Nursing Inquiry 1994; 1: 46-56

Confronting ‘reality’: Nursing, science and the micro-politics of representation

Kim Walker Tasmanian School of Nursing, University of Tasmania, Newnhom, Tasmania, Australia

Accepted for publication 17 August 1994

WALKER K. Nursing Inquiry 1994; 1: 4 6 5 6 Confronting ‘reality‘: N~using, science and the micro-politics of representation In an age where previous frames of reference lose their certainty nurses are finding themselves rethinking their relations to the ‘real’. In this paper I interrogate an empirical ‘text’ of a local nursing cultural practice through a poststructural critique of the ways in which language, discourses, representation and experience intersect to construct ‘reality’ for us with specific consequences. I do this in an attempt to disclose the micro-politics at work in the processes of signlfylng and thus repre- senting nursing to a world of potential students. The discourses of science and caring find themselves exposed in particu- lar representational technologies and practices that mark nursing’s collusion with the ‘truths’ of science at the expense of those we loosely name ‘caring’. This cultural theoretical work constitutes a provisional and historical fragment of analysis designed to trouble the relations we often unwittingly sustain with dominant ‘regimes of truth’.

Key words: caring, culture, discourse, politics, representation, science, text.

SITUATING THE SELF: WHO SPEAKS, WHO WRITES?

People ... must know how to resist a diversity of represen- tational practices that would traverse them, claim their time, control their space and their bodies, impose limita- tions on what can be said and done, and decide their being.’

In an age of uncertainty and rupture I find myself as a nurse increasingly implicated in a peculiar politics of iden- tity, experience, location and self-esteem. Such a hybrid of politics often impels me to rail against the dominant and sometimes oppressive ‘truths’ of my time; to speak over and against what I believe to be the dogma and canon of my culture. The ‘text’ of which I will speak here is utterly historical, local, ephemeral and yet curiously permanent. In my representation of this textual fragment of our cul- ture I will undoubtedly distort and inflect it through the ‘frames of constructed visibility’ available to me currently.2

Correspondence: Kim Walker; Tasmanian School of Nursing, University of

Josmania, PO Box I 2 14, Newnharn, Jasrnonia 7250, Australia.

In so doing, I will necessarily recuperate and appropriate it for my own political ends as my ‘will to truth’ urges me to create an empirically grounded critique of science, nurs- ing, the micro-politics of representation, and ultimately of certain discourses of the real through which I believe we are positioned to both speak and be spoken in the world. My aim is to seduce, provoke, disarm and, obviously, to engage. This is a paper born of the conviction that we are increasingly forced to live with a condition Jane Flax has called ‘a most uncomfortable form of intellectual vertigo’.3 Such a condition for me means that we continue as we have been in our scholarly work at our peril.

‘Representation’ has been a problem for me for some time now. It is a theoretical concern that first appeared to me during my doctoral project in which I found myself working with narrative data. Throughout the analysis of this empirical material I struggled with the issue of how to represent the voices of those women whose experiences I had captured on tape and transcribed, and the voices of those theorists whose work informed the analysis. The pressing question was how best to position such disparate voices without inflicting a form of epistemological violence

The micro-politics of repesentation

on the data? In struggling with this concern I became aware of what I have come to recognize as ‘the crisis of faith in the production of meaning’. This crisis alerts me to the diiculties of speaking ‘for’ myself and others; of speaking ‘to’ issues and concerns that are derived from my own and others’ experiences in the world; speaking ‘from’ a cease- lessly shifting range of discursively informed subject posi- tions; and of speaking ‘out’ in a culture not always ready or able to listen to those issues and concerns that impel my theoretical projects. Such a crisis of faith urges me to remain ever vigilant to how I say what I say and when and to whom I say it. Like many nurses nowadays, I keep a per- sonal/professional journal from time to time as a way of problematizing my work; it provides me with a rich source of data for later reflection and analysis. Let me share a moment from my journal which captures something of how the crisis of representation became an issue for me only very recently:

There I was amongst all these curious teenagers . . . a swirl of eager and not so eager bodies and faces pressing against ‘our space’ in this vast hall of noise and activity . . . so this is what a vocational exposition is like I thought ... and there I was, with some undergraduate students of nursing selling nursing to a hungry audience . . . but when I looked around me at what it was we were ‘selling’ I got a bit of a shock _ _ _ the images we had displayed and the things we were doing seemed to tell only one story __. a story about how scientific we could be, it was a story which seemed alI too familiar ... and yet set amongst these images (pho- tographs, posters, blood pressure machines and a pulse oximeter) were other messages . . . photographs of people in beds, nurses smiling beneficently . . . but these messages were not so clear as those which seemed to be telling a story of nursing as a science . . . nursing as a technical, sci- entific activity . . . where was nursing as a caring activity . . . nurses as carers not scientists?

Indeed I was confronted. And in struggling with this con- frontation, I was compelled to find some answers to those questions. They have been questions nagging at me for many years now.

Patti Lather has written recently of the sensibility that has come to be known as the ‘postmodern’. Among many of postmodernism’s important activities is a critique of the ways in which the world can be represented; how we say what we want to say. Postmodernists are concerned that the issue of ‘cultural’ representation has been ignored in much philosophical and theoretical work until now. Indeed, with the exception of those thinkers from what is commonly known as the Frankfurt School, and the line of French intellectuals from Saussure through Barthes to Foucault, representation was, until recently, almost transparent to much Western epistemology. As a central concern to those of us who wish to render problematic the taken-forgranted

aspects of how we make sense of the world, the crisis of r e p resentation as it has been opened up via the late nine- teenth century writings of ,the necdantians, Bergson, Heidegger and, of course, Nietzsche, and as it can be thought of in general philosophical terms, lays bare fertile ground for rethinking how we say what we want to say. For Lather then, ‘the crisis of representation is an erosion of confidence in prevailing concepts of knowledge and truth. Whatever ‘the real’ is, it is discursive. Rather than dismiss- ing ‘the real’, postmodernism foregrounds how discourses shape experiences of ‘the real’ in its proposal that the way we speak and write reflects the structures of power in our society’.4 This paper is an attempt at a partial working out of the issues Lather voices above, particularly as they are constituted in the culture of nursing. I will articulate the instance of a crisis of representation to which I gave voice above through fragments of the theoretical structures from the discourses of postmodernity; most notably, poststruc- tural theories of language, subjectivity, and power- knowledge. My goal with all of this will be to offer one highly partial and local critique of the production of truth in our culture in which ‘criticism is ... an instrument of struggle, with which the critic seeks to change, if only for the moment, the balance of power in the present regime of truth’.5 Criticism is not merely a negative moment in the evolution of our understandings but is a process through which we can identiq, analyse and theorize those concerns which most constrain and disable our lives as nurses.

Nursing and science have a long and well established relationship. Indeed the body of literature aff%ming,6~7~s contesting? and critiquinglOJlJ2 this relationship is now a body of substantial proportions. Scholars of nursing from all over the world have invested much intellectual energy debating the links between what I will call the discourses of nursing and those of science. They have done this in pur- suit of a connection that will secure, once and for all, a point of anchorage for our claims to legitimacy as a disci- pline, not to mention status as a profession. Indeed the preeminence of the discourses of science in nursing came to expression most recently for me in an international research conference ,at which a leading North American scholar proclaimed to the large and diverse audience that ‘the progress achieved by the nursing community in the last quarter of a century in establishing a scientific basis for practice is no less than daunting’.ls As an opening to the keynote address the message for me was both confronting and disturbing. Its utter lack of equivocation, the audacity of its claim to truth, its universalizing pretensions and its self legitimating tenor spoke loudly to me of a culture in which a growing body of work thoroughly critical of such

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K Walker

claims14J5J6J7 can be all but ignored in the name of a foun- dation and progress for nursing. It seems to me then, as Johnson recently remarked, that ‘serious consideration has not been given to the position that nursing is not a science’.18 It is the deeply engraved irony in such a com- ment I hope to expose here and that I will suggest is in urgent need of reappraisal. In order to begin this work I will set up my critique of ‘nursing as a science’ from the contemporary personal narrative I disclosed above. In con- sidering it here, I am taking up Foucault’s call to ‘open up problems that are as concrete and general as possible, problems that approach politics from behind and cut across societies on the diagonal’ (pp. 375-376) .I9

NURSING AND THE POLITICS OF REPRESENTATION: LANGUAGE AND

DISCOURSE

If we think of politics most simply as a field of relations of power then, in a politics of representation, we are most concerned with the relations among specific signs and sym- bols which generate particular meanings in a particular context. Representation is the human act of signifying what passes for a particular ‘reality’ in the world; it constitutes specific expressions of our efforts to render the thought and the unthought as perceivable and hence, ‘realized’. Human beings are distinguished from other living crea- tures by their capacity to create and manipulate signs and symbols for particular political ends. In this way we must think representation as ‘delegation; one individual repre- sents another in parliament. It is resemblance; a painting represents on the canvas what the painter observes. It is replication; the photograph (image) represents the person photographed (object). It is repetition; a writer puts on paper the word (language) that represents his/her idea or thought (meaning). It is substitution; a lawyer represents a client in court. It is duplication; a photocopy represents the original’.20 Representation when rendered more theoreti- cally sophisticated and hence more problematic however, is, ‘that by which we make our will known and, simultane- ously, that which alienates our will from ourselves in both the aesthetic and political spheres’.21 Representation is thus a two edged sword. It both enables us as human agents to share a world of understandings but in doing so, it severely compromises how we might form and reach those understandings in the very act of representing. As Mitchell warns, representing something always extracts a cost. Something is lost in the transfer from ‘original’ to ‘copy’ (always a precarious distinction), be it ‘immediacy, pres-

~

ence, or truth’.21 Furthermore, that loss may be trivial, or substantial. The analyses of particular representations of nursing this paper pursues speak to a political and aes thetic cost that I believe is difficult to ignore.

In order to grasp fully how a politics of representation is effected, we must share first, an understanding of the nature of language and experience as text. Now while it may seem strange that the data on which I draw is not lan- guaged data, the ways in which we are able to make sense of the data are thoroughly imbricated in language. In other words, the data constitute a form of textual evidence. As Lewis and Simon put it, “‘text” refers to a particular con- crete manifestation of practices organized in a particular discourse. In everyday life, meaning-making does not exist in isolation but forms complexes that are organized con- tingently through time and space. Examples of text include written passages, oral communication, non-verbal commu- nication accomplished through body movements and expression, and visual forms of representation such as paintings, photographs and sculpture’.22 The business of interpretation, the process of understanding texts such as photographs (which contain frozen moments of body movement and expression and non-verbal communica- tion) is only available to us in that we must first transform what we see into the structures of language; language is the process through which meaning is constructed.23 As Tyler puts it, ‘seeing is always mediated by sayingl.24

It is not, as commonsense would have us believe, that language merely reflects experience, but rather, ‘in so far as it is meaningful, experience is constituted in language. Language offers a range of ways of interpreting our lives . . . we give meaning to things by learning the linguistic processes of thought and speech, drawing on the under- standings of the world to which we have access’ (p. 85).Z5 Language understood as not just a set of relationships between words and things, but rather as, ‘the primary medium through which individuals socially construct their knowledge of the real’ constitutes a significant aspect of postmodern thought.26 Building on this understanding of language then, discourses are ‘modalities that to a signifi- cant extent determine what can be said, by what kinds of speakers, and for what types of imagined audiences’.27 Therefore discourses ‘represent political interests and in consequence are constantly vying for status and power. The site of battle for power is the subjectivity of the individual and it is a battle in which the individual is an active but not sovereign protagonist’ (p. 41) .Z5 Discourses, put most simply, ‘organise a way of thinking into a way of doing. They actively shape the practices that the discourses serve’.27 Discourses then, are not merely language, but

The micrqolitics of repaentation

practices as they are constituted in language. This last point will become plainly evident in the ensuing analysis. What I aim to suggest then, is that who we are as nurses is largely (but not exclusively) the result of our positioning in dis- courses such as science. Our subjectivities (our sense of ourself, or more correctly, our sense of our many shifting selves) have been produced in specific ways through par- ticular discourses. I am arguing here that the discourses to which we, as nurses, have had access, are discourses which have discouraged and inhibited critique. Moreover, they have limited our understandings of the ‘real’ to those of modernity’s great ‘malestream’ thinkers.28

Thus if language is not simply a transparent medium but rather opaque and constructing of our realities, then how we choose to say what we want to say is of utmost importance to the meanings we create, circulate and to which we must inevitably, respond. In other words, our r e p resentations of nursing can never be innocent. They always presuppose particuiar modes of understanding of which we may or may not be conscious at their moment of represen tation.

SCl€NCE AND THE MACRO-POLITICS OF REPRESENTATION: HOW SCIENCE SPEAKS

THE WORLD FOR US

Kuhn’s work on the nature of ‘normal science’ exposed how ‘paradigms’ (of which science is perhaps the exemplar par excellence) ‘gain their status because they are more successful than their competitors in solving a few problems that the group of practitioners has come to recognise as acute.’z9 More to the point, however, is the way in which the ‘promise’ they extend to society is actualized. Chalmers recites the long rehearsed credo that ‘scientific knowledge is proven knowledge . . . derived in some rigorous way from the facts of experience acquired by observation and exper- iment . . . scientific knowledge is reliable knowledge because it is objectively proven knowledge.’w Such potent claims it seems to me, become a peculiarly irresistible form of truth because they appease humanity’s anxiety when it is confronted with the enormity, uncertainty and fragility of life and experience. Indeed as Flax asserts, ‘[slcience serves as the exemplar of the right use of reason and the paradigm of all true knowledge. Science ‘progresses’ (e.g., acquires ever more accurate knowledge of the ‘real’ world) by applying and improving its own unique ‘logic of dis- covery’ (p. 31).3

Thus when a nurse proclaims, ‘If [nurse scientists] abandon their attempts to predict and control, [they]

threaten nursing‘s status as a legitimate science and autonomous professi~n’,~’ (author’s emphasis). We hear compelling evidence h a t our cultural representations of nursing as science, and nurses as scientists, are still grafted onto a politics of identity and location that is concerned to establish nursing within the parameters of a science that can deliver the ‘promise’ of which Kuhn, Chalmers and Flax speak. As Joan Cocks argues, ‘any individual always begins to think, desire, and act in terms specified for it by an established order of things, elaborated by past genera- tions of individuals who began their thinking, desiring, and acting in the same way’.32 What this means for us as nurses, is that today we are almost inescapably constructed in the name of science because our predecessors have estab lished, indeed, enshrined science, as the vehicle in which our thoughts, desires and acts as nurses must be carried.

I argue here that any project that attempts to decon- struct such culturally normative modes of understanding is almost doomed to failure precisely because the politics of representation at work in our culture inhibits any disman- tling of its prevailing definitions. Indeed an oppositional discursive positioning is rendered extremely difficult through the normalizing and stabilizing impulses of scien- tific discourses. The master discourse of science works to subvert alternative understandings of how the world might be through its positioning (and with which we have been utterly complicit) as a ‘regime of truth’ (p. 133).33 Science enjoys its privileged position because it ‘traverses and pro- duces things, it induces pleasure, forms knowledge, pro- duces discourse’. These are what power (and hence sci- ence) does and ‘[w] hat makes it hold good, what makes it accepted’ (p. 119).33 Indeed science assumes a place in nursing in which, as for Foucault, ‘science has become institutionalised as power’.s* Such a positioning is the effect of Nietzsche’s will to truth’, for as Foucault asks, ‘doesn’t science produce ‘truths’ to which we submit? ... Why, in fact, are we attached to the truth? Why the truth rather than lies? Why the truth rather than myth? Why the truth rather than illusion?% These are the very questions discourses of contestation and opposition such as post- modernism attempt to wedge in the cracks and fissures of scientific discourses; ithose tiny instabilities and inconsis- tencies that science disguises in its totalizing rhetoric. Postmodernism thus opens and deepens the critique to the point where the hegemonic status of science can be sub verted and undermined.

My argument rests then, on this notion that science as a constellation of specific discourses (such as those of medicine, education, psychology and so on), produces par- ticular variants of what passes for ‘truth’ in our health care

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culture (‘truth’ understood here ‘as a system of ordered procedures for the production, regulation, distribution, circulation and operation of statements’ (p. 133) .33

Moreover, science and its various ‘technologies of power’ induce particular ‘truth effects’ (p. 131) .33 Those effects in the culture of nursing manifest in our unconscious and hence largely uncritical appropriation of ‘science’ as the ‘truth’, as ‘the ensemble of rules according to which the true and the false are separated and specific effects of power attached to the true’ (p. 132).s3

The problem that concerns me here, can be best phrased as a question: How do we represent nursing to the latent and potential consumers of our undergraduate degree courses? This is a question that is at once highly spe- cific, insofar as I recently found myself positioned as a r e p resentative of our culture in an ‘Employment and Education Expo’ in Launceston, Tasmania. But it is also a question of a most general nature because it raises, I believe, significant questions about the cultural and ideo- logical production of meaning in what we call nursing. It is especially a problem for those of us who sometimes speak on behalf of others who are also nurses. Academics, as Spivak rightly points out for us, are in the business of ideo- logical production.35 As such it is important that I am scrupulous in putting my interests on the table. To this end I am not attempting to negate the value of science in our culture. Rather, I am concerned to render it problematic in a way that exposes the pervasive, indeed pernicious effects, it has on our self and social understandings as nurses. It is not only that science dominates, but the way that it domi- nates; this is the problem for me. Of course my subjective position on this issue is one of an undeniable pessimism about the ‘truth effects’ of science in our culture and by saying this much, I could hardly deny charges of being somewhat single mi.nded on this issue. What is more the point I feel, however, is that my uncompromising stance affords me the opportunity of developing (and sustaining) what Spivak has described as ‘a certain degree of rage’ against a history that has written such an abject script for nurses (pp. 61-62) .35 This history has found nurse scholars writing a contemporary nursing ‘script’ which has been replete with prescriptions. for the ways in which nurses might like to interpret their world. It is a script desperately in need of rewriting.

SETTING THE SCENE A PRELIMINARY ANALYSIS OF NURSING AS A SCIENCE

Each year the governing fathers of our city set up an expo- sition for high school leavers at which they are able to

gather information on a wide variety of potential career options. Various trades, tertiary institutions and profes- sions are represented and large numbers of young people and their parents come to see what is on offer. This year our school of nursing set up a ‘stand’ (next to social work, opposite the school of business; an interesting, if not delib- erate, juxtaposition) that consisted of a long rectangular table set against a backdrop of some photographs and two posters. Several first year students from our undergraduate course were in attendance as well as myself. On the table (at each end) were a couple of sphygmomanometers; in the middle was a pulse oximeter. Each of these ‘objects’ represents science in that it is both a sign of science in its technological manifestation and a symbol of the power sci- ence exercises over us when it ‘makes real’ aspects of the human condition otherwise unavailable to our sensory apparatus. These instruments make available representa- tions of our innermost workings; our embodied existence is delivered to us in ways that are both qualifiable and quantifiable.

On the wall behind this table were secured eleven large photographs. Each photograph represents a fragment of a cultural text in that it speaks the culture of nursing. The discourse of photography brings into play a potent mode of representation. Indeed the objects of which the discourse of photography can speak are themselves representations. Representation almost exclusively employs the visual mode of signification; photographs, therefore, carry enormous authority in a culture which valorizes knowledge produc- tion mediated through powerful metaphors of vision and illumination.36 Seeing they say, is believing.

It was the composition of these photographs that most attracted my attention; what were they saying to me? In each photograph was a collection of our students posing in various combinations around either another person who represented a patient, or as in three of the photographs, students were grouped around a piece of bio-medical tech- nology. The two large posters that flanked either side of the stand depicted on the audience’s left hand, ‘Nurse the carer’, on the right, ‘Nurse the technician’. These large representations (both resemblances and replications) cast opposing messages. In the poster on the left was a woman surrounded by other humans; each was engaged in some ‘connected’ activity with another individual, the poster was suffused with gentle, warm, yellows and golds. In the poster on the right was a woman surrounded by a collection of bio-medical instruments, biochemical hieroglyphics and other scientific tools and trappings; this poster was coloured in muted, cool, blues and greens. Such represen-

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The mimc+olitacs of representation

tations carried potent overt and occult images of nursing, they were images which I believe were essentially conflic- tual rather than mutually constitutive. This is not to suggest I would wish to resolve such contradictions. A postmod- ernist acknowledges and lives with such things. Rather, it is to once again expose them in the name of critique in order that we can move beyond the binary logic of opposition inherent in specific cultural representations and which so insidiously penetrates our individual and collective under- standings of the ways in which we can think and act in the world. In other words, the spatial and metaphorical jwta- position of such polarized representations creates a hierar- chy in which one representation is privileged over the

The poster on the right hand side was imbued with a sort of semiotic primacy. I say this insofar as the values that infuse our cultural self and social understandings are quite specific: cool (read rational), muted (read objective) colours, are inherently superior to warm (read emotional), gentle (read subjective) colours. Right handedness is valorized over left handedness. The right is symbolic of orthodoxy, the left is symbolic of deviance. Such powerful unconscious and symbolic signifiers have their genesis in the dichotomous thought patterns that have dominated Western culture for the last two thousand years. Such dichotomies carry subtle yet significant messages which are actually ideologically and culturally encoded gendered constructions. In such constructions, the first (and always male associated) term is privileged; consider for example, reason/emotion; objective/subjective; public/private; hard/soft. For this analysis then, cool colours = male; warm colours =female. Right = male; left = female. Juxtapose the representations of science as technical activity (male) and caring as non-technical activity (female) against the speci- fic chromatic encoding and spatial positioning of the two posters and a persuasive hierarchy of values is established. What might have been conceived as an innocent depiction of a potential reality becomes a dangerous manifestation of an altogether different reality fiction; science as a regime of truth inserts itself in nurses’ self and social understandings through a complex set of mediations of the ways in which we choose to represent our world to ourselves and to oth- ers. The pernicious effects of science then, are exactly that our understandings are ‘always already’ invaded by a mode in the production of meaning that is invisible to our ways of seeing, inaudible to our ways of listening. It is not, as Foucault says, that everything is bad, rather, that everything is dangerous. And, ‘if everything is dangerous, then we always have something to do’ (p. 343).19 (The ‘always already’ is a term coined originally by Heidegger and later

other.S7.38.39,40,4/42

appropriated by Derrida to describe the absolute circular- ity of language. It serves to remind us that we are ‘always’ born into a world in which social and cultural meanings are ‘already’ inscribed on our body/subjects. In other words, there can be no pre-discursive state in which we are free from the structures of language. Language is both anterior and posterior to our existence.)

A TALE OF SIGNIFICATION: HOW TO LURE THE PASSING ADOLESCENT TO A CAREER

IN NURSING

Young people were filing past us constantly. The sphygmos and the oximeter certainly caught the attention of this predominantly young audience; the students busied them- selves taking blood pressures and oxygen saturations. Thus we had a scenario in which our ‘representations’ of nursing were giving simple but effective messages and eliciting quite powerful responses. As the adolescents giggled and gawked at these signifiers and signifying practices of tech- nology, it was obvious the students of nursing certainly enjoyed being at the centre, and in control, of all this activ- ity. Indeed, I overheard these students talking of nursing in terms of its scientific ‘content’ and of their seduction by the technology and the skill such technology required of them. This activity, of taking blood pressure and oximetry readings, in itself constructed the discourse of science inas- much as such practices formed the very objects of which these young students of nursing could speak. The dis- course of science came to expression in and through the practice of these young people. In other words, science was made available to our sense-making activities through such technologies as they were mediated by the discursive prac- tice of these young people eager to demonstrate their newly found identities as students oEthe science of nursing. In manipulating and engaging the technologies for their designated function science was spoken of, the discourse of science reciprocally shaped their activity as scientific while it allowed its name tci be inscribed on their subjectivities. Such a process of inscription constitutes what Mchren had described as the ‘politics of enfleshment’. Such a politics recognizes that bodies are ‘socially situated and incarnated social practices that are semiotically alive’.*s

In all of this I seem to be suggesting that something was missing. Somehow nursing was being under-, if not indeed, mis-represented. A certain aesthetic cost was being extrac- ted. Moreover, that aesthetic cost incurred, I will shortly suggest, an even greater political cost. But how might we have otherwise (or better?) represented nursing? How

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K W a k

indeed, might we have represented nursing as caring? Such questions serve now, to ampllfy how the discursive produc- tion of reality is always a culturally invested, historically specific and therefore political (if not always conscious) process. In posing them, I am attempting to further force my argument to a critical edge from which the practices of representation are less able to recentre themselves in pur- suit of a justificatory and conservatory politics of defence.

To answer such questions, I need to analyse in more detail what was in the photographs I briefly described above. It is in such representations that I feel we, as nurses, were indeed making ‘our will known’; more problematic- ally, we were also alienating and politicizing that will with some contradictory messages. A certain ‘politics of truth’ was alienating our best intentions from other possible r e p resentations of nursing. In other words, science as a ‘regime of truth’ intersected and inserted itself in our r e p resentations at the expense of another regime of truth con- stituted through the discourse of caring. Such a politics of truth served to buttress our claims to viability, status and legitimacy as a discipline, moreover, a professional disci- pline with a substantive body of knowledge called ‘scientif- ic knowledge’. The discourse of science found expression over and against the discourse of caring because it was politically more expedient and aesthetically less compli- cated to promote nursing as a science rather than as any- thing else which we might like to call non-scientific. How might such assertions be verified?

In only two of the photographic representations of ‘our work’ did nurses have any eye contact with the person who was presumably the focus of that ‘work’. In only one pho- tograph did nurses make any physical contact with our r e p resentations of a ‘patient’. Nurses were disengaged from these simulations of care. (Indeed, in three photographs there was no person on which to focus; bio-technology held these nurses in awe.) Such representations, I suspect, served the function of promoting nursing as a commodity eminently marketable to a predominantly young, upwardly mobile and technologically literate audience. After all, this is perhaps the most significant mode representation employs. Authenticity of intent and desire is often masked by those who wish to sell an idea or product to consumers. But if we were also attempting to tell our audience that nurses care for people, then why not construct representa- tions in which the nurse is indeed ‘connected’ to and with the subject of her care?

It seems to me that perhaps the simulations conveyed ambiguous messages because indeed there was an ambiva- lence on the part of both those taking part in the exercise and those constructing it, as to how much realism to r e p

resent. Caring is an activity that comes to expression in a multitude of ways. It is a discourse in which the objects of which it can speak are almost infinite. Consequently, as a way of organizing a way of thinking into a way of doing, car- ing resists not only representation, but language itself. To put it another way, the photographs constructed ambiva- lent messages of our commitment to caring because it seems to me that in having to represent such an activity, such a mode of being, caring was immediately rendered fragile. Caring was made problematic and difficult, its com- plexity became all too apparent and hence, caring impli- cated itself in a politics of representation. Caring found itselfcaught in a politics that called into question its taken- for-granted status in our culture. Thus it was set up to be contested a significant point of contestation arose from our ‘other’ commitment to science. To put it another way, the very act of attempting to represent caring created a ten- sion between the aesthetics of such a representation (how to best capture caring in a photograph), and the politics of positioning caring alongside science in such a way so as not to diminish the value of the former against the latter. It seems to me then, that the discourses of science and of car- ing competed for primacy in the ways we attempted to rep- resent nursing to the public. A close inspection of these representations reveals that our constructions of nursing were indeed confused, conflicting and paradoxical.

THE CRISIS OF REPRESENTATION: MAKING OUR WILL KNOWN, CONTRADICTIONS

AND PARADOX

If, as Leininger,M*45 Watson,& Par~e4~ and many others would have us believe, ‘caring is the heart of nursing’, then in these representations (as I have represented above) that heart was ectopic; worse still, we had all but excised it. Perhaps our maxim should read ‘science is the heart of nursing’? In the posters, photographs and in our scientific activity, we had unwittingly represented nursing as a sci- ence almost to the utter exclusion of nursing as a practice that has as its focus the care of people. This is not to sug- gest yet another untenable dichotomy, that caring = non- science and science = noncaring. Rather, I am deliberately polarizing the issue in order to highlight how cleverly binary thought sets up either/or distinctions which them- selves perform particular political ends by an exclusionary logic that always (re)positions the dominant element in the dichotomy at the expense of the other.

The effects of power manifest in such representations of nursing as a science (the truth about what nursing might

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The micro-politics of rep-esentation

be?) are exactly that we unwittingly focused our young and potential career aspirants, toward instruments of bio- medical technology. Obversely, we focused them away from the people in whose name our caring might be directed. In each of the representations of nursing we sent messages that were both constructed by and constructing of a par- ticular reality we desired to convey. We needed and wanted to represent nursing as a science because the many truths of science are seductive and compelling. Science has come up with the goods which have made our lives ineluctably more comfortable and more efficient. If nurses and the culture of nursing ascribe to such truths, then maybe, just for a moment, we can claim the status and legitimacy sci- ence confers on all those who are in thrall to its prowess. But it is even more poignant, that we represented the very people in whose name our caring profession is constructed in positions of marginality. In only two of the eleven pho- tographs on display to our potentially captive audience it was in evidence that our patients were central to our r e p resentations (and I use the possessive pronoun advisedly).

I said earlier that science as a regime of truth has at its disposal various ‘technologies of power’. These technolo- gies can be thought, with respect to my argument, of the ways in which we allow science to speak for us as nurses. By asking students of nursing to take our audience’s blood pressure and oxygen saturation, it is as if we were saying, ‘this is what nursing is really about, none of this wishy- washy caring stuff ... or, ‘nurses are scientists too you know; we measure and record, we wear white coats and stethoscopes and we interpret complex bio-medical data’. Of course, nurses do indeed take part in such practices. Such practices, however, do not form the totality of our work (if indeed one can imagine something as finite as a ‘totality’ of our work that is necessarily destined to remain always unfinished). I would argue that scientific practices constitute only a fraction of what passes for nursing care in our hospitals (except perhaps, in the (post)modern tech- nocracies, the ‘high-tech’ panoptic spaces of the intensive care units and their ilk).

In contradistinction, if we listen to the rhetoric of our aforementioned ‘caring’ scholars, that nursing is caring, that caring is the essence, the centre, the very heart of nurs- ing, then it seems to me from the specific situation I have analysed here, that we do not have at our disposal an ade- quate representation of such a construction of a possible reality. I would suggest that perhaps this is so because as I suggested earlier, ‘caring’ defies and resists representation. Caring as a discourse that shapes the very objects of which it speaks resists representation precisely because caring resides in the order of the almost ineffable. It does not and

cannot be adequately articulated or captured in represen- tation because it resides in the flesh and sinews of nurses; caring comes to expression only in a politics of experience and identity, caring is a discourse constitutive of enfleshed ~ubjectivity.~~ It is a discourse that is both socially and cul- turally inscribed in and on the body/subjects4* of nurses themselves. As such, i t seldom comes adequately to expres- sion in the sometimes superficial structures from which mere representations are forged. Caring as a discourse of enfleshed practices evades language and yet is not entirely outside of language. Rather, I am suggesting that caring is a discursive practice for which we have not yet the language structures to capture it adequately in representation (because we can and do talk of caring without ever defin- ing it precisely and we can and do share understandings of caring activity despite our inability to name it). Perhaps car- ing can remain in that space between the ineffable and the expressible (a decidedly postmodern paradox) because Western epistemology privileges vision over the other senses, precisely because representation is an inherently masculinist mode of expression. There is, as Irigaray argues, a ‘logic that has dominated the West since the time of the Greeks’; a particular ‘phallocratic economy’ of sig- nification and representation that decides who can speak, about what, with whose words and to which audiences (p. 172).3 But, more poignantly, it is in and through such a critique of phallogocentricism, that we discover caring has been assigned through the binary logic of opposition to the female and thus becomes invisible; women in our CUE ture argues Owens, are on the side of the invisible (p. 72) .%

How might one a.dequately capture caring in a photo- graph? HOW might we ‘speak’ caring in ways that attest to the complexity of caring as practice? As Mitchell warned us above, ‘representation exacts some c&t, in the form of lost immediacy, presence, or truth, in the form of a gap between intention and realisation, original and copy’.” Nursing, it seems to me, must pay a particularly high price in the act of representing itself. To make our will known, to tell nursing like it is, is a project that poses seemingly insu- perable difficulties for the technologies of representation. I believe this is so because what we know of nursing, the knowledges that inhere in our nursing practices, are often invisible, silent and :as Foucault has commented, ‘subjug- ated’ (p. 82) .33 But the knowledge enshrined in our culture through the effects of power produced, regulated, circulat- ed and replicated in the discourses of science are manifest as potent truths to which we ascribe enormous value (and indeed they too, are inscribed in and on our body/sub jects) .

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Such truths (unlike those generated and circulated in the discourse of caring) are unquestionably representable. Witness the sphygmomanometer, the pulse oximeter, the photograph in which the nurse focuses on the intravenous pump and ignores the person in the bed, the photograph in which nurses are in thrall to the electrocardiogram machine, the discursive practices of monitoring blood pres- sure and oxygen levels. Each of these substitutions of and delegations for science speak unambiguously to the very discourse that circumscribes its meanings for us as they are always objects and practices of and for our desire. Indeed, in one photograph in which the nurse unequivocally makes her focus the patient, her gaze is mediated through science, through an auroscope.

CODA: SClENC€, NURSING AND REPRESEN JAJION. THE RELEN JESS STRUGGLE TO CONFRONT ‘REALIT/’

Thus, as a regime of truth, science and its techniques and technologies of power - its representations - is able to weave itself further and further into the fabric of the cul- ture of nursing. In so doing, science insidiously permeates our understandings of who we are, who we can be as nurses, with its own understandings. Science and our com- plicity with its regime of truth has already made it almost impossible for us to conceive of nursing as anything else. Such a fact is constitutive of both the political and aesthetic alienation installed by our representations of nursing as a science. This point discloses the irony in Johnson’s afore- mentioned statement that ‘serious consideration has not been given to the position that nursing is not a science’. We are ‘attached to the truth’ we call science rather than lies, myths and illusions as Foucault suggested earlier, because it compels us (through its alignment with another pervasive set of truths circulated by the discourses of liberal- humanism which not only support, but legitimate science’s truth claims) to create a world in which we are able to fool ourselves into believing we are the rational authors of our lives; in the name of science we can deceive ourselves with the potent truth that we are the self-constituting, self“ knowing subjects of a world which is ours to control and dominate. Science as a regime of truth seduces us, through its powerful truth effects, with delusions of privilege and power; it allows us to take its name but withholds the glit- tering prizes society confers on those who call themselves ‘scientist’. Such people are almost always men; very seldom are they women, hardly ever are they nurses. It seems to me that it is time we created a new regime of truth in which to

construct who we want to be as nurses. The politics of truth of science means it will always be a politics shot through with androcentric values and constituted in male structures of rationality and objectivity. It will be a politics obsessed with prediction, and ultimately, control. But perhaps most seriously, it will be a politics that does violence to other forms of truth through its self legitimating claims to supremacy as the knowledge, the practice, upon which all other knowledges and practices must model themselves if they are to secure a position of primacy in the epistemo- logical hierarchy. I close by asking: Surely such a politics is not only dangerous, but more significantly, antithetical to the nursing work we consider so important and worth- while. For those of us who struggle to better understand our lives while aMicted with the ‘intellectual vertigo’ of our contemporary era, it is our task to occupy and open up those fissures and cracks in the discourses of science and attempt to more adequately represent what it is we call nursing. As Paul Bove suggests:

Not to struggle against [a] regime and its affiliations is inevitably to reproduce and extend it and the misery it causes. To imagine alternatives within it, without at the same time struggling against it. By, for example, calling into question the seemingly highest ideals we have and desire is not critical at all. Critique is practiced only when the appropriation of truth itself is at stake, not simply morals or attitudes (p. lM).32

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