Neonatal Food and The Politics of Theory - Some Questions of Method

Neonatal Food and the Politics of Theory: Some Questions of Method Author(s): Annemarie Mol and Jessica Mesman
Reviewed work(s): Source: Social Studies of Science, Vol. 26, No. 2, Special Issue on 'The Politics of SSK: Neutrality, Commitment and beyond' (May, 1996), pp. 419-444 Published by: Sage Publications, Ltd. Stable URL: http://www.jstor.org/stable/285425 . Accessed: 17/12/2012 14:53
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The Politics of SSK: New Directions/Places/People/Things
* ABSTRACT
The nurses on an intensive care ward for new-borns feed babies with food and doctors with information. Showing that this is so is one of the ways in which scholars working in humanist traditions of social analysis, such as symbolic interactionism, reveal the politics of hospital relations. However, semiotics, along with similar 'non-humanist' theoretical traditions, is no less political; neither, as is sometimes suggested, does it necessarily side with the strong. Here we demonstrate that semiotics implies another style of political theory - one in which the relevant axes of difference are not primarily between groups of people, but between ways of ordering the world. Thus the differences between two modes of feeding or of calculating the contents of a bottle can be understood as both 'political' and 'technical' matters.
Neonatal Food and the Politics of Theory: Some Questions of Method

Annemarie Mol and Jessica Mesman
In this paper, we address some questions of method. We don't expect to find a warrant for truth. Nor do we need a method to link up with reality in a looser manner. Reality, we feel, is overwhelming enough as it is. No: our aim is different. We want to unravel and understand how the methods we're caught up in, make us observe and write. We want to know what they do to us and to our fields of study. And we especially want to know about their politics. For a long time, discussions of method were all about how to avoid 'taking sides'. It was hoped that by setting rules, villains could be ruled out. But such hopes have proved problematic. We won't repeat that story here.' Instead we set out with the idea that when a retreat into more and more protective measures isn't working, it is better to try and turn the question around. So the
problem we deal with here is not how to avoid politics in theory, but how to do it well. Social Studies of Science (SAGE, London, Thousand Oaks, CA and New Delhi), Vol. 26 (1996), 419-44
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Social Studies of Science
'Normative questions deal with what ought to be done or believed'; this is the opening line of a paper in which Hans Radder pleads for more reflection on such questions in science and technology studies.2 His words sound like a truism, but they hide another - articulated in the very same paper - which is that normative questions don't start after the facts, with what ought to be done or believed. Instead they start right at the beginning, with the business of framing what is the case. For normativity doesn't simply reside in the subject-author but in the subject-matter too. How to investigate it there? In what ways may one's writings relate to the normative order of one's field of study? That is the 'politics of theory' question that we explore here.3 We tackle this question by comparing the politics inherent in two major theoretical traditions, both of which are extensively drawn upon by authors in the social studies of science, technology and medicine. These two traditions have a common enemy: all those versions of realism which assume that words somehow stand for objects or matters of fact. But they take the linguistic turn in different ways. One of these traditions is verstehende sociology. Instead of treating social facts as if they were natural phenomena, sociologists within this tradition try to unravel what reality is like for the people they study. Their motto is: humans may be turned into objects, but they are subjects, too. They speak. They interpret the world they live in, and their own ways of living in it. From all the versions of verstehende sociology which we might explore, here we choose to look at symbolic interactionism.4 The second tradition is that of semiotics. Semiotics originated not in sociology but in linguistics. So its primary object is not humans, not even talking humans, but language. Instead of treating language as a bag of labels each fitting an object, semioticians analyze it as a system of interrelated signs. Instead of treating language as an instrument people use pragmatically, semioticians analyze it as a set of juxtaposing grids each of which has a history and momentum of its own. There are, again, several ways to go from this point. We'll try carefully to articulate our own. This text is a hybrid: it moves between sociology, anthropology and philosophy. Our questions of method are informed by our empirical practice. Therefore we'll present you with some stories set in the neonatology ward of hospital M, a Dutch university hospital. This is a place where tiny babies lie in glass cages, with lots of machinery attached to them. Adults dressed in white move
Politics of SSK: Mol & Mesman: Questions of Method
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around. They read and write, adjust dials, inspect the children's bodies and talk endlessly. However, you'll get to know only a little bit about the ward. Because time and again we interrupt our stories to address big and important questions. So we come to speak about human voices and giving voice; about order, noise and alternative orderings. Thus our empirical stories end up resembling the babies in the ward: there are so many theoretical wires and tubes attached to them that they cannot live without them. 'Nice material', empirically-minded readers are likely to tell us; 'why don't you show us more of it? Why bother with all these theoretical distractions?'. And if philosophers were to read this text, most of them would wonder why we went to so much trouble finding 'illustrations' in the first place. What to do? Defend empirical philosophy in our turn as the only genre worthy of being printed? We prefer to get on with what we set out to do. Talk method. Post-method? If we discuss method here, it isn't objectivity we're after, nor new rules which warrant political correctness rather than empirical soundness.5 We hope, instead, to find out more about handling commitment, compassion. Passion. We want to be/come more articulate about this unbounded, unfinishable project: that of doing politics in theory.
After Epistemology J said: 'Can I ask you some questions of method?'. Whereupon A said: 'Well, sure'. And that is how, long before these lines were written, this article got started. J was planning to do fieldwork in a neonatology ward in order to gather material for her PhD thesis.6 She wanted to write about the co-existence of different perspectives or orderings and there was no doubt that this high density zone of doubt would be a rich site of study. Intermingled facts and values, complicated human relations, interactions between bodies and machines: everything J' s favourite books talked about would be there, co-existing. And so much morality!7 So the question was how to go about studying it. Since A was the nearest person with fieldwork experience in hospitals, J sought A's advice.
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A was reluctant. She had never believed in 'method' as a warrant for whatever it may be taken to be a warrant for.8 Worse: she had loathed the obligatory 'methods-section' of her own PhD thesis, which risked talking about what she took to be interesting findings as if they were preliminary thoughts. In the few years since she had finished her thesis A had tried hard to forget about method. Discussing it somehow always seemed mainly restrictive. She would gladly have underscored Steve Woolgar's words (if they'd been written at the time): 'Those attracted by the intellectual challenge will note with regret that their potential allies' obsession with method bespeaks a poverty of imagination and excitement'.9 But then: as a PhD student J had every right to ask for advice. 'Of course it all depends on what you want to know, on what your aims are', was the first passe-part-tout she got for an answer. J, who had been immersed in various constructivisms from the very beginning of her academic training, thought that this was pretty obvious.10 'Sure, but which methods help me to "know" what? And which "aims" can I hope to achieve by which "means"?'. One could hear the quotation marks as J spoke. But we soon realized that there were problems here; a lot of problems. In the first instance, problems of method are practical. To do fieldwork is to do something. So you get up early in the morning and ride your bicycle to the hospital. Attend this meeting or the other. Drink coffee with the nurses - who take drinking coffee as their break, but for the observer all the chatting is hard work. So you walk around the ward. Ask the parents of the baby who came in yesterday if they'd mind talking with you. Go and find a place to talk. Face their fear. Listen. But make it clear that you're not a doctor and you don't know if their child is going to be all right. You sit behind a desk for a while, making notes. You stand up to go and see what is happening at the other side of the ward, where a machine has suddenly started to bleep alarmingly. Instead of simply switching off the alarms and doing nothing as they often do, several nurses and doctors gather around the incubator. What are they up to? J had read that she should follow the actor. But after following the medium care neonatologist around for a day, J came home exhausted because the man walked so fast. And what about the pieces of paper that travel from the ward to the dispensary? J couldn't enter the hospital's postal system with them, for its plastic tubes were big enough for forms, but far too small for human
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bodies. Yes, these problems were soluble. The secretary advised J to carry the forms to the dispensary herself - which would serve the extra function of proving that she was trustworthy as well as making sure she was at the scene of the action right from the beginning. And A advised J to take a day off as soon as she was tired. 'That's the one rule of method I'm sure about', A said, 'an extra weekday off during periods of fieldwork'. ('Do you practise that yourself?' J asked with a tone of wonder in her voice.) Taking free time was difficult. Even when she came to the ward for eight hours a day, five days a week, J felt like a failure.11 Observe here. Put the video camera elsewhere and have it observe for you. Did those parents leave? Hmm, it would have been nice to interview them. And gosh: the child whose case seemed to offer a good example of the complexities of 'withdrawing treatment', died during the night. How did he go? 'Quietly', the nurses say. Just that: 'Quietly'. The emotions they had at the time are lost to the observer.12 So the practicalities aren't easy to deal with. But then a second set of problems start to surface. What are these practicalities linked up with? Why do they occur? Do they yield anything good in the first place? What is all this fieldwork for? Talking about that, we wondered how J could avoid using the neonatology ward as the mere decor for yet another story about construction. Sure, it could be done. The construction of breath, blood sugar levels, the ideal parent, hope or despair, could all be traced. It was possible, but why would one do so? By now, supervisors in science studies have been telling their PhD students to write up their cases in this way for decades, as if it were the students' task to stabilize the constructivist programme by adding to its mass. Go and unravel the construction of an object. Any object! It doesn't matter what. The laws of gravity, a nuclear power plant or the HIV virus - anything will do. Just show that the thing doesn't exist by itself, but depends on something else. Which is true. But why repeat it? The only reason for doing so seems to be to undermine epistemology. Again. And again. And yet again. And once you've shown your object doesn't rest on sure foundations you can sit back and relax.13 Some of the people who supervise theses even argue that it's enough to undermine epistemology, that this is what needs to be done. They don't care about the content of their subjects' work. Let them go ahead with whatever they're doing: it's just that they
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should do so with less pretensions. 'The discovery that the foundations of physics are not as secure as was once believed makes no difference to what it means to be a good physicist though it does mean that physics cannot claim authority over competing knowledge claims in virtue of epistemology', write Collins and Yearley with self-assurance.14 We think they've got it wrong. Let's face it: taking away foundations makes a difference. Once legitimations are no longer called upon, something has changed. Once the local god is no longer in its shrine, receiving offerings of candles and coca cola, it may still be wrong to go about committing murder, but this has to be asserted in another way; and it isn't easy to see how. Therefore a lot of people cling to some variety of epistemology, even after its death.15 We prefer to try and address the good in another way. Instead of reinventing epistemology or being proudly anti-epistemological, we think it is about time to leave foundational questions behind. And to confront, instead, the content of whatever it is one studies: the work of people, texts, technologies, theories. This implies that in one's writing one does try to make a difference to what it means to be a good physicist (a good nurse, a good intravenous line). Not by throwing around judgements or by spelling out how everybody and everything should behave. Addressing the good may also be practised through attending to the normative ordering of one's field of study. How?
Nurses' Food A tradition that has some credentials when it comes to being explicit about its own politics, is that of symbolic interactionism. It sets out to protect people from the dangers of being dehumanized. That is its politics, its normative stance. Those parts of social science that try to mimic the natural sciences are treated as the enemy. They are wrong because they study people as if they were 'mere objects'. They forget that human beings have a language with which they interpret the world around them. For humanist social scientists, language is important. Its mastery is what distinguishes humans from non-humans. Thus language is at the core of the methodological appeal always to listen to what people say, instead of getting stuck in just watching what they're doing.
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The politically outspoken symbolic interactionists radicalize this approach. They listen, but not just to anyone. They listen for silenced voices. That is, they pay special attention to those people whose interpretations and activities tend to get erased from public awareness. In the words of Leigh Star: 'To do a sociology of the invisible means to take on the erasing process as the central human behaviour of concern, and then to track that comparatively across domains. This is, in the end, a profoundly political process, since so many modem forms of social control rely on the erasure or silencing of various workers, on deleting their work from representations of the work.'16 In the neonatology ward, this seemed like a good method. It seemed helpful to treat the ward as a site where people belonging to different worlds and talking in different languages gathered.17 It would, for instance, make it possible for J to study the relations between doctors and nurses while neither moralistically blaming the doctors for their power, nor assuming medical authority to be inevitable. Symbolic interactionism seemed to offer the possibility of clearly exposing professional hierarchies and the way they are ingrained in daily practice. Thus here was a method with which we could investigate the normative order of the ward.18 So for a while J became the unfailing shadow of nurse N.19 The day-shift nurses start at seven. Before leaving, the nurses of the night shift tell about the night: whether the children they took care of were quiet or restless, and whether their food and medicine made it to their bloodstream. All the nurses on the day shift have to pay attention, because responsibility for the children is only divided between them at the end of the meeting. 'Thus', says N, 'if one of us is out for coffee, the others know enough to replace her'. (The nurses in hospital M do not take care of the same child every day. As N explains during a lunch break: 'You'd get too attached to them that way. That isn't wise'.) It is almost seven-thirty when N fetches water in a wash basin, puts it on a cart beside an incubator and starts to wash Sarah, 33 weeks from conception, born five days ago. The field notes provide many more pages of detailed description of N's working day. But where does this go? On and on, a lot longer than your patience, and most other readers', is likely to last. Maybe, we thought, it is better to focus. The frictions, hierarchies and interweavings between various ways of living reality are easier to see if a specific part of that reality is outlined.
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'You might try blood', A suggested - as blood is her own favourite object of study, and this seemed a nice way of learning more about it. But J thought that 'blood' would yield doctorcentred stories. She had a better idea. Food. Doctors decide how a new-born should be fed. For this decision they need data: the child's weight, blood levels of all kinds, the nurse's report on what happened yesterday. Nurses feed the children. When they do so, they are taken to be replacing the parents, which isn't the case when they do other things, like adjusting the sensors of a monitor. For intravenous feeding, the nurse must wash her hands, link the perfusor to a line attached to one of the baby's blood vessels and set the pump going. In the case of gavage (stomach-tube) feeding, the food has to be heated, taken into a syringe, and slowly injected into the gavage. Sometimes the child regurgitates her food and then its small body and its bed have to be cleaned. Bottle feeding requires a nurse to heat the bottle, pull up a chair, take the child out of its incubator, persuade it to suck, and wait for it to belch. And every individual act of feeding is only over once the appropriate forms have been filled in. Nurses have to adjust their other activities to the task of feeding. In the case of intravenous feeding this is easy so long as the lines remain open, for the foodbag is changed only once a day. But gavage feeding and bottle feeding have to be done every few hours. Nurses have to watch the clock as well as watching the child. Nurses feed babies with food. And they feed doctors with information. Nurse N tells how important her observations are to the doctor. 'I see how this baby eats. So I report this back. Well, usually if we have a suggestion, then, . .. like if we think the child is still hungry after a bottle, they reckon with that, the doctors, they do'. The doctor depends on the observations of the nurse and takes them into account. But the doctor decides all alone, or in consultation with other doctors. If N's arms hurt because she has had to hold a bag containing food high above the baby's head for a long time with lots of other things waiting to be done, she may say so. 'So I suggested that we attach the gavage to a pump but the doctors didn't want that. I don't think it would make any difference to the child. But they don't want a drip system. So they don't want a pump. And there I stand, my arm trembling. The doctors only think about the child, not about my work.'
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The doctors subordinate the work of the nurses to their own decisions in the name of the child. Doctors literally prescribe the food, and thus have a large say in the nurses' feeding activities. That the nurses do the actual feeding, meanwhile, is easily forgotten. In the files where everything that is happening to a child is noted, the 'food intake' is mentioned. Together with other elements of the 'total intake', it is balanced against the 'total output'. All numbers are noted down. But who it was who did the feeding only becomes relevant if something went wrong. Neonatologists who give a case report to their colleagues will look at a file and say: 'We gave the child seven bottle feeds a day of 50 millilitres each'. But 'we' never did this: the doctors decided it should be done and the nurses warmed the appropriate fluids, put them in a bottle, took the baby out of its incubator, woke it up whenever it fell asleep again, waited for it to belch, and put it back to bed again. Using symbolic interactionism as a source of inspiration, we can show the subordination of nurses' activities to doctors' decisions. And we can show the way the nurses' work is hidden. So this is the politics inherent in symbolic interaction. It makes the silenced (nurse) audible and brings the processes that lead to (her) subordination into view. No one is blamed, no one is praised, no rules are laid out. It is through its articulation of the hierarchies of the ward that symbolic interactionism intervenes in them.
Food Itself But what about the child, who sleeps, or cries, or tries with more or less enthusiasm, to engage in the art of sucking? It isn't easy to get at the child's perspective. New born babies don't talk. We cannot ask them what they feel and smell and see. With some imagination, however, we might get a sense of how they experience the world. Nurses and doctors do so all the time. 'He's unhappy', they say when they look at a child gasping for breath. Or: 'Gosh, she's really fighting for her life, isn't she?'. Expanding upon this skill, we could talk about the huge effort it takes to suck one's own food and about the satisfaction that follows from it. We could address the horrors of being woken up time and again in order to eat. We could mention the pain caused by the needle
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which is used to fill one's veins with more and more fluids. Now we've spoken for the nurses it would make perfect sense to try and listen to the babies as well. Yet, instead of doing so, we'll pose a different question. This is the question: What about the gavages, the pumps, the incubators, the food? For if we keep giving voice to silenced people while treating 'things' simply as objects manipulated by humans, before long Bruno Latour will point his finger at us and ask severely: 'Are you aware of your discriminatory biases? You are discriminating between the human and the inhuman'.20 So what are we doing? Are we simply pushing the line of discrimination 'downwards' a little, from doctor to nurse, from nurse to child, only to stop short at the boundaries of the human species? Are we wrongly being asymmetrical? There is a huge complication here. As we noted, the verstehende tradition thrives by trying to liberate itself from the natural sciences. So it is asymmetrical, but takes this to be a virtue. How else to liberate humans from a fate as 'mere things'? Against this historical background the additional appeal to liberate 'things' seems like a sick joke. In lots of places in sociology, it looks like little more than a way of subscribing to the exploitation of people who have to sell their labour as a commodity on the market. In science studies, it looks like a way of putting natural scientists back in power. We quote: 'Because the special power and authority of natural scientists comes from their privileged access to an independent realm, putting humans at the centre removes the special authority.'21 Meanwhile, however, the method which our accuser Latour wants us to use to focus on 'things' and make sure that they are not deleted, doesn't come from the natural sciences at all. Semiotics comes, instead, from the other end of the intellectual spectrum: from linguistics. That doesn't seem like something fearful. Why should one be afraid of the power and authority of a science of signs? Should one? Since we're still looking for the politics inherent in theories, and since semiotics promises to be very different from symbolic interactionism, we will take it along to the neonatology ward and see what happens. Is semiotics a way to empower 'the enemy' or does it lead to a form of emancipation larger than life? Semiotics started out as a way to analyze language. Instead of
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taking words to be labels designating objects on a one-to-one basis, semiotics treats language as a system of related signs. The value of any one sign depends on that of the others to which it relates.22 From this starting point there have been many analyses of texts. A semiotic analysis doesn't work on the assumption that the words of a text become clear the moment one leaves the text for the world. What words mean can be found out by analyzing what they make each other mean. It can be found out by digging out their mutual relations. In the light of such disdain for what happens outside texts, it may come as a surprise that semiotics might be used as a method for doing fieldwork in a ward. But, to begin with, wards produce texts. There are many studies in which researchers listen to and record talk for later analysis of the resultant texts. It is also possible to go beyond words by extending the semiotic method from language to other sign systems. A big desk may mean that a big person sits behind it. And a lot of bleeping machines signal the drive to control.23 And then semiotics may also go so far as to forget about signs and signification, and only retain the stress on interdependence. Madeleine Akrich and Bruno Latour put it thus: 'Semiotics is the study of order building or path building and may be applied to settings, machines, bodies and programminglanguages as well as texts'.24 This version of semiotics is not about meaning: it makes one try to find out instead what elements, of whichever character, associated in whichever way, make each other be. We started to use it. J went to the ward again and tracked down all kinds of interdependencies. Do you see that machine, over there, that records the electrocardiogram? It marks the heart beat by detecting the rhythmically changing field of potential, just as electrocardiograms do in any intensive care ward. Its graphs are made by the baby's beating heart, and in turn they make her heartbeat. And look: there's a big baby - though he's only big because the others are so very tiny. But wait a minute. It would be nice if our semiotic materials were more focused and easily compared with our symbolic interactionist findings. So J set out once again to follow food. But what is 'food'? When words aren't labels designating single objects, this becomes a difficult question: not of meaning, but of being; and indeed, an empirical question. When J posed it in an
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empirical way, she found not one, but many answers. When, in the morning, the intern has finished her calculations, food is a series of numbers. These are put into the computer where they change from the outcome of a calculation - in the ward - into an instruction to act - in the dispensary. In the sterile space of the dispensary, small bottles are filled, fluid by fluid, not child by child. Food is fluid. One assistant concentrates on bottles with lipid solutions, the other on those containing glucose. So here food is either a lipid or a glucose solution. At a quarter-to-five a nurse comes to take all the bags and bottles on a trolley from the dispensary to the ward. A weight, that's what food is. To become Matthew's dripping infusion once the food supplies of all babies on intravascular feeding schemes are attached. The single word 'food' takes the semiotician from one object to another. And the transitions aren't necessarily smooth. Let's taken an example. First 'food' is a number written down by an intern as the outcome of calculation. Then, in the dispensary the number changes into an instruction to mix nutrients in proper quantities. From being a part of a calculation the number turns into a part of a manipulation. The two activities relate to numbers differently. This doesn't necessarily lead to friction. It is easier to count '10 ml' than '9.734 ml', and manipulating 10 ml is easier than manipulating 9.734 ml. But sometimes it does. Often it is easier to do arithmetic with a 30% solution than one of 33.33%. While in the dispensary, diluting a fluid to one-third of its original concentration is easier than making a 30% solution. While numerical measurements are needed to get 30%, diluting by a third only requires adding double the amount of the solvent to the original fluid, and any container can be used. This is what our semiotic analysis brings to light: that using one set of numbers as opposed to another isn't 'innocent'. It facilitates either the calculation, or the manipulation, of food. Or it represents some compromise between the exigencies of both practices.25 J wanted more examples. Instead of starting her investigation from a word again, she sat down and observed the sticky fluid in the bottle hanging above Matthew's incubator. What is it? There isn't one word for it. There are many. The bottle contains food for the baby. It contains the infusion dripping into a vein. And a sugar suspension. Or part of the 120 calories for every kilo a day. And then again the bottle's content is a fluid with a particular
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composition. Every 120 ml of it is composed of: 45 ml Aminovernos Paed 6; 40 ml glucose 20%: 4 ml PED-EL; 0.6 ml KCl 7.45%: 1.17 NaCI 10%; 10.3 ml Ca gluconaat 10% and micronutrients. But it is also nutrition. It is classified as intake. And it is definitely everything that this small patient is going to get for the next 24 hours. So there are many words for the content of a single bottle.26 They relate to different concerns and their value doesn't need to stay the same. The implication that the fluid is a 'sugar suspension' is that a medicine which is soluble in fat needs to be attached to another line. The practice in which the fluid is 'intake' requires a balance with the 'loss'. Or take this divergence that comes back time and again in discussions about medical practice: as 'food for the baby', the dripping infusion is a meagre substitute for the warmth of a breast flowing with milk. Where food is valued as an element of the relation between people, a gift, a reflection of care and love, infusions are horrendous. While in terms of nutrition there's nothing wrong with them: it is food enough to live on, of good value so long as it comes in appropriate amounts. In a neonatology ward, the frictions between such different orderings of food and their concomitant normativities can be observed. For they are lived in the relief of the parents that their child is fed - and in their disappointment that this is done through an intravenous line instead of by mouth. And they also surface in the discussions of the morning round. 'What are we doing with Matthew? Do we keep him on a line for a few more days?', a resident asks. 'Hmm, we might try a bottle, it would be nice for him to suck', says the attendant. 'Yes, it would be nice, and he has to get used to it at some point', says a nurse, 'but I think Matthew isn't getting enough sleep as it is, with all these investigations he's submitted to all the time. If we were to start with bottles, that would mean much less sleep. He's not going to thrive on that'. This discussion is concerned with the work to be done by doctors and nurses and the emotions of the parents. But it is also about what will happen with the body and soul of the patient. Semiotics is a method that helps to show that a discussion about food is also a discussion about the way Matthew's life is ordered. Which logic will inform it: that of food supply, the need for love and cuddling, or that of want of sleep? And the next question to dig out is the nature of the compromise between them.27
432 Two Political Styles
J and A sat down to talk about this paper with a draft of it on the table between them. There: at last both methods were out in the open. Our version of the difference between them would help J to improve her next round of fieldwork.28 'For some reason', J said, 'if we hadn't unravelled it like this, I might have sympathized too much with people and their perspectives. It must be that, like a good nurse, I've had a lot of training in human relations. Semiotics is more for doctors. They are in the habit of linking signs that are visible on the surface of a body with the diseases that are hidden inside it'. J suspected that A's love for semiotics was her way of playing at medicine without being a doctor.29 We might have developed this. Our conclusion could have shown that the theoretical variants analyzed so far do not stand in a comfortable meta-position in relation to neonatology. They are inside it, too. They circulate from one place to another, from a field to its self-reflections. We might also have gone into an analysis of how individuals get involved with methods in the course of their personal theoretical histories. But here and now, we're after something different. We want to understand more about being passionate in theory. Committed. We want to unravel which - one politics one performs when one uses - or gets caught up in theory rather than another.30 What do methods make of the normative order of a field of study? Symbolic interactionism asks one to follow different people and see and hear the world through their eyes and ears - even if one is not supposed to go native, and is allowed to remember that one has senses of one's own, too. Without being a nurse, J can, if she follows N, write stories about N's work. If J were a nurse herself, she wouldn't have time to write stories. And she wouldn't, moreover, be able to juxtapose N's perspective with that of doctors, parents or babies. Symbolic interactionism opens up a space in which the worlds of all these groups are made audible the voices of those who are usually able to make themselves heard, as well as those who are usually silenced or forgotten. As Howard Becker put it: 'The question is not whether we should take sides, since we inevitably will, but rather whose side we are on'.31 Symbolic interactionists try to be on the side of the weak. Does semiotics, as it is sometimes alleged, attend not to the silenced, but to heroes who network so cleverly and scream so
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loudly that all the action is attributed to them?32 Does it take sides with the strong? But no: this cannot be right. Semiotics is not about people, whether winners or losers. It is about signs, or other entities, co-constituting each other and together forming a discourse, a network, a logic or another 'Order of Things'. What is left out of such an order is not people who are forced to be silent, but signs which are not incorporated as information. Noise. Noise is constantly differentiated from order.33 Semiotics shows the effort that this takes. It makes the fragility of the established order visible, and shows that it is constantly in the process of being established. In classical semiotic studies, individual orders were studied as if they were wholes: the Text, Medicine, Reason. Whatever does not form a part of these orders was depicted as their noise: the unarticulated, lay traditions, madness. However, semiotics also allows one to assume that everything which is noise in relation to one order, is information in another. It's not chaos, but another kind of tune. Then a different question comes to the fore: how is it that different orders (discourses, networks, modes of ordering, logics) co-exist?.34 As opposed to food there are non-foods, ranging from infections to sleep. As opposed to foodstuffs, there is care. As opposed to calculations, there are manipulations. All these oppositions beg the question of the nature of the relation between the two sides that have been differentiated- the relation between one order and another. So Latour's liberal rhetoric is potentially misleading.35 By pressing the importance of talking about non-humans with the very words that symbolic interactionism uses to propel its humanism - unjustified discrimination and giving voice - Latour creates a continuity between the politics of semiotics and that of symbolic interactionism.36 They are both about liberation, the only difference is that semiotics encompasses a wider domain. But no! The originality and the radical potential of semiotics as a political method isn't like this. Rather, the study of the co-existence of different orders shows how normativities clash and support one another in a given field. Order doesn't oppose chaos, there are many orders. 'On fait toujours la meme erreur. On croit qu'il y a du barbare et du civilise, du construit et du dissolu, de l'ordonn6 et du d6sordon6.' Hey, wait a minute, where did we read this outcry that implies that, in fact, there are multiple orders? Yes: it comes straight out of Latour's own Irreductions.37 So he knew all along!
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Social Studies of Sclence
Semiotics tells that life (or non-life) could have been different for all humans, animals, objects: in short, the entities that populate the world. There is a historical, diachronic, version which says that what seems like noise now could, if things had happened slightly differently, have been incorporated into 'the Order': another order. Once upon a time, when this or that piece of science was still in action, the current version rather than some alternative managed to get established, for contingent reasons that might be examined. But there is also a topographical, synchronic, version which says that at any given time there is more than a single order. Rather, different orderings co-exist. So 'our' version of semiotics, committed to present-day multiplicity, has another element in common with symbolic interactionism: not that of giving voice, but rather that of the co-existence of different 'worlds'.38 But whereas in symbolic interactionism worlds are created by people who attribute meaning, in semiotics they are complex orderings of bodies, food, machines and numbers.39 The difference between symbolic interactionism and semiotics, then, is not that one is politically sensitive whereas the other is not. Or that one sides with the weak and the other with the strong. Rather, it is that their political styles are different. Symbolic interactionism sets out by thinking about the way in which different groups of people make sense of the world. In line with this, its politics has to do with the relations between different groups of people: between those who speak up and those who are silenced. Semiotics starts from the way entities co-construct each other. It tracks the way orderings are generated. In line with this, its politics is one which explores and exposes the orderings we currently live. Its archaeological versions dig out alternatives that have been forgotten. And those versions that are committed to multiplicity, unravel the relations, the frictions and the resonances between modes of ordering that co-exist in the present. This doesn't mean that symbolic interactionism is about people and semiotics about 'things'. Nurse N's stories told above contain many 'things'. Nurse N is certainly not indifferent about whether she has to hold up a gavage herself, or can make use of a pump. And she has lots of other stories about the way in which some things are convenient, while others are designed with no thought for the way in which she works.40 Again, semiotic stories are not simply about the orderings of bodies, food, machines and numbers. They also tell about the humans who write down the
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numbers or put the food into containers. If sleep is lost because of physical examinations, then the doctor's needs are met by overruling the immediate desires of the baby. So the symbolic interactionist method doesn't prevent one from learning about the way in which humans live with things. And semiotics allows one to learn about the ordering of the lives of doctors, dispensary assistants, nurses and babies in incubators. But there is a difference. For symbolic interactionism, language separates humans from 'things'. Humans are the active pole: they use language to attribute meaning to things. By contrast, in semiotics there is no hierarchy between humans and other entities, mediated by language. Instead, when language is extended from words to something larger (whether this be a discourse, a network, a mode of ordering or a logic), this extension absorbs things within the linguistic order. And when this process is extended, a point is reached where the order is no longer linguistic, but a medium of interdependent entities in which humans, too, are dissolved. They become part of such a medium when they learn to talk and to manipulate tubes, bags and sticky fluids. Making a Difference Two theories, two methods, two political styles. No, we aren't going to decide between them.41 But we do want to say something more about the way in which they relate. For in the framing of this text, we haven't handled the way they relate in a neutral way. Each time symbolic interactionism came first. We never criticized it, but we did use it as the contrast, the background for our account of semiotics. Even at the point where we explained to semioticians why humanist sociologists might consider it offensive to level humans and things, we wrote as if to explain to humanists how the 'misunderstanding' might ever have come about. In short: this text isn't a passive description of facts about theories, it is an active move in a theoretical discussion. So the history of this text doesn't begin with J and A talking method, but a lot earlier: with the clashes between theoretical humanism and its others. Perhaps especially when these discussions take place in English, it seems that humanism has the better credentials. Since symbolic interactionism is about the liberation of one group of people from (the complicated and subtle)
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domination by another, it fits in neatly with traditional humanist images of politics. For semiotics it is different. It is a lot further away from the common sense of traditional political theory. The politics of semiotics - or maybe it's better to say by now: the politics we try to articulate here - is unconventional. Its location, its substance, and the way it relates to differences are all fairly recent inventions.42 This politics doesn't reinforce or undermine the great divides between groups of people that seem to have been politicized for ever. Instead it generates new axes of difference. It creates new political categories.43 And these do not meet in some centre from which the world is ruled. For there is, in this politics, no unique parliament where one needs to be represented; no single place for speaking up or being heard. Instead of being concentrated in a privileged location, this politics is everywhere. It is in the king's palace, but also in the neonatology ward. It is in the prescriptions of the doctor, but also in the rate at which a fluid drips through a line. Thus neither is there any favourite political substance. For as well as 'the subject' and 'the citizen', the substance of this politics includes such entities as the body, food, or the temperature of an incubator. As well as groups of people, it includes the shape of a building, the rhythm of the day, or systems of calculation. Politics, then, is not an activity that can be separated from others. For while using '0.3' or 'one-third' is a political matter, it also remains an arithmetical question. And while 'sleep' and 'hunger' are elements of different modes of ordering the world, this doesn't mean that they stop being infant desires, or professional assignments. Thus this politics may well be about medicine (or any other field of study) but it is inside it, too. Every tension, every difference, is thus simultaneously caught up in a range of evaluative logics. Which means that there is never a single metric or system for weighing different things and comparing them with one another: rather, there are many. So someone who comes from another political tradition, hoping to measure the value of one mode of ordering against another, will be disappointed. There are no zero-sum games that lead to conclusions here: instead there is complexity. Which need not prevent one from acting. After all, we wrote this text, didn't we? It is clear and distinct about lots of different things. It just doesn't sum together at the end. There is no final word. The move is made, but the movement isn't over. This text
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does something: it favours semiotics, as if it were a silenced voice that deserves to be listened to. But it does not argue for semiotics and against symbolic interactionism, as if we needed to make a choice. This is not because we are indifferent, but because we do not hold the difference between symbolic interactionism and semiotics to be a conflict that needs to be, or can be, resolved. Neither deserves to win when it is measured against a neutral standard - for there is no such standard. And equally, there is no firm ground for a compromise. So a fusion between the two will never be smooth. There are many hybrids around. Fine! But remember: they all show the traces of irreducible difference. Look at this text. At one point we write about 'symbolic interactionists' and 'semioticians' as if we were comparing people who interpret the world in different ways. At another point this text is about 'symbolic interactionism' and 'semiotics' as if these were two modes of ordering that exist as theoretical repertoires. We write/the text is. That's hybrid. In the very words of this article both sociologies appear. Irreducible. 'It's a bit dense, here and there. And there's plenty more to say, as always. But I think this is as far as we can get now. Any more suggestions?' J: 'Listen maybe we should do something with these little stories about us that we inserted. Why are they there, anyway?' A: 'Don't you like them any more? In the previous version you did'. J: 'Oh no, I mean yes, fine, they're all right. I've got quite attached to them by now. But I mean, are they symbolic interactionist, or semiotic?' A: 'Hmm. Good question. [Pause] Now that I think about it, I think they are both'. J: 'A compromise?' A: 'No. They are both. Another hybrid, one in which something is either the duck or the rabbit. But not both at once. A symbolic interactionist might say that they show that this text is the product of two human beings collaborating, you and me. These stories are a way of exposing ourselves, of being honest, of not pretending that we didn't sweat. On the other hand, a semiotician might take them to be a rhetorical device. Something to liven up the text a little. A A:
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Social Studies of Science trick used to glue the pieces together and to engage in an implicit discussion about some of the problems of supervising and co-authoring. Like who did the fieldwork and who chewed on the theory. Or who asks the clever questions and who pretends to answer them. Do you see what I mean?' 'Let's write down that, yes, of course I do. But we can't know about the reader'.
J:
* NOTES
We want to thank first and foremost the neonatology staff, parents and patients who so generously allowed Jessica Mesman to witness life on the intensive care ward. We also thank The Netherlands Organization for Scientific Research, whose grant gives Annemarie Mol the time to write. And for their criticism and encouragement our thanks go to Malcolm Ashmore, Marc Berg, Wiebe Bijker, Nicolas Dodier, Ruud Hendriks, Stefan Hirschauer, Marianne de Laet, Mike Lynch, Gerard de Vries, Rein de Wilde and Dick Willems. Finally we would like to thank John Law who worked on the English in this article several times and each time made suggestions about how its argument might be improved, too. 1. But see Robert Lifton, The Nazi Doctors: Medical Killing and the Psychology of Genocide (New York: Basic Books, 1986). 2. Hans Radder, 'Normative Reflexions on Constructivist Approaches to Science and Technology', Social Studies of Science, Vol. 22, No. 1 (February 1992), 141-73. 3. We do not claim that this is the only or best way to be political in theory, but it surely warrants being explored. For a defence of the investigation of the normativity residing in one's field of study as opposed to 'being critical', see Luc Boltanski, L'Amour et la Justice comme Competences (Paris: Metaile, 1990). 4. As categorizations go, it is both right and wrong to present symbolic interactionism as a subspecies of verstehende sociology. We know that they have different historical backgrounds - the former in American pragmatism, and the latter in the German discussions about explanation versus understanding. Yet in the contrast with semiotics that we set up in this paper, it is useful to group all 'humanist' approaches together. But since we cannot deal with all of them at once, and do justice to all the varieties, we have picked out symbolic interactionism. One of our reasons for doing so is that our work is also part of medical sociology, a domain where this tradition is particularly strong. 5. The question of the politics of theory has been extensively dealt with in feminism, one of our backgrounds and sources of inspiration. We don't take up an analysis of the various feminisms in science and technology studies here, but we think it would be possible to make a more or less similar division between a verstehende and a semiotic tradition there, too. This division might well run right through some of the best studies, such as: Ludmilla Jordanova, Sexual Visions:
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Images of Gender in Science and Medicine between the Eighteenth and Twentieth Centuries (New York: Harvester Wheatsheaf, 1989); Londa Schiebinger, The Mind Has No Sex? Women in the Origins of Modern Science (Cambridge, MA: Harvard University Press, 1989); and Donna Haraway, Primate Visions: Gender, Race and Nature in the World of Modern Science (New York: Routledge, 1989). 6. A neonate is a new-born child. Neonatology is the subspecialism in paediatrics which takes care of new-born babies with medical problems. In severe cases, newborn babies with medical problems are kept in the hospital. In very severe cases they stay in incubators in 'neonatal intensive care'. That's where J did most of her observations (but she also went to see what happened in the low- and medium-care parts of the ward). J first observed for several months in a Dutch hospital, and later in one on the east coast of the United States. 7. Among J's favourite books there were several based on fieldwork in hospitals, such as the famous study of the regulation of norms among surgeons: Charles Bosk, Forgive and Remember: Managing Medical Failure (Chicago, IL: The University of Chicago Press, 1979); and of course that other book situated in a neonatology ward, investigating the local meaning of 'ethics': Fred Frohock, Special Care: Medical Decisions at the Beginning of Life (Chicago, IL: The University of Chicago Press, 1986). Though these two are clearly part of the verstehende tradition, recent anthropological studies often show a theoretical mixture: see some of the studies in Margaret Lock and Deborah Gordon (eds), Biomedicine Examined (Dordrecht: Kluwer, 1988); and in Shirley Lindenbaum and Margaret Lock (eds), Knowledge, Power and Practice (Berkeley, CA: University of California Press, 1993). 8. For the undermining of the hope that methods or any other form of epistemology could function as a shield against sexism and racism, see Annemarie Mol, 'Wombs, Pigmentation and Pyramids: Should Feminists and Anti-Racists Show Biology Its Proper Place?', in Alkeline van Lenning and Joke Hermes (eds), Sharing the Difference (London: Routledge, 1991), 149-63. 9. Steve Woolgar, 'Some Remarks about Positionism: A Reply to Collins and Yearley', in Andrew Pickering (ed.), Science as Practice and Culture (Chicago, IL: The University of Chicago Press, 1992), 327-42, quote at 339. 10. Traditional epistemology isn't appreciated as a 'received view' by (former) students of constructivist teachers. They get the impression that the books and articles they are encouraged to read, written by such authors as Latour, Haraway, Mulkay, Bijker, Knorr-Cetina, Cowan, name them, present them with wellestablished views. And so they do. 11. Others have also reported on the dreadful feeling that may haunt a fieldworker, that she is never where the action is. See, for a particularly vivid example, John Law, Organizing Modernity (Oxford: Blackwell, 1994). And, for another ethnography in which the work of doing fieldwork is reflected upon in an intriguing way, see Dorinne Kondo, Crafting Selves: Power, Gender and Discourses of Identity in a Japanese Workplace (Chicago, IL: The University of Chicago Press, 1990). 12. For questions to do with treatment and not-treatment, see Jessica Mesman, 'Machines en Moraal: Verslag van een Onderzoekservaring', Krisis, Vol. 48 (1992), 5-18. 13. For a similar criticism, in a feminist mode, see Stefan Hirschauer and Annemarie Mol, 'Shifting Sexes, Moving Stories: Feminist/Constructivist Dialogues', Science, Technology, & Human Values, Vol. 20, No. 3 (Summer 1995), 368-85.
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(Anti-)epistemological preoccupations also dominate the other recent attempt to unravel differences between different kinds of construction-stories: Sergio Sismondo, 'Some Social Constructions', Social Studies of Science, Vol. 23, No. 3 (August 1993), 515-54. Sismondo, however, misses the point of the semiotic strands in science and technology studies. 14. H.M. Collins and Steven Yearley, 'Epistemological Chicken', in Pickering (ed.), op. cit. note 9, 301-26, at 324. Quoting another text of Collins', which defends a similar position, Radder remarks that Collins asks us to 'respect the norm of not criticizing science' - thereby nicely revealing the normativity of this position: see Radder, op. cit. note 2, 143. 15. Hans Radder (ibid.) is a good, thoughtful example of this. Radder argues that a modest realism is needed to account for any politics of the risks technological systems entail. 16. Susan Leigh Star, 'The Sociology of the Invisible: The Primacy of Work in the Writings of Anselm Strauss', in David Maines (ed.), Social Organization and Social Processes: Essays in Honor of Anselm L. Strauss (Hawthorne, NY: Aldine de Gruyter, 1991), 265-83. 17. For an example of a study using the concept 'world', in the sense of 'social worlds', see Adele Clarke, 'A Social Worlds Research Adventure: The Case of Reproductive Science', in Thomas Gieryn and Susan Cozzens (eds), Theories of Science in Society (Bloomington, IN: University of Indiana Press, 1989), 15-42. 18. In medical sociology many texts have an undertone of either admiration or anger. Parsons' enthusiasm for the medical profession, which he saw escaping the dichotomy between Gemeinschaft and Gesellschaft, keeps on clashing with Freidson's moral outrage, provoked by the sad outcomes of a wide range of empirical studies. For a further analysis of the theoretical roots of medical sociology, see Uta Gerhardt, Ideas about Illness: An Intellectual and Political History of Medical Sociology (Basingstoke, Hants.: Macmillan, 1989). Symbolic interactionism, as we have mentioned, is also strong in the field of medical sociology: see, for a good example, Anselm Strauss, Shizuko Fagerhaugh, Barbara Suczec and Carolyn Weiner, The Social Organization of Medical Work (Chicago, IL: The University of Chicago Press, 1985). 19. 'The nurse' may of course be a problematic point of departure. Nurses aren't all alike, nor are the ways they work with food and the meanings this has for them. For a defence of breaking down all group categories and taking individuals, and the different situations they find themselves in, as the appropriate units of analysis, see Nicolas Dodier, L'Expertise Medicale: Essai de Sociologie sur l'Exercice du Jugement (Paris: Metaile, 1992). 20. In the rest of Latour's text the word 'nonhuman' is used, instead of 'inhuman': Bruno Latour, 'Where Are the Missing Masses? The Sociology of a Few Mundane Artifacts', in Wiebe Bijker & John Law (eds), Shaping Technologyl Building Society: Studies in Sociotechnical Change (Cambridge, MA: MIT Press, 1992), 225-58, quote at 236. 21. Collins & Yearley, op. cit. note 14, 310. 22. For most English-language writers this is confusing. Semiotics includes the early Wittgenstein among its enemies, for it doesn't take words to refer. But semiotics doesn't follow the later Wittgenstein when he presents words as actions. Semiotics links words to each other, not to the situations in which they are spoken. It localizes signs in sign systems, not in pragmatics. For a serious introduction to
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semiotics, see Algirdas J. Greimas, Semiotique et Science Sociales (Paris: Editions du Seuil, 1976). For a series of examples from outside the field of science studies, see Marshall Blonsky (ed.), On Signs (Oxford: Basil Blackwell, 1985). 23. There are a lot of studies of medicine that semiotically analyze 'sign systems', ways of talking, of making sense. In so far as they go into the field, they turn it into an assemblage of spoken words. Others take up events and objects but only in as far as they are 'signifying'. See, for instance, Kathryn Vance Staiano, Interpreting Signs of Illness: A Case Study in Medical Semiotics (Berlin: Mouton de Gruyter, 1986). In this mode, semiotics comes close to and is linked up with hermeneutics; see, for example, Byron J. Good and Mary-Jo Del Vecchio Good, 'The Meaning of Symptoms: A Cultural Hermeneutic Model for Clinical Practice', in Leon Eisenberg and Arthur Kleinman (eds), The Relevance of Social Science for Medicine (Dordrecht: Reidel, 1980) 165-96. 24. Madeleine Akrich and Bruno Latour, 'A Summary of a Convenient Vocabulary for the Semiotics of Human and Nonhuman Assemblies', in Bijker & Law (eds), op. cit. note 20, 259-64, quote at 259. This version of semiotics draws on a Foucauldian tradition of attending to material elements. And it doesn't always go by the name of 'semiotics'. There are a variety of names around, each indicating something slightly similar and slightly different: discourse analysis, actor-network theory, post-structuralism. See, for some of the background, Christopher Tilley (ed.), Reading Material Culture (London: Basil Blackwell, 1990). 25. For other examples of the politics entailed in different modes of calculation, see Malcolm Ashmore, Michael Mulkay and Trevor Pinch, Health and Efficiency: A Sociology of Health Economics (Milton Keynes, Bucks.: Open University Press, 1989). 26. In semiotics, everything is what it is relative to the other elements of the practice (network, order, . . .) it is a part of. This means that semiotics is a powerful method for putting the natural sciences in their place. Instead of confronting the natural scientists' stories with those of other people, it confronts all the various practices with which the natural sciences are intertwined with each other, and with other practices linked up with other truths and norms. 27. For an interesting analysis of relations between different orderings, see the study of the way people justify their actions and plans in Luc Boltanski and Laurent Th6venot, De La Justification: Economies de la Grandeur (Paris: Gallimard, 1991). For an analysis of medical judgement that comes out of this tradition and is also closely related to what we are doing here, see Dodier, op. cit. note 19. 28. And her writing. For an analysis of the importance of numbers in the regulation of decisions and doubt in the neonatology ward, see Jessica Mesman, 'The Digitalisation of Medical Practice: Uncertainty in the Neonatal Intensive Care Unit' (paper presented at the 4S Annual Meeting, Purdue University, West Lafayette, Indiana, 19-21 November 1993). 29. The classic example of an analysis of semiotics in medicine, that is also in some ways semiotic, is of course Michel Foucault, La Naissance de Ia Clinique (Paris: PUF, 1963). Foucault himself, meanwhile, is a good example of someone who imported elements of medical thought into social theory. In taking 'bodies' rather than 'persons' as the starting point of social theory, his sociology is social medicine rather than social psychology. 30. There's a lot left to say about theory-passion: see also, Janet Rachel, 'Acting
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and Passing, Actants and Passants, Action and Passion', American Behavioral Scientist, Vol. 37 (1994), 809-23. 31. Howard Becker, Sociological Work (New Brunswick, NJ: Transaction Books, 1970), 123. 32. For this accusation, followed by a beautiful attempt to save the alleged 'good elements' of semiotics by absorbing them into symbolic interactionism, see Susan Leigh Star, 'Power, Technologies and the Phenomenology of Conventions: On Being Allergic to Onions', in J. Law (ed.), A Sociology of Monsters? (London: Routledge, 1991), 26-56. 33. For an intriguing study on noise and its exclusion, on the dream of purity and the parasites who constantly come and spoil it, see Michel Serres, Le Parasite (Paris: Grasset, 1980). 34. We're comfortable with none of these words, but know none that are any better. 'Discourse' is the word drawn from Foucault's work: see Michel Foucault, L'ordre du discours (Paris: Gallimard, 1970). For the use of 'network' in a semiotic way, see Michel Callon and John Law, 'On the Construction of Sociotechnical Networks: Content and Context Revisited', in Lowell Hargens, R. A. Jones and Andrew Pickering (eds), Knowledge and Society: Studies in the Sociology of Science Past and Present (Greenwich, CT: JAI Press, 1989), Vol. 8, 57-83. 'Modes of ordering' is the term used by John Law, op. cit. note 11. For an example of a study that analyzes the co-existence of several medical 'logics', see Annemarie Mol and Marc Berg, 'Principles and Practices of Medicine: The Co-Existence of Various Anemias', Culture, Medicine and Psychiatry, Vol. 18 (1994), 247-65. 35. For a fiercer attack on the liberalism of what it calls 'actor-network theory', see Steve Brown and Nick Lee, 'Otherness and the Actor Network: The Undiscovered Continent', American Behavioral Scientist, Vol. 37 (1994), 772-90. 36. And Latour is not alone. We're only attributing all the action to him. So see also, John Law, 'Introduction: Monsters, Machines and Sociotechnical Relations', in Law (ed.), op. cit. note 32, 1-23. Law urgently warns us not to be speciesist while attempting to avoid classicism, sexism and ethnocentrism, thus locating his call for attending to non-humans in the best of liberal traditions. But see, for a different approach, Law, op. cit. note 11. 37. Bruno Latour, Les Microbes: Guerre et PaixllIrreductions (Paris: Metaile, 1984), 180. 38. For some interesting reflections on multiplicity, using the notion of 'versions' of the world in a way that borders on symbolic interactionism, see Nelson Goodman, Ways of Worldmaking (Indianapolis. IN: Hackett Publishing Company, 1978). 39. This talk about 'our' semiotics implies neither that we claim it as our invention, nor that we want to stick to it. For an example of network semiotics being used and then supplemented with another method (or non-method), see Annemarie Mol and John Law, 'Regions, Networks and Fluids: Anemia and Social Topology', Social Studies of Science, Vol. 24, No. 4 (November 1994), 641-71. 40. Maybe this explains why symbolic interactionists incorporate the semiotic attention to 'things' so gratefully and eagerly. Clarke and Gerson, for instance, write that Latour 'insists, correctly we believe, that we view all participants in a setting as actors, not just humans. ... This point is an important extension to basic interactionist principles and ties to issues of meaning and action which Mead explored philosophically': Adele Clarke and Elihu Gerson, 'Symbolic Interactionism
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in Social Studies of Science', in Howard Becker & Michal McCall (eds), Symbolic Interaction and Cultural Studies (Chicago, IL: The University of Chicago Press, 1990), 179-214, quote at 198. We hope that we have managed to make it clear that matters are a little more complicated than this suggests. 41. The easy sociology here is that this is because we're Dutch authors. 'We Dutch' prefer not to get caught up in international fights. Instead of taking a stand, we specialize in importing and exporting. Thus our compatriots Wiebe Bijker and Gerard De Vries even managed to keep their cool in the 'Chicken' debate in which Harry Collins and Steven Yearley directed all their aggression at Bruno Latour and Michel Callon, who didn't miss the opportunity to strike back: see Collins & Yearley, op. cit. note 14; Collins and Yearley, 'Journey into Space', in Pickering (ed.), op. cit. note 9, 369-89; and M. Callon and B. Latour, 'Don't Throw the Baby Out with the Bath School! A Reply to Collins and Yearley', in ibid., 343-68. As De Vries commented, 'I happened to be present in Bath at the meeting where the first shots were fired. After this meeting, as a true citizen of a trading nation, I tried to keep in touch with both parties' (Gerard De Vries, 'Bath/Paris, SSK and ANT: Two Rival Philosophies', [paper presented at Groningen University, 27 November 1993]). 42. In our framing of 'the political', we mostly draw on Foucault and discussion about his work. See also, for recent shifts in the meaning of 'political' in political theory, Agnes Heller and Ferenc Feher, The Postmodern Political Condition (Oxford: Blackwell, 1988). 43. This in part explains the uneasy relation between feminism and semiotics. Non-feminist semioticians tend to defend themselves against attacks from nonsemiotic feminists who say that 'they're not paying enough attention to gender questions', by arguing that the difference between the genders - and indeed the sexes - isn't pregiven. Semiotically-attuned feminists, meanwhile, try to find out if, when and how sex differentiations are locally made. For a series of interesting struggles with this matter, see Donna Haraway, Simians, Cyborgs and Women: The Reinvention of Nature (London: Free Association Books, 1991); and, for an example of the way this may work out in an analysis of medical practice, see Vicky Singleton and Mike Michael, 'Actor-Networks and Ambivalence: General Practitioners in the UK Cervical Screening Programme', Social Studies of Science, Vol. 23, No. 2 (May 1993), 227-64.
Annemarie Mol studied medicine and philosophy, and contributed to the writing of this paper while she was a Constantijn en Christiaan Huygens fellow of The Netherlands Organization for Scientific Research, and attached to the Department of Philosophy at the University of Limburg. She publishes in philosophy, feminism and social studies of science, technology and medicine. Jessica Mesman studied nursing and theory of the health sciences. She is currently writing a thesis on ethics in the clinic, for which she did fieldwork in the neonatology wards of a Dutch and a North American hospital.
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Authors' addresses: (AM) Willem de Zwijgerstraat 25; 3583 HB Utrecht; The Netherlands; e-mail: a.mol.@cc.ruu.nl (JM) Department of Philosophy, Faculty of CulturalStudies, University of Limburg, P.O. Box 616, 6200 MD Maastricht, The Netherlands: e-mail: J.Mesman@tss.rulimburg.nl

Neonatal Food and The Politics of Theory - Some Questions of Method

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Neonatal Food and The Politics of Theory - Some Questions of Method

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Neonatal Food and the Politics of Theory: Some Questions of Method Author(s): Annemarie Mol and Jessica Mesman

The Politics of SSK: New Directions/Places/People/Things

Neonatal Food and the Politics of Theory: Some Questions of Method

Social Studies of Science

Politics of SSK: Mol & Mesman: Questions of Method

Social Studies of Science

Politics of SSK: Mol & Mesman: Questions of Method

Social Studies of Science

Politics of SSK: Mol & Mesman: Questions of Method

Social Studies of Science

Politics of SSK: Mol & Mesman: Questions of Method

Social Studies of Science

Politics of SSK: Mol & Mesman: Questions of Method

Social Studies of Science

Politics of SSK: Mol & Mesman: Questions of Method

432 Two Political Styles

Social Studies of Science

Politics of SSK: Mol & Mesman: Questions of Method

Social Studies of Sclence

Politics of SSK: Mol & Mesman: Questions of Method

Social Studies of Science

Politics of SSK: Mol & Mesman: Questions of Method

Politics of SSK: Mol & Mesman: Questions of Method

Social Studies of Science

Politics of SSK: Mol & Mesman: Questions of Method

Social Studies of Science

Politics of SSK: Mol & Mesman: Questions of Method

Social Studies of Science

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