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Risky Maps for Contested Territories

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... Although several researchers state that they used an ethnographic approach, many do not provide detailed descriptions of how they analyze data. This is consistent with McGrail's (2005) observation that the practical difficulties for those engaged in ANT studies are often obscured. Initially, I gathered six case studies to serve as insight cultivators into the process of using ANT to analyze and write my study. ...
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... The map that we create cannot possibly articulate the near-infinite amount of detail that characterizes all phenomena, but if we hope to avoid prematurely assigning causation, we must nevertheless attempt to explicate all those points of translation that are essential to the assemblage we are following. As McGrail puts it, a good ANT map will always be stubbornly situated: " performing its terrain well for some purpose without becoming a general model waiting to swallow up distant settings or implying undue relevance to 'Cleopatra's nose' 3 by blindly following actors " (McGrail 2005: 129). Drawing attention to the points of translation, and the practices of interessement, enrolment and the activities of spokesagents should insure that our map of the medical practices involved in a diagnosis is sufficiently detailed while remaining void of unnecessary, banal detail. ...
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This project is an investigation into medicine in action. The aim is to understand how medical interactions generate order via the diagnosis of disease; how the patient, the body, and illness are made intelligible, and how particular courses of action are decided upon as a result. Using video and audio data supplied by the Applied Research on Communication in Health (ARCH) research team, this project follows Simon, a middle aged, Caucasian male with chest pain, as he participates in consultations with his GP and cardiologist, and as he undergoes a cardio treadmill-stress test. This project argues for adopting an Actor-Network theory (ANT) based approach to studying interactions. Unlike more traditional sociology approaches, this project considers the role of non-human objects in interaction. Non-human objects are often key actors in the interactions that provide the world with a sense of order. I will provide an epistemological justification for ANT's key premises and outline the method that these premises entail. Following three interactions, this project illustrates that the principal actors involved in producing intelligibility varies. In the GP consultation, the GP and Simon were principal actors in rendering chest pain intelligible. In the treadmill stress test, the material instrumentation, carefully aligned with the Simon's body by the cardiologist, was vital to ensuring a particular account of the heart was produced. Simon was little more than a compliant body in this interaction. In the final interaction, the cardiologist was the principal actor in making sense of these accounts of chest pain and the potentially conflicting picture of the "healthy" heart. The cardiologist suggests that the account of the heart produced by the treadmill-stress test may be flawed, and encourages Simon to self-monitor and self-regulate. I will argue that the uncertainty generated by conflicting accounts is common to medical practices. Medical professionals respond to this by encouraging individuals to monitor and reduce risk. By adopting the ANT approach, I found that the patient and his body are sometimes intelligible as somatic entities, sometimes as an expressive, accounting agent, and sometimes as a self-responsible individual. These various renditions hold together as a being a single individual "Simon".
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Using a material semiotics methodology, this paper explores the link between diagnostic practices, patient awareness of the body, and biopolitical governance. We collected video and audio recordings of a patient with chest pain involved in three medical interactions (a general practitioner [GP] consultation, an electrocardiogram stress test and a consultation with a cardiologist) in Wellington, New Zealand. Following the work of Annemarie Mol, we argue that each of these diagnostics interactions bring together a range of material and non-material entities that enact the body and disease. Consequently, we note how the diagnostic practices associated with cardiovascular medicine enable and prompt an awareness of the body based on uncertainty, and thus promotes the self-management of cardiac health and risk. This paper illustrates that a material semiotics methodology makes important contributions to the sociology of diagnosis. Firstly, it draws attention to the relationship between humans and material entities in rendering the body intelligible. Secondly, it illustrates that different diagnostic procedures can produce multiple, potentially conflicting, forms of self-awareness. Alongside these practices generating multiplicity, however, are those that presuppose and produce singularity and coherence. We illustrate how the cardiologist "patches" two potentially conflicting diagnoses together in order to provide a sense of coherence to the interactions. Thirdly, material semiotics illustrates how various diagnostic practices can reify risk, and produce bodies that lend themselves to particular forms of governance.
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