Discursive elements

3.5.2.1 The object of discourse, statements and enunciative function

The concepts of object, statements and enunciative function were described at the beginning of this chapter. The question in this section is: how have Foucault and the authors mentioned above used these discursive elements in their research?

In The Birth of the Clinic, Foucault´s object is medical practice and how it is characterized. He presents the concept of the medical gaze to describe a specific object that delimits a field of knowledge and power. In

medical education, as in other fields making use of Foucauldian discourse analysis, the object of research coincides with the object being described by discourse. These objects/objects range from “‘good doctor”, “patient centeredness” to “emotion” (Whitehead C. , 2011; Klingenberg, 2013). Many authors use the concept of the “keyword” to help identify the object of research in different documents under analysis. It is clear, though, that the keywords used may not coincide with the object of analysis, which may take different linguistic forms in the same or different texts, or be absent altogether (in which case the object might be defined in terms of what it is not). By using the idea of keyword as a tool to identify the object of a study, researchers can accelerate the process of finding the specific object of research in a text, through simple word-finding tools; however, they can also overlook the characterization of the object through its absence or its relationship to other objects.

In Whitehead et al.’s approach to the characterization of the discursive strategy of introducing science into the medical education discourse between 1910 and 2010, the authors used the keywords “science/scientific” to highlight a conflict between “specialist/specialty” and “generalist/family” doctors. These keywords were therefore the main tools in identifying the object of discourse in their study. In Carabine’s paper, the unmarried motherhood discourse is identified through the use of keywords such as “female/woman” and “bastard/bastardy”. However, the absence/presence of the male/father in the discourse also contributes to the characterization of the object of the research (Carabine, 2001). Her analysis, in other words, is not restricted to the presence of keywords which identify the

object; it also explores absences in the chosen texts and the object’s

relationship to other objects of the discourse.

Keywords can also lead a researcher to miss other descriptors of the object under investigation. If the object is portrayed negatively (through its absence) or its central characteristics are transferred to another object, a text search may not only deceive the researcher but deny them a broader comprehension of the discourse being conveyed and the object’s position in it.

3.5.2.2 The statement and enunciative function

The authors studied in this chapter employ a variety of terminologies or expressions to refer to a Foucauldian statement, including “metaphors”, “arguments” (Whitehead), “texts” (Carabine), “speech acts” (Klingenberg), and “lexical references” (Willig and Chin). What these have in common is that all carry an enunciative function (meaning, action, assumption of truth). As can be seen in previous sections, researchers used textual excerpts as the materialization of the statement. From these excerpts, each author captured the discursive strategy and subject positions to different extents. An important part of their analysis was to examine differences/similarities in statements that defined the same or different objects. It is unclear from their usage, however, if the objects of study were also characterized through a comparison with statements and enunciative

functions describing other objects. 3.5.2.3 The analytical process

In The Birth of the Clinic, the analytical tasks described by Foucault are undertaken without a formal definition of their character and

medical gaze as the object of discourse. The text also makes clear the

possible subject positions produced by the analysis to medical practitioners with regards to disease, patients, body, death, and how these are delineated and altered through historical vicissitudes in discourse. The medical gaze is defined as the main discursive strategy by which clinical/scientific institutions assume control over the dead and sick body. This shift of the medical gaze from the patient to the “depths of the body” is exemplified by the following extract, in which Foucault cites a passage from a 19th _{century medical}

dictionary to describe the change in discourse:

“Was not the change in medical knowledge at the

end of the eighteenth century based essentially on the fact that the doctor came close to the patient, held his hand, and

applied his ear to the patient’s body, that by thus changing

the balance, he began to perceive what was immediately behind the visible surface, and that he was thereby led

gradually ‘to pass on to the other side’, and to map the

disease in the secret depths of the body?

‘Pathological anatomy is a science whose aim is the knowledge of the visible alterations produced on the organs

of the human body by the state of disease. The opening up of corpses is the means of acquiring this knowledge; but in

order for it to become of direct use…it must be joined to

observation of the symptoms or alterations of functions that coincide with each kind of alteration in the organs [31].

R.Laënnec, Dictionnaire des Sciences médicales, article ‘Anatomie pathologique’, II 1840’” p. 135-136.

The discourse analysis undertaken by medical education researchers using Foucault´s approach places different emphases on the tasks delineated by Foucault. In general, greater stress is given to the formation of objects and the discursive strategy. With regards to the object, the focus tends to be on conceptual delimitation and the differentiation of

(Whitehead et al.), or repetitive (Klingenberg), recurrent (Carabine) and consistent (Willig) characteristics of statements describing the object. The analysis of statements is variously understood as a description of statements’ relations (Whitehead et al.), position (Carabine), inter-relationship (Willig) and hierarchy interactions (Klingenberg). Special attention should be given to Carabine´s emphasis on the perception of counter-discourses that challenge the dominant discourse as an internal expression of resistance. Such counter- discourses may also be acknowledged through the identification of absences, as in the following extract:

“Contesting the Bastardy Clauses

If we read outside of the Bastardy Clauses we find that there was widespread hostility and opposition to the 1834 New Poor Law which was ‘rejected by working people as a thoroughly heartless attack on the comfort, dignity and customary rights of the poor’ (Dinwiddy, 1986-72). According to Heriques (1967) the Bastardy Clauses were the most unpopular part of the 1834 Act. Protests focusing specifically on the provisions contained in the clauses criticized them for dealing with women unfairly, operating a dual standard of morality and for allowing men to seduce women with impunity (see Henriques, 1967; 112, 1979, 52-8; Rendal, 1985: 197; Taylor, 1983: 201-4). Indeed, the Bastardy Clauses were hotly debated in the House of Lords and they were only just approved by 93 to 82 votes (see Hansard (Lords) 8 August 1834 1096-7).” (Carabine, 2001)

With regards to formation of strategy, attention is paid to recurring discursive elements and their internal contradictions. Authors also refer to “the rationale that legitimizes statements” (Whitehead) or to rhetorical

strategies/conditions for possibility. Less importance is given to the

institutional networks surrounding discourse and the social context of the different historical periods analysed.

Often these authors present the final discursive strategies as re- groupings of statements into different categories or themes. In Whitehead’s

work, for instance, it was interesting to note the incompatibility between the scientific doctor proposed by Flexner (1910) and the “science-stuffed” doctor in later documents. In Klingenberg’s research, discourse produced by the Department of Health (UK) on patient-centredness becomes an “all- encompassing concept” – including not only patients’ health care but also “good management” – and a discursive strategy for recommended change. Incompatibilities presented by Carabine were clear in the examples provided: the relationship between unmarried motherhood and moral corruption, illegality, disgrace, guilt and blame is identified.

3.5.2.4 The concepts of Discourse, Archaeology and Genealogy Discourse, archaeology and genealogy are Foucault´s broader

definitions regarding the work of discourse analysis. According to Andersen, the archaeology of knowledge involves understanding discursive formation through the regularity in dispersed elements of discourse as an expression of power relations. The genealogy of knowledge is the historical dimension of the archaeology. The framework for the analysis of genealogy is continuity and discontinuity. In The Birth of the Clinic both archaeology and genealogy are clearly in play, despite Foucault not yet distinguishing the two.

All authors undertaking Foucauldian discourse analysis have used these terms, although with different emphasis on each depending on the research focus. Andersen, Whitehead and Carabine emphasize both

archaeology and genealogy; Willig emphasizes archaeology, with a special

3.6 Conclusions

This chapter has focused on providing a theoretical and empirical understanding of how discourse analysis was operationalized by Foucault and some selected authors. The study of Foucault’s work deeply influenced my own approach to the methodology. It also gave me a critical perspective with which to view the discourse analysis of authors such as Willig and Andersen, and to compare the use of Foucauldian elements of discourse in a range of other studies. The following table (4) summarizes the stages and tasks of analysis proposed by the three authors that developed a type of guideline cited in this chapter (Carabine, Willig, Andersen) and how these relate to Foucault’s description of his method in The Archaeology of Knowledge. All have contributed to the approach I adopted in my research, as described in detail in chapter 4.

Table 4 Summary of the comparison of guidelines to Foucauldian discourse analysis

Foucault Andersen Willig Carabine

Discursive formation Archaeology: Formation of objects and concepts

Describe the object (“grid of specification” (planes of emergence, authorities of delimitation and forms of specification) through the analysis of the statements and their enunciative function (intervention on the statements, which can appear as: (1)

techniques of rewriting, methods of transcribing (formalized or artificial

language), (2) modes of translating

(quantitative and qualitative), (3) approximation of statements (refine

exactitude), (4) delimitations (extension or restrictions to statements), (5) transfers

(statements from one field to the other), (6) systematizing propositions that already

exist. Analyse the construction or recycling of concepts.

Archaeology –

regulation and

dispersion

“Step 1: Discursive Constructions -

identification of the discursive object which is constructed through lexical references and shared meanings.

Step 2: Discourses - identification of various discursive constructions of the discursive object within a wider discourse.

Step 3: Action Orientation - analysis of how and why the object discourse is constructed in a particular way, and how it acquires functions and relates to other constructions.” (Willig, 2001)

Identify themes, categories and objects of the discourse

Genealogy – historical dimension of discourse

Continuity and discontinuity of discursive practices.

Genealogy –

continuity and

discontinuity in

history.

Context 1 – outline the background to the issue.

Context 2 – contextualize the material in the power/knowledge networks of the period

Formation of subjective positions

Subject positions produced by the analysis and available to actors involved in practice.

Self-technology –

subjection and

subjectivation

“Step 4: Positionings - identify the subject’s positions or location for persons within a structure of rights and duties who use that repertoire offered by the various constructions. Step 5: Practice – discourse analysis maps the possibilities for action contained within the discursive constructions identified in the text.” (Willig, 2001)

Identify the effects of discourse

Formation of strategic choices

Equivalent incompatibilities.

Economy of the discursive constellation. Authorities involved.

Dispositive analysis - apparatus and strategic logic

Look for evidence of an inter-relationship between discourses.

Identify the discursive strategies and techniques that are employed.

Dimension not considered by Foucault in discourse analysis

“Step 6: Subjectivity - traces the outcomes of adopting various subject positions by drawing links between discursive constructions and personal experiences.” (Willig, 2001)

Reflexivity: be aware of the limitations of the research, your data and sources.

4 FOUCAULDIAN DISCOURSE ANALYSIS