Impaired food: Routine, materiality and ontology in social care practice Presentation at the defence of the thesis (original) (raw)

In the Czech Republic, thousands of men and women identified as mentally impaired live in large residential institutions, many of them housing more than a hundred inhabitants. As part of the highly-institutionalized care routines followed by the staff of such “homes for people with health impairments”, they are served meals supposedly enhancing self-sufficiency and dignity and tailored to their “special needs”. However, despite the focus on individualisation and autonomy, the inhabitants of the asylums often get food that they cannot eat, or that they are forced to eat even if it does not suit them. The essays collected in this dissertation reflect upon six years of experience with a social invention project aimed at analysing and changing this situation. Through this reflection, the essays aim to enhance our understanding of the making of sociomaterially heterogeneous ‘objects’ – such as impaired food or mental impairment – in highly routinized everyday practices. Inspired by material semiotics, actor-network theory and disability studies, they investigate how different versions of mental impairment are enacted in repertoires of dining and how their encounters in the field of this activity disable/unable the various actors of residential care. Their main focus is on institutionalized care routines and their patterns, sociomateriality, force and durability, together with possibilities for formulating alternatives. Given the complex research environment riddled with numerous controversies regarding practices, ontologies and values, a praxiographic ethnography became the main research tool. Joint observations, interviews and discussions with communication partners were designed to comply with the key methodological rule of diplomatic ethnography: to “speak well to someone about something that really matters to that person”. This methodological dictum of Bruno Latour has been tested in a setting where some of the key actors not only meet considerable difficulties in voicing their matters of concern but are also disqualified as reliable witnesses by a strongly naturalised association with mental impairment. Staying true to the chosen approach meant paying heightened attention to the practical and embodied aspects of experience and sometimes also abandoning diplomatic negotiations for diplomatic arguing. It has been found that when the obduracy of the ordering arrangements is taken into account and values are honoured, the diplomatic argument might become a productive analytical tool. When discussing and doing “things that really matter”, the researchers and the communication partners discovered that among the many problems that are continually being addressed in residential institutions, a prominent role is played by “enhancing clients’ self-sufficiency when eating” and “professional blindness”, a characteristic of some of the staff members that allegedly hinders desirable interventions into the existing care routines. In our joint probing and intervening into “limited self-sufficiency” and “professional blindness”, neither of these qualities was found to be essential to the clients or the staff members. They appeared as heterogeneous quasi-objects/subjects, existing in a complex network of associations constituted by many human and non-human actors undergoing constant change. It has been found that “professional blindness” is not an impairment of sight or judgment, but an ordering of the network of care in which the space for promoting self-sufficiency is limited by existing regimes of haste, strongly influenced by the organizing object of mental impairment. In line with this insight, the main body of the research explores enactment of mental impairment in repertoires of dining, using diffraction of Annemarie Mol’s, Jeannette Pols’ and Ingunn Moser’s classical praxiographic studies as a means of analysis. In Hospital Z described in Mol’s book The Body Multiple, doctors, patients and various technical devices enact atherosclerosis, a disease to be cured. As almost everybody agrees that atherosclerosis is a useful object – in the sense that it enables treatment – its enactment could be described as the coordination and distribution of various versions of activities/objects. The object thus enacted is more than one and less than many. At Home Z in the Czech Republic, care workers, clients and various technologies and technical devices enact mental impairment, a disorder to be managed. The various different incarnations of the object in question – mental impairment enacted as a medical condition, as an object of care, as an opportunity for inclusion, as wickedness of the man-child, or as an object of critical attitude – are not made anew with the help of inscription devices, but are reiterated through many repertoires of care, including meal provision. Agreement on what mental impairment means is rare, and the utility of some of its versions is contested. Mental impairment is less than one and more than many, as none of its versions acquires coherence of a useful whole, and every practice of constructing it further multiplies incompatibilities. In addition to activities of coordination and distribution, which hold atherosclerosis together in Hospital Z, the infelicitous object of mental impairment is saved through thinking/acting from where one is (not), an activity which simultaneously relates to and denies multiplicity, often with disastrous effects on the intimately related subjects. But food, thanks to its fluid materiality, can become a space for enacting other ‘objects’ besides mental impairment. In efforts to change impaired meals into more a pleasurable experience, the home-like meal is supposed to infuse the residential institutions with home-like qualities. Staff members serving meals in “households”, organisational units built to provide domesticity, consider privacy and autonomy important characteristics of a home-like meal and strive to provide meals of the same qualities to the diners. At the same time, they consider this task impossible given the current orderings of the network of care. This discrepancy between the assessment of the current state of affairs and the desired ends in view is displaced by labelling the diners mentally impaired, in this specific case incapable of understanding and thus of enjoying the home-like meal. The text ends by retelling the story of one of the few former “home” residents. By leaving the institution but staying well-attached, he has enacted another version of home beyond the institutionalised discourses of communality and privacy, one conceptualized here as an intimate sphere. When evaluating the potential of different versions of home-like meal for driving reform, the conclusion is made that effective reform must be defined pragmatically, as one that cannot be pacified by the strategy of labelling. Like the repertoires of dining which it seeks to describe, this dissertation enacts mental impairment in a number of different and partially disparate ways. A methodological problem of re-telling accounts that nobody takes seriously, a rationale and an obstacle to heterogeneous socio-material practice of enhancing self-sufficiency, an unhappy object multiple held together by practices of adiaphora and by ghosts of the past, or a labelling strategy creating a semblance of home where there is none – all this is mental impairment as enacted by the individual chapters in this collection. If there is one single moral within this diversity, it is this: Mental impairment could be otherwise. Like many other biological entities aka scientific facts, it is not destiny. And the main objective of this collection is to open a path to this otherwise by deconstructing, as John Law puts it, the “commitment to visible singularity” that “not only hides the practice that enacts it, but also conceals the possibility that different constellations of practice and their hinterlands might make it possible to enact realities in different ways”.