Foucault’s principles of discursive analytics: reversal, discontinuity, specificity and exteriority (chapter two) emphasised recognising and revealing how truth claims are legitimised by authorised knowledge using a priori rules of author credentials and,
epistemological enforcers of what is sayable and heard. These principles informed methods to examine how the power/knowledge of discourse took effect as a will to truth, legitimised
85 and taken as “in the true”. Knowledge as truth claims, whether in legal hospital documents, care practices or authorised journals were always dependent on conditions of existence such as place/time where spoken and/or inscribed by whom. Discursive analytics served to make truth claims and other discursive formations of interest visible as objects on grids of specification used as data sources; grids of hospital systems, routines and spaces not in isolation but in relation to grids or systems of published literature germane to the topic of interest. These data sources held interconnected power/knowledge effects of discourses interiorly and by a “the wild exteriority”, a priori rules. Hence it was imperative in this study to include both hospital spaces made accessible by ethnography and a body of reviewed literature rendered germane through processes of discursive analytics. As such discursive ethnography could expose the power/knowledge of a discourse wherever it was recognised and located through knowing these a priori rules. Analysis could render visible the order of a discourse and its effects within and across different fields of relations, to see how/when re/distributed across literature and hospital spheres. For example, the power/knowledge of biomedical discourse was shown to have similar effect across these spheres, recognised at some level wittingly or unwittingly in hospital as the commentary of the grand narrative of medicine. A commentary that established, authorised and legitimised medicine as a
discipline defined and upheld by the delimited domain of the scientific method, ‘a corpus of propositions considered to be true, a play of rules and definitions’ (Foucault 1972, p. 59).
In doing discursive analytics it was important to treat ‘the text itself as the object of study’ rather than becoming caught up by what the text ‘seems to refer to’ (Parker 2004, p. 310). I examined texts for words, phrases, sentences, tropes and chunks of writing to discern how they made sense as statements not in isolation but organised to reveal how as interrelated discursive events they operated to produce knowledge about hospital systems, care technologies, practices and participants. This meant I looked for how such events were enmeshed in webs of conditions contextualised by research protocols, hospital rules, routines and practices. It was by recognising these webs of interrelatedness across texts as objects of study that I could make sense of the ordering of discourse and how one discourse and not another was predominately uttered, the event of a discourse. I examined how statements whether located on the texts of care technologies and/or the texts of care providers’ talk they presented as expert knowledge or expertise in tension with subjugated,
86 local or naive knowledges to reveal how power/knowledge is contingent on the context and conditions of discursive events. Table 3.5 below summarises how I located and recognised texts as data in analytic processes to figure and determine what discourse does and to see what the doing of discourse does.
Discursive analytics allowed funnelling ideas progressively by focussing on how patterns emerged in textual spaces across regimes of theory and practice within temporal- spatial spheres of data sets here. I could see a unity of discourse not so much in its
permanence and uniqueness but via ‘the space in which various objects emerge and are continuously transformed’ (Foucault 1972, p. 32) here as discursive formations.
Foucault significantly informed my thinking but is acknowledged as avoiding specific methods to clearly inform data collection, analysis, organising, interpreting and writing up the thesis. He (1994, p. 288) said ‘I care not to dictate how things should be’ with a
purposeful reluctance to prescribe methods claiming he ‘tried to reveal the specificity of a method that is neither formalizing nor interpretative…,’ (1972, p. 135). Rather, he offered various albeit incomplete frameworks to problematise and question possibilities amenable to his current study. His ideas on methods were simply not too clear or specific never mind shifting and changing as he came upon new thoughts and rejected or abandoned others. The challenge sharpened with trying to follow and understand his broad and diverse synthesis of ideas from social and political studies across many disciplines from the social sciences, literary works, history, philosophy, hard sciences to medicine and psychiatry. I drew from his philosophical, postmodern and post-structuralist approaches to knowledge, power, subjectivity and self-critique.
My methods were not designed to provide solutions as alternate truth claims to already-established health care practices. Methods focused on explicating truth claims for purposes of exposing the constitutive power of knowledge and truth regimes generated by the discourse of functional decline. Discursive analytics revealed how functional decline discourse embedded in the language of scientific study and scientific notions of care imbued care technologies that almost exclusively determined care practices. These methods were used to unpack the effects of the grand narratives of science by examining their discursive effects when redistributed from the literature into hospital systems translated as
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Textually mediated data Analytic processes What discourse does
Data organised as statements are located as events.
Statements can be textual products but only have meaning in the context of where located, their enunciative modality, who is the speaking subject (author function); the conditions allowing the event of a
discourse. For example, statements of functional decline discourse can surface as Activities of Daily Living (Katz et al, 1972) when written as scientifically determined and pre-established validated
measurements based on norms. Data presents on a patient chart as
objectified levels of capacity for mobility ~ useable for deciding what constitutes diminishing capacity, decreasing productivity, increasing illness, and/or recovery; positioning the patient in relation to measurable biophysical elements used to assess discharge status.
Data are located and identified elements appearing as events of discourse that structure patient care technologies.
Discursive analytics using Foucault’s strategies of reversal, discontinuity,
specificity, and exteriority are about locating the character of discourse as event to make visible how discourse is produced as
discursive formations and how it operates. The event is where a statement is enunciated and located as an artefact of a discourse. Data as a series/ensemble of statements recognised as a pattern of meaning becomes visible as discursive objects, concepts,
subjects, and strategies available for analysis, e.g., how items of assessment are enunciated on a patient chart as a grid of specification used to document level of functional status: levels of mobility itemised as dangling at bed edge, standing, etc...
Discursive practices can also be the manufacture of tropes such as bed # for patient or idea of assessment as scientific evidence informing the clinical pathway conceptualised as best practices despite being decontextualised and so forth.
Once discursive formations are made visible across interrelated fields of discourse, what they do becomes apparent. For example, how:
A patient is formed as object of care is established by the language and structure of patient charts. The discursive formations of charts is about production of knowledge, i.e., biomedical knowledge informing and constituting who a patient is via assessment and documentation strategies. Records of these social practices of hospital care are discursively constructed via tick box format that constitute subjectivities of nurses and patients accordingly, i.e., expert nurse using scientific measures positioning subjugated patients as objects of care.
The patient record, as a grid of specification is an enunciative modality for discursive meaning-making about the patient via a series of numeric values used to determine readiness for discharge. The patient becomes objectified as their subjectivity becomes defined by numeric values.
Analytic outcomes are how discursive formations of objects, subjects, enunciative modalities, concepts and strategies are constituted and constitute subjectivities as they operate to delimit, guide, and control patient care.