The diffusion of diagnosis and its implications for the epistemology and ontology of disease.

Rather than confining the categories health and sickness to a biomedical conception of the biological organism, there is growing recognition of epistemological and ontological multiplicity in the realm of diagnosis and, indeed, in the very realm of disease itself. In short, the empirical manifestations of health and illness as well as the processes thought to cause them are now understood to assume a much wider variety of both biological and other forms. This essay considers the underlying epistemological and ontological opportunities and challenges of taking what we are calling this diffusion of diagnosis seriously. By diffusion we mean the movement from a concentrated understanding of diagnostic authority as confined to scientific biomedicine to a less concentrated appreciation of the diverse approaches to diagnosis throughout the world. We consider the extent to which, and the manner in which, we as sociologists of diagnosis might not only critique these various processes but perhaps also take them seriously in an ethnographic sense as locally produced, evaluated and legitimated forms of health care.

The particularity of freedom and recovery from addiction in practice: On the therapeutic limitations of generalising addiction science.

Addiction science is very often cast as an indispensable source of political justification and clinical resources for engaging addicts therapeutically rather than punitively. It is said to promote an image of overcoming addictions as projects of recovery from disease or mental disorder rather than merely a repudiation of one's formerly troubled ways. Thusly, it is said to inform more compassionate and effective approaches to fostering constructive personal change than merely blaming and punishing addicts for their difficulties. In this essay I argue that because mainstream addiction science seeks to generalise regarding the nature of addiction and recovery, it invariably fails to capture the practices of freedom through which particular people undertake to recover from their particular addictions. I show how theoretical resources drawn from Michel Foucault, Harry Frankfurt and Donald Davidson allow us to develop the insights of posthumanist scholarship to provide in detail for the specific practices of freedom through which people undertake to recover from their particular addictions under the diverse practical conditions in which they seek to do so. This attention to particularity keys addiction science much more closely to the actual exigencies people encounter in the work of therapeutically fostering recovery from addiction in practice.

Psychosomatic subjects and the agencies of addiction.

Addiction science and public policy have for some time been articulated in conformity with a broader antinomy in Western thought between biological reductionism and liberal voluntarism. Hence, mainstream debates have concerned whether and how addiction might be understood as a disease in the biomedically orthodox sense of anatomical or physiological pathology or whether and how addiction might be understood as a voluntary choice of some kind. The fact that those who staff these debates have appeared either unable or unwilling to consider alternatives to this antinomy has resulted in a rather unhappy and intransigent set of intellectual anomalies both on the biomedical and the social scientific sides of this divide. Perhaps more importantly, it has also resulted in a striking isolation of scientific debates themselves from the vicissitudes of therapeutically caring for those putatively suffering from addictions both within and outside clinical settings. After briefly demonstrating the conformity of debates in addiction science with the broader antinomy between biological reductionism and liberal voluntarism and the anomalies that thereby result, this article considers the scientific and therapeutic benefits of a psychosomatic framework for the understanding of both self-governing subjects and the experience of a loss of self-control to agencies of addiction.

Post-humanism, addiction and the loss of self-control: reflections on the missing core in addiction science.

The core criterion of addiction is the loss of self control. Ironically enough, however, neither the social nor the biomedical sciences of addiction have so far made any measurable headway in linking drug use to a loss of self control. In this essay I begin by demonstrating the limitations in this regard suffered by the social and bio-medical sciences. Whereas the social sciences have variously reduced addicted drug use to deviant, but nonetheless self-governed, behaviour or discourses thereof, the bio-medical sciences have completely failed to adequately specify, let alone empirically analyse, how we might distinguish addicted from self-governed behaviour. I then show how these limitations can be very easily overcome by the adoption of a post-humanist perspective on self control and the various afflictions, including addiction, to which it is regarded heir. This argument provides occasion to acquaint readers with post-humanist scholarship concerning a spectrum of relevant topics including the human body, disease, drug use and therapeutic intervention and to show how these lines of investigation can be combined to provide an innovative, theoretically robust and practically valuable method for advancing the scientific study of addiction specifically as the loss of self control. The essay concludes with a discussion of some of the more important ramifications that follow from the adoption of this post-humanist approach for drug policy studies.

Learning disability and the limits of liberal citizenship: interactional impediments to political empowerment.

Recent policy initiatives have moved decisively toward empowering learning disabled citizens, recognising ability over disability, and promoting people's political empowerment and voice in the design of public services. While laudable and encouraging, these initiatives raise an important question: to what extent can a group of service users, whose very entitlement to state-sponsored assistance is justified by putative intellectual impairment, be empowered according to an exclusively liberal model of citizenship that presumes and requires, as its very defining features, intellectual ability and independence? In this paper we consider this question by means of an ethnographic analysis of an innovative advocacy group: the Parliament for People with Learning Disabilities (PPLD). We first document both an institutional and an interactional preference for clients to speak actively for themselves. We then describe three types of interactional trouble that emerged in the PPLD as obstacles to realising this preference in practice and the strikingly similar remedies that were generated to overcome these troubles. We conclude by discussing the limits of an approach to empowering learning disabled individuals that is cast too exclusively in terms drawn from liberal models of citizenship that prioritise voice over care, security, and wellbeing.

Concepts of social justice in community psychology: toward a social ecological epistemology.

In this paper we address the pervasive tendency in community psychology to treat values like social justice only as general objectives rather than contested theoretical concepts possessing identifiable empirical content. First we discuss how distinctive concepts of social justice have figured in three major intellectual traditions within community psychology: (1) the prevention and health promotion tradition, (2) the empowerment tradition, and most recently, (3) the critical tradition. We point out the epistemological gains and limitations of these respective concepts and argue for greater sensitivity to the context dependency of normative concepts like social justice. More specifically, we point to a pressing need in community psychology for an epistemology that: (1) subsumes both descriptive and evaluative concepts, and (2) acknowledges its own embeddedness in history and culture without thereby reducing all knowledge claims to the status of ideology. Finally, we describe and demonstrate the promise of what we are calling a social ecological epistemology for fulfilling this need.