I'm back again with a bit of my more current work today. This was an assignment intended to be a critical review of Annemarie Mol's The Body Multiple (https://www.dukeupress.edu/the-body-multiple). Elements of this work and my engagement in this piece have also worked their way into some of the theoretical underpinnings of my thesis work around blockchain - it may not be obvious in this piece, but hopefully will become apparent at a later date.
I was also holding back on publishing this piece here for a while also because I presented the content at my sociology department's annual conference, as I wanted to get some feedback on the ideas. One of the biggest critiques that came up is that we should be careful about putting so much weight on conversation and community in the creation or definition of realities - that conversation doesn't just make something a reality. I agree with this, and attempted to temper that aspect of the concept at the end of the piece with the line "We must also be careful when using theories of multiplicity in relation to governance, in that multiplicity doesn’t mean everything is and can be true, but that enactment does play a role in creating a reality". This is also dealt with by Mol directly in her "more than one - but less than many" line. Because of the critiques so far, I wanted to highlight this point from the outset as well.
As always, this piece has NOT gone through the peer-review process, but any comments and critiques are welcome.
Putting Theory to Work: Policy Implications of Multiplicity
Written by Kris Jones December 2016
Annemarie Mol’s The Body Multiple (2002) explores the various ways that the disease atherosclerosis is enacted within a Dutch hospital. Throughout the book, it is shown how atherosclerosis exists in different ways and is interacted with differently depending on the individual, whether a patient, a general practitioner, a vascular surgeon, a pathologist or a laboratory technician. Each atherosclerosis is characterized by different features, which are closely tied to each person’s relationship to the disease or their job related to it. Mol is careful to highlight that there are not infinite realities, but the concept of numeracy in multiplicity is summed up with the simple phrase “... more than one – but less than many” (Mol 2002:55). Her aim for the book and discussion is to explore how both objective and subjective experience has an effect on the diagnosis and treatment of atherosclerosis. In this way, Mol examines not necessarily the science of medicine, but instead the ways in which medicine enacts disease, and the ways in which these enactments inform and create realities.
One of the ways that sociology generates value is through its contribution to the realm of social policy. If Mol’s idea of realities informed by enactment and ontological multiplicity are to be taken seriously, this has a direct effect on policy creation based on sociological research. How can we take these ideas and apply them to policy creation, when policy is generally considered to be a set of rules or actions to be taken that can be applied to any number of locations (Law and Singleton 2014)?
John Law has written about the application of ontological realities and multiplicity in relation to policy and politics in a number of papers, and refers to the intersection of the two as ontological politics. While the name may be self-explanatory as a combination of the concepts, it is an attempt to move politics beyond the old notion that a single reality can be observed, toward a more contemporary 21st century understanding that realities are multiple and complex, emphasizing that politics and policies should grapple with these in conjunction with the social sciences to produce more useful, if complex, policies.
In order to do this, Law suggests that “the social sciences need to re-imagine themselves, their methods, and their ‘worlds’” (Law and Urry 2004: 390). The re-imagining of the social sciences is not enough in and of itself, as this transformation needs to also occur in politics and policy work in order to be effective. This is not a simple change, nor will it be seamless or cheered on by those accustomed to doing these things according to an understanding of a single reality that can be exposed; the shifts will require significant work and are likely to be met with resistance. This line of thinking is an extrapolation indirectly from Mol when she talks about the created singularity of objects in order to reduce conflict: “... the singularity of objects, so often presupposed, turns out to be an accomplishment... It comes about by keeping divergent objects apart if bringing them together might lead to too much friction.” (Mol 2002: 119). It would follow that bringing multiple divergent objects back together may be met with resistance when their achieved separation and singularity reduced this. This may be particularly evident in policy work, where previous practices were concerned with universal translation based on a single set of ideas or understanding of reality.
The issue of integrating multiplicity into policy may not be as big a problem in theory as it initially seems, given that work has already been done to explore the gap between the intentions and aspirations of policy, and how effective the policy is in practice. These studies then proposed a change in the idea of what policy is, toward a more flexible approach through interaction and negotiation (Pressman and Wildavksy 1984 and Matland 1995 cited in Law and Singleton 2014:381). This approach is backed up by Jain (2011) where she identifies themes relating to contemporary policy development and the need to incorporate many different perspectives into policy in order for it to be effective.
The gap between policy goals in theory and the reality of policy in practice is well known in government.The existence of an explicit casework role in Minister’s offices is evidence of this. These employees work to investigate and facilitate mediation or changes to individual files and provide feedback on potential policy changes within the Minister’s offices, and can sometimes advocate on behalf of citizens to have a policy change or exception made. This is done occasionally, and is evidence that institutions, and government in particular recognize the need for exceptions based on individual realities on occasion.However, the current system recognizes these alternative individual realities as exceptions to the one-reality model as opposed to the existence of multiple realities proposed and theorized by Mol and others. As such, these policy exceptions are only a stopgap measure while meaningful change toward policy development that takes multiplicity into account is a larger task to tackle.
Now that some of the ideas around multiplicity and multiple realities have been introduced, and the evidence that institutions that create and practice policy are aware of the limitations of enforcing policy based on an understanding of a single reality, how do we productively and effectively move on from this? It is suggested by Law and Urry (2004) that there are a number of ways that this can be interpreted, though the most important realization coming from the idea of multiplicity, ontological politics and reality as enactments is that methodology also involves performativity, and has an influence on the realities that it enacts and produces (397). This is to suggest that using different methods may report different findings, but that each of these may be equally true and valid, but simply unlike each other (ibid). This is a similar idea to the ways different atherosclerosis are enacted in different departments of the hospital in The Body Multiple (Mol 2002). In some ways this is not a new idea, as sociologists have often studied social issues from a variety of perspectives and have reached different, though sometimes complementary, conclusions based on their theories and methodologies. What is new is that with the acceptance of the idea that reality is multiple and that methodology plays a role in both studying and creating the social must come the acceptance that sociology takes a political stance in its treatment and probing of issues (Law and Urry 2004). In practice, this negates the impartiality of methods, because by researching and coming to conclusions about anything is to also enact and actively create reality (ibid). In this way, methods need to be understood to be political given their role in creating reality.
The idea that methods must be considered to be political as a result of multiplicity has serious significance and relevance to governance and politics generally. While this may be a welcome shift towards activism and for some areas, it also creates difficulties, particularly in the realm of bureaucratic and democratic government systems. The reason for this is quite simple: there has long been a clear demarcation point between the political apparatus and the bureaucratic systems, using Canada as one example. The research and preparation of policy options and briefings for the political arm of government is done by the bureaucratic arm of government, and the bureaucratic arm is to be thought of as apolitical. However, if studying and utilizing particular methods serves to both study and produce effects, the bureaucracy is no longer able to hold an apolitical position.
We must also be careful when using theories of multiplicity in relation to governance, in that multiplicity doesn’t mean everything is and can be true, but that enactment does play a role in creating a reality. This is becoming increasingly apparent in the United States with the current administration headed by Donald Trump, and the apparent disregard for information that had been regarded as fact by previous administrations and experts at large. Mol touches on this in her discussion of controversies, and that controversies and tension between theories are in actuality social conflicts between people (Mol 2002:90). In this way, the Donald Trump presidency offers both insight and caution into the power of multiplicity and enactment and the ways they can be used to dismantle previously held ideas of truth and fact. It also shows the pushback against such ideas and use for the promotion of ideas that are not supported by enactment and adequate observable evidence.
The existence of multiple realities, or multiplicity as discussed by Mol in The Body Multiple, provides new insight into the social aspect of doing medicine and the effects that different enactments have on the construction of disease. While helpful in conceptualizing the differences in multiple cases of atherosclerosis, the concept of multiplicity could have far reaching implications in other areas if it is considered a legitimate applicable theory, particularly in the area of policy development. Although there are ways in which policy is understood to have multiple dimensions and appropriate times for exception, contemporary uses of policy tend to focus on translation and exception as opposed to multiple realities. We also must consider that a move to ontological politics will create a shift in which methodology takes on a political dimension because it works to enact and create the reality it is attempting to study. These are not simple shifts to make, and will almost certainly be met with resistance. Nonetheless, it is an important shift to examine, particularly given the political climate and utilization of similar ideas to gain political power in the United States. Multiplicity in policy and governance is not a simple idea to grapple with, but something that should be examined in detail to determine best uses and to understand the ways in which it creates power in today’s society.
REFERENCES
Jain, Chaya. 2011. “Acknowledging Multiplicity in Policy Work”. Public Administration Review71(6):951-2.
Law, John and John Urry. 2004. “Enacting the social”. Economy and Society 33(3):390-410.
Law, John and Vicky Singleton. 2014. “ANT, multiplicity and policy”. Critical Policy Studies8(4):379-96.
Mol, Annemarie. 2002. the body multiple: ontology in medical practice. London, UK. Duke University Press.