Nursing and The Postmodern 1 June 8, 2005 Nursing and The Postmodern Condition Clinton E.

Betts Assistant Professor (P/T), School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. Abstract The general position of this paper is that, the postmodern turn in nursing, is not only understandable, but provisionally justified. The purpose is to provide a rationale for a post-Modern understanding of the world that represents a viable and potentially important theoretical tract for the future nursing. This is suggested on the basis of the psycho-social pathology that is an indirect, or iatrogenic, result of modernism. Specially, the modern double bind proposed by Richard Tarnas as a philosophical diagnosis of the postmodern condition within which nursing is now at work. First, a brief overview of the recent critique of postmodern nursing is provided. Second, the essential state of contemporary discourse is outlined. Third, Tarnas Post-Copernican Double Bind is offered as an understanding of the postmodern condition . Finally, postmodern nursing is discussed in the context of the double bind. The conclusion is that, as a result of the potential detriment to cultural health from the pervasive scientific metacommunication of contemporary socio-culture, the job of postmodern nurse-philosophers is to become social and cultural critics. Introduction Over the past few decades, there has developed a rather concerted critique of theoretical nursing. In particular, a number of writers and researchers, both within and outside of nursing, have objected to what Watson (1993) referred to as; the postmodern turn in the history of nursing. (p.63). Although there are exceptionally important elements to this general criticism, and of course they ought to be seriously attended to, there is also a unifying theme to it that, in my view, seems especially disagreeable. Put simply, this issue is science. This is to say that, any deviation in nursing theory from science proper, essentially quantitative methodology with perhaps a small allowance for qualitative as a supporting adjunct to research rigor, is often viewed with suspicion, scepticism and cynicism, even to the point of dismissive parody in many cases. Although I do not as a rule object to; suspicion, scepticism, cynicism, and even parody, I do take umbrage with certain forms of limited thinking. It is the general position of this paper then, that; the postmodern turn in nursing, is not only understandable, but provisionally justified. In what follows I shall attempt to qualify this thesis. My use of the term postmodern nursing in this paper is meant to refer broadly to

Nursing and The Postmodern 2 the body of theoretical work in nursing that has attempted to distinguish itself from biomedical science, for example, researchers and theorists such as Boykin and Schoenhofer (1993), Parse (1992), Watson (1988), Benner and Wrubel (1989), Leininger (1995) and others. Although many of these theorists might not identify themselves specifically as postmodernists in the manner that, for example, Watson does, they can be generally classified together in that they object, with differing degrees of voracity, to many of the assumptions of modernism. It is however, not my purpose to explicate or defend any particular postmodern understanding of nursing, nor do I intend to provide some general overview of postmodernism in nursing. Rather, I wish to provide a rationale for a post-Modern (meaning somewhat anti-modern) understanding of the world that represents a viable and potentially important theoretical tract for the future nursing. I suggest this on the basis of the psycho-social pathology that is an indirect, or iatrogenic, result of modernism. Specially, I refer to the modern double bind proposed by Richard Tarnas as a philosophical diagnosis of the postmodern condition within which nursing is now at work. To do this I will first, provide a brief overview of the recent critique of postmodern nursing. Second, I will outline, what seems to me to be, the essential state of contemporary discourse, the problem if you will. Third, I present an understanding of the postmodern condition using Tarnas (1991) Post-Copernican Double Bind. Finally, I will discuss postmodern nursing in the context of the double bind. Overview of the Critique of Postmodern Nursing As mentioned nursing has incurred a rather heavy critical burden over the last decade, particularly with regard to any manner in which it deviates from science proper, meaning established, generally accepted procedures, methods, and to some degree even purpose. Most recently, Paley (2005) has attempted to demonstrate that phenomenology [is] rhetoric. (p. 106). Although he means to refer to phenomenological research, as opposed to the philosophical thought associated with Husserl and Heidegger, his conclusion, beyond the fact that he thinks phenomenological research is rhetoric, is subtly telling. I think it is time that nurses got themselves better [research] tools. And they should certainly get themselves a different philosophy. (p. 114). One might ask then, does he have one in mind? The answer, of course, is yes science. In fact, he alludes to a previous paper that he has written; Caring as a slave morality: Nietzschean themes in nursing ethics (2002), wherein he states explicitly; nursing must learn to do proper science. (p. 32). Unfortunately, it is beyond the scope of this paper to offer a thorough critique of Paleys use of Nietzsche, therefore I shall have to ignore the seemingly preposterous notion of going from Nietzsche to proper science. Suffice it to say then, that I do not know how, to say nothing of seriously object to, an understanding of Nietzsche, used in this case to suggest that nursing is a slave revolt against medicine and hence a resentment based ideology of caring, leads one to consider nursing a noble discipline only if it becomes a proper science [of] recovery and rehabilitation. (p. 32). I suppose we are to think that since nurses, or nurse theorists at any rate, are, for the most part, female slaves who resent their oppression, they should not bother with thinking much beyond the methods of their masters (physicians and scientists I gather).

Nursing and The Postmodern 3 For OMathuna (2004) in; the marriage of postmodernism and nursing the honeymoon is over because it carries serious consequences (p. 5). Indeed, apparently; nurses, of all people, must deal with the real world (p. 11). The real world being referred to here appears to be some ill-defined wedding of science and Christianity, where we must walk as Paul did and deal with the physical realm. Again, I do not have the time and space to fully explore this odd matrimony, I will just comment then, that his claim; the excesses and dangers of science should be critiqued and corrected is ridiculously simplistic. One wonders why, given over 2000 years of western history, with some 400 of it seriously committed to science, no one has yet gotten around to finally doing that. Hussey (2004) adds to the rather dismissive critique of postmodern nursing by suggesting; that some nurses and nurse-philosophers are the victims of intellectual seductions a chain of reasoning which leads to mistaken or dubious conclusions. (p. 105). Some of these include; irrationalism, relativism and Guru worship of philosophers, such as Husserl, Heidegger, Foucault, Derrida and Martha Rogers. (p. 105). As well as fashions such as; nursing models, holism, advocacy phenomenology, patient autonomy, therapeutic touch, postmodernisms and so on (p. 195). Since Hussey permits himself the luxury of not having; to defend [his] critical evaluations of these fashions, a rather strange thing to hear from an analytic philosopher, perhaps he would not mind if I availed myself of a similar largesse. He claims, quite magnanimously, that even he was once so unfortunate as to have been seduced in his teens by the likes of Russell, Ayer, Wittgenstein and Popper and the very fashionable, positivist variety of analytic philosophy... although [he is] still... in the broadly analytic tradition. (p.105). His conclusion then, similar to Paley and OMathuna above, is that; we need to practice what has been dubbed analytic philosophy and that we require some form of realist view of epistemology and science. Although he claims to; keep an open mind about alternatives. (p. 110). To which Richard Rorty (1980) would no doubt reply that it is; the quest for certainty over the quest for wisdom Science, rather than living (p. 61). And Peter Sloterdijk (1988) might call it an enlightened false consciousness (p. 5), a pernicious realism through which human beings learn the crooked smile of open immortality. (p. 4). I wonder if Hussey might have turned out different had he encountered more poetry and art in his youth, rather than positivism and analytic philosophy, but I shall remain open minded to the possibility that poetry and art were not all that important after all. The tradition continues, descending into unabashed parody, with Glazer (2000) referring to certain elements of nursing as scientific mysticism, philosophical radicalism and the professions nuttier quasi-scientific theories (p. 5). Her conclusion; in setting science against humanism, nurse-theorists seem to have forgotten that there is still an important biological component in nursing. (p. 16). Raskin (2000) does likewise, suggesting crackpot scientific theories and that; nursing theory has become a home for New Age fallacies, alternative medicine, and hyperbole. (p. 35). Raskin is, in the end, as magnanimous as Hussey is; I hope this article will help academic nursing come out of the dark ages of authoritarianism and mysticism so that it legitimately can take its rightful place in academia and in medicine. (p. 35). Despite the fact that such a constructive adumbration is rather trite, I suppose we should be grateful for the advice nonetheless. Finally, Cave (2000) has labelled much of nursing thought regarding

Nursing and The Postmodern 4 holism; Humpty Dumpty territory [that] is to be avoided. (p. 20). There are, of course, others with a similar manner of opposition to postmodernism in nursing (for example see, Glazer, 2001; Holmes & Warelow, 2000; Paley, 1998, 1997; Holmes, 1996; Bradshaw, 1995; Cushing, 1994; Gortner, 1993). It is, I think, rather clear that the major point of contention with postmodern nursing, beyond its alleged track record of foolish thinking, is its rejection, or suspicion at any rate, of all things science. Interestingly though, there is another rather salient theme that runs through this critical literature. Nursing seems to be viewed, by virtue of its female dominated ranks and its historical subordination to the medical profession, as little more than a concourse of angry feminists lashing out at their long time oppressors. I wonder, even if it were possible to identify something of this sort in the development of nursing (or perhaps still present on some level), does this mean that; a) there is no legitimacy in an angry feminist, b) angry feminists have nothing to say beyond the womens issues that feminists are thought only to be angry about and c) that an angry feminist couldnt possibly be right? I have, quite obviously, omitted the exceptionally important aspects of this body of critique; in fact one could hardly disagree with many of them. This is certainly not an attempt to deny, or ignore them. It is largely the result then of my wish to identify and hence focus on, what I consider the objectionable element of it. I suspect that lurking somewhere behind the serious thinking that is rightly recommended to postmodernists in nursing and the apparent conclusion that such thinking should be scientific, there is a general distrust (perhaps even dislike) of all things postmodern. Indeed a modernist perspective of human knowledge and action seems to be the very foundation of the critique. Although I have no objection to a distrust of postmodernism, there might, I think, be good reasons to be suspicious of scientific rhetoric. At the very least, as Ian Hacking (1999), who is anything but a postmodernist, noted; constructionism can be used to unmask an ideology of science, an ideology that is intended to produce pious reverence. (p. 62). In fairness though, Hacking also warns that; what is true is that many science-haters and know-nothings latch on to constructionism as vindicating their impotent hostility to the sciences. Constructionism provides a voice for that rage against reason. (p. 67). I certainly do not wish to wade into the so called science-culture war, especially after invoking Hacking whom I could not hope to compete with. Rather, it is my purpose to claim the very real possibility that a scientific ideology, or as Tarnas (1991), whom I shall refer to shortly, calls it; scientific metacommunication, carries with it a significant health risk. And as such, it does behove nursing to claim a certain postModern turn. The Postmodern Problem, or Postmodern Problems? It is an understatement to say that we, of the western world, live in troubled times. Of course, one could say that there were troubles in any time or place of history, western or not, however ours are perhaps unique in that they are not merely a preponderance of problems that require solution, but rather a crisis in problem solving altogether. This is to say that we live in a time of methodological uncertainty, a time of; tremendous problems and dangers we have produced and which we are apparently unable to manage via the political process. (Leet, 2003, p. 683). Indeed the academic, intellectual and

Nursing and The Postmodern 5 cultural discourse of the majority of the twentieth century could be read in many respects as a continuous argument concerning methodology. Toynbee (1974, originally published in 1946), who coined the term post-Modern in his A Study of History, relegated it to a Time of Troubles as far as the stages of civilizations go, due to the disintegration of the Enlightenments ideals of rationalism, progress and social cohesion. Thus, virtually all of it (the trouble, one might say) revolves around a singular issue modernity, or the ways, means, methods and assumptions of the modern era. Although modernity is by no means easily conceptualized, it can, albeit simplistically, be summed up in a phrase; techno-rational progress. As van Niekerk (1999) put it; Modernity is born out of resistance to traditional authority It is rooted in the optimism of progress that has for almost four centuries been fed by the apparently infinite potential of science, technology and organization. (p. 228). Such an understanding is, as Cassirer (1951) remarked; imbued with the belief in the unity and immutability of reason. Reason is the same for all thinking subjects, all nations, all epochs, and all cultures (p. 6). Hence; Modern Theory ranging from the philosophical project of Descartes, through the Enlightenment, to the social theory of Comte, Marx, Weber and others [is the] search for a foundation of knowledge, for its universalizing and totalizing claims. (Best and Kellner, 1991, p. 4). It would follow from this truism that humans (that is, any humans) can learn about and know the world (the correspondence, or representational theory of truth), including each other, objectively as well as with sufficient certainty, and with such knowledge they are free to construct the world, materially, sociologically, culturally and ultimately politically, to better suit and fulfill human needs, wants and desires. All that is needed is a rigorous search for knowledge (science if you will), a commitment to effective and efficient application (research and development) and the continual ability to revaluate each (an accounting system, or quality control mechanism). Of course, almost no serious thinker today believes that this is simply the case at all. As the renowned historian William H. McNeil (1996) pointed out; the role of the observer in creating what is observed always hampered historians and social scientists in their efforts to arrive at eternal, objective truths. [with relativity and the oddities of quantum mechanics] this same dilemma now haunts the physicists as well. (p. 9). Or, put differently; Even the most adamant realist in, say, physics presupposes a cultural conception of how scientific cognition proceeds. (Bennet & Connolly, 2002, p. 148). The task of defining postmodernity is somewhat more difficult than that of modernity. Particularly given that postmodern culture, or socio-politics is not synonymous with postmodern thought. Indeed, although the two are related, we could not simply say that postmodernity, as a historical epoch, follows from postmodern thought. In fact, it might well be that what is referred to as postmodern culture follows more from the continuation of a developing modern socio-politics than with the postmodern theory that is a reaction to, or critique of, modernity. In this view, the contemporary world is perhaps better characterized as a second modernity (Beck, 1999), another modernity (Lash, 1999), high modernity (Giddens, 1993), or late capitalism (Jameson, 1984), in which case any grievance one might have with the current state of human affairs would amount to a problem with modernism rather than postmodernism. The last 20 years have seen an unprecedented re-naturalization of economics Together with the theme of globalization and neo-liberalism, it seems that

Nursing and The Postmodern 6 all indicators bear witness to an expansion of modernization with a vengeance. (Latour, 2003, p. 45) We might define postmodern theory (as distinct from postmodern culture) as Lyotard (1989) has; incredulity towards meta-narratives (p. xxiv). However, given that modernity, regardless of how one understands it, is the meta-narrative in question, we might just as well define postmodern thought as an incredulity toward modernity. This of course is rather simplistic; however for my purpose here I shall let it stand with a qualification. Outside of the analytic tradition, that is positivism, logical positivism and the like, perhaps the two most significant general systems of social and cultural thought (if they can be called this) of the twentieth century are; postmodern and critical theory. Postmodern thinking begins essentially with Nietzsches trenchant critique of modernity and culminates, presently at any rate and in perhaps its most extreme form, with Richard Rorty (in between one wanders the various paths beaten by the phenomenologists; Heidegger in particular, existentialists, pragmatists, poststructuralists and for lack of a better way of identifying them, postmodernists proper; for example Foucault, Deleuze and Guattari, Lyotard, Baudrillard, and Derrida though of course there are countless others). The incredulity towards meta-narratives is, for postmodernists, largely a rejection of the totalizing and potentially hegemonic discourse of modernity (that is, science, techno-rationalism, progress and so on), moreover for some a rather complete rejection. On the other hand (though perhaps we might just as well say, on the other fingers of the same hand), for the critical theorists, a system of social and cultural criticism which emanated from The Frankfort School in Germany after the first world war (for example, Adorno, Horkheimer, Marcuse, Fromm, and Habermas are just a few of its more famous proponents), though modernity is still seriously suspect, there is something to be salvaged in the modern commitment to reason and (some measure of) universality. In fact, for Habermas (1981), perhaps the most modern of the critical theorists though he still critical of modernity in many respects, some general capitulation to a, more or less, universal (though of course once again, critical) rational discourse, represents an emancipatory possibility that modernity has yet to fulfill. I think that instead of giving up modernity and its project as a lost cause, we should learn from the mistakes of those extravagant programs which have tried to negate modernity. (Habermas, 1981, p. 11). For Habermasians then, modernity represents an ongoing human potential that has yet to be completed, or realized. The critical theorists then, see some value in; reason, truth, reflexive subjectivity, or modern philosophy, [although] using reconstructed versions of modern categories (Best and Kellner, 1991, p. 233), while the postmodernists generally view modernity as a failed experiment that must be dispensed with, or at any rate, overcome. Hence, postmodernists (or poststructuralists) stress plurality and diversity over the universal; experience and praxis over abstraction and totalizing theory; and perspectivism or constructivism (though its critics claim relativism) as opposed to the systemization and ridged categorization of ratio-empirical knowing. Perhaps the most germane question at issue, in this modern postmodern debate, is similar to the one posed by Health (2004); Is it possible to emulate many of the attractive features of western societies while avoiding the social pathologies? (p. 666). The simplified answer is, for the postmodernist no, for the critical theorist yes for

Nursing and The Postmodern 7 Habermasians, and possibly for non-Habermasians. The greater point to be made is that, there are few who deny the social pathologies of the modern world and even for those who insist that there is an up side to it, there is no simple answer. In other words, there is little faith in a simple equation of science, techno-rationalism and progress, which is to say that more and better science, more and better application of techno-rational means, and more and better progress are simply not answers at all. It has been suggested (by both postmodern and critical theorists) that, rather than the anti-rational, anti-Enlightenment ethos of postmodern socio-culture which Toynbee referred to, it is the historically modern faith in scientific, or techno-rational progress which has lead us to this Time of Troubles. Hence, the talk of contemporary crisis that abounds is by no means a simple matter of modern versus postmodern, yet there is no dismissing the talk of crisis. we have to admit that [the western tradition] has brought about a crisis that is profoundly multidimensional ecological, political, social, economic, intellectual, psychological, spiritual. On every front we are in a crisis. (Tarnas, 1998, p. 25). Or, as Barry Allens (2002) assertion that; modern technoscience is certainly taking us somewhere, but it is more likely over a cliff than into [Jeremy] Benthams promise land. (p. 36). Indeed, he further suggests that the condition of the contemporary world is one of; Banal Utopia or Tragic Recompense. (p. 27). It seems then, to level the blame for such a postmodern cultural condition specifically at postmodern theory, which incidentally claims almost universally to be a reaction to the crisis, is at the very least simplistic. Moreover, one might suggest, along with innumerable contemporary thinkers (again postmodern, critical and otherwise), that the rhetoric of science and technology, rational and organizational systematization and, what Ivan Illich (1980) referred to as, social engineering, is quite possibly limited thinking. As Latour (2003) puts it; when the side effects are forever attached to the projects, when unwanted consequences proliferate even before the causes are triggered, then the life of the moderns should become miserable, brutal and short [yet] the moderns are simply falling back on business or at least anthropology as usual. (p. 40). The Postmodern Condition? In his landmark work; The Passion of the Western Mind, Richard Tarnas (1991) traces the entirety of western thought, discourse and methodology from the Hellenist culture (the pre-Socratics) to the radical triumph of the Modern World View. He ends with a short discussion of what he refers to as The Postmodern Mind. For the most part Tarnas intention is simply to tell the story, if you will, of the procession; I hesitate to use the word evolution given its modern connotation of progress, of the western view(s) of the world and the place of human beings in it, though with an impressive attention to detail and scholarly comprehensiveness. However, in the Epilogue, Tarnas proffers a philosophical diagnosis of sorts (The Post-Copernican, or Modern Double Bind) that he believes is applicable to the contemporary world, in effect, a psychological clarification of the postmodern cultural condition. For this, he takes a cue from Gregory Batesons Double Bind theory of Schizophrenia. Bateson (along with Jackson, Haley & Weakland, 1956) formulated the double bind initially as a theory to explain the aberrant manner of communication observed in those who were thought to be suffering from schizophrenia. For the sake of consistency,

Nursing and The Postmodern 8 and because I see no need to paraphrase, I shall present Tarnas understanding of Batesons double bind: (1) The child's relationship to the mother is one of vital dependency, thereby making it critical for the child to assess communications from the mother accurately. (2) The child receives contradictory or incompatible information from the mother at different levels, whereby, for example, her explicit verbal communication is fundamentally denied by the "metacommunication," the nonverbal context in which the explicit message is conveyed (thus the mother who says to her child with hostile eyes and a rigid body, "Darling, you know I love you so much"). The two sets of signals cannot be understood as coherent. (3) The child is not given any opportunity to ask questions of the mother that would clarify the communication or resolve the contradiction. And (4) the child cannot leave the field, i.e., the relationship. In such circumstances, Bateson found, the child is forced to distort his or her perception of both outer and inner realities, with serious psychopathological consequences. (Tarnas, 1991, p. 419) Beyond its function as an understanding of schizophrenic causation, the double bind is essentially concerned with how and why certain unproductive elements of behaviour are rooted in a scenario of problematic communication. In a response to those critics of the double bind as an explanatory theory exclusive to schizophrenia, Bateson, Jackson, Haley & Weakland (1962) claim: What is more important in our work is a general communication approach to the study of a wide range of human behaviour, including schizophrenia as one major case Especially, we have been concerned with the importance of attending adequately to the complexity of communication. (p. 154) Clearly then, the double bind is an issue of communication, or more to the point the problems that arise with conflicts, specifically paradoxical conflicts, in communication. As Mustain (2002) puts it; The metaphorical weight of the double bind hypothesis lies not in its explanation of a particular psychosis, however, but in its assertion of the fundamental contextuality of the emergent pathology. (p. 105). It seems safe to assert that communication is important, indeed rather vital, to human intercourse in virtually any sphere of activity. In fact, as previously mentioned Habermas (1984, 1987), the critical theorist who most desires to preserve certain facets of modernity, holds that communication is (or must be), in essence, a normative paradigm which structures human congress, hence his use of the phrase; discourse ethic. In the extreme, Nietzsche (1974) suggested that it is the essential function of consciousness. Consciousness is really only a net of communication between human beings; it is only as such that it had to develop. (p. 298). While for Rorty (1980); conversation [is] the ultimate context within which knowledge is to be understood. (p. 398). Finally, Svenaeus (2000) claims, in The Hermeneutics of Medicine and the Phenomenology of Health, that; only through dialogue are truth and health to be attained. (p. 9). I mention this primarily to draw attention to the fact that the importance of communication as context, perhaps even construct, of knowing (as opposed to a mere conveyance of knowledge) for a great many contemporary theorists, whether critical, postmodern or otherwise, cannot be overestimated. Therefore, it might, at the very least, be a cause of concern if communication, and essential communication at that, were to lead to a generalized pathological paradox.

Nursing and The Postmodern 9 Now if we substitute in these four premises [of Batesons double bind] world for mother, and human being for child, we have the modern double bind in a nutshell: (1) The human being's relationship to the world is one of vital dependency, thereby making it critical for the human being to assess the nature of that world accurately. (2) The human mind receives contradictory or incompatible information about its situation with respect to the world, whereby its inner psychological and spiritual sense of things is incoherent with the scientific metacommunication. (3) Epistemologically, the human mind cannot achieve direct communication with the world. 4) Existentially the human being cannot leave the field. (Tarnas, 1991, p. 419-420) Tarnas then proceeds to identify some of the symptoms that are a result of the double bind; distorted inner and outer realties as in apathy and psychic numbing or narcissism and egocentrism, escapism in the form of compulsive economic consumption, absorption in the mass media, faddism, cults, ideologies, nationalistic fervor, alcoholism, drug addiction. When attempts at diversionary and avoidance behaviours are inhibited or exhausted; anxiety, paranoia, chronic hostility, a feeling of helpless victimization a sense of purposelessness and absurdity, a feeling of irresolvable inner contradiction, a fragmenting of consciousness often ensues. Finally; at the extreme there are the full-blown psychopathological reactions of the schizophrenic: self-destructive violence, delusional states, massive amnesia, catatonia, automatism, mania, nihilism. (p. 420-421). It is not hard to glimpse, in this double bind mediated state, the potential for social pathologies, or what Horkheimer and Adorno (1972) referred to in The Culture Industry: Enlightenment as Mass Deception (from Dialectic of Enlightment) as; the progress of barbaric meaninglessness. (p. 158). In effect, we see in Tarnas version of the double bind the radical juxtaposition of a form of holistic existence (the inner psychological and spiritual sense of things) with a rationalist mode of order and organization (scientific metacommunication), the result of which is a range of psychosocial pathology, or perhaps social iatrogenesis. Such is the cost (as in cost-benefit) of living in a time of efficiency, calculability, predictability and control by non-human means (technology), a process that Ritzer (1993) termed The McDonaldization of Society, where a universalizing approach to social structuring, that is everything from fast food to health care, appears to be evident. Or as Illich (1980) put it: The main source of pain, disability, and death is now engineered albeit nonintentional harassment. The prevailing ailments, helplessness, and injustice are now the side effects of strategies for progress now so prevalent that it is readily mistaken for part of the human condition The desperate disability of contemporary man to envisage an alternative is an integral part of the curse from which he suffers. (p. 116-117). It seems to me then, rather absurd to argue that more efficiency, calculability, predictability and control, that is science and techno-rational progress, is any kind of productive answer at all to the problem of double bind ill-health. In effect, the pervasive and intractable scientific metacommunication that is the context of human affairs in the contemporary western world is, to put it simply potentially bad for ones cultural health, and as such a significant source of ill-ness and dis-ease.

Nursing and The Postmodern 10 I am not referring here to the discourse that runs through Nietzsche, Heidegger, Popper, Kuhn, Feyerabend et al (and perhaps arrives at the radical antirepresentationalism of Rorty) concerning scientific epistemology, or the issue of the foundation of knowledge. Rather, I am suggesting that the issue of science, and more generally scientific metacommunication is as Allen (2002) claims; the problem concerns the place or value of science in the wider culture, what science does for or to culture, and to people who believe in its truth. (p. 27). For example, in the late 20th century Francis Fukuyama (1989) suggested, though not without significant controversy, that we of the western world had reached the end of history. By this he meant to imply a certain socio-political stability in; the triumph of the Western idea evident in the total exhaustion of viable systematic alternatives to Western liberalism. (p. 1). However, less than two decades later, he proffers the notion of a posthuman future of bio-technology (Fukuyama, 2002). Indeed; today molecular biology, biological medicine, brain science, and even computer science have far more cultural authority than physics. (Hacking, 2001, p. 93). This is no doubt due to their remarkable applicability. For example, we are increasingly able to replace those parts of us that breakdown, or wear out, to say nothing of the potential for reshaping, or enhancing those that are simply not good enough anymore. We can control and manage certain elements of unproductive human behaviour, thoughts, desires, dispositions and the like as never before. However, such a propensity is multi-variant, serving everything from therapeutic and medicinal ends to economic and sociological ends. To put it bluntly, we can do it, so we do it, and we consider that a good in itself. Doctors and consumers are becoming locked within a fantasy that everyone has something wrong with them, everyone and everything can be cured medicines finest hour is the dawn of its dilemmas its triumphs are dissolving in disorientation. (Porter, 1998, p. 718). We should not though, restrict the problem to just physicians and medicine. Perron, Fluet and Holmes (2005) have recently claimed that nursing is by no means neutral in this developmentalism of bio-power. Using the work of Foucault concerning power, control and legitimization they conclude that; nurses use various strategies aimed at shaping individual and collective behaviours, and operate at a (strategic) crossroads that involves government authorities and patients. They serve as cogwheels within the healthcare apparatus. (p. 543). In explicating the double bind it was never the intention of Bateson and his colleagues to single out and label a schizophrenogenic mother as the locus of the problem, though it did of course have its pejorative implications. Rather, as previously noted, it was communication and the intricate context of human interaction that they were generally concerned with and its potential for psychopathology. The context of communication now, in health at any rate, is biology or biochemistry. In effect, psychopathology has been, by and large, reduced to biochemistry; dopamine for schizophrenia, serotonin and GABA (gamma amino-butyric acid) for mood disorders, cortisol for chronic stress and so on. The response is then to fight chemistry with chemistry so to speak (antidopaminergics, selective serotonin reuptake inhibitors etc) with the complex nuances of communication, interaction and connection, to say nothing of socio-cultural factors, relegated to a lesser importance, or, when time, money, commitment and procedure present problems, to not important at all. The point to be made here, and it has been the conclusion of numerous theorists and writers, is that perhaps the actual triumph of the western idea, though we should

Nursing and The Postmodern 11 perhaps more carefully refer to it as the modern idea, is far less a political organization issue than an ideological consensus concerning the indispensability, and hence nearly undisputed value, of scientific methodology and techno-rational progress. Moreover, one that has led us to the precipice of a posthuman future, or perhaps we might simply refer to it as a Brave New World. Indeed, Aldous Huxley (1983, first published in 1959) claimed with great prescience in Brave New World Revisited that: when Brave New World was being written, I was convinced that there was still plenty of time. The completely organized society, the scientific caste system, the abolition of free will by methodical conditioning, the servitude made acceptable by regular doses of chemically induced happiness, the orthodoxies drummed in by nightly courses of sleep-teaching [read advertising now], but not in my time, not even in the time of my grandchildren The prophecies made in 1931 are coming true much sooner than I thought they would. (p.11-12) Huxleys frightful book is rarely spoken of today without contrast to that other, not so fictitious, masterpiece of totalitarianism, Orwells (1983 originally published in 1949) Nineteen eighty-four. Indeed, we still hear the incessant admonition of political domination, and rightfully so, in both the postmodern and critical theory language of hegemony, totalitarianism and normalization. However, as Postman (1985) suggested; In 1984 people are controlled by inflicting pain. In Brave New World, they are controlled by inflicting pleasure. In short, Orwell feared that what we hate will ruin us. Huxley feared that what we love will ruin us. (p. viii). Furthermore, he was concerned with; the possibility that Huxley, not Orwell, was right. (p. viii). Science is perhaps the greatest legacy of modern theory. In fact, some consider it (certainly the early moderns) the light in Enlightenment. That which banishes the darkness of superstition, mythology, tradition, folklore and the like, leading to a secure (and purportedly universal) foundation of knowing from which proper doing (though intervention is perhaps a better term) can then be undertaken. It is little wonder then that it has been held up as the standard of truth and has come to dominate our linguistic, cultural and political conceptions of legitimate knowledge. Science as an ideology has become (in place of religion) the dominating imaginary institution of the moderns. (Heller, 2000, p. 5). However, if Tarans double bind has any validity, the problem is clear; we live, in the west at any rate, in a perpetual schizophrenia like socio-cultural, socio-political state of existence, which seems to me to be rather unhealthy, regardless of what conception of health one subscribes to (i.e. biomedical, holistic, or any other). Just what would be achieved then, one wonders, by demanding more and better science, more and better application of techno-rational means, and more and better progress, in effect more scientific metacommunication, which seems to be just what many of the critics of postmodern nursing do (Hussey, 2004; OMathuna, 2004; Paley, 2002; Glazer, 2000; Raskin, 2000)? I fail to see how the answer to this pressing question could ever be more and better health. Postmodern Nursing: I do not intend here to proffer some specific notion of what postmodern nursing is, or should be, indeed I doubt that I could if I wanted to I simply am not certain at this point, which is consistent I suppose with the uncertainty ethos of postmodernism

Nursing and The Postmodern 12 altogether. Although such an admission will no doubt leave me open to any number of criticisms, so be it, I am not a politician with a well rehearsed plan, I am a nurse with a very real set of fears. With this in mind, what I would like to do is to attempt a reformulation of Tarnas double bind as a care-cure juxtaposition. First, it seems to me that Tarnas reference to inner psychological and spiritual sense of things sounds suspiciously like what many postmodern nursing theorists mean by caring as a way of being. For example; The caring theory and the evolution of the notion of transpersonal caring ultimately evokes and invites ontological development mindbody-spirit oneness, which is connected with all, elicits the spiritual and expanded views of what it means to be human: embodied spirit, both immanent and transcendent, whole, and connected in right relation. (Watson, 1997, p. 51). Second, the use of the term scientific metacommunication can certainly serve as an apt characterization of biomedical cure. Modern medicine claims its dominance is based on the accuracy of its scientific knowledge of health and how to treat illness. (OMathuna, 2004, p. 4). Finally, it is no shocking claim to suggest that biomedicine is the current context of our general view of what health is and what to do about it. Such a fact is however not unproblematic. As Roy Porter (1998) claims in his remarkable work The Greatest Benefit To Mankind A Medical History Of Humanity; Medicine has now turned into the proverbial Leviathan, comparable to the military machine or the civil service, and is in many cases no less business and money-oriented than the great oligopolistic corporations The medical machine has a programme dedicated to the investigation of all that is objective and measurable and to the pursuit of high-tech, closely monitored practice. (p. 628-629). Moreover, Porter also states that; the root of the problem is structural [and] endemic... (p. 718). I am forced to wonder then, if the Tarnas double bind can be reformulated as follows: (1) Caring relationships are affairs of vital communication and dependency, thereby making it critical for the human being to assess the nature of the relationships (communication). (2) The human mind receives contradictory or incompatible information about its situation whereby its enmeshment in caring situations is incoherent with the scientific and techno-rational metacommunication of biomedical cure. (3) The human mind cannot negotiate caring (communicative) relationships which are structured by biomedical contexts. 4) Given that such a situation is structural and endemic, the human being cannot leave the field. As the result of such a double bind scenario; the law of diminishing returns necessarily applies. Extending life becomes feasible, but it may be a life exposed to degrading neglectbestowing meagre increments of unenjoyed life! (Porter, 1998, p. 718). Indeed, we see here perhaps something quite similar to the Batesonian diagnosis put forth by Tarnas. Postmodern nursing then, despite its; intellectual seduction (Hussey, 2004), nuttier quasi-scientific theories (Glazer, 2000, p. 5), crackpot scientific theories. (Raskin, 2000), Humpty Dumpty territory (Cave, 2000) and resentment based ideology of caring (Paley, 2002), seems to me a more promising alternative to more and better science, more and better application of techno-rational means, and more and better progress. This is, of course, not to suggest that these obviously pejorative accusations against postmodern nursing theory are in any way above critical reproach and that serious thinking is not called for. However, there is that brand of serious thinking (essentialist, representationalist, realist and so on) that Rorty, as an example of the extremes of postmodern thought, claims to dispense with altogether (with

Nursing and The Postmodern 13 an uncomfortably convincing argument for some), and then there is that brand of thinking which Heidegger (1977) took from the poetry of Holderlin; We ourselves are in the text and texture of the question. The question What calls on us to think? has already drawn us into the issue in question What calls for thinking? does more than merely struggle with an object, in the manner of a scientific problem. (p. 362). Or, that of Adorno (1974); The only philosophy which can be responsibly practiced in the face of despair is the attempt to contemplate all things as they would present themselves from the standpoint of redemption. Knowledge has no light but that shed on the world by redemption: all else is reconstruction, mere technique. (p. 247). If you will recall, in the introduction I stated that; the postmodern turn in nursing, is not only understandable, but, provisionally, justified. What provisionally was meant to imply, was that serious thinking is needed, in this I certainly concur with many of the critics of postmodern nursing to which I am responding. Of course, there is a very important difference between those critics who simply parody, or make fun of postmodern nursing theorists, and those who seriously examine the thinking that goes into it (though sometimes they are one and the same). Those who would have us believe (usually the former) that acts against reason, science, objective knowledge and universalizing claims are some brand of high treason against a common sensical realism, would also have us ignore the potentiality of high treason against the human soul, either glossing over the pervasive double bind pathology of the postmodern world, or foolishly thinking that more efficiency, calculability, predictability and control is not a commitment to more of the same iatrogenic problems. Of course, we only use the term soul these days as a metaphor, but as Postman (1995) suggested; a metaphor is not an ornament. It is an organ of perception. (p. 174). Interestingly, the response that Tarnas (1991) finds appropriate to the potentiality of the double bind is something of transpersonal psychology, which has also influenced a number of postmodern nursing theorists. He cites research from Stanislav Grof and James Hillman, two transpersonal psychologist in the Jungian Archetype tradition, to suggest; a widespread and constantly growing collective impetus in the Western mind to articulate a holistic and participatory world view (p. 440). It should be noted that there are certainly some aspects of the modern project which we should not so easily dismiss, human rights comes immediately to mind, moreover there is a great deal of room for a (serious) critique of postmodern theory (in nursing and otherwise), as well as critical theory for that matter. However, we must be cognizant throughout such thinking that modernity, at least narrowly construed as technorational progress, might just be counterproductive to health, certainly holistic health, but quite possibly health of any kind. In fact, it may very well make us sick in ways that medical science, or perhaps science of any kind, can do nothing about. Concluding Remarks: Admittedly, the incessant postmodern talk of newness, as in the need for new ideas, a new way of thinking, new approaches to discourse, analysis, understanding and so on, can be somewhat tiresome, if not outright irritating at times, I seen no other option than that something different than modernity should come to pass. I confess that I do not know what that new is yet, although at the risk of upsetting the critics of postmodern

Nursing and The Postmodern 14 nursing, I think that Heidegger has begun the project better than most, that is if we, of a postmodern nursing persuasion, can manage to understand just what it is that his thought means for us. Indeed, I imagine a currently practicing nurse, or even some nursing theorists, finding this paper confusing, perhaps even ridiculous (though I certainly hope not everyone feels this way). I believe this is the case simply because we are unable to envisage anything outside of the current context in which we live and work. Such a predicament is reminiscent of Grants Impasse, referring to the Canadian philosopher George Grant. As Andrew (2003) states it; technological society has deprived us of any standards by which our world can be judged; our lives are so informed, indeed constituted, by technique that we have no standpoint outside the technological civilization (p. 484). This is to suggest that, we cannot make sense of postmodern nursing, beyond the fact that some of it just doesnt make any sense, chiefly because in order for anything of it to be realized it requires a, perhaps radically, different context, and with that a radically different mode of communication from that which has been bequeathed to us by the Enlightenment. Perhaps then, the job of postmodern nursephilosophers is not the self consumed efforts to define or conceptualize what it is that nursing is, which much of its intellectual history seems to be, but rather to become social and cultural (context if you will) critics. That is, to become cultural nurses. Not though, in the manner outlined by Leininger, but rather that suggested by Ahern (1995) in his discussion of Nietzsche as Cultural Physician; to play with interpretations, not for interpretations sake, but for the sake of a revaluation of humanity. (p. 199). In short, a revaluation toward something healthier a double bind context of cultural schizophrenia.

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