POSTMODERNITY
POSTMODERNITY/ISM
• Postmodernity – a historical period; current
economic climate, structural changes
– Implications for medicine & health
• Welfare state (liberalism) to remobilzation of
liberal arguments for individual responsibility
(neoliberalism)
• Reflected in epidemiology
• -ism – a “discourse”
Modern/ity/ism/ization
• Modernity -- historical condition, process, a
characteristic period -- a post-traditional order –
rupture
• Modernism -- a practice, usage, expression peculiar to
modern times
– Modernism as cultural project that renew symbolic
practices with an experimental or critical sense
• Modernization as a socioeconomic process that tries to
construct modernity; the act of modernizing; the state
of being modernized
• reflexivity of modernity
– the susceptibility of most aspects of social activity, and
material relations with nature, to chronic revision in the
light of new info or knowledge
• Implications for health
The promise of the enlightenment, the
promise of the modern
• Unending era of material progress &
prosperity
• Abolition of prejudice & superstition
• Mastery of the forces of nature based on the
expansion of human knowledge
• Laws of development & social sciences
• The costs of becoming modern -- the
discontents
– alienation; estrangement; anomie; iron cage;
neurotoxic effects of modern, urban life
Postmodernism
• Postmodern as incredulity (challenging) toward meta-narratives
• contemporary rejection of all overarching or totalizing modes of
thought that tell universalist stories (Marxism, Christianity,
‘scientific progress’).
• Metanarratives operate through strategies of exclusion and
inclusion, marshalling and homogenizing heterogeneity into
ordered realms
– Postmodernists are suspicious of authoritative definitions and singular
narratives of any trajectory of events
• the increasing sound of a plurality of voices from the margins, with
an insistence on difference, on cultural diversity and on claims of
heterogeneity over homogeneity.
– Fragmentation
– celebrates the multiple, incompatible, heterogeneous, fragmented,
contradictory nature of postmodern society
• No linguistic normality — we can only produce pastiche
(heteroglossia), partial truths
Hasan: The Culture of Postmodernism
Modernism
Purpose
Design
Hierarchy
art object, finished work
creation, totalization
Presence
Centering
genre, boundary
Semantics
lisible (readerly)
Narrative
grande histoire
master code
origin, cause
Determinacy
Transcendence
Postmodernism
play
chance
anarchy
process, performance,
decreation, deconstruction
absence
dispersal
text, intertext
rhetoric
scriptible (writerly)
anti-narrative
petite histoire
idiolect
difference-difference, trace
indeterminacy
immanence
Postmodernity
• Changes in capitlaist society over past 30 years
• Decline of industrial sector, working class,
unionization, & occupation as source of identity
• Weakening of distinction between public &
private sectors
– With associated gender division of labor
• Increased focus on the individual
• Reflexivity of social identity – construct our own
biographies
Liberalism, Neoliberalism, Health in
Capitalist Society
• Liberalism & welfare state capitalism
– Liberalism emphasizes individual rights and equality of opportunity
– Different forms of liberalism may propose very different policies
– Liberalism rejected many foundational assumptions that dominated most
earlier theories of government, such as the Divine Right of Kings, hereditary
status, and established religion
• Liberalism: two major streams of thought which compete over the use
of the term "liberal"
– Classical liberals: only real freedom is freedom from coercion
• state intervention in the economy as a coercive power that restricts the economic
freedom of individuals and favor a laissez-faire economic policy
• oppose the welfare state
– Social liberals: governments must take an active role in promoting the
freedom of citizens
• real freedom can exist only when citizens are healthy, educated, and free from dire
poverty
• Government ensures the right to an education, the right to health care, and the right
to a minimum wage.
Liberalism, Neoliberalism, Health in
Capitalist Society
• Structuralist basis of welfare state capitalism
undermined by decline of industrial sector &
globalization of capitalist investment strategies
• State policy now directed at control over costs
(rather than provisions) & quantity of health care
• Medicine caught between state & market
• From production to consumption as foundation
of class formation in capitalist society
Liberalism, Neoliberalism, Health in
Capitalist Society
• Neoliberalism
– move from a bureaucratic welfare-based society
toward a meritocracy acting in the interests of
business
– based on individual and economic liberty
• Health & health care consequences
– Individual centric
– Achieved health
– Decentralization in the organization/delivery of health
care
• Privatization of costs & services
Postmodern health
• Social/economic/political cultural Inequality
“increasing”
• Resurgence of patterns of infectious disease
• Increasing mortality rates among the poorist
• Dying of diseases of affluence in 20th cent.
now dying from poverty
• Individual risk and “risk society”
From Modern to Post-/Risk Society
epidemiology
• Originally a part of public
health – “people’s health;
the study of/the
knowledge of the
distribution of health in a
population
• Used to plan & evaluate
strategies to prevent
illness
• Guide to the
management of patients
in whom disease has
already developed
Epi- of Risk and Lifestyle
• Contemporary focus on “susceptibility”
– Predisposition & risk
• Inherited flaw
• Aversion by adopting a careful/moderate way of life
• Epi & Risk
– Prevalence of disorders & diseases among different sectors of
the population – differentiated by age, gender, ethnicity, family,
history, weight, diet, use of alcohol/cigarettes/drugs
– Use of risk scales to assess likelihood of an individual developing
a disorder
• The allocations of risk categories
• The dream of contemporary diagnostics of susceptibility
– Identifications – way of life; genetics
Type 2 Diabetes – the quintessential
postmodern condition
• Idea of susceptibility brings potential futures
into the present
• The subject of calculation (biopower)
• The object of remedial intervention
(education; reflexivity)
• Individual must optimize their life chances
• New forms of life taking shape in the age of
susceptibility (risk society)