An inquiry into the constitution of the experience of patienthood. It understands “becoming a patient” as a production of a subjectivity, in other words as a process of individuation and milieu that occurs through an ontology of production. This ontology of production can, of course, also be understood as a political ontology. Therefore, this is, first of all, an inquiry into a mode of production, and, secondly, an inquiry into its relation to the issue of social justice – because of effects of digital divisions. In these terms, it also reflects on how expert discourses, such as in medical sociology and science studies (STS), can (and do) articulate their problems.
An integrative mode of discourse analysis, strongly related to discursive institutionalism, called semantic agency theory: it considers those arrangements (institutions, informal organizations, networks, collectivities, etc.) and assemblages (intellectual equipment, vernacular epistemologies, etc.) that are constitutive of how the issue of “patient experience” can be articulated form its position within an ontology of production.
The aim not being the production of a finite result, what is needed is a shift in how “the construction of patient experience” is produced by expert discourses. While the inquiry is not primarily an empirical study and is also limited to “Western societies,” it emphasizes that there is a relation between political ontologies (including the issues of social justice) and the subjectivities that shape the experiences of people in contemporary health care systems, and, finally, that this relation is troubled by the effects of the digital divide(s).
A proposal “to interrogate and trouble” some innovative extensions and revisions – even though it will not be able to speculate about matters of degree – to contemporary theories of biomedicalization, patienthood, and managed care.
There is a large number of people in various professional fields and areas of life, who would deserve to be mentioned here and to say thanks to. However, some of them are also informants in said fields and deserve to remain anonymous, whereas others have helped me “only” intellectually. Therefore, with a small exception, I will just say a general “thank you” to the everyone who help(ed) me in my work on biomedicine and care regimes. This paper has a strange history, which leads me to thank (a) most sincerely Harry Dahms, in his role as editor who re-invited its submission and kept insisting on its importance, and (b) the two anonymous reviewers who were brutally honest but equally sincere in insisting on the paper’s potential. This paper was originally written as requested by an editor of another, then brand-new journal in 2008/9. With that journal changing its premise from theory to state-of-the-field reviews, I was asked to rewrite it as a review without, however, changing its message – impossible, but I tried. Then a peer-reviewer and a co-editor suggested in 2009/10 a complete overhaul, which would have meant for me to say the exact opposite of what I intended to say back then; I was also given an untenable timeline, while being already backlogged on work. Consequently, I withdrew the paper, though I felt somewhat relieved. I rewrote portions of the paper again in 2010 and 2011 after being asked for a contribution for a different anthology. However, by then I had met Sabrina Weiss and we co-wrote a different, original paper for that opportunity. I had also adopted and rewritten a key section from the 2011 version of this paper for the concluding chapter of our book Worlds of ScienceCraft, when shortly after, in 2012, Harry Dahms was looking for fun submissions. Thematically, it was not a good fit for the 2013 volume, but it was for this one. Except, the paper was in terrible shape: outdated, a patchwork of ideas, in need of substantial editing and proof-reading, and inconsistently – well, to be brutally honest: horribly – written. What you are looking at now represents half of the central ideas of the original, and incorporates perhaps 25% of the original text (of course, heavily edited). For changes regarding its content, I blame, largely, students. I have taught courses at Leuphana University from winter 2011/12 until winter 2013/14 on issues of care, justice, and biomedicine. Students can be wonderful in their way of “innocently” taking apart (your) ideas. I am grateful, for I learned a lot from their questions and discussions, which helped me improve this paper. I need to thank Prof. Dr.med. Thomas Kühlein, who works hard to make his fellow physicians (and unsuspecting STSers) understand what Bayes’s theorem means for clinical practice and how important “quartery prevention” is. Intellectually, as will become clear, I am indebted to – besides being quite in awe, admiration, and taken with – my partner in life and crime, Sabrina M. Weiss, for “making all this trouble” with me.
Stingl, A.I. (2014), "Digital Fairground – The Virtualization of Health, Illness, and the Experience of “Becoming a Patient” as a Problem of Political Ontology and Social Justice", Mediations of Social Life in the 21st Century (Current Perspectives in Social Theory, Vol. 32), Emerald Group Publishing Limited, Leeds, pp. 53-92. https://doi.org/10.1108/S0278-120420140000032004
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