Neonatal Food and the Politics of Theory: Some Questions of Method

Author(s): Annemarie Mol and Jessica Mesman

Reviewed work(s):
Source: Social Studies of Science, Vol. 26, No. 2, Special Issue on 'The Politics of SSK:
Neutrality, Commitment and beyond' (May, 1996), pp. 419-444
Published by: Sage Publications, Ltd.
Stable URL: http://www.jstor.org/stable/285425 .
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The Politics of SSK: New
Directions/Places/People/Things
*
ABSTRACT
The nurses on an intensive care ward for new-borns feed babies with food
and doctors with information.
Showing
that this is so is one of the
ways in
which scholars
working
in humanist traditions of social
analysis,
such as
symbolic interactionism,
reveal the
politics
of
hospital
relations. However,
semiotics,
along
with similar 'non-humanist' theoretical
traditions,
is no
less
political; neither,
as is sometimes
suggested,
does it
necessarily
side
with the
strong.
Here we demonstrate that semiotics
implies
another
style
of
political theory
- one in which the relevant axes of difference are not
primarily
between
groups
of
people,
but between
ways
of
ordering
the
world. Thus the differences between two modes of
feeding
or of
calculating
the contents of a bottle can be understood as both
'political'
and 'technical' matters.
Neonatal Food and the Politics of
Theory:
Some Questions of Method
Annemarie Mol and Jessica Mesman
In this
paper,
we address some
questions
of method. We don't
expect
to find a warrant for truth. Nor do we need a method to link
up
with
reality
in a looser manner.
Reality,
we
feel,
is overwhelm-
ing enough
as it is. No: our aim is different. We want to unravel
and understand how the methods we're
caught up
in,
make us
observe and write. We want to know what
they
do to us and to our
fields of
study.
And we
especially
want to know about their
politics.
For a
long
time,
discussions of method were all about how to
avoid
'taking
sides'. It was
hoped
that
by setting rules,
villains
could be ruled out. But such
hopes
have
proved problematic.
We
won't
repeat
that
story
here.' Instead we set out with the idea that
when a retreat into more and more
protective
measures isn't
working,
it is better to
try
and turn the
question
around. So the
problem
we deal with here is not how to avoid
politics
in
theory,
but how to do it well.
Social Studies of Science
(SAGE, London, Thousand
Oaks,
CA and New
Delhi), Vol. 26
(1996), 419-44
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Social Studies
of
Science
'Normative
questions
deal with what
ought
to be done or
believed';
this is the
opening
line of a
paper
in which Hans Radder
pleads
for more reflection on such
questions
in science and
technology
studies.2 His words sound like a
truism,
but
they
hide
another
-
articulated in the
very
same
paper
-
which is that
normative
questions
don't start
after
the
facts,
with what
ought
to
be done or believed. Instead
they
start
right
at the
beginning,
with
the business of
framing
what is the case. For
normativity
doesn't
simply
reside in the
subject-author
but in the
subject-matter
too.
How to
investigate
it there? In what
ways may
one's
writings
relate
to the normative order of one's field of
study?
That is the
'politics
of
theory' question
that we
explore
here.3
We tackle this
question by comparing
the
politics
inherent in
two
major
theoretical
traditions,
both of which are
extensively
drawn
upon by
authors in the social studies of
science, technology
and medicine. These two traditions have a common
enemy:
all
those versions of realism which assume that words somehow stand
for
objects
or matters of fact. But
they
take the
linguistic
turn in
different
ways.
One of these traditions is verstehende
sociology.
Instead of
treating
social facts as if
they
were natural
phenomena,
sociologists
within this tradition
try
to unravel what
reality
is like
for the
people they study.
Their motto is: humans
may
be turned
into
objects,
but
they
are
subjects,
too.
They speak. They interpret
the world
they
live
in,
and their own
ways
of
living
in it. From all
the versions of verstehende
sociology
which we
might explore,
here
we choose to look at
symbolic
interactionism.4
The second tradition is that of semiotics. Semiotics
originated
not in
sociology
but in
linguistics.
So its
primary object
is not
humans,
not even
talking
humans,
but
language.
Instead of
treating
language
as a
bag
of labels each
fitting
an
object,
semioticians
analyze
it as a
system
of interrelated
signs.
Instead of
treating
language
as an instrument
people
use
pragmatically,
semioticians
analyze
it as a set of
juxtaposing grids
each of which has a
history
and
momentum of its own. There
are, again,
several
ways
to
go
from this
point.
We'll
try carefully
to articulate our own.
This text is a
hybrid:
it moves between
sociology, anthropology
and
philosophy.
Our
questions
of method are informed
by
our
empirical practice.
Therefore we'll
present you
with some stories
set in the
neonatology
ward of
hospital
M,
a Dutch
university
hospital.
This is a
place
where
tiny
babies lie in
glass cages,
with
lots of
machinery
attached to them. Adults dressed in white move
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Politics
of
SSK: Mol & Mesman:
Questions
of
Method
around.
They
read and
write, adjust dials,
inspect
the children's
bodies and talk
endlessly.
However,
you'll get
to know
only
a little bit about the ward.
Because time and
again
we
interrupt
our stories to address
big
and
important questions.
So we come to
speak
about human voices
and
giving
voice;
about
order,
noise and alternative
orderings.
Thus our
empirical
stories end
up resembling
the babies in the
ward: there are so
many
theoretical wires and tubes attached to
them that
they
cannot live without them.
'Nice
material',
empirically-minded
readers are
likely
to tell
us;
'why
don't
you
show us more of it?
Why
bother with all these
theoretical distractions?'. And if
philosophers
were to read this
text,
most of them would wonder
why
we went to so much trouble
finding
'illustrations' in the first
place.
What to do? Defend
empirical philosophy
in our turn as the
only genre worthy
of
being
printed?
We
prefer
to
get
on with what we set out to do. Talk
method. Post-method?
If we discuss method
here,
it isn't
objectivity
we're
after,
nor
new rules which warrant
political
correctness rather than
empirical
soundness.5 We
hope, instead,
to find out more about
handling
commitment,
compassion.
Passion. We want to be/come more
articulate about this
unbounded,
unfinishable
project:
that of
doing
politics
in
theory.
After
Epistemology
J said: 'Can I ask
you
some
questions
of method?'.
Whereupon
A
said:
'Well,
sure'. And that is
how,
long
before these lines were
written,
this article
got
started.
J was
planning
to do fieldwork in a
neonatology
ward in order to
gather
material for her PhD thesis.6 She wanted to write about the
co-existence of different
perspectives
or
orderings
and there was
no doubt that this
high density
zone
of
doubt would be a rich site of
study. Intermingled
facts and
values,
complicated
human
relations,
interactions between bodies and machines:
everything
J' s favourite
books talked about would be
there,
co-existing.
And so much
morality!7
So the
question
was how to
go
about
studying
it. Since
A was the nearest
person
with fieldwork
experience
in
hospitals,
J
sought
A's advice.
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Science
A was reluctant. She had never believed in 'method' as a
warrant for whatever it
may
be taken to be a warrant for.8 Worse:
she had loathed the
obligatory
'methods-section' of her own PhD
thesis,
which risked
talking
about what she took to be
interesting
findings
as if
they
were
preliminary thoughts.
In the few
years
since she had finished her thesis A had tried hard to
forget
about
method.
Discussing
it somehow
always
seemed
mainly
restrictive.
She would
gladly
have underscored Steve
Woolgar's
words
(if
they'd
been written at the
time):
'Those attracted
by
the intellectual
challenge
will note with
regret
that their
potential
allies' obsession
with method
bespeaks
a
poverty
of
imagination
and excitement'.9
But then: as a PhD student J had
every right
to ask for advice.
'Of course it all
depends
on what
you
want to
know,
on what
your
aims
are',
was the first
passe-part-tout
she
got
for an answer.
J,
who had been immersed in various constructivisms from the
very
beginning
of her academic
training, thought
that this was
pretty
obvious.10
'Sure,
but which methods
help
me to "know" what?
And which "aims" can I
hope
to achieve
by
which "means"?'. One
could hear the
quotation
marks as J
spoke.
But we soon realized
that there were
problems
here;
a lot of
problems.
In the first
instance,
problems
of method are
practical.
To do
fieldwork is to do
something.
So
you get up early
in the
morning
and ride
your bicycle
to the
hospital.
Attend this
meeting
or the
other. Drink coffee with the nurses
-
who take
drinking
coffee as
their
break,
but for the observer all the
chatting
is hard work. So
you
walk around the ward. Ask the
parents
of the
baby
who came
in
yesterday
if
they'd
mind
talking
with
you.
Go and find a
place
to
talk. Face their fear. Listen. But make it clear that
you're
not a
doctor and
you
don't know if their child is
going
to be all
right.
You sit behind a desk for a
while,
making
notes. You stand
up
to
go
and see what is
happening
at the other side of the
ward,
where a
machine has
suddenly
started to
bleep alarmingly.
Instead of
simply switching
off the alarms and
doing nothing
as
they
often
do,
several nurses and doctors
gather
around the incubator. What are
they up
to?
J had read that she should follow the actor. But after
following
the medium care
neonatologist
around for a
day,
J came home
exhausted because the man walked so fast. And what about the
pieces
of
paper
that travel from the ward to the
dispensary?
J
couldn't enter the
hospital's postal system
with
them,
for its
plastic
tubes were
big enough
for
forms,
but far too small for human
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Politics
of
SSK: Mol & Mesman:
Questions
of
Method
bodies.
Yes,
these
problems
were soluble. The
secretary
advised J
to
carry
the forms to the
dispensary
herself - which would serve
the extra function of
proving
that she was
trustworthy
as well as
making
sure she was at the scene of the action
right
from the
beginning.
And A advised J to take a
day
off as soon as she was
tired. 'That's the one rule of method I'm sure
about',
A
said,
'an
extra
weekday
off
during periods
of fieldwork'.
('Do you practise
that
yourself?'
J asked with a tone of wonder in her
voice.)
Taking
free time was difficult. Even when she came to the ward
for
eight
hours a
day,
five
days
a
week,
J felt like a failure.11
Observe here. Put the video camera elsewhere and have it observe
for
you.
Did those
parents
leave?
Hmm,
it would have been nice
to interview them. And
gosh:
the child whose case seemed to offer
a
good example
of the
complexities
of
'withdrawing
treatment',
died
during
the
night.
How did he
go? 'Quietly',
the nurses
say.
Just that:
'Quietly'.
The emotions
they
had at the time are lost to
the observer.12
So the
practicalities
aren't
easy
to deal with. But then a second
set of
problems
start to surface. What are these
practicalities
linked
up
with?
Why
do
they
occur? Do
they yield anything good
in the first
place?
What is all this
fieldwork for?
Talking
about
that,
we wondered how J could avoid
using
the
neonatology
ward as the mere decor for
yet
another
story
about
construction.
Sure,
it could be done. The construction of
breath,
blood
sugar levels,
the ideal
parent, hope
or
despair,
could all be
traced. It was
possible,
but
why
would one do so?
By
now,
supervisors
in science studies have been
telling
their PhD students
to write
up
their cases in this
way
for
decades,
as if it were the
students' task to stabilize the constructivist
programme by adding
to its mass. Go and unravel the construction of an
object. Any
object!
It doesn't matter what. The laws of
gravity,
a nuclear
power plant
or the HIV virus
-
anything
will do. Just show that
the
thing
doesn't exist
by
itself,
but
depends
on
something
else.
Which is true. But
why repeat
it? The
only
reason for
doing
so
seems to be to undermine
epistemology. Again.
And
again.
And
yet again.
And once
you've
shown
your object
doesn't rest on sure
foundations
you
can sit back and relax.13
Some of the
people
who
supervise
theses even
argue
that it's
enough
to undermine
epistemology,
that this is what needs to be
done.
They
don't care about the content of their
subjects'
work.
Let them
go
ahead with whatever
they're doing:
it's
just
that
they
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should do so with less
pretensions.
'The
discovery
that the
foundations of
physics
are not as secure as was once believed
makes no difference to what it means to be a
good physicist
-
though
it does mean that
physics
cannot claim
authority
over
competing knowledge
claims in virtue of
epistemology',
write
Collins and
Yearley
with self-assurance.14 We think
they've got
it
wrong.
Let's face it:
taking away
foundations makes a difference. Once
legitimations
are no
longer
called
upon, something
has
changed.
Once the local
god
is no
longer
in its
shrine,
receiving offerings
of
candles and coca
cola,
it
may
still be
wrong
to
go
about
committing
murder,
but this has to be asserted in another
way;
and it isn't
easy
to see how. Therefore a lot of
people cling
to some
variety
of
epistemology,
even after its death.15 We
prefer
to
try
and address
the
good
in another
way.
Instead of
reinventing epistemology
or
being proudly anti-epistemological,
we think it is about time to
leave foundational
questions
behind. And to
confront, instead,
the
content of whatever it is one studies: the work of
people,
texts,
technologies,
theories. This
implies
that in one's
writing
one
does
try
to make a difference to what it means to be a
good
physicist (a good
nurse,
a
good
intravenous
line).
Not
by throwing
around
judgements
or
by spelling
out how
everybody
and
every-
thing
should behave.
Addressing
the
good may
also be
practised
through attending
to the normative
ordering
of one's field of
study.
How?
Nurses' Food
A tradition that has some credentials when it comes to
being
explicit
about its own
politics,
is that of
symbolic
interactionism. It
sets out to
protect people
from the
dangers
of
being
dehumanized.
That is its
politics,
its normative stance. Those
parts
of social
science that
try
to mimic the natural sciences are treated as the
enemy. They
are
wrong
because
they study people
as if
they
were
'mere
objects'. They forget
that human
beings
have a
language
with which
they interpret
the world around them. For humanist
social
scientists,
language
is
important.
Its
mastery
is what dis-
tinguishes
humans from non-humans. Thus
language
is at the core
of the
methodological appeal always
to listen to what
people say,
instead of
getting
stuck in
just watching
what
they're doing.
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of
SSK: Mol & Mesman:
Questions
of
Method
The
politically outspoken symbolic
interactionists radicalize this
approach. They
listen,
but not
just
to
anyone. They
listen for
silenced voices. That
is, they pay special
attention to those
people
whose
interpretations
and activities tend to
get
erased from
public
awareness. In the words of
Leigh
Star: 'To do a
sociology
of the
invisible means to take on the
erasing process
as the central human
behaviour of
concern,
and then to track that
comparatively
across
domains. This
is,
in the
end,
a
profoundly political process,
since so
many
modem forms of social control
rely
on the erasure or
silencing
of various
workers,
on
deleting
their work from
representations
of
the work.'16
In the
neonatology
ward,
this seemed like a
good
method. It
seemed
helpful
to treat the ward as a site where
people belonging
to different worlds and
talking
in different
languages gathered.17
It
would,
for
instance,
make it
possible
for J to
study
the relations
between doctors and nurses while neither
moralistically blaming
the doctors for their
power,
nor
assuming
medical
authority
to be
inevitable.
Symbolic
interactionism seemed to offer the
possibility
of
clearly exposing professional
hierarchies and the
way they
are
ingrained
in
daily practice.
Thus here was a method with which we
could
investigate
the normative order of the ward.18
So for a while J became the
unfailing
shadow of nurse N.19 The
day-shift
nurses start at seven. Before
leaving,
the nurses of the
night
shift tell about the
night:
whether the children
they
took care
of were
quiet
or
restless,
and whether their food and medicine
made it to their bloodstream. All the nurses on the
day
shift have
to
pay
attention,
because
responsibility
for the children is
only
divided between them at the end of the
meeting.
'Thus',
says
N,
'if
one of us is out for
coffee,
the others know
enough
to
replace
her'.
(The
nurses in
hospital
M do not take care of the same child
every
day.
As N
explains during
a lunch break: 'You'd
get
too attached
to them that
way.
That isn't
wise'.)
It is almost
seven-thirty
when
N fetches water in a wash
basin,
puts
it on a cart beside an
incubator and starts to wash
Sarah,
33 weeks from
conception,
born five
days ago.
The field notes
provide many
more
pages
of detailed
description
of N's
working day.
But where does this
go?
On and
on,
a lot
longer
than
your patience,
and most other
readers',
is
likely
to
last.
Maybe,
we
thought,
it is better to focus. The
frictions,
hierarchies and
interweavings
between various
ways
of
living
reality
are easier to see if a
specific part
of that
reality
is outlined.
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'You
might try
blood',
A
suggested
-
as blood is her own
favourite
object
of
study,
and this seemed a nice
way
of
learning
more about it. But J
thought
that 'blood' would
yield
doctor-
centred stories. She had a better idea. Food.
Doctors decide how a new-born should be fed. For this decision
they
need data: the child's
weight,
blood levels of all
kinds,
the
nurse's
report
on what
happened yesterday.
Nurses feed the chil-
dren. When
they
do
so,
they
are taken to be
replacing
the
parents,
which isn't the case when
they
do other
things,
like
adjusting
the
sensors of a monitor.
For intravenous
feeding,
the nurse must wash her
hands,
link the
perfusor
to a line attached to one of the
baby's
blood vessels and
set the
pump going.
In the case of
gavage (stomach-tube) feeding,
the food has to be
heated,
taken into a
syringe,
and
slowly injected
into the
gavage.
Sometimes the child
regurgitates
her food and
then its small
body
and its bed have to be cleaned. Bottle
feeding
requires
a nurse to heat the
bottle, pull up
a
chair,
take the child
out of its
incubator,
persuade
it to
suck,
and wait for it to belch.
And
every
individual act of
feeding
is
only
over once the
appro-
priate
forms have been filled in.
Nurses have to
adjust
their other activities to the task of
feeding.
In the case of intravenous
feeding
this is
easy
so
long
as the lines
remain
open,
for the
foodbag
is
changed only
once a
day.
But
gavage feeding
and bottle
feeding
have to be done
every
few
hours. Nurses have to watch the clock as well as
watching
the
child.
Nurses feed babies with food. And
they
feed doctors with
information. Nurse N tells how
important
her observations are to
the doctor. 'I see how this
baby
eats. So I
report
this back.
Well,
usually
if we have a
suggestion,
then,
. .. like if we think the child
is still
hungry
after a
bottle, they
reckon with
that,
the
doctors,
they
do'. The doctor
depends
on the observations of the nurse and
takes them into account. But the doctor decides all
alone,
or in
consultation with other doctors. If N's arms hurt because she has
had to hold a
bag containing
food
high
above the
baby's
head for a
long
time with lots of other
things waiting
to be
done,
she
may say
so. 'So I
suggested
that we attach the
gavage
to a
pump
but the
doctors didn't want that. I don't think it would make
any
difference to the child. But
they
don't want a
drip system.
So
they
don't want a
pump.
And there I
stand, my
arm
trembling.
The
doctors
only
think about the
child,
not about
my
work.'
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The doctors subordinate the work of the nurses to their own
decisions in the name of the child. Doctors
literally prescribe
the
food,
and thus have a
large say
in the nurses'
feeding
activities.
That the nurses do the actual
feeding,
meanwhile,
is
easily
forgotten.
In the files where
everything
that is
happening
to a child
is
noted,
the 'food intake' is mentioned.
Together
with other
elements of the 'total
intake',
it is balanced
against
the 'total
output'.
All numbers are noted down. But who it was who did the
feeding only
becomes relevant if
something
went
wrong.
Neo-
natologists
who
give
a case
report
to their
colleagues
will look at a
file and
say:
'We
gave
the child seven bottle feeds a
day
of 50
millilitres each'. But 'we' never did this: the doctors decided it
should be done and the nurses warmed the
appropriate
fluids, put
them in a
bottle,
took the
baby
out of its
incubator,
woke it
up
whenever it fell
asleep again,
waited for it to
belch,
and
put
it back
to bed
again.
Using symbolic
interactionism as a source of
inspiration,
we can
show the subordination of nurses' activities to doctors' decisions.
And we can show the
way
the nurses' work is hidden. So this is the
politics
inherent in
symbolic
interaction. It makes the silenced
(nurse)
audible and
brings
the
processes
that lead to
(her)
subordination into view. No one is
blamed,
no one is
praised,
no
rules are laid out. It is
through
its articulation of the hierarchies of
the ward that
symbolic
interactionism intervenes in them.
Food Itself
But what about the
child,
who
sleeps,
or
cries,
or tries with more
or less
enthusiasm,
to
engage
in the art of
sucking?
It isn't
easy
to
get
at the child's
perspective.
New born babies don't talk. We
cannot ask them what
they
feel and smell and see. With some
imagination, however,
we
might get
a sense of how
they experi-
ence the world. Nurses and doctors do so all the time. 'He's
unhappy', they say
when
they
look at a child
gasping
for breath.
Or:
'Gosh,
she's
really fighting
for her
life,
isn't she?'.
Expanding
upon
this
skill,
we could talk about the
huge
effort it takes to suck
one's own food and about the satisfaction that follows from it. We
could address the horrors of
being
woken
up
time and
again
in
order to eat. We could mention the
pain
caused
by
the needle
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which is used to fill one's veins with more and more fluids. Now
we've
spoken
for the nurses it would make
perfect
sense to
try
and
listen to the babies as well.
Yet,
instead of
doing
so,
we'll
pose
a
different
question.
This is the
question:
What about the
gavages,
the
pumps,
the
incubators,
the food? For if we
keep giving
voice to silenced
people
while
treating 'things' simply
as
objects manipulated by
humans,
before
long
Bruno Latour will
point
his
finger
at us and
ask
severely:
'Are
you
aware of
your discriminatory
biases? You
are
discriminating
between the human and the inhuman'.20 So
what are we
doing?
Are we
simply pushing
the line of discrimination
'downwards' a
little,
from doctor to
nurse,
from nurse to
child,
only
to
stop
short at the boundaries of the human
species?
Are we
wrongly being asymmetrical?
There is a
huge complication
here. As we
noted,
the verstehende
tradition thrives
by trying
to liberate itself from the natural
sciences. So it is
asymmetrical,
but takes this to be a virtue. How
else to liberate humans from a fate as 'mere
things'? Against
this
historical
background
the additional
appeal
to liberate
'things'
seems like a sick
joke.
In lots of
places
in
sociology,
it looks like
little more than a
way
of
subscribing
to the
exploitation
of
people
who have to sell their labour as a
commodity
on the market. In
science
studies,
it looks like a
way
of
putting
natural scientists back
in
power.
We
quote:
'Because the
special power
and
authority
of natural scientists comes from their
privileged
access to an
independent
realm,
putting
humans at the centre removes the
special authority.'21
Meanwhile, however,
the method which our accuser Latour
wants us to use to focus on
'things'
and make sure that
they
are not
deleted,
doesn't come from the natural sciences at all. Semiotics
comes, instead,
from the other end of the intellectual
spectrum:
from
linguistics.
That doesn't seem like
something
fearful.
Why
should one be afraid of the
power
and
authority
of a science of
signs?
Should one? Since we're still
looking
for the
politics
inherent in
theories,
and since semiotics
promises
to be
very
different from
symbolic
interactionism,
we will take it
along
to the
neonatology
ward and see what
happens.
Is semiotics a
way
to
empower
'the
enemy'
or does it lead to a form of
emancipation
larger
than life?
Semiotics started out as a
way
to
analyze language.
Instead of
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Method
taking
words to be labels
designating objects
on a one-to-one
basis,
semiotics treats
language
as a
system
of related
signs.
The
value of
any
one
sign depends
on that of the others to which it
relates.22 From this
starting point
there have been
many analyses
of texts. A semiotic
analysis
doesn't work on the
assumption
that
the words of a text become clear the moment one leaves the text
for the world. What words mean can be found out
by analyzing
what
they
make each other mean. It can be found out
by digging
out their mutual relations.
In the
light
of such disdain for what
happens
outside
texts,
it
may
come as a
surprise
that semiotics
might
be used as a method
for
doing
fieldwork in a ward.
But,
to
begin
with,
wards
produce
texts. There are
many
studies in which researchers listen to and
record talk for later
analysis
of the resultant texts. It is also
possible
to
go beyond
words
by extending
the semiotic method
from
language
to other
sign systems.
A
big
desk
may
mean that a
big person
sits behind it. And a lot of
bleeping
machines
signal
the
drive to control.23 And then semiotics
may
also
go
so far as to
forget
about
signs
and
signification,
and
only
retain the stress on
interdependence.
Madeleine Akrich and Bruno Latour
put
it thus:
'Semiotics is the
study
of order
building
or
path building
and
may
be
applied
to
settings, machines,
bodies and
programming languages
as
well as texts'.24 This version of semiotics is not about
meaning:
it
makes one
try
to find out instead what
elements,
of whichever
character,
associated in whichever
way,
make each other be. We
started to use it.
J went to the ward
again
and tracked down all kinds of
interdependencies.
Do
you
see that
machine,
over
there,
that
records the
electrocardiogram?
It marks the heart beat
by
detect-
ing
the
rhythmically changing
field of
potential, just
as electro-
cardiograms
do in
any
intensive care ward. Its
graphs
are made
by
the
baby's beating
heart,
and in turn
they
make her heartbeat.
And look: there's a
big baby
-
though
he's
only big
because the
others are so
very tiny.
But wait a minute. It would be nice if our
semiotic materials were more focused and
easily compared
with
our
symbolic
interactionist
findings.
So J set out once
again
to
follow
food.
But what is 'food'? When words aren't labels
designating single
objects,
this becomes a difficult
question:
not of
meaning,
but of
being;
and
indeed,
an
empirical question.
When J
posed
it in an
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empirical way,
she found not
one,
but
many
answers.
When,
in the
morning,
the intern has finished her
calculations,
food is a series of
numbers. These are
put
into the
computer
where
they change
from
the outcome
of
a calculation
-
in the ward
-
into an instruction to
act
-
in the
dispensary.
In the sterile
space
of the
dispensary,
small bottles are
filled,
fluid
by
fluid,
not child
by
child. Food is
fluid.
One assistant concentrates on bottles with
lipid
solutions,
the other on those
containing glucose.
So here food is either a
lipid
or a
glucose
solution. At a
quarter-to-five
a nurse comes to take all
the
bags
and bottles on a
trolley
from the
dispensary
to the ward.
A
weight,
that's what food is. To become Matthew's
dripping
infusion
once the food
supplies
of all babies on intravascular
feeding
schemes are attached.
The
single
word 'food' takes the semiotician from one
object
to
another. And the transitions aren't
necessarily
smooth. Let's
taken an
example.
First 'food' is a number written down
by
an
intern as the outcome of calculation.
Then,
in the
dispensary
the
number
changes
into an instruction to mix nutrients in
proper
quantities.
From
being
a
part
of a calculation the number turns
into a
part
of a
manipulation.
The two activities relate to numbers
differently.
This doesn't
necessarily
lead to friction. It is easier to
count '10 ml' than '9.734
ml',
and
manipulating
10 ml is easier than
manipulating
9.734 ml. But sometimes it does. Often it is easier to
do arithmetic with a 30% solution than one of 33.33%. While in
the
dispensary, diluting
a fluid to one-third of its
original
concentra-
tion is easier than
making
a 30% solution. While numerical measure-
ments are needed to
get
30%, diluting by
a third
only requires
adding
double the amount of the solvent to the
original
fluid,
and
any
container can be used. This is what our semiotic
analysis
brings
to
light:
that
using
one set of numbers as
opposed
to
another isn't 'innocent'. It facilitates either the
calculation,
or the
manipulation,
of food. Or it
represents
some
compromise
between
the
exigencies
of both
practices.25
J wanted more
examples.
Instead of
starting
her
investigation
from a word
again,
she sat down and observed the
sticky
fluid in
the bottle
hanging
above Matthew's incubator. What is it? There
isn't one word for it. There are
many.
The bottle contains
food
for
the
baby.
It contains the
infusion dripping
into a vein. And a
sugar
suspension.
Or
part
of the 120 calories
for every
kilo a
day.
And then
again
the bottle's content is a fluid with a
particular
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composition. Every
120 ml of it is
composed
of: 45 ml Aminovernos
Paed
6;
40 ml
glucose
20%: 4 ml
PED-EL;
0.6 ml KCl 7.45%:
1.17 NaCI
10%;
10.3 ml Ca
gluconaat
10% and micronutrients. But
it is also nutrition. It is classified as intake. And it is
definitely
everything
that this small
patient
is
going
to
get for
the next 24
hours.
So there are
many
words for the content of a
single
bottle.26
They
relate to different concerns and their value doesn't need to
stay
the same. The
implication
that the fluid is a
'sugar suspension'
is that a medicine which is soluble in fat needs to be attached to
another line. The
practice
in which the fluid is 'intake'
requires
a
balance with the 'loss'. Or take this
divergence
that comes back
time and
again
in discussions about medical
practice:
as 'food for
the
baby',
the
dripping
infusion is a
meagre
substitute for the
warmth of a breast
flowing
with milk. Where food is valued as an
element of the relation between
people,
a
gift,
a reflection of care
and
love,
infusions are horrendous. While in terms of nutrition
there's
nothing wrong
with them: it is food
enough
to live
on,
of
good
value so
long
as it comes in
appropriate
amounts.
In a
neonatology
ward,
the frictions between such different
orderings
of food and their concomitant normativities can be
observed. For
they
are lived in the relief of the
parents
that their
child is fed
-
and in their
disappointment
that this is done
through
an intravenous line instead of
by
mouth. And
they
also surface in
the discussions of the
morning
round. 'What are we
doing
with
Matthew? Do we
keep
him on a line for a few more
days?',
a
resident asks.
'Hmm,
we
might try
a
bottle,
it would be nice for
him to
suck',
says
the attendant.
'Yes,
it would be
nice,
and he has
to
get
used to it at some
point', says
a
nurse,
'but I think Matthew
isn't
getting enough sleep
as it
is,
with all these
investigations
he's
submitted to all the time. If we were to start with
bottles,
that
would mean much less
sleep.
He's not
going
to thrive on that'.
This discussion is concerned with the work to be done
by
doctors
and nurses and the emotions of the
parents.
But it is also about
what will
happen
with the
body
and soul of the
patient.
Semiotics
is a method that
helps
to show that a discussion about food is also a
discussion about the
way
Matthew's life is ordered. Which
logic
will inform it: that of food
supply,
the need for love and
cuddling,
or that of want of
sleep?
And the next
question
to
dig
out is the
nature of the
compromise
between them.27
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Two Political
Styles
J and A sat down to talk about this
paper
with a draft of it on the
table between them. There: at last both methods were out in
the
open.
Our version of the difference between them would
help
J to
improve
her next round of fieldwork.28 'For some
reason',
J
said,
'if we hadn't unravelled it like
this,
I
might
have
sympathized
too much with
people
and their
perspectives.
It must be
that,
like a
good
nurse,
I've had a lot of
training
in human relations. Semiotics
is more for doctors.
They
are in the habit of
linking signs
that are
visible on the surface of a
body
with the diseases that are hidden
inside it'. J
suspected
that A's love for semiotics was her
way
of
playing
at medicine without
being
a doctor.29
We
might
have
developed
this. Our conclusion could have
shown that the theoretical variants
analyzed
so far do not stand in
a comfortable
meta-position
in relation to
neonatology. They
are
inside
it,
too.
They
circulate from one
place
to
another,
from a
field to its self-reflections. We
might
also have
gone
into an
analysis
of how individuals
get
involved with methods in the course
of their
personal
theoretical histories. But here and
now,
we're
after
something
different. We want to understand more about
being passionate
in
theory.
Committed. We want to unravel which
politics
one
performs
when one uses - or
gets caught up
in
-
one
theory
rather than another.30 What do methods make of the
normative order of a field of
study?
Symbolic
interactionism asks one to follow different
people
and
see and hear the world
through
their
eyes
and ears
-
even if one is
not
supposed
to
go
native,
and is allowed to remember that one
has senses of one's
own,
too. Without
being
a
nurse,
J
can,
if she
follows
N,
write stories about N's work. If J were a nurse
herself,
she wouldn't have time to write stories. And she
wouldn't,
moreover,
be able to
juxtapose
N's
perspective
with that of
doctors, parents
or babies.
Symbolic
interactionism
opens up
a
space
in which the worlds of all these
groups
are made audible
-
the voices of those who are
usually
able to make themselves
heard,
as well as those who are
usually
silenced or
forgotten.
As Howard
Becker
put
it: 'The
question
is not whether we should take
sides,
since we
inevitably
will,
but rather whose side we are on'.31
Symbolic
interactionists
try
to be on the side of the weak.
Does
semiotics,
as it is sometimes
alleged,
attend not to the
silenced,
but to heroes who network so
cleverly
and scream so
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Method
loudly
that all the action is attributed to them?32 Does it take sides
with the
strong?
But no: this cannot be
right.
Semiotics is not
about
people,
whether winners or losers. It is about
signs,
or other
entities,
co-constituting
each other and
together forming
a dis-
course,
a
network,
a
logic
or another 'Order of
Things'.
What
is
left out of such an order is not
people
who are forced to be
silent,
but
signs
which are not
incorporated
as information. Noise. Noise
is
constantly
differentiated from order.33 Semiotics shows the
effort that this takes. It makes the
fragility
of the established order
visible,
and shows that it is
constantly
in the
process
of
being
established.
In classical semiotic
studies,
individual orders were studied as if
they
were wholes: the
Text, Medicine,
Reason. Whatever does not
form a
part
of these orders was
depicted
as their noise: the
unarticulated,
lay traditions,
madness.
However,
semiotics also
allows one to assume that
everything
which is noise in relation to
one
order,
is information in another. It's not
chaos,
but another
kind of tune. Then a different
question
comes to the fore: how is it
that different orders
(discourses, networks,
modes of
ordering,
logics)
co-exist?.34 As
opposed
to food there are
non-foods,
ranging
from infections to
sleep.
As
opposed
to
foodstuffs,
there is
care. As
opposed
to
calculations,
there are
manipulations.
All
these
oppositions beg
the
question
of the nature of the relation
between the two sides that have been differentiated- the relation
between one order and another.
So Latour's liberal rhetoric is
potentially misleading.35 By
pressing
the
importance
of
talking
about non-humans with the
very
words that
symbolic
interactionism uses to
propel
its human-
ism
-
unjustified
discrimination and
giving
voice
-
Latour creates
a
continuity
between the
politics
of semiotics and that of
symbolic
interactionism.36
They
are both about
liberation,
the
only
differ-
ence is that semiotics
encompasses
a wider domain. But no! The
originality
and the radical
potential
of semiotics as a
political
method isn't like this.
Rather,
the
study
of the co-existence of
different orders shows how normativities clash and
support
one
another in a
given
field. Order doesn't
oppose chaos,
there are
many
orders. 'On fait
toujours
la meme erreur. On croit
qu'il y
a
du barbare et du
civilise,
du construit et du
dissolu,
de l'ordonn6 et
du d6sordon6.'
Hey,
wait a
minute,
where did we read this
outcry
that
implies that,
in
fact,
there are
multiple
orders? Yes: it comes
straight
out of Latour's own Irreductions.37 So he knew all
along!
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Sclence
Semiotics tells that life
(or non-life)
could have been different
for all
humans, animals, objects:
in
short,
the entities that
populate
the world. There is a
historical, diachronic,
version which
says
that
what seems like noise now
could,
if
things
had
happened slightly
differently,
have been
incorporated
into 'the Order': another
order. Once
upon
a
time,
when this or that
piece
of science was
still in
action,
the current version rather than some alternative
managed
to
get
established,
for
contingent
reasons that
might
be
examined. But there is also a
topographical, synchronic,
version
which
says
that at
any given
time there is more than a
single
order.
Rather,
different
orderings
co-exist. So 'our' version of
semiotics,
committed to
present-day multiplicity,
has another element in
common with
symbolic
interactionism: not that of
giving
voice,
but
rather that of the co-existence of different 'worlds'.38 But whereas
in
symbolic
interactionism worlds are created
by people
who
attribute
meaning,
in semiotics
they
are
complex orderings
of
bodies, food,
machines and numbers.39
The difference between
symbolic
interactionism and
semiotics,
then,
is not that one is
politically
sensitive whereas the other is not.
Or that one sides with the weak and the other with the
strong.
Rather,
it is that their
political styles
are different.
Symbolic
interactionism sets out
by thinking
about the
way
in which
different
groups
of
people
make sense of the world. In line with
this,
its
politics
has to do with the relations between different
groups
of
people:
between those who
speak up
and those who are
silenced. Semiotics starts from the
way
entities co-construct each
other. It tracks the
way orderings
are
generated.
In line with
this,
its
politics
is one which
explores
and
exposes
the
orderings
we
currently
live. Its
archaeological
versions
dig
out alternatives that
have been
forgotten.
And those versions that are committed to
multiplicity,
unravel the
relations,
the frictions and the resonances
between modes of
ordering
that co-exist in the
present.
This doesn't mean that
symbolic
interactionism is about
people
and semiotics about
'things'.
Nurse N's stories told above contain
many 'things'.
Nurse N is
certainly
not indifferent about whether
she has to hold
up
a
gavage
herself,
or can make use of a
pump.
And she has lots of other stories about the
way
in which some
things
are
convenient,
while others are
designed
with no
thought
for the
way
in which she works.40
Again,
semiotic stories are not
simply
about the
orderings
of
bodies, food,
machines and
numbers.
They
also tell about the humans who write down the
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numbers or
put
the food into containers. If
sleep
is lost because of
physical
examinations,
then the doctor's needs are met
by
over-
ruling
the immediate desires of the
baby.
So the
symbolic
interactionist method doesn't
prevent
one from
learning
about the
way
in which humans live with
things.
And
semiotics allows one to learn about the
ordering
of the lives of
doctors,
dispensary
assistants,
nurses and babies in incubators.
But there is a difference. For
symbolic
interactionism,
language
separates
humans from
'things'.
Humans are the active
pole: they
use
language
to attribute
meaning
to
things. By contrast,
in
semiotics there is no
hierarchy
between humans and other
entities,
mediated
by language.
Instead,
when
language
is extended from
words to
something larger (whether
this be a
discourse,
a
network,
a mode of
ordering
or a
logic),
this extension absorbs
things
within
the
linguistic
order. And when this
process
is
extended,
a
point
is
reached where the order is no
longer linguistic,
but a medium of
interdependent
entities in which
humans, too,
are dissolved.
They
become
part
of such a medium when
they
learn to talk and to
manipulate
tubes,
bags
and
sticky
fluids.
Making
a Difference
Two
theories,
two
methods,
two
political styles. No,
we aren't
going
to decide between them.41 But we do want to
say something
more about the
way
in which
they
relate. For in the
framing
of this
text,
we haven't handled the
way they
relate in a neutral
way.
Each time
symbolic
interactionism came first. We never criticized
it,
but we did use it as the
contrast,
the
background
for our account
of semiotics. Even at the
point
where we
explained
to semioticians
why
humanist
sociologists might
consider it offensive to level
humans and
things,
we wrote as if to
explain
to humanists how the
'misunderstanding' might
ever have come about. In short: this text
isn't a
passive description
of facts about
theories,
it is an active
move in a theoretical discussion.
So the
history
of this text doesn't
begin
with J and A
talking
method,
but a lot earlier: with the clashes between theoretical
humanism and its others.
Perhaps especially
when these discussions
take
place
in
English,
it seems that humanism has the better
credentials. Since
symbolic
interactionism is about the liberation
of one
group
of
people
from
(the complicated
and
subtle)
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domination
by
another,
it fits in
neatly
with traditional humanist
images
of
politics.
For semiotics it is different. It is a lot further
away
from the common sense of traditional
political theory.
The
politics
of semiotics
-
or
maybe
it's better to
say by
now: the
politics
we
try
to articulate here
-
is unconventional. Its
location,
its
substance,
and the
way
it relates to differences are all
fairly
recent inventions.42
This
politics
doesn't reinforce or undermine the
great
divides
between
groups
of
people
that seem to have been
politicized
for
ever. Instead it
generates
new axes
of
difference.
It creates new
political categories.43
And these do not meet in some centre from
which the world is ruled. For there
is,
in this
politics,
no
unique
parliament
where one needs to be
represented;
no
single place
for
speaking up
or
being
heard. Instead of
being
concentrated in a
privileged
location,
this
politics
is
everywhere.
It is in the
king's
palace,
but also in the
neonatology
ward. It is in the
prescriptions
of the
doctor,
but also in the rate at which a fluid
drips through
a
line. Thus neither is there
any
favourite
political
substance. For as
well as 'the
subject'
and 'the
citizen',
the substance of this
politics
includes such entities as the
body,
food,
or the
temperature
of an
incubator. As well as
groups
of
people,
it includes the
shape
of a
building,
the
rhythm
of the
day,
or
systems
of calculation.
Politics, then,
is not an
activity
that can be
separated
from
others. For while
using
'0.3' or 'one-third' is a
political
matter,
it
also remains an arithmetical
question.
And while
'sleep'
and
'hunger'
are elements of different modes of
ordering
the
world,
this doesn't mean that
they stop being
infant
desires,
or
pro-
fessional
assignments.
Thus this
politics may
well be about medicine
(or any
other field of
study)
but it is inside
it,
too.
Every
tension,
every
difference,
is thus
simultaneously caught up
in a
range
of
evaluative
logics.
Which means that there is never a
single
metric
or
system
for
weighing
different
things
and
comparing
them with
one another:
rather,
there are
many.
So someone who comes from
another
political
tradition, hoping
to measure the value of one
mode of
ordering against
another,
will be
disappointed.
There are
no zero-sum
games
that lead to conclusions here: instead there is
complexity.
Which need not
prevent
one from
acting.
After
all,
we wrote
this
text,
didn't we? It is clear and distinct about lots of different
things.
It
just
doesn't sum
together
at the end. There is no final
word. The move is
made,
but the movement isn't over. This text
436
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of
Method
does
something:
it
favours semiotics,
as if it were a silenced voice
that deserves to be listened to. But it does not
argue for
semiotics
and
against symbolic interactionism,
as if we needed to make a
choice. This is not because we are
indifferent,
but because we do
not hold the difference between
symbolic
interactionism and
semiotics to be a conflict that needs to
be,
or can
be,
resolved.
Neither deserves to win when it is measured
against
a neutral
standard - for there is no such standard. And
equally,
there is no
firm
ground
for a
compromise.
So a fusion between the two will
never be smooth. There are
many hybrids
around. Fine! But
remember:
they
all show the traces of irreducible difference.
Look at this text. At one
point
we write about
'symbolic
interactionists' and 'semioticians' as if we were
comparing people
who
interpret
the world in different
ways.
At another
point
this
text is about
'symbolic
interactionism' and 'semiotics' as if these
were two modes of
ordering
that exist as theoretical
repertoires.
We write/the text is. That's
hybrid.
In the
very
words of this article
both
sociologies appear.
Irreducible.
A: 'It's a bit
dense,
here and there. And there's
plenty
more to
say,
as
always.
But I think this is as far as we can
get
now.
Any
more
suggestions?'
J: 'Listen
maybe
we should do
something
with these little
stories about us that we inserted.
Why
are
they there,
anyway?'
A: 'Don't
you
like them
any
more? In the
previous
version
you
did'.
J: 'Oh
no,
I mean
yes, fine,
they're
all
right.
I've
got quite
attached to them
by
now. But I
mean,
are
they symbolic
interactionist,
or semiotic?'
A: 'Hmm. Good
question. [Pause]
Now that I think about
it,
I
think
they
are both'.
J: 'A
compromise?'
A: 'No.
They
are both. Another
hybrid,
one in which some-
thing
is either the duck or the rabbit. But not both at once.
A
symbolic
interactionist
might say
that
they
show that this
text is the
product
of two human
beings collaborating, you
and me. These stories are a
way
of
exposing ourselves,
of
being honest,
of not
pretending
that we didn't sweat. On
the other
hand,
a semiotician
might
take them to be a
rhetorical device.
Something
to liven
up
the text a little. A
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trick used to
glue
the
pieces together
and to
engage
in an
implicit
discussion about some of the
problems
of
supervis-
ing
and
co-authoring.
Like who did the fieldwork and who
chewed on the
theory.
Or who asks the clever
questions
and who
pretends
to answer them. Do
you
see what I mean?'
J: 'Let's write down
that,
yes,
of course I do. But we can't
know about the reader'.
*
NOTES
We want to thank first and foremost the
neonatology staff, parents
and
patients
who so
generously
allowed Jessica Mesman to witness life on the intensive care
ward. We also thank The Netherlands
Organization
for Scientific
Research,
whose
grant gives
Annemarie Mol the time to write. And for their criticism and
encouragement
our thanks
go
to Malcolm
Ashmore,
Marc
Berg,
Wiebe
Bijker,
Nicolas
Dodier,
Ruud
Hendriks,
Stefan
Hirschauer,
Marianne de
Laet,
Mike
Lynch,
Gerard de
Vries,
Rein de Wilde and Dick Willems.
Finally
we would like to
thank John Law who worked on the
English
in this article several times and each
time made
suggestions
about how its
argument might
be
improved,
too.
1. But see Robert
Lifton,
The Nazi Doctors: Medical
Killing
and the
Psychology
of
Genocide
(New
York: Basic
Books, 1986).
2. Hans
Radder,
'Normative Reflexions on Constructivist
Approaches
to
Science and
Technology',
Social Studies
of Science,
Vol.
22,
No. 1
(February 1992),
141-73.
3. We do not claim that this is the
only
or best
way
to be
political
in
theory,
but it
surely
warrants
being explored.
For a defence of the
investigation
of the
normativity residing
in one's field of
study
as
opposed
to
'being
critical',
see Luc
Boltanski,
L'Amour et la Justice comme
Competences (Paris:
Metaile, 1990).
4. As
categorizations go,
it is both
right
and
wrong
to
present symbolic
interactionism as a
subspecies
of verstehende
sociology.
We know that
they
have
different historical
backgrounds
-
the former in American
pragmatism,
and the
latter in the German discussions about
explanation
versus
understanding.
Yet in
the contrast with semiotics that we set
up
in this
paper,
it is useful to
group
all
'humanist'
approaches together.
But since we cannot deal with all of them at
once,
and do
justice
to all the
varieties,
we have
picked
out
symbolic
interactionism. One
of our reasons for
doing
so is that our work is also
part
of medical
sociology,
a
domain where this tradition is
particularly strong.
5. The
question
of the
politics
of
theory
has been
extensively
dealt with in
feminism,
one of our
backgrounds
and sources of
inspiration.
We don't take
up
an
analysis
of the various feminisms in science and
technology
studies here, but we
think it would be
possible
to make a more or less similar division between a
verstehende and a semiotic tradition
there,
too. This division
might
well run
right
through
some of the best
studies,
such as: Ludmilla
Jordanova,
Sexual Visions:
438
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SSK: Mol & Mesman:
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of
Method
Images of
Gender in Science and Medicine between the
Eighteenth
and Twentieth
Centuries
(New
York: Harvester
Wheatsheaf, 1989);
Londa
Schiebinger,
The Mind
Has No Sex? Women in the
Origins of
Modern Science
(Cambridge,
MA: Harvard
University Press, 1989);
and Donna
Haraway,
Primate Visions:
Gender,
Race and
Nature in the World
of
Modern Science
(New
York:
Routledge, 1989).
6. A neonate is a new-born child.
Neonatology
is the
subspecialism
in
paediatrics
which takes care of new-born babies with medical
problems.
In severe
cases,
new-
born babies with medical
problems
are
kept
in the
hospital.
In
very
severe cases
they stay
in incubators in 'neonatal intensive care'. That's where J did most of her
observations
(but
she also went to see what
happened
in the low- and medium-care
parts
of the
ward).
J first observed for several months in a Dutch
hospital,
and later
in one on the east coast of the United States.
7.
Among
J's favourite books there were several based on fieldwork in
hospitals,
such as the famous
study
of the
regulation
of norms
among surgeons:
Charles
Bosk,
Forgive
and Remember:
Managing
Medical Failure
(Chicago,
IL: The
University
of
Chicago Press, 1979);
and of course that other book situated in a
neonatology
ward,
investigating
the local
meaning
of 'ethics': Fred
Frohock, Special
Care:
Medical Decisions at the
Beginning of Life (Chicago,
IL: The
University
of
Chicago
Press, 1986). Though
these two are
clearly part
of the verstehende
tradition,
recent
anthropological
studies often show a theoretical mixture: see some of the studies in
Margaret
Lock and Deborah Gordon
(eds),
Biomedicine Examined
(Dordrecht:
Kluwer, 1988);
and in
Shirley
Lindenbaum and
Margaret
Lock
(eds), Knowledge,
Power and Practice
(Berkeley,
CA:
University
of California
Press, 1993).
8. For the
undermining
of the
hope
that methods or
any
other form of
epistemology
could function as a shield
against
sexism and racism, see Annemarie
Mol, 'Wombs, Pigmentation
and
Pyramids:
Should Feminists and Anti-Racists
Show
Biology
Its
Proper Place?',
in Alkeline van
Lenning
and Joke Hermes
(eds),
Sharing
the
Difference (London: Routledge, 1991),
149-63.
9. Steve
Woolgar,
'Some Remarks about Positionism: A
Reply
to Collins and
Yearley',
in Andrew
Pickering
(ed.),
Science as Practice and Culture
(Chicago,
IL:
The
University
of
Chicago Press, 1992), 327-42, quote
at 339.
10. Traditional
epistemology
isn't
appreciated
as a 'received view'
by (former)
students of constructivist teachers.
They get
the
impression
that the books and
articles
they
are
encouraged
to
read, written
by
such authors as Latour, Haraway,
Mulkay,
Bijker,
Knorr-Cetina, Cowan, name them, present
them with well-
established views. And so
they
do.
11. Others have also
reported
on the dreadful
feeling
that
may
haunt a
fieldworker,
that she is never where the action is. See, for a
particularly
vivid
example,
John
Law, Organizing Modernity (Oxford: Blackwell, 1994). And, for
another
ethnography
in which the work of
doing
fieldwork is reflected
upon
in an
intriguing way,
see Dorinne
Kondo, Crafting
Selves: Power, Gender and Discourses
of Identity
in a
Japanese Workplace (Chicago,
IL: The
University
of
Chicago Press,
1990).
12. For
questions
to do with treatment and
not-treatment,
see Jessica
Mesman,
'Machines en Moraal:
Verslag
van een
Onderzoekservaring', Krisis, Vol. 48
(1992),
5-18.
13. For a similar
criticism, in a feminist mode, see Stefan Hirschauer and Anne-
marie
Mol, 'Shifting Sexes, Moving
Stories: Feminist/Constructivist
Dialogues',
Science, Technology,
& Human
Values, Vol. 20, No. 3
(Summer 1995),
368-85.
439
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(Anti-)epistemological preoccupations
also dominate the other recent
attempt
to unravel differences between different kinds of construction-stories:
Sergio
Sismondo,
'Some Social
Constructions',
Social Studies
of Science,
Vol.
23,
No. 3
(August 1993),
515-54.
Sismondo, however,
misses the
point
of the semiotic
strands in science and
technology
studies.
14. H.M. Collins and Steven
Yearley, 'Epistemological
Chicken',
in
Pickering
(ed.), op.
cit. note
9, 301-26,
at 324.
Quoting
another text of
Collins',
which
defends a similar
position,
Radder remarks that Collins asks us to
'respect
the norm
of not
criticizing
science'
-
thereby nicely revealing
the
normativity
of this
position:
see
Radder,
op.
cit. note
2,
143.
15. Hans Radder
(ibid.)
is a
good, thoughtful example
of this. Radder
argues
that a modest realism is needed to account for
any politics
of the risks
technological
systems
entail.
16. Susan
Leigh Star,
'The
Sociology
of the Invisible: The
Primacy
of Work in
the
Writings
of Anselm
Strauss',
in David Maines
(ed.),
Social
Organization
and
Social Processes:
Essays
in Honor
of
Anselm L. Strauss
(Hawthorne,
NY: Aldine
de
Gruyter, 1991),
265-83.
17. For an
example
of a
study using
the
concept
'world',
in the sense of 'social
worlds',
see Adele
Clarke,
'A Social Worlds Research Adventure: The Case of
Reproductive
Science',
in Thomas
Gieryn
and Susan Cozzens
(eds),
Theories
of
Science in
Society (Bloomington,
IN:
University
of Indiana
Press, 1989),
15-42.
18. In medical
sociology many
texts have an undertone of either admiration or
anger.
Parsons' enthusiasm for the medical
profession,
which he saw
escaping
the
dichotomy
between
Gemeinschaft
and
Gesellschaft, keeps
on
clashing
with
Freidson's moral
outrage, provoked by
the sad outcomes of a wide
range
of
empirical
studies. For a further
analysis
of the theoretical roots of medical
sociology,
see Uta
Gerhardt,
Ideas about Illness: An Intellectual and Political
History of
Medical
Sociology (Basingstoke,
Hants.:
Macmillan, 1989). Symbolic
interactionism,
as we have
mentioned,
is also
strong
in the field of medical
sociology: see,
for a
good example,
Anselm
Strauss,
Shizuko
Fagerhaugh,
Barbara
Suczec and
Carolyn Weiner,
The Social
Organization of
Medical Work
(Chicago,
IL: The
University
of
Chicago Press, 1985).
19. 'The nurse'
may
of course be a
problematic point
of
departure.
Nurses aren't
all
alike,
nor are the
ways they
work with food and the
meanings
this has for them.
For a defence of
breaking
down all
group categories
and
taking
individuals,
and the
different situations
they
find themselves
in,
as the
appropriate
units of
analysis,
see
Nicolas
Dodier, L'Expertise
Medicale: Essai de
Sociologie
sur l'Exercice du
Jugement (Paris:
Metaile, 1992).
20. In the rest of Latour's text the word 'nonhuman' is
used,
instead of
'inhuman': Bruno
Latour,
'Where Are the
Missing
Masses? The
Sociology
of a Few
Mundane
Artifacts',
in Wiebe
Bijker
& John Law
(eds), Shaping Technologyl
Building Society:
Studies in Sociotechnical
Change (Cambridge,
MA: MIT
Press,
1992),
225-58,
quote
at 236.
21. Collins &
Yearley, op.
cit. note
14,
310.
22. For most
English-language
writers this is
confusing.
Semiotics includes the
early Wittgenstein among
its
enemies,
for it doesn't take words to refer. But
semiotics doesn't follow the later
Wittgenstein
when he
presents
words as actions.
Semiotics links words to each
other,
not to the situations in which
they
are
spoken.
It localizes
signs
in
sign systems,
not in
pragmatics.
For a serious introduction to
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of
SSK: Mol & Mesman:
Questions
of
Method
semiotics,
see
Algirdas
J.
Greimas, Semiotique
et Science Sociales
(Paris:
Editions
du
Seuil, 1976).
For a series of
examples
from outside the field of science
studies,
see Marshall
Blonsky (ed.),
On
Signs (Oxford:
Basil
Blackwell, 1985).
23. There are a lot of studies of medicine that
semiotically analyze 'sign systems',
ways
of
talking,
of
making
sense. In so far as
they go
into the
field,
they
turn it into
an
assemblage
of
spoken
words. Others take
up
events and
objects
but
only
in as
far as
they
are
'signifying'. See,
for
instance, Kathryn
Vance
Staiano,
Interpreting
Signs of
Illness: A Case
Study
in Medical Semiotics
(Berlin:
Mouton de
Gruyter,
1986).
In this
mode,
semiotics comes close to and is linked
up
with
hermeneutics;
see,
for
example, Byron
J. Good and
Mary-Jo
Del Vecchio
Good,
'The
Meaning
of
Symptoms:
A Cultural Hermeneutic Model for Clinical
Practice',
in Leon
Eisenberg
and Arthur Kleinman
(eds),
The Relevance
of
Social Science
for
Medicine
(Dordrecht: Reidel, 1980)
165-96.
24. Madeleine Akrich and Bruno
Latour,
'A
Summary
of a Convenient
Vocabulary
for the Semiotics of Human and Nonhuman
Assemblies',
in
Bijker
&
Law
(eds), op.
cit. note
20, 259-64,
quote
at 259. This version of semiotics draws on
a Foucauldian tradition of
attending
to material elements. And it doesn't
always go
by
the name of 'semiotics'. There are a
variety
of names
around,
each
indicating
something slightly
similar and
slightly
different: discourse
analysis,
actor-network
theory, post-structuralism. See,
for some of the
background, Christopher Tilley
(ed.), Reading
Material Culture
(London:
Basil
Blackwell, 1990).
25. For other
examples
of the
politics
entailed in different modes of
calculation,
see Malcolm
Ashmore,
Michael
Mulkay
and Trevor
Pinch,
Health and
Efficiency:
A
Sociology of
Health Economics
(Milton Keynes,
Bucks.:
Open University Press,
1989).
26. In
semiotics, everything
is what it is relative to the other elements of the
practice (network, order,
. .
.)
it is a
part
of. This means that semiotics is a
powerful
method for
putting
the natural sciences in their
place.
Instead of
confronting
the natural scientists' stories with those of other
people,
it confronts all
the various
practices
with which the natural sciences are intertwined with each
other,
and with other
practices
linked
up
with other truths and norms.
27. For an
interesting analysis
of relations between different
orderings,
see the
study
of the
way people justify
their actions and
plans
in Luc Boltanski and Laurent
Th6venot,
De La
Justification:
Economies de la Grandeur
(Paris: Gallimard, 1991).
For an
analysis
of medical
judgement
that comes out of this tradition and is also
closely
related to what we are
doing here, see
Dodier, op.
cit. note 19.
28. And her
writing.
For an
analysis
of the
importance
of numbers in the
regulation
of decisions and doubt in the
neonatology ward, see Jessica
Mesman,
'The
Digitalisation
of Medical Practice:
Uncertainty
in the Neonatal Intensive Care
Unit'
(paper presented
at the 4S Annual
Meeting,
Purdue
University, West
Lafayette, Indiana,
19-21 November
1993).
29. The classic
example
of an
analysis
of semiotics in
medicine, that is also in
some
ways semiotic,
is of course Michel
Foucault, La Naissance de Ia
Clinique
(Paris: PUF, 1963).
Foucault
himself, meanwhile,
is a
good example
of someone
who
imported
elements of medical
thought
into social
theory.
In
taking
'bodies'
rather than
'persons'
as the
starting point
of social
theory,
his
sociology
is social
medicine rather than social
psychology.
30. There's a lot left to
say
about
theory-passion:
see also, Janet Rachel, 'Acting
441
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Social Studies
of
Science
and
Passing,
Actants and
Passants,
Action and
Passion',
American Behavioral
Scientist,
Vol. 37
(1994),
809-23.
31. Howard
Becker, Sociological
Work
(New Brunswick,
NJ: Transaction
Books, 1970),
123.
32. For this
accusation,
followed
by
a beautiful
attempt
to save the
alleged 'good
elements' of semiotics
by absorbing
them into
symbolic
interactionism,
see Susan
Leigh Star, 'Power, Technologies
and the
Phenomenology
of Conventions: On
Being Allergic
to
Onions',
in J. Law
(ed.),
A
Sociology of
Monsters?
(London:
Routledge, 1991),
26-56.
33. For an
intriguing study
on noise and its
exclusion,
on the dream of
purity
and
the
parasites
who
constantly
come and
spoil it,
see Michel
Serres,
Le Parasite
(Paris:
Grasset, 1980).
34. We're comfortable with none of these
words,
but know none that are
any
better. 'Discourse' is the word drawn from Foucault's work: see Michel
Foucault,
L'ordre du discours
(Paris: Gallimard, 1970).
For the use of 'network' in a semiotic
way,
see Michel Callon and John
Law,
'On the Construction of Sociotechnical
Networks: Content and Context
Revisited',
in Lowell
Hargens,
R. A. Jones and
Andrew
Pickering (eds), Knowledge
and
Society:
Studies in the
Sociology of
Science
Past and Present
(Greenwich,
CT: JAI
Press, 1989),
Vol.
8,
57-83. 'Modes of
ordering'
is the term used
by
John
Law, op.
cit. note 11. For an
example
of a
study
that
analyzes
the co-existence of several medical
'logics',
see Annemarie Mol and
Marc
Berg, 'Principles
and Practices of Medicine: The Co-Existence of Various
Anemias', Culture,
Medicine and
Psychiatry,
Vol. 18
(1994),
247-65.
35. For a fiercer attack on the liberalism of what it calls 'actor-network
theory',
see Steve Brown and Nick
Lee,
'Otherness and the Actor Network: The
Undiscovered
Continent',
American Behavioral
Scientist,
Vol. 37
(1994),
772-90.
36. And Latour is not alone. We're
only attributing
all the action to him. So see
also,
John
Law,
'Introduction:
Monsters,
Machines and Sociotechnical
Relations',
in Law
(ed.), op.
cit. note
32,
1-23. Law
urgently
warns us not to be
speciesist
while
attempting
to avoid
classicism,
sexism and
ethnocentrism,
thus
locating
his call for
attending
to non-humans in the best of liberal traditions. But
see,
for a different
approach,
Law, op.
cit. note 11.
37. Bruno
Latour,
Les Microbes: Guerre et
PaixllIrreductions (Paris:
Metaile,
1984),
180.
38. For some
interesting
reflections on
multiplicity, using
the notion of 'versions'
of the world in a
way
that borders on
symbolic
interactionism,
see Nelson
Goodman,
Ways of Worldmaking (Indianapolis.
IN: Hackett
Publishing Company, 1978).
39. This talk about 'our' semiotics
implies
neither that we claim it as our
invention,
nor that we want to stick to it. For an
example
of network semiotics
being
used and then
supplemented
with another method
(or non-method),
see
Annemarie Mol and John
Law, 'Regions,
Networks and Fluids: Anemia and Social
Topology',
Social Studies
of Science,
Vol.
24,
No. 4
(November 1994),
641-71.
40.
Maybe
this
explains why symbolic
interactionists
incorporate
the semiotic
attention to
'things'
so
gratefully
and
eagerly.
Clarke and
Gerson,
for
instance,
write that Latour
'insists, correctly
we
believe,
that we view all
participants
in a
setting
as
actors,
not
just
humans. ... This
point
is an
important
extension to basic
interactionist
principles
and ties to issues of
meaning
and action which Mead
explored philosophically':
Adele Clarke and Elihu
Gerson, 'Symbolic
Interactionism
442
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Politics
of
SSK: Mol & Mesman:
Questions
of
Method
in Social Studies of
Science',
in Howard Becker & Michal McCall
(eds), Symbolic
Interaction and Cultural Studies
(Chicago,
IL: The
University
of
Chicago Press,
1990), 179-214,
quote
at 198. We
hope
that we have
managed
to make it clear that
matters are a little more
complicated
than this
suggests.
41. The
easy sociology
here is that this is because we're Dutch authors. 'We
Dutch'
prefer
not to
get caught up
in international
fights.
Instead of
taking
a
stand,
we
specialize
in
importing
and
exporting.
Thus our
compatriots
Wiebe
Bijker
and
Gerard De Vries even
managed
to
keep
their cool in the 'Chicken' debate in which
Harry
Collins and Steven
Yearley
directed all their
aggression
at Bruno Latour and
Michel
Callon,
who didn't miss the
opportunity
to strike back: see Collins &
Yearley, op.
cit. note
14;
Collins and
Yearley, 'Journey
into
Space',
in
Pickering
(ed.), op.
cit. note
9, 369-89;
and M. Callon and B.
Latour,
'Don't Throw the
Baby
Out with the Bath School! A
Reply
to Collins and
Yearley',
in
ibid.,
343-68. As De
Vries
commented,
'I
happened
to be
present
in Bath at the
meeting
where the first
shots were fired. After this
meeting,
as a true citizen of a
trading nation,
I tried to
keep
in touch with both
parties' (Gerard
De
Vries, 'Bath/Paris,
SSK and ANT: Two
Rival
Philosophies', [paper presented
at
Groningen University,
27 November
1993]).
42. In our
framing
of 'the
political',
we
mostly
draw on Foucault and discussion
about his work. See
also,
for recent shifts in the
meaning
of
'political'
in
political
theory, Agnes
Heller and Ferenc
Feher,
The Postmodern Political Condition
(Oxford: Blackwell, 1988).
43. This in
part explains
the
uneasy
relation between feminism and semiotics.
Non-feminist semioticians tend to defend themselves
against
attacks from non-
semiotic feminists who
say
that
'they're
not
paying enough
attention to
gender
questions', by arguing
that the difference between the
genders
-
and indeed the
sexes
-
isn't
pregiven. Semiotically-attuned feminists, meanwhile,
try
to find out
if,
when and how sex differentiations are
locally
made. For a series of
interesting
struggles
with this
matter,
see Donna
Haraway, Simians,
Cyborgs
and Women: The
Reinvention
of
Nature
(London:
Free Association
Books, 1991); and,
for an
example
of the
way
this
may
work out in an
analysis
of medical
practice,
see
Vicky Singleton
and Mike
Michael,
'Actor-Networks and Ambivalence: General
Practitioners in the UK Cervical
Screening Programme',
Social Studies
of Science,
Vol.
23,
No. 2
(May 1993),
227-64.
Annemarie Mol studied medicine and
philosophy,
and
contributed to the
writing
of this
paper
while she was a
Constantijn
en Christiaan
Huygens
fellow of The
Netherlands
Organization
for Scientific
Research,
and
attached to the
Department
of
Philosophy
at the
University
of
Limburg.
She
publishes
in
philosophy,
feminism and
social studies of
science,
technology
and medicine.
Jessica Mesman studied
nursing
and
theory
of the health
sciences. She is
currently writing
a thesis on ethics in the
clinic,
for which she did fieldwork in the
neonatology
wards
of a Dutch and a North American
hospital.
443
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444 Social Studies
of
Science
Authors' addresses:
(AM)
Willem de
Zwijgerstraat
25;
3583
HB
Utrecht;
The
Netherlands;
e-mail: a.mol.@cc.ruu.nl
(JM)
Department
of
Philosophy, Faculty
of Cultural
Studies,
University
of
Limburg,
P.O. Box
616,
6200 MD
Maastricht,
The Netherlands: e-mail:
J.Mesman@tss.rulimburg.nl
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