The connections between meaning and language have been the subject of different theories about how language is used to represent the world and have lead to three broad categories of inquiry: the reflective, the intentional and constructionist approaches (S. Hall, 1997). According to Stuart Hall, reflective theories of representation approach language as if it were a mirror, reflecting meanings that already exist in the world; whereas intentional approaches assume language is used to convey only what an author intended. Of interest to this study is the constructionist approach, which is concerned with how meaning is constructed through language. It comprises two distinct branches of analysis, that of semiotics and the discursive.
Semiotics is derived from the work of Saussure, who proposed a ‘scientific’ model of language that became known as structuralism (Audi, 1995). Like binary pairings, Saussure insisted that it is the difference between signifiers that give the signified their meaning. Meaning thus becomes relational and is subject to change and to history (S. Hall, 1997). It is difference that has importance because “this approach to language unfixes meaning … and opens representation to the constant ‘play’ or slippage of meaning, to the constant production of new meanings, new interpretations” (S. Hall, 1997, p. 32), and interpretations can never result in a final and complete truth.
The discursive approach to discourse analysis is also constructionist, but was not considered by Foucault as structuralist. While many saw his early work this way, he refuted the claims in his conclusion to The Archaeology of Knowledge (1989).
He also remained noncommittal about the label of post-structuralist, suggesting that it was not necessary to know exactly where he fitted, other than as a “historian of thought” (Foucault in Martin, 1988, p. 10). He did agree with the structuralists that language and society were shaped by rule-governed systems, but he did not think that there were unifying underlying structures in language that could explain the human condition. Foucault’s interest lay not just in meaning through language, but rather on discourse as a system of representation (S. Hall, 1997, 2001a).
Moving away from discourse solely as a linguistic concept, Foucault’s notion of discourse concerned the ways that an issue or topic is ‘spoken of’ through such means as speech, texts, writing and practice (Wetherell et al., 2001a). A set of ways of referring to a topic is said by Foucault to belong to the same discursive formation (S. Hall, 1997). The constructionist view is that language is more than simply a system of representations of physical things and actions, but that they take on meaning as they are spoken of within discourse (Weatherall, 2002). Foucault (1989) argued that nothing has any meaning outside of discourse, and suggested that because knowledge is concerned only with what is meaningful, discourse produces knowledge. The constitutive nature of discourse produces the objects of which they speak, constructing a particular version that is construed as real. Thus ‘truth’ is defined and established by discourse (Carabine, 2001) and has material effects or consequences (Weatherall, 2002). The ‘truth’ then has a bearing on how something is controlled and regulated (S. Hall, 1997).
Control is achieved and regulated by the use of techniques such as dividing practices, which delineate normal from abnormal. In post-structural terms, the boundaries of what is acceptable and appropriate are created against a discourse of what is ‘normal’ or ‘natural’ as an effect of the cultural and political order (Carabine, 2001). However, these normalisation techniques construct binaries that serve to create a devalued notion of the ‘other’. Challenging and dismantling the assumptions underlying hierarchical binaries is the aspect of Derrida’s general deconstructive method that I wish to integrate with a discourse analysis after the style of Foucault. This may seem surprising given the acrimony between Derrida and Foucault, but a plural approach of textuality and discursivity has greater potential than either on its own. Foucault’s position is that a text can best be read against its context of discursive practices (Boyne, 1990), whereas “Derrida valorizes and gives voice to otherness by subverting the dichotomies of presence/alterity on which Western philosophy, culture, and society rest” (Agger, 1994, p. 502). For Foucault (1989), nothing has any meaning outside of discourse, and for Derrida (1976, p. 158), “there is nothing outside of the text”.
Eventually Foucault and Derrida found common ground in relation to power and ethics. Both imply an allegiance to Kant’s categorical imperative8: Derrida in his writings against racism and Foucault in his commitment to practical political activities (Boyne, 1990). Central to the work of both is the operation of power; however, as Boyne (1990, p. 2) suggests, “the concept of power that is only implicit in Derrida’s work is made explicit by Foucault”. While Foucault deliberately rejected a top-down characterisation of power based on binary structures (such as oppressor/oppressed), my reading of Derrida suggests that power lies within the Western philosophical assumptions that maintain an opposition.
I see the fusion of ideas from each of these writers as fitting for my area of study because even a general scan of the literature about nurse practitioners reveals ‘othering’ (particularly by medicine) as a striking feature. However, my research interest is also in the wider formative and transformative statements that gave rise to the possibility of a nurse practitioner role for New Zealand and of its subsequent development, and Foucault’s approach offers productive possibilities to examine this.
Fairclough (1993), too, adopts a multidimensional approach to the analysis of discourse and brings together three analytical traditions. Although his view of discourse as text is narrower (in a linguistic sense) than I have adopted, and his understanding of power different from that of Foucault, his work in particular has informed many aspects of the general approach I have taken to the handling of data in this study.