc., of a drug on a piece of paper. Instead, it was about a medical doctor using an keyboard to type into a module in the electronic patient record which drugs she had prescribed to a particular patient. One might say that the hand and mouth of the doctor has been harmonized in an input activity, while the nurses and other professional groups are aligned to mediate the output to the patient. As will be evident, however, it is far more complicated to write down and print out medicine than can be expressed in a
18
simple, linear model. It involves a number of complex cordinations and displacements of existing competencies, that confront the outcome of any such model. Let us take a closer look at the obvious result of the new writing-reading practice on the ward: the list with the doctor's prescriptions bearing the headline: MEDICINE LIST - CURRENT. On the surface, it is a piece of paper partly covered with laser-printed text. If we look more closely at it, and begin to scratch the texture/surface, it becomes clear that it is more productive to refer to the list as a material-semiotic system, in which tight relationships between materiality and linguistic meaning are manifested.6 Here, we will point to a single dimension of the system with regard to the reconfiguration of doctors and nurses. The core of the new configuration is to be found in the creation of a stable column, and the politics of the daily rhythm. In order to justify these odd bedfellows, it would be practical to look at a 'medicine list current' in a slightly modified version to fit into this space. It was on the very
MEDICINE LIST - CURRENT Social security no: xxxxxx Name: xxxx xxxxxxx Prescribed
Name/Dosage
Change/disc Form/Strength
Fixed 20-09-2000 20-09-2000
26-09-2000
Effervescent pills 300 mg
Zantac 1 pill at bedtime
Injection liquid 100 mg/ml
Klexane 20 mg subcutaneous daily
Pills 20 mg
Diural 1 pill daily
Pills 15 mg
Serepax 1 pill twice daily
Periodic 02-10-2000
p.n. 20-09-2000
We will touch only on a few points in this subject in the present connection, but will make it the main theme of a forthcoming publication 6
19
day when the EMM module was put into use, and it was printed for use on that same day. In other words, it was still a labile material-semiotic system, tremulously balancing on the border between the banal and the foreign: Fig. 1
20
In the above English translation of a particular list we have attempted to retain the headline, fonts, and font sizes along with the horizontal lines, in order to give a fairly precise idea of what a list looks like when it is printed to be used for measuring out medicine. The reader should see the figure as covering the top half of a standard (A-4) sheet of paper. At the bottom of the sheet there is a line of text, stating the date and the initials of the person who logged on to Medicare.7 At the time of production the blanks in the prescription were filled out partly based on the doctor’s entering data, and partly based on ideas of system designers and programmers with regard to adequate set-ups for data, and partly software’s suitability for creating such fields. (See Markussen & Olesen 2002a and 2003 for further details.) At this early stage of entering data to the EMM, the doctor primarily filled out the blanks based on her requirements and ideas of meaningful information; for instance, '1 pill at bedtime' is taken to be a clear, unambiguous message. It is a message which is communicated daily between health care professionals in the verbal form preferred by doctors as communication. But it does not take into consideration the column as a material tool for the nurses, who are to participate in ensuring great precision in the task of measuring medicine at the correct time. One doctor stated directly to us that he found the 1+1+1+1 code arbitrary and a nuisance. To him there was no connection between this notation and the daily rhythm of the individual patient. Most people take their medicine at their main meals, i.e. 3 times a day, hence, the 'four times daily' built into the formalism do not fit: "One might say that the patient must adjust to the hospital’s rhythm, as defined by the four
The initials of the person who logged onto Medicare in the morning would almost always be put at the bottom of the subsequent medicine plans the rest of that day. The individual actor at the ward rarely felt any need to log off Medicare after use. The local working collectives, especially among the nurses, had, in other words, no need to differentiate identity in regard to password formalism. (See also Markussen and Olesen 2002a). 7
21
times”, he stated. It is necessary to go into this subject more thoroughly in order to understand why the need by nurses, Medicare and the computers for a new material-semiotic configuration very much depends on a shift in the doctor’s writing practice. Previously, it was the nurses themselves who filled out printed list, with columns and lines designed for the task of measuring out medicine. But the prescription module is not designed for that task! When the nurse responsible for the patient in question has printed the medicine list, she puts it in a plastic folder, which is placed at the front of the cardex - the nurse's patient record made for each patient, which is a thin, dark blue file, placed along with all the other patients’ cardex on a shelf in the ward office. When the next normal time to administer medicine is approaching, i.e. 8 a.m., 12 noon, 6 or 10 p.m., the medicine list is taken out of the cardex and taken along with the other similar medicine lists into the medicine room next door, where they are placed next to the medicine closet. The nurse then begins to measure medicine into small plastic cups. We soon learned that the process of measuring out medicine was closely connected to the material conditions of writing. Thus, the nurse measures out the medicine by following a column with her eye and a finger. But as can easily be seen in the above example in Fig. 1, there are no printed columns or vertical lines to refer to in 'Medicine list - current'! The table does fulfil its function in the light of medical and programming perspectives, but the professional group who most need the new list to prevent misreadings, the nurses, have lost the column’s stabilizing effect on the eye’s vertical movement, when compared with their pre-electronic charts and forms. 'Name/Dosage' is to show whether the patient is to be given medicine at this time, e.g. in the evening. And even though it says '1 pill at bedtime', that is not in accordance with the concrete needs of the medicine room, while the nurse is
22
measuring out the products. Does it mean '6 p.m.', or 'in the course of the evening', or 'at bedtime'? Previously, the text in the columns of the medicine list was wellassimilated into the process of measuring out medicine, thus, creating a high degree of certainty in this procedure. But the new 'Medicine list - current' is not compatible with the original process, as we can see. The new situation is therefore inconvenient for the nurses. It may well be, that they no longer need to write down the medical products themselves, a task now left to the prescribing doctor and an electronic database system with a past. At the same time, however, an unexpected displacement in the balance between text and materiality has arisen in this crucial phase of the medicine’s transformation from verbal prescription to physical consumption. The measurement phase was marked by, what we choose to call, a weak, vertical materiality, and something had to be done. A new discipline quickly arose around the writing of medicine prescriptions, where some of the nurses gradually took on the task of pushing the doctors to write correctly and on time – if not with enthusiasm, at least straightforwardly. As a nurse said: “We can’t be bothered to be nursemaids for the doctors. They must remember to write the prescriptions themselves. Of course, they differ; some just write them, while others have to be reminded. It’s probably a question of the generation gap, where we younger nurses refuse to do the doctors’ remembering for them. […] So it’s a conflict that, on the one hand, we leave it to the doctors, and on the other hand, we are dependent on being able to print out the medicine list.” In other words, a new kind of dependency to be handled in the complex, sociotechnical collective at the ward has arisen. Here, the material-semiotic and the sociotechnical dimensions clearly intersect. At the same time, it illustrates the ambiguity of the work of interaction, for the clear initial sharing of work tasks in connection with the introduction of the module 23
is not just transmitted to the relevant actors compared to the diffusion model, but instead prompts a number of pragmatic transformations of roles, needs and agency. In the local context, the medicine list must provide some virtual columns, which the nurses can use in measuring medicine. This can be illustrated by another medicine list, produced about a month later, and correctly completed in the nurses’ eyes:
24
Figure 2
MEDICINE LIST - CURRENT Social security no: Name: Prescribed
xxxxxx-xx xx
Change/Dis.
Form/strength
Navn/Dosage
20-09-2000
Pills 500 mg
Panodil 2+2+2+2
02-10-2000
Pills 20 mg
Diural 1+0+0+0
20-09-2000
Pills 100 mg
Persantin 2+0+2+0
Fixed
We have added the vertical lines to the above list to illustrate the nurses’ requirements. Note that it is a question of training the eye and the finger to check whether this patient is to have a specific product at this time. For instance, the patient is to have two 500-mg Panodil pills, but no Diural. If reading from the list was to be relatively reliable, the doctors had to learn to write according to the 1+1+1+1 code, and not 'four times daily'. One can call it a compromise, where the nurses will add the vertical lines themselves, if only doctors, the computers and the printer will live up to a disciplined writing practice, where morning, noon, evening and night are translated into numerical values. The material-semiotic transformations developed further according to the needs that arose in the course of the fall. Even though it was made illegal, several nurses began writing on concrete medicine lists, because they need to write as part of their medicine-related practice. It appeared that for some, the writing acted as a marker signaling uncertainty as to the correctness of the medicine list. In the sociotechnical arrangement of the EMM there had been no 25
allowance made for this alliance with paper as a mnemotechnic tool or aid to memory. The reconfigured writing practice was expressed in various ways, from pencilled question marks by the name of a product, over corrections in the dosage text, to pencilled vertical lines, or crossing out of discontinued medicine. 'Current medicine list' contains a column headed 'Change/Disc'. It is intended to show when a product may have changed dosage or been discontinued, i.e. treatment has been completed or interrupted for a period. Some nurses had mentioned the discrepancy between the title’s claim to be a current medicine list and the reference to products not currently being given. A nurse described how she had measured out medicine for a patient who, from his bed told her that he was no longer to have this product according to the doctor. The discrepancy had not been noticed during the measuring, where her eyes were fixed on the Name/Dosage column. Again, we see that an ideal simplification demands a good deal of work by the actors involved, in this case also a patient. The nurse further stated that she had begun crossing the discontinued medicine out with a pencil before going to the medicine room, so as not to measure it out by mistake. Here we see the dawning need to reclaim the materiality of the medicine list. The rule against writing is in effect capable of counteracting the aimed-for simplicity in handling medicine, so it must be violated with a layer of graphite added by hand to the machine-printed layer of ink. Another nurse showed us a list she had written on because she was not sure of the dosage shown for a certain product. Her eyes had stopped at a surprising dosage in the text, making it necessary for her to put words on paper. That way she materialized her uncertainty, so that it was not forgotten, but could be followed up by herself or other nurses. The following example illustrates well the often sublime transition between the material and semiotic dimensions of medicine. It proved 26
impossible to prescribe children’s vitamins through the EMM, because the product was not found in the module’s database. In consultation with a doctor, a nurse therefore wrote 'Multitabs Junior 1+0+0+0' with a ball-point pen at the bottom of a 'Current medicine list', so that her child patient could be given the necessary vitamins. When the patient’s other medicine was altered and new medicine lists printed, the hand written prescription was cut off the original medicine list, put in a plastic pocket, and laid with subsequent lists. This mix of text and paper was in no way planned, but was shown to be both necessary and practical as a local counter-program to the formal program of the medicine prescription module, which did not satisfy locally situated needs and interests. The medicine list arose from rules that were intended to ensure a simpler, more reliable procedure, but it also meant that the nurses lost a writing tool that was significant for their collective work form. In other words, for the first months, the medicine prescription module was exclusively seen as a set of rules, and not as a tool for the nurse and other professional groups (Engeström 1990: 171ff). This pair of concepts expresses quite well what was put at risk on the ward. Thus there was a continual transformation of the rules laid down, so that they were not allowed to stand in the way of a gradually recognized need by nurses for tools with which to make note of their deliberations. Halfway through the process of incorporating the module, the prescription group allowed the nurses to write on the 'Current medicine list', although only in the right margin! With this, both map and landscape, module and medicine handling were significantly altered in ways that were not planned previous to the inauguration of the system. For a time, at least, the EMM had become a stable actor in the hypercomplex, sociotechnical arrangements at the ward.
4. Conclusion
27
In this contribution we explored some relationships between the things we (can) say about things and some stances from where we can say things about things. It has also been emphasized, that the way we study things around us is inherent to what we may learn about human beings in a situated practice. In other words, our philosophical conceptions of the materiality of things entail a view of humans and things in mutually dependent arrangements. One may study things as if they are somehow pre-given objects with certain known qualities; but they may also be studied as if they are dynamic elements in a continuous flow of activities. A brief, conceptual analysis of the term 'thing' showed that principal or essentialist notions are rather futile. Instead, it seemed promising to investigate things in meaningfull contexts of material practice. We went through a few established notions of materiality and human practice: mechanical materialism and historical materialism, and ended up in support of the material-semiotic stance of Donna Haraway, not least because it questions the basic philosophical anthropologies of the former stances. Her notion of material-semiotic figurations offers a different, politically motivated understanding of social practice, allowing for a rather broad understanding of human-things relationships. In the last section we tried out this understanding on findings from our own field study. The aim was to demonstrate that a dynamic sense of the material-textual reality will disclose - often in surprising ways - the effectual doings of things. The exorbitant rendering of a figure, such as the 'medicine list - current', as representative of a category or a domain, creates a possibility to exhibit the situated, micro-political entanglements of sociotechnical practices, in which humans and things are intricately woven into one another. The material things are never 'just material', as we have argued. Materiality will also always comprise fictional constructions. 28
A we have tried to make evident, Haraway's work may be used to perform such playful, politically motivated escavation of the field of tension between what is material and figurative in things. But that will remain hidden for those, who do not look for the semiotics in material reality, and who do not look out for the materiality of semiotic figurations.
29
References Bartsch, Ingrid, Carolyn DiPalma, Laura Sells, 2001. "Witnessing the Postmodern Jeremiad - (Mis)Understanding Donna Haraway's Method of Inquiry". In Configurations, vol. 9, 1, pp. 127-164. Biagioli, Mario (ed.) 1999. The Science Studies Reader. New York: Routledge. Callebaut, Werner (ed.) 1993. Taking the Naturalistic Turn – Or How Real Philosophy of Science Is Done. Chicago: University of Chicago Press Douglas, Mary, 1994. "The Genuine Article". In Stephen Harold Riggins (ed.) The socialness of things – essays on the socio-semiotics of objects. Berlin: Mouton de Gruyter. Hacking, Ian, 1991. "A Tradition of Natural Kinds". In Philosophical Studies, vol. 61, pp. 109-126. Haraway, Donna, 1991. Simians, Cyborgs, and Women — The Reinvention of Nature. New York: Routledge. Haraway, Donna, 1997. Modest_Witness@Second_Millennium. FemaleMan©_Meets_OncoMouse™– Feminism and Technoscience. New York: Routledge. Johnson, Mark & George Lakoff, 1980. Metaphors We Live By. Chicago: The University of Chicago Press. Johnson, Mark, 1987. The Body in the Mind — The Bodily basis of Meaning, Imagination, and Reason. London: The University of Chicago Press. Latour, Bruno, 1988. The Pasteurization of France (Part one: 'War and Peace of Microbes'; Part two: 'Irreductions'). Cambridge, Massachusetts: Harvard University Press. Latour, Bruno, 1993. We Have Never Been Modern. New York: HarvesterWheatsheaf. Lakoff, Georg, 1987. Women, Fire, And Dangerous Things — What Categories Reveal About the Mind. Chicago: The University of Chicago Press. Lykke, Nina, Randi Markussen and Finn Olesen, 2000a. "Cyborgs, Coyotes and Dog. A Kinship of Feminist Figurations. Interview with Donna Haraway". In Kvinder, køn og forskning, vol. 9, 2, pp. 6-15. Lykke, Nina, Randi Markussen and Finn Olesen, 2000b. ""There are always more things going on than you thought!" – Methodologies as Thinking Technologies. Interview with Donna Haraway, part two". In Kvinder, køn og forskning, vol. 9, 4, pp. 52-60.
30
Markussen, Randi & Finn Olesen, 2001. "Information Technology and Politics of Incorporation – The Electronic Trading Zone as coordination of Beliefs and Actions". In Outline, vol. 3, October, pp. 35-47. Markussen, Randi & Finn Olesen, 2002a. "Negotiating Indentities – Refiguring Collectives in Emerging Infrastructures". Unpublished conference presentation. Markussen, Randi & Finn Olesen, 2002b. “Kyborger på arbejde – elektronisk medicinordination”. In NIKK magasin, 2, pp. 20-22. Markussen, Randi & Finn Olesen, 2003. "Rekonfigureret medicin – Medicinskrivning i en socioteknisk praksis". In Mette Bryld & Randi Markussen (red.) Cyberkulturer & rekonfigurationer. (January, 2003). Olesen, Finn, 1995. "Kendsgerningernes verden og orden". In Philosophia, vol 24, 1-2, p. 43-70. Pickering, Andrew (ed.) 1992. Science as Practice and Culture. Chicago: University of Chicago Press. Quinton, Anthony, 1973. The Nature of Things. London: Routledge and Kegan Paul. Shapin, Steven & Simon Shaffer, 1985. Leviathan and the Air-pump – Hobbes, Boyle, and the Experimental Life. Princeton: Princeton University Press. Siggaard Jensen, Hans & Ole Skovsmose, 1986. Teknologikritik. København: Systime. Witt-Hansen, Johannes, 1973. Historisk materialisme [Historical Materialism]. København: Berlingske Leksikonbibliotek. The working paper is produced as part of the research project CYBORGS & CYBERSPACE – BETWEEN NARRATION AND SOCIOTECHNICAL REALITY that is funded by a grant of 5 million DKr. (app. 700.000 EURO) by the FREJA-programme of the Danish Research Agency for the period 1999-2002. Director of research: NINA LYKKE Participating researchers - from the University of Southern Denmark: METTE BRYLD BODIL KIRSTINE JENSEN NINA LYKKE LOTTE NYBOE ANNE SCOTT SØRENSEN
31
- from Aarhus University: RUNE DALGAARD RANDI MARKUSSEN FINN OLESEN - in cooperation with: THE DEPARTMENT OF INFORMATICS & THE DEPARTMENT OF PLASTIC SURGERY, Odense University Hospital - and with GERT BALLING, IT University of Copenhagen ANJA FRANKE, The Funen Academy of Fine Arts HILLEVI GANETZ, Linkoeping University, Sweden CHARLOTTE KROLØKKE, University of Southern Denmark BETTINA LAMM, the Royal Danish Arts Academy, The School of Architecture, Copenhagen ANDERS MICHELSEN, University of Copenhagen
32
