Enacting Appreciations: Beyond the Patient Perspective

Abstract

The "patient perspective" serves as an analytical tool to present patients as knowing subjects in research, rather than as objects known by medicine. This paper analyses problems encountered with the concept of the patient perspective as applied to long-term mental health care. One problem is that "having a perspective" requires a perception of oneself as an individual and the ability to represent one's individual situation in language; this excludes from research patients who do not express themselves verbally. Another problem is that the idea of "talk" as a representation of the world ignores the fact that talk is also performative in the world: it requires, at least, the ability to deal with an interview situation. To think up alternative ways of including patients as subjects in research, I develop an approach that takes this performativity as a starting point. Analysing practical situations and activities, I argue that patients enact appreciations, making known what they like or dislike by verbal or non-verbal means in a given material environment, in situations that are co-produced by others. Thus, subjectivity is linked to situations and interactions, rather than just to individual characteristics; to "patient positions;" rather than "patient perspectives".

Care at a Distance : On the Closeness of Technology

“…This knowledge is rarely studied. There are, of course, exceptions where daily practices, including medical practices, are analysed, even though knowledge is not explicitly stressed everywhere: Corbin & Strauss 1988;Hendriks 1998;Nijhof 2001;Winance 2001;Moser 2006;Moser & Law 1999;Struhkamp 2004;Pols 2005;Callon & Rabéharisoa 2004;Willems 1995;Mol 2008;Willems et al 2006. 31.…”

Sociomaterial Will-Work: Aligning Daily Wanting in Dutch Dementia Care

“…Within this tradition, I have been particularly inspired by the work of Jeannette Pols with patients in psychiatric and residential care. She draws our attention to the fact that residents of psychiatric nursing homes, rather than saying what they like, make their appreciations known by enacting them (Pols 2005). Positing that appreciations can be enacted means that they can be expressed both verbally as well as non-verbally.…”

The Patient's View: Perspectives from Neurology and the ‘New’ Genetics

“…When this has been interrogated it has typically been in relation to issues of 'data collection': whose experiences become known (the question of representativeness); and how they become known (the question of methods). In relation to the former, one key concern is what happens to patients who are unable or unwilling to articulate their experiences (Pols, 2005) -an issue that is clearly relevant to many neurological conditions and one that is and 'identity' of the patient is precisely what is at stake. But it also subtly permeates Neurogentic Diagnoses.…”