Medication as Infrastructure: Decentring Self-care
Keywords:Self-care, infrastructure of care, medication, chronic conditions, exnovation
Drawing on science and technology studies (STS), and specifically the concept of infrastructure as conceptualised by Bowker and Star (2000; Star 1999), this paper argues and empirically demonstrates that self-care may be considered a practice that is thoroughly sociotechnical, material, distributed and de-centred. Comparing the practices related to medication in the treatment of asthma, type 2 diabetes and haemophilia, we show that in practice there is no ’self’ in self-care. More specifically, the ’self’ in self-care is an actor who is highly dependent on, and intertwined with infrastructures of care, in order to be self-caring. Infrastructures of care are the more or less embedded ’tracks’ along which care may ’run’, shaping and being shaped by actors and settings along the way. Obtaining prescriptions, going to the pharmacy, bringing medication home and administering it as parts of daily life are commonplace activities embedded in the fabric of life, especially for those living with a chronic condition. However, this procurement and emplacement of medication involves the establishment and ongoing enactment of infrastructures of care, that is, the connections between various actors and locations that establish caring spaces and caring selves.
Locations and actors are included as allies in treating chronic conditions outside the clinical setting, but these infrastructures may also be ambiguous, with respect to their effects; they may simultaneously contribute to the condition’s management and neglect. Particularly precarious is management at the fringes of healthcare infrastructure, where allies, routines and general predictability are scarce. We conclude by arguing that these insights may induce a greater sensitivity to existing infrastructures and practices, when seeking to introduce new infrastructures of care, such as those promoted under the headings of ’telemedicine’ and ’healthcare IT’.
Aarhus, Rikke & Stinne Aaløkke Ballegaard (2010): “Negotiating Boundaries: Managing disease at Home”, Proceedings of the 28th international conference on Human factors in computing systems, 1223-1232.
Akrich, Madeleine (1995): “The De-scription of Technical Objects”, Wiebe Bijker and John Law (eds): Shaping Technology/Building Society: Studies in Sociotechnical Change, Cambridge MA.: MIT Press, 205-224
Bateson, Gregory (1973): Steps to an Ecology of Mind, Chicago: University of Chicago Press.
Bowker, Geoffrey (1994): Science on the Run: Information Management and Industrial Geophysics at Schlumberger 1920-1940, Cambridge, MA: MIT Press.
Bowker, Geoffrey & Susan Leigh Star (2000): Sorting Things Out: Classification and its Consequences MIT Press.
Charmaz, Kathy (1993): Good Days, Bad Days: The Self in Chronic Illness and Time Rutgers University Press.
Clarke, Adele (2005): Situational Analysis: Grounded Theory after the Postmodern Turn, Thousand Oaks CA: Sage Publications.
Cocksedge, Simon & Carl May (2005): “Pastoral Relationships and Holding Work in Primary Care: Affect, Subjectivity and Chronicity”, Chronic Illness, 1:2, 157-163.
Corbin, Juliet & Anselm Strauss (1985): “Managing Chronic Illness at Home: Three Lines of Work”. Qualitative Sociology 8:224-47.
Corbin, Juliet & Anselm Strauss (1988): Unending Work and Care: Managing Chronic Illness at Home, 1st ed. San Francisco: Jossey-Bass Publishers.
Danish Regions (2011): Strategi for IT-Understøttelse af Patient Empowerment, Regionernes Sundheds-IT.
Dean, Mitchell (1999): Governmentality: Power and Rule in Modern Society, Thousand Oaks, CA: Sage.
Department of Health (2007): http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_5711554 (accessed 2012-04-01)
Duff, Cameron (2011): “Networks, Resources and Agencies: On the Character and Production of Enabling Places”, Health & Place, 17:1, 149-156 .
Garfinkel, Herold (1967/1991): Studies in Ethnomethodology, Cambridge: Polity.
Gomart, Emily & Antoine Hennion (1999): “A Sociology of Attachment: Music Amateurs, Drug Users”, in John Law and John Hassard (eds): Actor Network Theory and After, Oxford, Malden MA: Blackwell/Sociological Review, 220-247.
Heidegger, Martin (1927): Being and Time, Malden MA: Wiley-Blackwell.
Hodgetts, Darrin, Kerry Chamberlain, Jon Gabe, Kevin Dew, Alan Radley, Helen Madden, Pauline Norris & Linda Waimarie Nikora (2011): “Emplacement and Everyday Use of Medications in Domestic Dwellings”, Health & Place, 17:1, 353-360.
Jensen, Casper Bruun (2010): Ontologies for Developing Things: Making Health Care Futures Through Technology, Rotterdam: Sense Publishers.
Langstrup, Henriette & Brit Ross Winthereik (2010): “Producing Alternative Objects of Comparison in Healthcare: Following a Web-based Technology for Asthma Treatment through the Lab and the Clinic”, Thomas Scheffer & Jörg Niewöhner (eds): Thick Comparison: Reviving the Ethnographic Aspiration, Leiden; Boston MA: Brill,103-128.
Latour, Bruno (1987): Science in Action: How to Follow Scientists and Engineers through Society, Cambridge MA: Harvard University Press.
Latour, Bruno (1999): Pandora’s Hope: Essays on the Reality of Science Studies. Cambridge MA: Harvard University Press.
Latour, Bruno (2000): “On the Partial Existence of Existing and Non-existing Objects”, Lorraine Daston (ed.): Biographies of Scientific Objects, University of Chicago Press, 247-269.
Latour, Bruno (2002): Aramis or the Love of Technology, 4th ed. Cambridge MA: Harvard University Press.
Latour, Bruno (2004): Politics of Nature: How to Bring the Sciences into Democracy, Cambridge MA: Harvard University Press.
Law, John & Inguun Moser (1999): “Good Passages, Bad Passages”, John Law & John Hassard (eds): Actor Network Theory and After, Oxford; Malden, MA: Blackwell/Sociological Review, 196-219.
Leder, Drew (1998): “A Tale of Two Bodies: the Cartesian Corpse and the Lived Body”, Don Welton (ed.): Body and Flesh: a Philosophical Reader, Oxford: Blackwell-Wiley, 17-36.
May, Carl (2010): “Rethorizing the Clinical Encounter: Normalization Processes and the Corporate Ecologies of Care”, Graham Scambler & Sasha Scambler (eds): New Directions in the Sociology of Chronic and Disabling Conditions, Palgrave Macmillan, 129-45.
Mesman, Jessica (2008): Uncertainty in Medical Innovation: Experienced Pioneers in Neonatal Care, Basingstoke, New York: Palgrave Macmillan.
Mol, Annemarie (2002): The Body Multiple: Ontology in Medical Practice, Durham: Duke University Press.
Mol, Annemarie (2008): The Logic of Care: Health and the Problem of Patient Choice, Oxon: Routledge.
Mol, Annemarie, Inguun Moser & Jeannette Pols (eds) (2010): Care in Practice: On Tinkering in Clinics, Homes and Farms, Bielefeld: Transcript Verlag.
Peters, Peter Frank (2006): Time, Innovation and Mobilities: Travel in Technological Cultures, London: Routledge.
Prout, Alan (1996): “Actor-network Theory, Technology and Medical Sociology: An Illustrative Analysis of the Metered Dose Inhaler”, Sociology of Health and Illness, 18:2, 198-219.
Scambler, Graham & Sasha Scambler (eds) (2010): New Directions in the Sociology of Chronic and Disabling Conditions: Assults on the Lifeworld, New York: Palgrave Macmillan.
Scheffer, Thomas & Jörg Niewöhner (eds) (2010): Thick Comparison: Reviving the Ethnographic Aspiration. Leiden; Boston MA: Brill.
Star, Susan Leigh (1999): “The Ethnography of Infrastructure”, American Behavioral Scientist, 43:3, 377.
Star, Susan Leigh & Karen Ruhleder (1994): “Steps Towards an Ecology of Infrastructure: Complex Problems in Design and Access for Large-scale Collaborative Systems”, Proceedings of the 1994 ACM conference on Computer supported cooperative work, 253–264.
Strauss, Anselm, Shizuko Fagerhaugh, Barbara Suczek & Carolyn Wiener (1985): The Social Organization of Medical Work, New Brunswick: Transaction.
Suchman, Lucy (1995): “Making Work Visible”, Communications of the ACM, 38:9, 56–64.
Suchman, Lucy (2002): “Located Accountabilities in Technology Production”, Scandinavian Journal of Information Systems, 14:2, 7.
WHO (1998): http://www.asmi.com.au/self-care/What-Is-Self-Care.aspx (accessed 2012-04-01).
Willems, Dirk (1995): Tools of Care: Explorations into the Semiotics of Medical Technology, PhD Diss.; University of Maastricht.
Willems, Dirk (2000): “Managing One’s Body Using Self-management Techniques: Practicing Autonomy”, Theoretical Medicine and Bioethics, 21:1, 23–38.
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