ESTRUCTURA ECOLÓGICA

Subjectivity may be usefully understood to refer to identity: it is a construct, an experience (Mansfield, 2000) or, more specifically, the “conscious and unconscious thoughts and emotions of the individual, her sense of herself and her ways of understanding her relation to the world” (Weedon, 1987, p. 32). Foucault’s main objective was to create a history of how human beings are made subjects (Foucault, 1983b; Rabinow & Rose, 2003). His conception of subjectivity rejected the notion of a free and autonomous individuality, preferring any such definition to concern subjectivity being “the product of culture and power” (Mansfield, 2000, p. 51). As a construct, subjectivity is made up of the effects of power and, at the same time, subjectivity is the vehicle for the exercise of power (Foucault, 1980b). Foucault’s aim was to better understand how the subject was constituted precisely to avoid the assumption (since Descartes) of the subject as constituent. He therefore turned his “philosophical investigation on the concept of subjectivity itself” (A. Allen, 2000, p. 122).

A post-structural approach to subjectivity suggests that particular roles are not linked to specific individuals, but rather a person will take on a role that has been in existence for some time perhaps. In doing so, they enter “into the processes which regulate what occurs within the field, and their identity or subjectivity is shaped by the operations of that field” (Danaher et al., 2000, p. 33). It is discourse that determines the possibilities for the field, serving to produce the subject in particular ways. While all forms of subjectivity are theoretically open to an individual, an individual’s access to particular subject positions is determined and often limited by historical social elements (Weedon, 1987). For example, because the traditional nurse’s role is to follow the orders of a physician, a nurse practitioner who initiates his or her own treatment order adopts a new subjectivity foreign to existing nursing practice.

During a period of ‘autocritique’ in the mid 1970s, Foucault reconsidered his largely negative and repressive conception of power (Rabinow, 1997). He began to realise that:

[w]hat makes power hold good, what makes it accepted, is simply the fact that it doesn’t only weigh on us as a force that says no, but that it traverses and produces things, it induces pleasure, forms knowledge, produces discourse. It needs to be considered as a productive network which runs through the whole social body, much more than as a negative instance whose function is repression (Foucault, 1980a, p. 119).

Considering power as productive makes it possible to conceive of the subject as produced. Disciplinary practices as techniques of power may be thought of therefore, as not only producing objects, but also subjects:

Individuals are subject to disciplinary power, which is exercised over them and subtly and insidiously constrains their choices, desires, and actions, and, at the same time, they are made into subjects by disciplinary power, which creates various subject-positions and incites individuals to take them up. In this way, power both enables the constitution of subjects and constrains the subject so constituted (A. Allen, 2000, p. 123).

Importantly, Foucault argued for the possibility of a subjectivity “constructed in different – potentially more liberating – ways” and that individuals play a role in their own self-constitution (A. Allen, 2000, p. 125). Recognising ‘discipline’ as a very important technique, Foucault began to consider it as only one aspect of the art of governing. Thinking about “the way a human being turns him - or herself into a subject” (Foucault, 1983b, p. 208) led to two different but related concepts of how power shapes the modern subject – concepts he coined ‘biopower’ and ‘governmentality’.

Biopower/Governmentality

The concepts of biopower and governmentality represented a further development in Foucault’s thinking in the sense that “power relations had become progressively governmentalized, that is to say, elaborated, rationalized, and centralized in the form of, or under the auspices of, state institutions” (Foucault, 1983b, p. 224). However, he stressed these ideas did not supersede disciplinary practices, rather: “we need to see these things not in terms of the replacement of a society of sovereignty by a disciplinary society by a society of governmentality, in

reality one has a triangle, sovereignty-discipline-governmentality” (Foucault, 1991b, p. 102). Thus, an ensemble of disciplinary techniques (surveillance, examination and normalisation), domination and government of others and self may be used to achieve particular ends.

In the final chapter of The History of Sexuality, Foucault noted “one of the characteristic privileges of [juridical] sovereign power was the right to decide life and death” (Foucault, 1990, p. 135). The right of death came to be replaced, however, by the power over life and how to secure, extend and improve it. Foucault called this new form of power ‘biopower’, taking two main forms. First, in the manner of disciplinary technologies, the body is treated as a productive, economically useful machine, creating a more effective population. Second, in the regulation of population, the health, mortality, longevity, and particularly reproductive capacity contributed to the development of capitalism (Foucault, 1990). Foucault argued that capitalism “would not have been possible without the controlled insertion of bodies into the machinery of production and the adjustment of the phenomena of population to economic processes” (Foucault, 1990, p. 141). In this sense, the introduction of economy into political practice was the essential issue, positioning the population as an “object in the hands of the government” (Foucault, 1991b, p. 100).

The realisation that government was not only dealing with subjects, or people, but populations coincided with the human science disciplines which developed the ability to quantify the population in terms of “birth and death rates, life expectancy, fertility, state of health, frequency of illnesses, patterns of diet and habitation” (Foucault, 1990, p. 25). This led to the discovery that if the population could be analysed, it could also be a target of intervention. By employing new tactics and techniques to the population, the economy of a country can develop, which in turn benefits the population. Hence the new power, biopower, subjected human life to politics.

Connecting the question of government and politics to the self more securely is the concept of governmentality. Foucault maintained it was “not possible to study technologies of power without an analysis of the political rationality underpinning

them” (Lemke, 2001, p. 191). As a practice of governmentality, the central rationality of liberal and neoliberal thought is to limit governmental activity, and this is achieved by continually encouraging autonomous individuals to self-govern (Foucault, 1997a). Using indirect techniques, the state leads and controls individuals, rendering them ‘responsible’ for problems of self-care (for example, for health, employment and wealth). Governmentality became the term coined by Foucault (1988) to explain the rationality of government, but more precisely the encounter between technologies of the self (explained further in the next section) and technologies of domination.

So governmentality encompasses an ensemble of techniques targeted at the population as a means to ‘conduct the conduct’ of people. It is a “politics concerned with subjects as members of a population, in which issues of individual … conduct connect with issues of national policy and power” (Gordon, 1991, p. 5). Rather than imposing law on people (although this may be used), governmentality makes use of knowledge and expertise to educate and persuade a population towards particular behaviours coincident with government ambitions (Rose & Miller, 1992) and with the intention of maximising life (Lacombe, 1996). Thus Foucault’s theorising on the constitution of the self involves “a subtle integration of coercion technologies and self-technologies”, connecting relations of power and knowledge with relations to oneself and to others (Foucault, 1993, p. 204).

Technologies of the self

Foucault’s ideas on the constitution of the subject suggest that individuals are, or can be, active and self-governing agents. Through a series of techniques, individuals work on themselves to regulate “their bodies, their thoughts, and their conduct” (Danaher et al., 2000, p. 128). The desire for an individual to act upon him or her self is driven by the current regime of truth. Foucault (1997c, p. 224) warns against accepting this knowledge “at ‘face value’, but to analyze these so- called sciences as very specific ‘truth games’ related to specific techniques that human beings use to understand themselves”. Self-governance techniques of self- care and self-improvement are tied up with a neo-liberal rationality of lessening an individual’s burden on society. An example is of the notion of ‘risk’ in public

health discourse in which combinations of abstract factors predict the likely occurrence of disease in later life (Petersen, 1997). An individual is able to modify his or her risk by engaging in particular health-promoting behaviours, such as smoking cessation, weight loss, exercise and eating healthy food.

The introduction of the PHC Strategy (Ministry of Health, 2001b) and the nurse practitioner role to New Zealand are examples used in part three of this thesis to illustrate how governmentality and technologies of the self can be applied theoretically. As regimes of truth, both harness and direct health practitioners less towards a system of constraint and more towards “a kind of regulated freedom” (Rose & Miller, 1992, p. 174).

Another technique of the self involves the knowledge of oneself, discovered and formulated through practices of self-examination. Originating with Christian practices of confession to a priest, the secret truth of the self is explored in the sharing of thoughts and deeds with a friend, an adviser, a guide, or in the keeping of a journal (Foucault, 1993). The purpose of self-examination is to transform the individual “to become competent to take up a position in society that would not harm others, and that, through the exercise of ‘proper’ relations, would benefit the community as a whole” (Danaher et al., 2000, p. 130).

Foucault argues that governance serves to structure “the possible field of action of others” but can only be exercised over subjects who are free to choose (Foucault, 1983b). Thus, personal autonomy (the freedom to choose) becomes key to the exercise of political power (Rose & Miller, 1992). Much more than compliance with a set of rules, the freedom to constitute oneself in particular ways – or to choose not to – becomes a question of personal, and in this case, professional ethics (Foucault in Luxon, 2004). These theoretical ideas are used in chapter ten to illustrate the nurse practitioner subject, who is no longer defined by the power/knowledge regimes of others but is free to “actively and reflexively constitute themselves via a particular kind of ethical relation to self” (A. Allen, 2000, p. 118).

Summary

This chapter has presented the key theoretical concepts used throughout the thesis to inform the analytical process employed to examine the construction of the nurse practitioner role in New Zealand. Adopting a postmodern epistemology rejects the metanarrative of a rational, stable and ordered construction of nurses and nursing and leads to an inevitably partial analysis of the discourses shaping the nurse practitioner identity. A deconstructive approach, in which language is considered to be constitutive, allows for a focus on texts and questions the priority of things seen to be self-evident, such as the hierarchical relationship of doctors to nurses.

Foucault’s historical method of analysis, genealogy, accounts for the way in which subjectivity is constituted by discourse, emphasising historical events marked by shifts and reversals in relationships, where power is usurped and vocabulary appropriated. The method problematises those disciplines that produce knowledge and generate norms to which individuals then conform. Discourses are, therefore, bodies of knowledge constituted by power, producing possible subject positions. No longer is power conceived of solely as hegemonic; it is deployed via a number of tactics and strategies involving disciplinary techniques of surveillance, normalisation and examination to produce a body that is both docile and useful.

Historically, the nurse as subject is constituted through disciplinary techniques of objectification that maximise productivity; or, appreciating the productive notion of power, a nurse turns him or herself into a subject through technologies of the self. Rather than resorting to techniques of domination, the art of government is to make use of knowledge in such as way that a given population is conducted towards particular behaviours consistent with the current political rationality, and this in turn benefits the wider population. Enabling a more autonomous subject the freedom to constitute oneself without reference to the power/knowledge regimes of others produces ‘another’ and not ‘other’ (Cheek, 2000) type of health practitioner, the nurse practitioner. Foucault’s theoretical toolbox raises

possibilities for the nurse practitioner role to define itself within a nursing

Chapter 3: Methodology

Constructing history can be compared to the construction of a sandwich. It is always best to prepare your own, and with mustard (Winterson, 1996.)

Introduction

As explained in chapter two, this qualitative study is informed by the writings of philosophers such as Foucault, Derrida and Lyotard. I am guided by postmodern and post-structural epistemological perspectives that challenge and critique assumptions about claims to truth and interrogates language, meaning and subjectivity (Weedon, 1987). A discourse analysis methodology that operationalises the principles and theoretical assumptions governing the research was utilised with guidance from various discourse analysts such as Fairclough (1993), Cheek (2000), Carabine (2001), Riggins (1997), Wetherell, Taylor and Yates (2001a), and Stuart Hall (1997, 2001b). That there is no single understanding of discourse analysis is evident in the variety of approaches these writers take. A single prescriptive study design or method is neither possible nor desirable. What is of paramount importance to discourse analysis, as with all research, is alignment between theory, methodology and method.

This chapter starts out with an overview of the methodological principles driving the study and then outlines the specific analytical tools employed to uncover voices subjugated by the power and control of more dominant discourses. Later sections describe the research methods, tracing the steps in the research process I have taken to obtain ethical approval and conduct interviews, as well as my use of qualitative data analysis software during the project. I also track the analytical process used, drawing on notions of methodological transparency and reflexivity. Excerpts from my project journal and other formative ‘evidence’ that has guided the analytic process are included. The final section offers a critique of the truth status of my claim to a transparent account of the research process I have followed.