Technology and healthcare
So where does technology fit into the picture? Well, at first sight, it
doesn’t seem to fit at all. After all, I’ve been arguing against the technical
rationality model of nursing practice, and against the technocratic model
of nurse education, in favour of something far more person-centred. I’ve
argued against the technological application of knowledge to practice in
favour of the reflective and reflexive model of knowledge from practice.
However, if we accept the definition of technology as
The practice, description and terminology of any or all of the
applied sciences which have practical value and/or industrial use
(Chambers science and technology dictionary)
then we might be justified in speaking, as Foucault does, of technologies
of the self.
Technologies of the self are the ways in which we transform our selves
through our own actions. In nursing, these might include reflection-onaction, clinical supervision, action research and open learning. These are
all techniques, if you like, by which we can come to understand ourselves
differently and as a result, make improvements to our practice.
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These technologies of the self are based on the assumption, as Schutz
tells us, that:
If I were to change places with my fellow man I would experience
the same sector of the world in substantially the same perspectives
as he does
That might provide an adequate understanding in some circumstances.
After all, we all share a common humanity and some common
experiences. But our patients sometimes occupy some very unfamiliar
psychological, social and emotional spaces of which most nurses will
have had very little first-hand experience. There are certain things that
some of my patients have experienced that I hopefully never will. How,
for example, can I really feel the terror of a psychotic episode or the
despair of a major bereavement solely by reflecting on my own meagre
experiences? As the philosopher Ernest Nagel asks:
Must a psychiatrist be at least partly demented if he is to be
competent for studying the mentally ill?’
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Or, indeed, must a nurse working in a fracture clinic have suffered a
broken limb? Perhaps not, but arguably a nurse needs more than a
cognitive, academic understanding of the experience of distress and
illness. How, it might be reasonably asked, are we to fully engage in
therapeutic relationships with our patients if all we know of their
suffering is what we have read in research journals?
Which brings us back to technology. I would like to introduce you to a
remarkable echnological device that can give us direct insight into the
feelings of others. It is small, portable and has minimal power
consumption. It is cheap; in fact, it can be borrowed free of charge. It can
be used almost anywhere: in the home, in the park, on the bus, even in
the bath. It’s called a novel.
If we wish to engage with patients whose suffering lies outside of our
own experiences, then scientific technology such as the RCT is never
enough. As Noam Chomsky observed:
It is quite possible - overwhelmingly probable, one might guess that we will always learn more about human life and human
personality from novels than from scientific psychology.
(Chomsky 1988, p 159)
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The scientific researcher would obviously object at this point. How, she
might ask, could we possibly learn more from a novel than from science.
Science deals in the truth whereas novels deal in fiction.
Or does it?
Scientists wish us to believe that there is only one kind of truth, and that
is factual truth. The concept of factual truth suggests that we can
objectively and accurately measure the empirical world. So, it is a fact
that the distance from the earth to the sun is 93 million miles. It is a fact
that the colour of my shirt is grey. Philosophers call this the
correspondence theory of truth: a statement is true when it corresponds to
something in the real world.
But can we talk about emotional or psychological states in this way?
What exactly do we mean when we say that it is a fact that Mrs Brown is
anxious about her operation? Does our statement ‘correspond’ with
something in the world called ‘anxiety?
Well, we might mean that she displayed certain recognised symptoms, or
that she scored highly on a psychological measure of anxiety. But that’s
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all it means. We have no way of knowing Mrs Brown’s psychological
state because it is private to Mrs Brown. All we know is what she tells us
about that state either through her words, her actions, or her responses to
our tests. So, it is a fact that Mrs Brown scored high on an anxiety scale,
but the truth of her psychological state is known only to her.
But, the scientist might further object, how do we recognise such internal
psychological truths. The answer, I’m afraid, is that we just know. Just as
external truths are validated by the extent to which they correspond to
some objective external reality, so internal truths are validated by the
extent to which they correspond to our subjective internal reality. The
truth of a novel is recognised by the extent to which it resonates with our
internal state, just as a wine glass resonates when a singer sings a certain
note.
Listen:
Camus – The Outsider, pp9-10
In one sense, this can’t be said to be a factual account of the state of mind
of a bereaved person. It is fiction; there is no correspondence between
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this story and the ‘true’ state of mind of someone in the days following
the death of a loved one.
Fiction, then.
But then again, the story might ‘ring true’ with your own experiences; it
might resonate with your internal state; or rather, it might cause you to
resonate like a wine glass. It might offer you an insight into the ‘truth’ of
how it feels to be bereaved. Or you might resonate at a different
frequency, in which case some other novel might do the trick. Or a
painting. Or a piece of music.
This idea, that fiction can be a source of truth, was recognized, for
example, by Foucault, who did not seek to apologise for the lack of
empirical research in his work, but acknowledged that:
I am well aware that I have never written anything but fictions. I
do not mean to say, however, that truth is therefore absent. It
seems to me that the possibility exists for fiction to function in
truth, for a fictional discourse to induce effects of truth. (Foucault
1980, p 193, my italics)
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External truths are discovered by the method of science and other
empirical approaches. Internal, emotional and psychological truths, such
as the truth about how it feels to suffer a bereavement, are ‘induced’, as
Foucault would have it, through art and fiction.
These different conceptions of truth, as correspondence with the external
and internal world, are brought into sharp relief by Picasso’s observation
that
art is a lie that helps us see the truth (cited in Horgan 1996).
From the perspective of the scientific paradigm, all of art, including
fiction, is a lie, since it is not derived from empirical research, but from
the imagination. But this lie enables us, as Foucault pointed out, to
“induce effects of truth”. The ‘lie’ of fiction (indeed, of all art) is also a
source of truth. This argument is moving inexorably towards the
conclusion, as the philosopher of science John Ziman (1978) put it, that
the challenge to the behavioural [and, we might add, social]
sciences does not come from physics but from the humanities.
He continued:
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In the search for reliable knowledge about, say, the psychology of
sexual relations, do we turn to a book expounding the evidence for
‘exchange’, ‘reward’ and ‘balance’ models of love? Or do we read
again our Anna Karenina, or Madame Bovary, or Pride and
Prejudice, or Proust, or Saul Bellow, or Patrick White? The
novelist, with his sensible ear and discriminating eye, articulates
the universal elements in our emotional lives, and teaches us more
about mankind than any formal theory. (Ziman 1978, p 185)
To learn about mankind... Isn’t that exactly what we as nurses are
looking to do? Of course we need to know about scientific theories of
medicine; of course we need to know about the effectiveness of different
modes of treatment. But as nurses, we need more. We need to understand
our patients and their experiences, we need to know, as far as we are able,
the inner truths as well as the outer truths, and for this, we must turn to
art and to fiction.
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