In her famous monograph ‘Death without weeping’, anthropologist Scheper-Hughes1 argues that social scientists should be involved in ‘epistemological struggles’ about how knowledge is generated, the interests it serves and how we can make social science more relevant and non-oppressive. These themes were implicitly and explicitly woven into the programme of the 9th biannual conference of the International Society of Critical Health Psychology (ISCHP) in Grahamstown, South Africa. ISCHP conferences excite me because they are, as is to be expected, critical (of e.g. methods, social injustice and psychology) and interdisciplinary. I would like to share some key messages of two keynotes which stood out for me, which I think will interest many social scientists working on health, care and social justice.
Lesley Swartz (Distinguished Professor, Stellenbosch University) provided insightful reflections on notions of care and ethics. For instance, the currently popular notion of ‘task-shifting’ reduces care to a series of impersonal tasks, and overlooks and obscures the centrality of intimacy and interpersonal relationships to care. Much of the care people receive is performed by informal workers, such as cleaners or security guards, who often remain invisible. However, increasing their visibility and formalising their caring risks changing the dynamics in such a way that the most valuable aspects of their work are lost. Another danger Swartz commented on is that we make nursing care look good for funders from the global North; instead, we must focus on localised forms of care and what is contextually appropriate. Indeed, global theories of health and well-being appear to apply to some bodies but not others. On-going reflection on the multiple meanings of health, well-being and care is required.
Michelle Fine (Distinguished Professor, City University New York) also asked us to reflect critically on the categories and concepts we use in our research. In her keynote she unpacked the notion of precarity, using stark examples of racism and other forms of structural violence in the US and South Africa. Fine pointed out that to some extent we all ‘know’ precarity, although most certainly it affects some much more than others. After all, we live in a fundamentally unequal world, in which policy decisions are made which determine who will live and who will die. The precarity of elites deserves attention given their ‘aggressive appetite’ to reclaim power and control if threatened, often shrouded in the suggestion that it is ‘for people’s own good’. We witnessed this in the extremely powerful and upsetting documentary Miners Shot Down, which shows how a ‘toxic collusion’ of powerful players led to the killing of 34 South African miners in 2012, the subsequent prosecution of miners and impunity for those responsible for the killing.
Fine reminded us that ‘there is a wisdom in precarity which we ought to honour’; and that we should avoid simplistic categories which box people in and are out of sync with their life-world. We can work ‘alongside and in solidarity with’ marginalized people by using participatory research methods, such as asking LGBT youth to design their own survey tools to explore their experiences, or asking participants to read, literally, between the lines of newspaper articles and write down the ‘real’ story. These Freirian methods help them to not merely sit at the table, but change the table too.
These keynotes offered a valuable reflective space and made visible what we normally ‘look past’. This can also be achieved by communication studies, as Swartz noted. A number of presentations, my own included, discussed analyses of language use in health care settings. Language may appear too ‘micro’ and insignificant for those with an interest in social justice. Yet, language is central to health care and will affect its quality and fairness. It can be usefully explored as a tool to construct realities and perform social actions. My own work on loss in childbearing in Malawi illustrates how women can be held accountable for pregnancy complications, for instance by discursively framing them as an ‘uncooperative woman’ rather than as someone who lacks the energy to push during labour. Discursive studies can provide new perspectives on social justice themes such as how (gendered) identity, knowledge and power are co-constructed and operate in health care interactions2.
The ISCHP conference then, was a powerful reminder of the need to remain critical of the categories and concepts we use; the topics we focus on; and of the many methodological tools and disciplinary perspectives we can use to foster health, care and social justice.
1 Scheper-Hughes, N. (1992). Death without weeping: The violence of everyday life in Brazil. Berkely: University of California Press.
2 I make a similar point in my chapter ‘Discursive Psychology and its potential to make a difference’, published in C. Horrocks and Johnstone (eds). (2012). Advances in Health Psychology: Critical Approaches. Hampshire: Palgrave MacMillan.