blips

Logic of Care - book cover

In looking for ways to frame my research on wrist pain and ergonomics w/r/t typing and computing (for my upcoming Computers and Writing presentation), I ran into this slim book by Annemarie Mol.  Familiar with her work in Actor-Network Theory, I was interested to see how she’d use those insights in a work clearly aimed at a wide, less specifically science-studies audience.  Also, I was hoping to see some parallels to my research into techne (tekhne), as the art of medicine has often been used as an example/illustration of this concept.  The book delivered on both counts.

Mol describes two competing and opposed logics in health care–the logic of choice, defined by the movement for “patient choice”, and the logic of care. Aware that many folks from diverse (left and right) camps promote patient choice as an unqualified good (used to counter paternalistic doctors and paternalistic government programs alike), Mol carefully lays out her skepticism with the way the logic of choice plays out in practice.  She uses the case of diabetes care as the particular lens with which to explore the ways these logics play out in medical care. Through a variety of examples and stories from consulting rooms, she analyzes these logics by exploring several themes: the market (the difference between customers and patients), the public (the difference between citizens and patients), and individuals vs collectives. For instance, in her analysis of the marketing of blood sugar testers, she contrasts the logic of care with that of choice by arguing that “Care is a process: it does not have clear boundaries. It is open-ended” (18). Choice, on the other hand, needs to be spelled out at the forefront–what is offered, what will be the result, etc. She continues:

When it calls patients ‘customers’ the logic of choice opens up splendid panoramic views. From the top of the mountain you see no suffering. The language of the market contains only positive terms. Products for sale are attractive. Tellingly and non-neutrally, they are called ‘goods’. The logic of care, by contrast, starts out from something negative: you would prefer not to have diabetes. And if you do, you will never be healthy again. But the fact that health is out of reach does not mean that you should give up. The active patient that the logic of care tries to make of us is a flexible, resilient actor who, by caring, strives after as much health as her disease allows. What the results of the joint activities of a care team turn out to be is uncertain. Diseases are unpredictable. The art of care, therefore, is to act without seeking to control. To persist while letting go. That is care: wherever you are, if you need to, you sit down, prick the side of your fingertip, squeeze out some blood, put the test strip into the blood sugar monitor, and wait for the results to appear on the screen. (p. 28, emphasis mine)

This paragraph neatly describes a techne ready to face a seemingly random and unpredictable world.  Additionally, I think it translates well to what I’m tracking down with computing and hacking/diy activity.  Successful digital rhetors (technorhetoricians?) learn about software and hardware and act from that knowledge, but also remain attentive to the slippage between what they expect to happen and what will happen.  I save my text in Word frequently knowing that it could crash “unexpectedly.”  I install new software after reading about its features, but am ready to play with it in an open-ended fashion to explore what it might unpredictably offer.  Digital rhetors know they can’t control computers, like people with diabetes know they can’t will their cells to process sugar properly–but both groups act regardless and in full awareness of the limits of their actions and expectations.