Process philosophy in healthcare - Part 2
There are no things in process philosophy
There’s been a lot of interest in process philosophy concepts and ideas in recent years, especially in the more avant-garde qualitative health literature. Terms like assemblage, bricolage, indeterminacy, interstitial space, lines of flight, movement, nomadism, and rhizomes are becoming increasingly popular.
I suspect some of the people using these terms don’t realise these derive from process philosophy. I also suspect that some of these terms are being misused; coopting the new funky language of flux and flow where the work itself is anything but.
But I also think it’s actually really hard to work with process philosophy or, at least, to abandon the substance philosophy we’ve been socialised to for generations.
If you’ve been raised to practice, think and research in the classical Western tradition of reductive, humanistic, instrumental science — as almost all of us have — turning your back on it and adopting an entirely new philosophy is incredibly hard; even if the evidence for process philosophy is all around us all of the time.
So the biggest challenge to anyone wanting to use process philosophy is to fully embrace it and not just use process-lite language to mask an otherwise substance-based metaphysics.
What then are the traps that substance metaphysics lays for us, and how might we know if we’ve truly avoided them?
Let’s begin with the biggest: the pull to give the thing a name.
We think in terms of things
The first, and most obvious, substance-based Heffalump trap we have to face is whether we talk about things, objects, matter, stuff, the furniture of the world, identities, labels, signs or taxonomic references when we should be talking about processes.
Throughout almost the entire history of Western philosophy, and especially since the Renaissance, the concept of substances has dominated thought.
And yet the closest process philosophy gets to the existence of any fixed or stable ‘thing’ is to use terms like metastable states (Nail 2024), temporary concrescences, or actual occasions (Whitehead 1929/1978).
There really are no things in process philosophy.
Now, imagine what this means for how you normally think about health and healthcare.
Try this short exercise: describe your specialist area of work without referring to any fixed, stable, named thing: individual or collective, real or imagined. Hard, isn’t it.
It’s hard because in the Western metaphysical tradition, you and not you are fundamental philosophical absolutes. God made man, didn’t He (sic)? He didn’t make an ongoing process of material flows that manifested temporarily in metastable states that embodied a form we might call Adam and Eve.
So, it’s a cornerstone of substance thinking that we can distinguish ourselves from others.
This idea manifests in so many ways: especially in references to ourselves as autonomous and independent entities, and in our labelling of things and conferring ‘identities’ on all of the stuff around us — actual and virtual, real and imagined, material and immaterial.
Of course, the surrealists were mocking this kind of fixation on immovable, fixed, static things more than a century ago. But such substance-based thinking holds hard in healthcare.
This is not a pipe, it’s a painting of a pipe.
And this isn’t a right sided pneumothorax, it’s a two-dimensional representation of tissue density.
If you were seriously trying to use process philosophy, then, you would have to remember that nothing is ever fixed or stable long enough to bear anything that might serve as a defined identity.
Even when people talk about assemblages and use hyphens to connect different things (the midwife-mother-pregnancy assemblage, for instance), you are still defining three fixed identities and so being pulled back into the Western world of substance thinking.
There is no ‘being’ in process philosophy, only becoming.
An example and some prompts
Here’s the abstract from a paper from 2019 to illustrate the problems of applying process philosophy. There are some questions below that this abstract made me ponder.
‘This paper plateau describes children's interspecies relation with a classroom canine, utilising posthumanism, post-structuralism and new materialism as its research paradigm and methodology. Once feelings are cognitised or articulated, their true essence can be lost. Therefore, elucidating moment-to-moment child-dog interactions through the lens of affect theory attempts to materialise the invisible, embodied, 'unthought' and non-conscious experience. Through consideration of Deleuzian concepts such as the 'rhizome' and 'Body-without-Organs' being enacted it illuminates new, 'situated knowledge'. This is explicated and revealed using visual methods with 'data' produced by both, the children and their classroom dog such as photographs and video footage mounted on the dogs harness, from a GoPro micro camera. In addition, individual drawings, artefacts and paintings completed by the children are profound points in the research process, which are referred to as 'plateaus'. These then become emergent as a children's comic book where their relationship with 'Dave', their classroom dog is materialised. Through their interspecies relationship both child and dog exercise agency, co-constitute and transform one another and occupy a space of shared relations and multiple subjectivities. The affectual capacities of both child and dog also co-create an affective atmosphere and emotional spaces. Through ethnographic, participant observation and the 'researcher's body' as a tool, they visually create illustrations through the sketching of 'etudes' (drawing exercises) to draw forth this embodied experience to reveal multiple lines and entanglements, mapping a landscape of interconnections and relations’ (Carlyle 2019).
Questions and prompts for thoughts:
If the body-without-organs can be read as a body that is not organised into a fixed form, how strongly did you feel the author relied on the fixed identities and normalised social distinctions between the children and the dog to make their case? (I note the dog was called Dave. Apart from this being a clear ‘tell’ of substance-based metaphysics coming through, I’d like to point out that this had nothing to do with me critiquing this paper.)
What did this study add that other existing philosophies and methodologies could not have achieved through arts-based critical theory or post-phenomenology, for example? In other words, what made the ‘process’ difference here?
Did the researcher need to retain their stable identity to do the research? Their use of participant observer and ethnographic methods suggests they did.
Thinking not in terms of things, objects or matter but in terms of true processes seems like it would be a major shift in the way we do quantitative and qualitative research. But we’re only just getting started!
In the next post I’ll move on to another of the substance-based Heffalump traps and talk about the thorny subject of transcendence.
References
Carlyle D. (2019). Walking in rhythm with Deleuze and a dog inside the classroom: being and becoming well and happy together. Medical humanities, https://doi.org/10.1136/medhum-2018-011634
Lenton, T. M., Dutreuil, S., & Latour, B. (2024). Gaia as Seen from Within. Theory, Culture & Society, https://doi.org/10.1177/02632764241275574
Nail, T. (2024). The Philosophy of Movement: An Introduction. University of Minnesota Press.
Whitehead, A. N. (1929/1978). Process and reality. Free Press.