This paper discusses some of the anthropological andphilosophical features of the use of self-managementplans by patients with a chronic disease, focusing onpatients with asthma. Characteristics of thistechnologically mediated form of self-care arecontrasted with the work of Mauss and Foucault on bodytechniques and techniques of self. The similaritiesand differences between self-management of asthma andFoucault's technologies of self highlight some of theways in which self-management contributes tomodifications in the definitions of patients andphysicians. Patients, in measuring their lungfunction, first come to rely on (...) measurements more thanon felt disturbances, but next, felt disturbancesbecome modified by previous measurements. Physicians,on the other hand, see their role changed from expertto being a participant in a joint treatment. It isargued that the concept of agency is more appropriatefor describing the advantage of self-management forpatients than autonomy. (shrink)

In reference to the different approaches in philosophy(of medicine) of the nature of (medical) technology,this article introduces the topic of this specialissue of Theoretical Medicine and Bioethics, that is,the way the different forms of medical technologyfunction in everyday medical practice. The authorselaborate on the active role technology plays inshaping our views on disease, illness, and the body,whence in shaping our world.

In this article, I am using the example of the introduction of osteosynthesis into surgical routine practice to analyze the use of the notions of art and science in medical innovation. The examination of the renegotiations of power and responsibility associated with the introduction of this new technique shows that proponents and critics actively linked their arguments to more fundamental epistemological and social issues. The proponents claimed to manage the uncertainties of innovation through making surgery more scientific, drawing on the (...) ideals of control, rationality, objectivity, and predictability. The critics mobilized another discursive pattern. They considered surgery an art and emphasized the individuality, contingency, and situatedness of medical practice. I investigate the discursive function of these argumentative patterns and how they played out in the concrete example of this surgical technique. (shrink)

Goal setting is an important professional method and one of the key concepts that structure a practical field such as physical rehabilitation. However, the actual use of goals in rehabilitation practice is much less straightforward than the general acceptance of the method suggests as goals are frequently unattained, modified or contested. In this paper, I will argue that the difficulties of goal setting in day-to-day medical practice can be understood by unravelling the normative assumptions of goal setting, in this case (...) three different tensions that come along with it. First, goals are developed for a future state that may require activities that clash with necessities of the present situation. Second, professionals in clinical rehabilitation centres elaborate goals for an environment that differs in terms of spatial and social characteristics from the environment in the centre, where people train for the accomplishment of goals. Finally, goal setting requires active patient participation and individual control that sometimes appears impossible, unrealistic, and undesirable. I will describe how professionals deal with these tensions in a creative and dynamic way. With my articulation of the assumptions of goal setting, I hope to contribute to the self-reflection of rehabilitation practitioners as well as to theoretical discussions of goal setting in contexts other than rehabilitation. (shrink)

This article explores the reasons women of diverse class, racial ethnic, national, and religious backgrounds give for their decisions not to accept an amniocentesis or, having accepted one, not to pursue an abortion after diagnosis of serious fetal disability. The narratives of refusers reveal conflicts and tensions between the universalizing rationality of biomedical interventions into pregnancy and the wider heterogeneous social frame work to which women respond in their decision-making processes.

This article analyzes how the recent call for accounting in health care interferes with daily care practice and raises the question of how accounting practices relate to the aim of good care. The most influential accounting methods in the Netherlands suggest ways for professionals to legitimize their activities. The analysis of washing patients in long-term mental health care shows that different styles of accounting evaluate and legitimize care while structuring notions of what good care is. A specific style of accounting (...) enforces certain values but does not tell about the tragic or unexpected effects that come with it, nor does it provide a repertoire to deal with these. Thus, care practices incorporating specific styles of accounting remain dependent on forms of care that are not accountable or ask for new forms of reflexivity. (shrink)

In feminist and cultural studies, there is a growing body of work concerned with how people’s lives are subjected to multiple, intersecting axes of differentiation and power. There is growing concern that we seem unable to address more than one difference at a time, thus failing to interrogate enactments of class, race, ethnicity, gender, and sexuality in science, technology, and medicine. This article aims to contribute to the effort to conceptualize the making of and interactions between differences. It explores how (...) differences such as disability, gender, and class are made and unmade in sociotechnical practices. It shows that interactions between enactments of differences are complex, contradictory, unpredictable, and surprising and defy simple conclusions about effects and politics. These patterns of interference need to be investigated in situated practices, and we have to examine carefully how processes of differentiation interact to support and reinforce but also to challenge and undermine each other. (shrink)

In this article, I investigate the process of coordination between three ‘bodies’ of surgery: the patient-ensemble(s) constructed in pre-operative activities; the surgeon-body constructed with these ensembles in the operating room; and the body-world inhabited by the surgeon. This investigation is done through an ethnography of a neurosurgical clinic, with an analytical focus on the relationship between the spatial configuration of the body of the surgeon and the embodied practices of operating that this configuration demands. My argument is that coordination between (...) those three bodies is organized in the layered space into which the multiple ensembles of surgery are assembled. This relationship, I suggest, lies at the core of the power and technical expertise held by surgeons, and constitutes a challenge for explorations of other forms of articulation between subject body-worlds and the embodiment of power in subject-bodies. (shrink)

How to improve clinical practice and, in particular, that of physical therapy? Currently, several strategies are used which all fit the label scientification. These scientific strategies have to make physical therapy''s clinical practice more homogeneous. Sometimes this homogenization is thought to be necessary for other strategies of innovation including effectiveness research. But it has also been suggested that more homogeneity in the clinic is already itself an improvement. In this article we comment on these strategies. More specifically, we direct our (...) attention at attempts in physical therapy to establish a uniform, generally adopted scientific language. We argue that these attempts fail to appreciate the specificity of therapeutic work. The effectiveness research that follows is therefore liable to take irrelevant variables into account. We illustrate this argument with examples taken from analyses of diverging therapies for stroke patients. (shrink)

Book reviewed in this article: Good Days, Bad Days: The Self in Chronic Illness and Time. By Kathy Charmaz.

The article argues against the common notion ofdisciplinary medical traditions, i.e. Obstetrics, asmacro-structures that quite unilinearily structure thepractices associated with the discipline. It shows that the various existences of Obstetrics, their relations with practices and vice versa, the entities these obstetrical practices render present and related, and the ways they are connected to experiences, are more complex than the unilinear model suggests. What allows participants to go from one topos to another – from Obstetrics to practice, from practice to politics, (...) from politics to experience – is not self-evidently induced by Obstetrics, but needs to be studied as a surprising range of passages that connect (or don't). Techniques and devices to supervise the delivery, to render present the fetus during pregnancy, and to monitoring birth, are described in order to show that such techniques acquire different roles in connecting and creating Obstetrics as a system andobstetrical practices. (shrink)

I. Nature as a System of Production and Reproduction 1. Animal Sociology and a Natural Economy of the Body Politic 2. The Past Is the Contested Zone 3. The Biological Enterprise II. Contested Readings: Narrative Natures 4. In the Beginning Was the Word 5. The Contest for Primate Nature 6. Reading Buchi Emecheta III. Differential Politics of Innappropriate/d Others 7. ’Gender’ for a Marxist Dictionary 8. A Cyborg Manifesto 9. Situated Knowledges 10. The Biopolitics of Postmodern Bodies.

The Body Multiple is an extraordinary ethnography of an ordinary disease. Drawing on fieldwork in a Dutch university hospital, Annemarie Mol looks at the day-to-day diagnosis and treatment of atherosclerosis. A patient information leaflet might describe atherosclerosis as the gradual obstruction of the arteries, but in hospital practice this one medical condition appears to be many other things. From one moment, place, apparatus, specialty, or treatment, to the next, a slightly different “atherosclerosis” is being discussed, measured, observed, or stripped away. (...) This multiplicity does not imply fragmentation; instead, the disease is made to cohere through a range of tactics including transporting forms and files, making images, holding case conferences, and conducting doctor-patient conversations. The Body Multiple juxtaposes two distinct texts. Alongside Mol’s analysis of her ethnographic material—interviews with doctors and patients and observations of medical examinations, consultations, and operations—runs a parallel text in which she reflects on the relevant literature. Mol draws on medical anthropology, sociology, feminist theory, philosophy, and science and technology studies to reframe such issues as the disease-illness distinction, subject-object relations, boundaries, difference, situatedness, and ontology. In dialogue with one another, Mol’s two texts meditate on the multiplicity of reality-in-practice. Presenting philosophical reflections on the body and medical practice through vivid storytelling, The Body Multiple will be important to those in medical anthropology, philosophy, and the social study of science, technology, and medicine. (shrink)