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This chapter explores the implications of patrimonial politics in the Dutch East India Company empire in the context of establishing a settlement at the Cape of Good Hope in southern Africa in the mid-seventeenth century. The Cape extended the reach of Company patrimonial networks with elite Company officials circulating throughout the Indian Ocean empire and consolidating their familial ties through marriage both within the colonies and in the United Provinces. These patrimonial networks extended to the Cape as elite Company officials created families locally or married Cape-born women. As the colony grew, the Company created a class of free-burghers some the wealthiest of whom were tied directly into elite Company patrimonial networks. But from the early eighteenth century onwards these elite Company networks came into conflict with the evolving free-burgher patrimonial networks with which they were in direct competition. This paper argues that local patrimonial networks can evolve in a settler colony that challenge the elite patrimonial networks of the imperial elite.

It is hard to imagine more thoughtful and stimulating responses to The Familial State (Adams, 2005a) than the four gathered in this symposium. Mounira Maya Charrad, Ivan Ermakoff, Edgar Kiser and Pavla Miller raise important challenges not only for me but for all those who tackle questions of large-scale comparative history. Rather than arguing about this or that point of specific interpretation – in fact I think that unlike some “Author Meets Critics” sessions, these commentators have the main arguments of the book nailed down – I will immediately turn to those issues. These include the relationship of the argument to today's patrimonial states; patriarchal power and internal family dynamics; the reasons for the decline of hegemonic powers; the microfoundations of collective action and the place of evolutionary biology in comparative historical explanation.

In Weberian scholarship, conventional wisdom views the corruption of the modern rational-legal bureaucratic state by local patrimonialisms as an endemic feature in non-Western postcolonial state formation. The resultant neopatrimonial state is often blamed for the social, political, and economic ills plaguing these societies. This essay challenges conventional wisdom and argues that neopatrimonialism is a process of hybrid state formation that has its origins in the cultural politics of colonial state building. This is achieved by drawing on a comparative study of British Malaya and the American Philippines, which offers contrastive trajectories of colonialism and state formation in Southeast Asia.

Because of the precariousness of state power due to local resistance and class conflicts, colonial state building involved the deepening of patron–client relations for political control and of rational-legal bureaucracy for social development. In the process, local political relations were marked and displaced as traditional patrimonialisms distinguished from the new modern center. Through native elite collaborators and paternal-populist discourses, new patron–client relations were institutionalized to connect the colonial state to the native periphery. However, colonial officials with different political beliefs and ethnographic world views in the center competed over native policy and generated cyclical crises between patron-clientelist excess and bureaucratic entrepreneurship.

Instead of the prevailing view that postcolonial states are condemned to their colonial design, and that authoritarian rule favors economic development, my study shows that non-Western state formation is non-linear and follows a cyclical pattern between predation and developmentalism, the excesses of which could be moderated.

Purpose – To assess labeling and social control of clients in contemporary mental health care organizations.

Methodology/approach – Fifteen months of observation in two multiservice mental health care organizations, interviews with workers and clients, and analysis of organizational documents.

Findings – The organizations used a variety of organizational labels, both official and informal, which served distinct purposes in organizational life and which did not always agree in their construction of the client. Official mental illness diagnosis was a bureaucratic label, while informal labels determined the types of social control to which clients were subjected. Clients who were informally labeled severely mentally ill were subject to integrative social control, while exclusionary social control was applied to those informally seen as not being severely mentally ill. Unlike in classic studies of mental health care, looping processes, in which client behaviors are viewed as symptoms, do not reliably predict the types of labels or social control applied to clients.

Implications – It is important for a sociology of diagnosis to contextualize official diagnosis in the repertoire of organizational labels applied to clients in mental health care, recognizing that it plays a limited but important role in organizational life. Informal labels, which at time conflict with official diagnosis, play a more prominent role in the management of everyday organizational life.

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.