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Deconstructing Evidence-Based Practice
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Author(s):
Dawn Freshwater
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Gary Rolfe
Publication date
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August 2 2004
Publisher:
Routledge
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ISBN (Electronic):
9781134305452
Publication date (Online):
August 2 2004
DOI:
10.4324/9780203422311
SO-VID:
b0574867-4060-403e-a504-edc450890f67
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Book chapters
pp. 9
The authority of the 'is'
pp. 21
Preface 2 The first time I saw Jacques Derrida
pp. 22
next'.
pp. 23
taking in the scenery, whereas, as I said, Derrida was burrowing. Barthes was writing himself when I first saw him ('I am writing a text, and I call it RB' , as he famously said); Derrida was just writing. That is to say, he was writing a text. But that is also to say that he was doing far more than writing a text, if by writing we mean 'to make letters or other symbols on a surface, especially with a pen or pencil on paper', or even 'to compose in written form for publication', and if by a text we mean 'the wording of something written or printed or the main body of a book or page' ' ' . No,
pp. 24
of different typefaces. This is a strategy that Derrida is also fond of (see, for example, Dissemination and Glas), although he rarely provides a key to his typographics. The key employed in this book is simple. Most chapters in this book begin with a pre-text, a leading-in, which is also a pretext, an excuse (but also a concealment) for what follows. The text you are now reading is a pre-text, and is denoted by this standard serif typeface. All chapters include a con-text, a thesis, which also provides the context, situation or 'original meaning' of the chapter. The con-text is denoted by this sanserif typeface. However, you have seen that Derrida (along with Barthes) rejects the idea of original authorial meaning in favour of a multiplicity of meanings that are 'read in' by the multiple readers of the text. Most of the chapters therefore also include at least one sub-text, a deconstructive excavation of the con-text, a burrowing into its subconscious, which is also a subtext, an occult or hidden mean ing, one of many (an infinitude?) alternative readings. The sub-text i s denoted by thistypewriter -l ike font to remind you that deconstruction isfirst and foremost an act of writ ing . In addition to the micro level of the individual chapters, the book as a whole is also divided into three parts that function as pre-text, con-text and sub-text on a macro level. Pre-text: before the text, explaining deconstruction, justifying it, providing it with a pretext. Con-text: with the text, weaving together deconstruction and evidence-based practice, situating it, providing it with a context. Sub-text: beneath the text , delving into the foundations of deconstruction, exploring itsroots , providing i t with a subtext.
pp. 26
employed both metaphorically and literally in what becomes a spiral labyrinth. Metaphorically, 'Tympans' is an investigation into the marginalisation of the term 'outer' of the binary pair 'inner:outer'. In the left hand col umn is the philosophical discussion of the inner and the outer that begins: 'To tympanize - philosophy', with a translators note pointing out that 'In French, tympaniser is an archaic verb meaning to criticize, to ridicule publicly' . In the right hand column is a long quotation from the memoirs of the writer Michel Leiris which meditates on the spiral shape in nature. This juxtaposition of two seemingly unrelated texts points to another theme running throughout the work of Derrida, that of the play on similar sounding words. In this case, the play is clearly on the word tympaniser, to critique, and also the tympanic membrane, which en closes the spiral shaped cochlea of the inner ear. You might also note that the quotation from Leiris is from a chapter entitled 'Persephone' and that one of its subjects is the earwig, the perce-oreille (literally, ear-piercer), which not only sounds similar to Persephone, but also continues the theme of the outer and the inner, and in particular, of the attempts to reinstate the marginalised term (outer) as equal to its binary opposite (inner) (that is, of the attempt of the outer to pierce the inner). You can see, then, that Derrida intends his writing to operate on many different metaphoric levels. But as I have said, the theme of the margin is also played out literally, since the text is arranged on the page as two unequal columns, one of which appears to be the margin of the other. As Peggy Kamuf points out: By means of these typographics, Derrida contrives to proliferate the margins on which and in which he is writing. In its much narrower column, the Leiris quotation appears to be written in the margin of Derrida's column on the left, whereas the space between the two is a thin blank column running down the right third
pp. 27
of the page . She continues: Although Derrida never explicitly refers to the quotation, it incessantly crosses over the minimal barrier set up to its left and intrudes on the space reserved for the introductory discourse . What, then, is the relationship between these texts? Is Derrida's writing a pre-text to Leiris or is it a deconstructive sub-text? Or, indeed, is there some other relationship? As I have said, Derrida gives very few clues. I turn now to Derrida's other and more famous/notorious deployment of parallel texts in columns on the same page. Glas, first published in
pp. 28
into the column at various points, forming inscribed incisions either along its outermost edge, or down the center. There are no notes, no chapter headings, no table of contents. Each column begins in what appears to be the middle of a sentence and ends, 283 pages further on, without any final punctuation . Or, as Derrida puts it, in the right-hand column of page 1 (the square brackets contain translators' notes): Two unequal columns, they say distyle [disent-ils], each of which -envelop(e)(s) or sheath(es), incalculably reverses, turns inside out, replaces, remarks, overlaps [recoupe] the other .
pp. 29
keeping two distinct narrative follow both sets of ideas voices in your head at the same simultaneously and accurately. time. Ready? Well: you'll recall that Ready? Well: when I re-entered chapter before last I declared to my office the clock in the tower Mister Haecker that anyone who of the Municipal Building was wishes.. . just striking two... Have you got the knack? In Preface 3 you will have the opportunity to put your new-found reading skills to the test. Notes 1 Derrida, J. (1972) Positions, Chicago: University of Chicago Press, 1982 2 Derrida, J. (1972) Dissemination, London: Athlone, 1981, p.15 3 Ibid., p.7, emphasis in original 4 Ibid., p.75 Ibid., p.76 Spivak, G.C. Translator's preface. In J. Derrida (1967) Of Gramma-tology, Baltimore: The Johns Hopkins University Press, 1976, p.xii 7 Derrida (1972) Dissemination, op. cit., p.38 Johnson, B. Translator's preface. In Derrida, ibid., p.xxxii 9 Cixous, H. (1994) What is it o'clock? Or the door (we never enter). In H. Cixous Stigmata, London: Routledge, 1998, p.57 10 van Manen, M. (1990) Researching Lived Experience, Ontario: Althouse, 1997 11 Barthes, R. (1975) Roland Barthes, Basingstoke: Macmillan, 1995, p.56 12 Oxford Paperback Dictionary, Oxford: OUP 13 Derrida, J. (1967) Of Grammatology, op. cit., p.158 14 Ibid., p.158 15 Derrida (1972) Dissemination, op. cit. 16 Derrida, J. (1986) Glas, Lincoln: University of Nebraska Press, 1990 17 See translator's note in Derrida, J. Points..., Stanford: Stanford University Press, 1995, p.90
pp. 30
Derrida, J. (1980) The Postcard: From Socrates to Freud and Beyond, Chicago: The University of Chicago Press, 1987, p.25 19 Tissue, from the early French tissu, woven 20 Text, from the Latin texere, to weave 21 Derrida, J. (1967) Form and meaning: a note on the phenomen ology of language. In J. Derrida, Margins of Philosophy, New York: Harvester Wheatsheaf, 1982, p.160 22 Derrida, J. The double session, Tel Quel, whole issues 41 & 42 23 Derrida, J. (1970) The double session. In Dissemination, op. cit., pp.173-285 24 Derrida, J. (1972) Tympan. In J. Derrida Margins of Philosophy, New York: Harvester Wheatsheaf, 1982, pp.ix-xxix 25 Ibid.,p.x 26 Kamuf, P. (ed) A Derrida Reader: Between the Blinds, New York: Harvester Wheatsheaf, p.146 27 Ibid.,p.l46 28 Derrida Glas, op. cit. 29 Kamuf, op. cit., p.315 30 Derrida Glas, op. Cit., p.1 31 Kamuf, op. cit., p.315 32 Barth, J. (1956) The Floating Opera, New York: Bantam, 1972, p.168
pp. 31
Preface 3 The event of a narrative
pp. 32
which the message is delivered, its 'subliminal charge', is at least as important as the message itself. A constant theme throughout Derrida's work has been his insistence that speech and writing are
pp. 34
Bass, A. Translator's introduction. In J. Derrida Writing and Difference, London: Routledge, 1978, pp.301-2
pp. 42
Preface 3
pp. 53
The event of a narrative
pp. 57
Deconstruction
pp. 93
Deconstruction 2
pp. 94
Of is a 350-page deconstruction of the 'Spoken
pp. 104
of a recognised
pp. 129
That dangerous supplement... 123
pp. 132
Deconstruction 3
pp. 135
is taken to be "out there", inde-
pp. 152
Dissent in the academy According to Karl Marx, the purpose of intellectual inquiry was not simply to understand the world, but more importantly, to change it. Whilst Marxism is no longer influential within universities, the last forty years has seen a dramatic rise in the number of new social movements seeking to change the way our societies are organised. Hence, 'New developments in social theory, in the form of postmodern and post structuralist theory, have replaced Marxism as a way of thinking critically about the world.. . ' . Thus, whilst Althusser viewed Marxism as a science, the critical theorists see it as an emancipatory movement akin to psychoanalysis. Postmodern and poststructuralist thought poses serious challenges to the epistemological foundations of both Marxism and critical theory, proposing a further way of being critical in the academy. This paradigm atic shift, away from assumptions that the external world can be appre hended accurately through the senses and via information processing systems, leads to the belief that it is impossible to view the world directly. This shift is often referred to as the shift from 'world to word' . 'Know
pp. 153
Potter, J. and Wetherell, M. Discourse and Social Psychology: Beyond Attitudes and Behaviour, London: Sage, 1987 6 Billig, M. Talking of the Royal Family, London: Sage, 1999 7 Gergen, K.J. The social constructionist movement in modern psychology, American Psychologist, 1985, 40, 266-275 8 Lomax, Y. Writing the Image: An adventure with Art and Theory, London: I.B. Tauris, 2000 9 Mann, D. Psychotherapy: An Erotic Relationship, London: Routledge, 1997 10 Bruna-Seu, I. Change and Theoretical Frameworks. In I. Bruna-Seu & M. Colleen Heenan (eds) Feminism and Psychotherapy, London: Sage, 1998, p.204 11 Foucault, M. The History of Sexuality. Vol. 1: An introduction, Harmondsworth: Penguin, 1981, p.204 12 Laing, R.D. The Facts of Life, Harmondsworth: Penguin, 1976, p.85 13 The New Penguin English Dictionary, Harmondsworth: Penguin 14 Laing, R.D. The Voice of Experience: Experience, Science and Psychiatry, Harmondsworth: Penguin, 1982, p.53 15 Parker, I. Discursive Psychology. In D. Fox & I. Prilleltensky (eds) Critical Psychology, London: Sage, 1997 16 Potter & Wetherell, op. cit. 17 Gordon, P. Therapy as Ethics, London: Constable, 1999, p.36 18 Rogers, op. cit., p.210 19 Ibid., p.210 20 Jacoby, M. The Analytic Encounter: Transference and Human Relationship, Toronto: Inner City Books, 1984 21 Foucault, M. Power/Knowledge: Selected Interviews and Other Writings, 1972-77, Brighton: Harvester, 1980 22 Jacoby, op. cit., p.105 23 Ibid.,p.ll2 24 Twiggs, J. Transferences, Fayetteville: University of Arkansas Press, 1987 25 Strachey, J. Footnote in S. Freud & J. Breuer (1895) Studies on Hysteria, Harmondsworth: Penguin Books, 1974, pp.95-6 26 Jones, E. Sigmund Freud: Life and Work, Vol. 1, London: The Hogarth Press, 1956, p.247
pp. 154
Twiggs, op. cit. 28 Freud, S. (1917) Introductory Lectures on Psychoanalysis, Harmondsworth: Penguin, 1974, p.496 29 Rogers, C. (1987) Reflection of feelings and transference. In H. Kirschenbaum & V.L. Henderson (eds) The Carl Rogers Reader, London: Constable, 1990, p.134 30 Twiggs, op. cit. 31 Haule, J. The Love Cure, Therapy Erotic and Sexual, Dallas: Spring, 1996, p.55 32 Schwartz-Salant, S. The Mystery of Human Relationships: Alchemy and the Transformation of Self, London: Routledge, 1998, p.2 33 Ibid., p.112 34 Donleavy, P. Analysis and Erotic Energies in The Interactive Field In Analysis, Illinois: Chiron, 1995, p.110 35 Casement, P. On Learning from the Patient, London: Routledge, 1985 36 Laing, R.D. The Facts of Life, op. cit., p.110 37 Jacoby, op. cit., p.109 38 Ussher, J. Women's madness: a material discursive intrapsychic approach. In D. Fee (ed) Pathology and Postmodernism, London: Sage, 2000, p.218 39 Parker, op. cit., p.36 40 Bruna-Seu, op. cit., p.206 41 Hollway, W. Gender difference and the production of subjectivity. In J. Henriques, W. Hollway, C. Urwin, C. Venn, V. Walkerdine (eds) Changing the subject: Psychology, Social Regulation and Subjectivity, London: Routledge, 1984 42 Harper, D.J. Discourse analysis and 'mental health'. Journal of Mental Health,1995, 4, 347-357 43 Billig, op. cit. 44 Bordieu, P. Pascalian Meditations, Cambridge: Polity Press, 2000 45 Phillips, R. The need for research-based midwifery practice. British Journal of Midwifery, 1994, 2, 7, 335-8 46 Goodband, S. Research is the new nursing ritual. Nursing Times, 2001, 97, 25, p.21
pp. 155
Fairclough, N. New Labour, New Language, London: Routledge, 2000 48 Travers, op. cit., p.122 49 Parker, op. cit., p.167 50 Ibid.,p.l20 51 Ibid.,p.96 52 Harper, op. cit., p.349 53 Parker, op. cit. 54 Curt, B. Textuality and Tectonics: Troubling Social and Psychological Science, Buckingham: Open University Press, 1994 55 Lowe, R. Family Therapy and the Uses of Postmodernism: From Revisionism to Descriptivism, University of Queensland: PhD Dissertation, 1995, p.52 56 Curt, op. cit. 57 Parker, op. cit. 58 Travers, op. cit., p.100 59 See, for example, Holloway & Jefferson, op. cit., Travers, op. cit., Chapman, J. The Rhythm Model. In I. Bruna-Seu & M. Colleen Heenan (eds) Feminism and Psychotherapy, London: Sage, 1998 60 Burr An introduction to Social Constructionism, London: Routledge, 1995, p.8
pp. 157
Afterword
pp. 159
Afterword 1 Rules for reading
pp. 160
Afterword 1
pp. 167
Rules for reading
pp. 169
Rules for reading 163
pp. 170
Afterword 1
pp. 171
Rules for reading 165
pp. 172
Afterword 1
pp. 174
Afterword 1
pp. 176
Afterword 1
pp. 177
Rules for reading
pp. 180
Afterword 1
pp. 181
Rules for reading 175
pp. 183
Afterword 2 Writing in the margins
pp. 190
Afterword 2
pp. 191
Writing in the 185 margins
pp. 193
Writing in the margins p.11
pp. 194
Afterword 2
pp. 195
Afterword 3 A tissue of truths
pp. 196
Afterword 3
pp. 197
that is not research-based must, by definition, be blindly dogmatic. Does all practice have to be based either on research evidence or on conjec-ture and ritual? Or are supporters of evidence-based practice cynically setting up practice that is not based on research as a straw (wo)man to be knocked down by the slightest puff of wind? I have argued elsewhere that the motivation for evidence-based practice (EBP) appears to be based on a kind of overcompensation, a 'mine is bigger than yours' attitude in which evidence (any evidence) for EBP is stacked up, piled high, in order to disguise the fact (yes, fact) that there is, in fact (yes, fact) very little evidence to support it. But of course, this strategy ultimately degenerates into what Freud typified as the logic of dreams, or 'kettle logic'. As Derrida says of this 'kettle logic': In his attempt to arrange everything in his favour, the defendant piles up contradictory arguments: 1. The kettle I am returning to you is brand new; 2. The holes were already in it when you lent it to me; 3. You never lent me a kettle anyway'.
pp. 198
This final Afterword brings together (at least) five characters. Firstly, there is Ben, a young man who has had a 'mental breakdown'. Secondly, there is Theo, a psychiatric nurse who is working with Ben and who reflects on their relationship. Thirdly, there is F, who does (at least) two things: she discusses the theory of reflective practice and she reflects on Theo's reflections as if she was Theo. Fourthly, there is R, who occasionally comments and theorises on F's reflections. And finally, there is the chorus, a series of voices telling a series of stories. These characters ask (but do not answer) a number of questions, largely concerned with truth and the nature of practice. Thus, if practice is seen as a text, then to what extent and in what sense can it be said to be true? And if reflection is a story that I tell to myself, then is it nothing but a branch of fiction? And if it is...? And finally, of course, we come to the question of endings... Notes 1 Derrida, J. Afterword: toward an ethic of discussion. In G. Graff (ed) Limited Inc, Evanston, Illinois: Northwestern University Press, 1988, p.146 2 Derrida, J. But, beyond... (Open letter to Anne McClintock and Rob Nixon), Critical Inquiry, 1986, 13, 1, 155-70, p.167, his emphases 3 Derrida, J. (1967) Of Grammatology, Baltimore: The Johns Hopkins University Press, 1974, p.94 Derrida, But, beyond..., op. cit., p.167 5 Lechte, J. Fifty Key Contemporary Thinkers, London: Routledge, 1994, p.106 6 Russell, B. The Problems of Philosophy, Oxford: Oxford University Press, 1973, p.40 7 Blomfield, R. & Hardy, S. Evidence-based nursing practice. In S. Reynolds & L. Trinder (eds), Evidence-Based Practice: A Critical Approach, Oxford: Blackwell Science, 2000 8 Derrida, J. (1972) Dissemination, London: The Athlone Press, 1981, p.111 9 All three statements are taken from DiCenso, A., Cullum, N. & Ciliska, D. Implementing evidence-based nursing: some misconceptions, Evidence-Based Nursing, 1, 2, 38-40, 1998 10 Ibid.,p.29
pp. 199
A tissue of truths 193
pp. 200
Afterword 3
pp. 201
A tissue of truths
pp. 202
Afterword 3
pp. 203
A tissue of 197 truths
pp. 204
Afterword 3
pp. 208
Afterword 3
pp. 217
. . . the problem of how to continue in an absurd
pp. 219
A tissue of truths
pp. 222
Afterword 3
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