I have been thinking about things for a while now – by which I mean things, not words or concepts or ideas or language or discourses or conversations….
Nursing theory and research pay far too little attention to things, objects, stuff, materiality – between the so-called paradigms of qualitative and quantitative research there is a duopoly of abstraction, one using numbers and one using words, and both ignoring the physical world.
The divide between nurses who nurse and nurses who do what academics (including me) do is not a theory-practice gap, it is an abstraction-reality gap.
When I first read about carnal hermeneutics, I seized upon it as an acknowledgement, still using the framework of hermeneutics, of our understanding as embodied and tactile. That is still important though not enough.
Rilke, the 20th century German poet, is much loved by hermeneutic philosophers (German philosophers all want to be poets and vice versa, it seems) not least because of the epigraph to Truth and Method from a Rilke poem about needing two players to play throwing and catching.
That poem dates from 1922, towards the end of Rilke’s life. At an earlier stage of his career he wrote what he called a “poetry of things.” There is another poem from this period, also about a ball being thrown, but this time from the ball’s point of view.
…not quite Thing and yet still Thing enough
to have remained, unlooked for and unseen,
beyond us in the organized outside,
…point to the players their new stance,
suddenly from your height ordering them
as though they were a figure of the dance-
The Ball from New Poems Second Part trans Marielle Sutherland, Rilke (2011) p 103.
Here the ball shapes the movements of the players, the ball is thing and not-thing because its movement pulls people into shapes around itself. This image leaves out the meanings and values ascribed to the ball (a father and daughter playing catch, a World Cup Final?), the invisible network of rules and expectations that mediate between players and ball (can they touch it with hands or only feet, do they need a tool like a bat, or are they just trying not to drop it?) and who the players are to each other (team mates, opposing teams, individuals, adult and child?). The poem perfectly captures what Michel Serres calls a “quasi-object” in his book The Parasite (1980/2021). He makes the same point, using the example of a ball, that a quasi-object has people moving in relation to it. There is no deliberative choice about this, but a sensorimotor, in-the-moment responsiveness. He uses the example of rugby, filling in the picture more concretely – if you watch a game of rugby you can see the constantly shifting disposition of players in relation to the ball, how a change in possession from one team to the other immediately alters the direction of movement, and the postures of players as they change from attack to defence, or vice versa, and the ball changes from object of potential victory to threat of defeat.
Sandelowski (2003) wrote an essay about how qualitative research relies too much on the interview and thus on words and ignores objects. She points out how much nursing practice is constitutively about using tools in concrete sites of affordances and limitations of built environments (this is still true of virtual care – there has to be a compatible set of tools at either end of the encounter, and each person in the encounter is still somewhere, taking up space, just not the same space).
In another book, Hominescence (2001/2019), Serres brings attention to how much our human world has changed in a relatively short space of time – he was writing around the turn of the 21st century and looking back on his childhood in rural France in the 1930s. We barely notice material changes within our own lifetime and ignore those outside of it, even by a few years. In healthcare, human expectations about suffering, about pain, disease, and dying have changed in the light of modern medicine. Biomedicine, much maligned in qualitative and “critical” academic circles by people with the privilege of being able to ignore (or pretend to at least, until something goes wrong with their own body) the stubborn empirical fact that modern medicine, unprecedently in human history, works. It fixes things. It cures diseases. It takes away pain. It prolongs life. Every time, perfectly, without error or unwanted effects? Of course not, but when we look at all of those, and other areas for improvement, we are like seagulls following in the wake of a ship for scraps. The ship has to be there to begin with.
If you want to know what we, collectively, think about biomedicine, don’t listen to academics, follow the stuff. Close to where I am writing, a massive new cancer centre has been built, visible for miles around, due to open next year. It is the physical expression of social value and where we want to channel resources. It is the product of a vast desire to be relieved of the suffering and threat to life of cancer, compounded with the belief that it will work. It is biomedicine made concrete. It is a monumental symbol of what matters to its home society, like Stonehenge or Angkor Wat.
Zadie Smith in her novel NW, commenting on a generational difference between two characters (who would be aged around 50 now based on the setting of the novel) and their mothers:
“Nature becomes culture
Many things that had seemed, to their own mothers, self-evident elements of a common-sense world now struck Natalie and Leah as either a surprise or an outrage. Physical pain. The existence of disease. The differences in procreative age between men and women. Age itself. Death.
Their own materiality was the scandal. The fact of flesh.” p. 313
Nurses, in this world of what Richard Kearney calls “excarnation,” are among the groups in society who are still privy, in a tactile, everyday way, to the ongoing scandal of materiality, flesh, and death. This in spite of our best efforts to offload the dirty work on health care aides, or to tell ourselves we are really all about abstractions like “leadership,” or to chatter about values over actions.
“To carry the self forward and illuminate myriad things is delusion. That myriad things come forth and illuminate the self is awakening.”
Dogen, p. 29, from Actualizing the Fundamental Point (Genjokoan),
References
Dogen Zenji. (2010). Treasury of the True Dharma Eye (Shobogenzo), (Ed. & Trans. Tanahashi). Shambhala.
Kearney, R. (2021). Touch. Columbia.
Rilke, R.M. (2011). Rilke: Selected Poems. Oxford.
Sandelowski, M. (2003). Taking things seriously: studying the material culture of nursing. In J. Latimer (Ed.). Advanced qualitative research for nursing, pp. 185-210. Blackwell Science.
Serres, M. (2019). Hominescence (R. Burks, Trans.). Bloomsbury.
Serres, M. (2021). The parasite (R. Burks & L. Schehr, Trans.). PDF retrieved from https://www.academia.edu/45684409/The_Parasite_by_Michel_Serres_translated_by_Randolph_Burks_and_Lawrence_Schehr
Smith, Z. (2012). NW. Penguin.
Nursing and Humanities 