Postmodernism has been described as "a social movement and philosophy that originated among French literary theorists in the 1960's” (Reed, 1995, p.71), and although post-modern ideas were expressed prior to this time11, the movement is now considered as "a rebellion against the formalities of modernity" (Doll, 1993, p.6). Postmodernism is a rebellion against
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The first implication of a ‘post-modern’ view was used by the artist John Watkins Chapman in the 1870s to signify a shift from one type of artistic impression, i.e. ‘impressionism’ towards a new and yet to be explored type, then loosely termed ‘post-impressionism’ (Jencks, 1995).
structuralism and the underpinning structuralist thinking that is closely allied with the empiricism/positivism of the modernist paradigm. Within that paradigm, the perceivable world of nature and human activities is structured as sets of binary opposites (such as being/nothingness, black/white, hot/cold) and these opposites are considered to be the basic elements that structure or ‘frame’ meaning. Structuralism therefore implies that meaning may be induced or deduced through a study of ‘difference’. Such differences have led to the categorisation of the observable world, including the world of human relationships and behaviours. For instance, in sociology/anthropology, a line may be traced from Augustus Comte’s (1975) observations12 through to the works of Emile Durkheim and Marcel Mauss (1963), Louis Althusser (1969), Max Weber (1978), and Claude Levi-Strauss (1963, 1963a, 1976).
Structuralist ideology remains influential within the social sciences to the present day, and rests upon the notion that there is a definable and observable social structure (rather than chaos, anarchy or no particular reliable social configuration). In this approach, human consciousness has little more than a purely receptive capacity; the conclusion being that human reality is a human construction, i.e. no more than a product of representative activities which are both culturally specific and generally unconscious. This idea of the human as a 'subject' - as opposed to the idea of the individual as a stable indivisible ego still holds a powerful influence in many fields (such as ethnology, psychoanalysis, and semiotics). As such, structuralism remains a movement associated with modernist hyper-rationalism, claiming that meaning is to be associated with “timeless and universal structures forming a stable and self-contained system based on binary oppositions” (Appignanesi & Garratt, 1995, p.70).
While structuralism seeks to explain abstract forces within society, it clearly does not deal with the more difficult abstract concepts, such as human values or morality, in that it fails to adequately provide reliable meaning or motivation of any given (‘subject’) individual (Bauman, 1992). Furthermore, those structuralist approaches within the social sciences that are underpinned by Saussurian ideas on language and identity (Saussure, 1971) tend towards an ahistorical viewpoint and present the ‘human agent’ as the ‘subject’. Saussure coined the term ‘semiology’ to describe a ‘new science’ which would be a part of social psychology: “Linguistics is only a part of the general science of semiology; the laws discovered by semiology will be applicable to linguistics, and the latter will circumscribe a well-defined area within the mass of anthropological facts” (Saussure, cited in Hawkes, 1977, p. 123).
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Comte was the first to apply the methods of positivism to the study of society (Comte, 1975; Lenzer, 1975) concluding that there were binary oppositions which were both ‘static’ and ‘dynamic’ components of social existence.
In other interpretations, such as through the use of a Marxist approach (Strinati, 1995), a historical position may emerge, but only in the sense that broad social structures are located within the broad sweep of history, and without consideration of particular discourses within particular time/space through which subjectivities are constructed. Subsequently, poststructuralist thinkers attack these and similar problems of structuralism by arguing that: “All perceptions, concepts, and truth claims are constructed in language, along with corresponding ‘subject-positions’ which are likewise (so it is argued) nothing more than transient epiphenomena of this or that cultural discourse” (Honderich, 1995, p.708). Structuralist research based approaches are therefore a problem in those areas of research where the topic requires an examination of societal structures and the motivations and desires within the cultural discourses of human actors within those structures; traditional structuralist approaches are therefore unsuitable for such projects.
In this thesis, post-structuralism is regarded as a transformation or extension of the modernist paradigm, and not necessarily its antithesis (Gedö, 1982); it is understood as a pluralist paradigm (i.e. there are post-modernist visions rather than a vision) that opens multiple layers of interpretation and transformations in theory, the arts and the sciences (Best & Kellner, 1991, 1997). In brief, this thesis is overlaid upon structuralist thinking and incorporates, challenges and extends structuralist thought to assist the transformative process where there are no longer structures, but rather the 'shared symbolic systems' (Bourdieu, 1977a) of the new paradigm; it is a post-structuralist thesis in a post-modern age that may at times mirror the orderliness of the previous paradigm, but it will also consider the paradoxical, the dialectical and the challenging. This thesis relies upon a poststructuralist position which includes a method of analysis that is ideal for the chosen topic. To understand why this should be so, it is now important to outline the use of poststructuralist inquiry in research, and especially in health care related research.
Poststructuralist inquiry in social and health related research
Poststructuralist inquiry views language as a most powerful definer, descriptor (of conventions), and control mechanism within society. It concentrates on analyses of literary and cultural texts because such texts represent “a theory of knowledge and language” as different from “a theory of society, culture and history” (Agger, 1991, p. 112). The poststructuralist approach to research therefore implies an examination of plural phenomena within a fragmented arena, and as in all poststructuralist endeavours, considers language, meaning and subjectivity within a postmodernist construction (Weedon, 1987). It is the political nature of language within society (as texts of varying types) that lends itself to poststructuralist research (Fairclough, 2003). Discourse is a study of the language acts of everyday life; it provides an insight into the ways in which individuals, groups or structures are ‘products’ of discourses and practices that achieve an
illusion of durability either through repetition and/or a series of historical settlements (Somers, 1992).
In the majority of the social sciences, including health and health related studies, the rational and empirical philosophical underpinnings of the modernist paradigm have not been entirely abandoned. As Habermas (1971) implied, technical knowledge is still required for a great deal of modern work practices, including health care work. The use of the natural and applied sciences, and the acquisition of practical skills, remains important in medicine and nursing, even if this type of empirical knowledge has been shown to be problematic in certain areas of research such as applied ethics or in the acquisition of ontological knowledge; in such cases, post-structuralist inquiry is becoming more popular. This is because it appears to provide an adequate response to an increasingly complex modern medical environment that remains a paradoxical mixture of both the traditional (as an art) and the modern (as a science) (Cheek, 2000). Such research highlights the paradoxical, dialectical and challenging aspects of modern health care because poststructuralist research is capable of 'multi-layered' interpretations and commentaries on health care delivery; it is therefore as useful to medicine and nursing as structuralist based research, but with a different purpose and in different ways.
Irrespective of the continuing emphasis on modernist responses to problems within health care, medicine and nursing focused research, there is a gradually emerging appreciation of postmodernist research studies in those areas (Cheek, 2000; Rolfe, 2000). These studies have brought the mechanistic and rationally orientated philosophical underpinnings of both the applied and social sciences in health care research into sharper view. That such research is now being undertaken is a reflection in itself of the recognition within at least part of academia that the 'modernist paradigm' has not provided contemporary answers to a number of difficult questions about health, care and illness. Such questions include the social meaning of and assumptions about health and health care (Cheek, 1997), the professionalization of nursing through the adoption of the discourses of others (Latimer, 1995), nursing as resistance (Peter, Lunardi & Macfarlane, 2004), and critical approaches to the current health care of the older adult with dementia (Gilmour, 2001; Neville, 2005). In a number of recent poststructuralist theses, a Foucaultian analytical perspective has been employed (Gilmour, 2001; Neville, 2005), and there is an emerging interest in the use of Bourdieusian themes and theoretical ideas (Rhynas, 2005).